Community Quiz #1 TB

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.

27. A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a. Adult day health b. Home health c. Long-term care d. Senior center

ANS: A Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision. It serves as more of a medical model than the senior center, and individuals typically return home to their caregivers at night. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems and help would not be available.

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.

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

ANS: A Agents represent potential dangers or risk to the health and safety of workers. If the flask had broken and glass got into the employees eye, then the flask would be an agent. However, in the case given, the chemical itself caused the damage.

24. Which of the following best explains why the home health nurse would essentially repeat the same information given to the client by the nurse in the hospital? a. Clients find it difficult to learn in the midst of the stress of the acute care setting and often dont remember what the hospital nurse taught. b. Hearing something from a different person, using different words and examples, can help ensure that learning is retained. c. Home health nurses often dont know what hospital-based nurses have already taught. d. Learning depends on receiving information more than once.

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

3. Which of the following best describes why it is helpful to be a member of a faith community? a. Belief and traditions help with coping. b. Members can ask others in the group for help. c. It is a social outlet. d. Members are able to get others to contribute to the causes they support.

ANS: A Although there is some truth in all the options, persons who encounter assaults with physical and emotional illness and brokenness and who are able to call upon their faith beliefs and religious traditions are able to increase coping skills and realize spiritual growth even during adversity.

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

ANS: A An estimated 10% of Americans do some form of shift work that has the potential to lead to a variety of psychological and physical problems, including exhaustion, depression, anxiety, and gastrointestinal disturbance. Strategies to minimize the adverse effects of shift work, such as rotating shifts clockwise, are beneficial.

29. Which of the following is the best way to ensure good nutrition in infants? a. Breastfeeding only b. Feed them only brand-name baby foods c. Feed them only brand-name cereals d. Feed them only brand-name formulas

ANS: A Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity.

6. Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager

ANS: A Children under the age of 4 years and children with special needs are at highest risk for abuse.

23. A nurse is working with incarcerated adults who are being released from prison. Which of the following nursing interventions would be most appropriate for the nurse to implement? a. Connect offenders with community-based mental health programs. b. Provide community supervision for mentally ill offenders. c. Advocate for increased prison time to decrease recidivism rates. d. Educate about available state resources.

ANS: A Connecting offenders with community-based mental health programs at the time of release from prison can decrease recidivism rates, because many incarcerated adults experience major psychiatric disorders. It would be impossible for the nurse to supervise all mentally ill offenders in the community. Increased prison time is not shown to decrease recidivism rates and education about available state resources is not the most important nursing intervention to provide for this population.

21. A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? a. Contracting b. Crisis intervention c. Empowerment d. Strategic planning

ANS: A Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

11. A new mother is a full-time college student who lives with her parents, because the babys father has been imprisoned related to theft and drug abuse. The infants grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this familys needs? a. Developmental b. Interactional c. Structure-function d. Systems

ANS: A Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughters (and grandchilds) needs.

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

ANS: A Each worker represents a host within the worker population group.

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 doesnt 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 districts committee on the disabled to develop individualized education plans (IEPs) for children.

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 audiences 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.

18. Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a. HRT does not prevent heart disease. b. Use of HRT is recommended to prevent osteoporosis. c. When used with complementary therapies, HRT is most effective. d. HRT is a contributing cause of breast cancer.

ANS: A HRT does not prevent heart disease. To prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active.

4. A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a. Does your 4 year-old have a booster seat in the car? b. Have you noticed any physical problems as you go about your daily routine? c. What concerns do you have today? d. Why did you decide to come in for a checkup?

ANS: A Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident.

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.

2. A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a. Accidents and injuries b. AIDS c. Childhood obesity d. Vaccine-preventable diseases

ANS: A Injuries are the number one cause of death for children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable. Obesity, although a significant problem, is not a common cause of death in children.

11. A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most likely use? a. Life expectancy b. Mortality rate c. Morbidity rate d. Health status

ANS: A Life expectancy is a measure that is often used to gauge the overall health of a population.

20. Which of the following comments was most likely stated by a home health nurse? a. Every time I see a client, it costs $80. b. Health care costs are killing our economy. c. I cant believe how much clients are charged for things. d. Medicaid costs are such a large portion of our states budget.

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

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

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

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.

20. During which phase of the home visit does the nurse document what was accomplished? a. Pre-visit phase b. In-home phase c. Termination phase d. Post-visit phase

ANS: D A major task of the post-visit phase is documenting the visit and services provided.

25. A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take? a. Conducting a sexual behavior survey with the adolescents b. Establishing in-school education related to transmission of sexual infections c. Providing free condoms at schools and universities d. Providing follow-up educational programs for those diagnosed with an STI

ANS: A Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

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.

32. A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? a. Establish lifestyle improvement programs through local youth organizations. b. Evaluate the food intake of a group of children for a 48-hour period. c. Provide education programs to overweight expectant parents. d. Evaluate the body mass index of children at regularly scheduled well-child exams.

ANS: A Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.

21. A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d. Survey families in the community to determine whether they eat clay and how much clay they eat.

ANS: A Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.

26. Toward whom is the TLC model targeted? a. Caregivers of older persons with health problems b. Community organizations that offer services for the elderly c. Elderly clients with health problems d. Nurses who care for older clients

ANS: A The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management.

12. A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Interactionist theory

ANS: A The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time.

3. A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? a. Be sure to take a 30-minute walk each day. b. Call our office if you have any questions or concerns at all. c. Come back in 2 weeks for follow-up on your surgery. d. Continue to take the drug until it is gone, even if youre feeling better earlier.

ANS: A The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

4. Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

ANS: A The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the twenty-first century exciting and challenging.

14. A community health nurse is planning to implement an intervention to reduce the prevalence of sexually transmitted diseases in the community. Which of the following actions would most likely be taken by the nurse? a. Establish immunization clinics to prevent STDs. b. Educate people with HIV about the mode of transmission. c. Explain to women that HIV is transmitted to women usually by IV drug abuse. d. Develop a STD clinic to increase community access to services.

ANS: A The goal of Healthy People 2020 is to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases and their complications. Nursing activities should align with these goals.

23. A nurse has been successful in creating improvement in a familys health. Which of the following characteristics is most likely displayed by the nurse? a. Skilled at recognizing and strengthening the familys competencies b. Skilled at obtaining referrals and resources for the family c. Skilled at communication and interpersonal relationships d. Skilled at assessing and naming the familys main problems

ANS: A The nurses approach to the family should be positive and focused on competencies rather than on problems or deficits.

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

ANS: A The population group at greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job. Because of the inherent risks, the nurse should spend extra time with this group to decrease risk.

13. A home health nurse who is visiting a family for the first time asks, Could we review your extended family and other persons or groups with whom you interact each week? Which of the following provides the best rationale for the nurse asking this question? a. To assess the familys environment and social resources and risks b. To communicate with relevant others as needed c. To determine financial assets available to the family in case of serious need d. To understand the extended family relationships

ANS: A The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the familys connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the familys interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

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 nurses 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.

22. Which of the following is a primary requirement for a client to be eligible for home health nursing and Medicare reimbursement of services? a. Must be homebound b. Must be living in a medically underserved area c. Must be indigent d. Must be insured or eligible for Medicare or Medicaid

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

8. A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c. Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the childs immunizations are up to date. d. A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.

ANS: A Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

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

ANS: A Transmission of tuberculosis (TB) within health care settings has reemerged as a major public health problem. Outbreaks of this type of TB have been reported in hospitals, and some workers have developed active drug-resistant TB. Many workers in these settings are employed as maintenance workers, security guards, aides, or cleaning people, who tend not to be well protected from inadvertent exposures, which include contaminated bed linen in the laundry, soiled equipment, and trash containing contaminated dressings or specimens.

26. Which of the following practices in the home is most crucial? a. Using good handwashing procedures b. Obtaining a puncture-resistant container for family to use for needles c. Putting all contaminated material directly into a trash bag d. Washing all surfaces with disinfectant

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

25. A nurse is implementing Wagners Chronic Care Model. Which of the following actions would the nurse most likely take? a. Educate a community group about hypertension control. b. Create a budget for chronic disease management. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

ANS: A Use of electronic health records, provider reminders for key evidence-based care components, interprofessional teams communicating regularly and community health classes to educate people with chronic diseases are various ways the CCM is being implemented. Creating a budget is not a way to use CCM. Administration of immunizations and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

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

ANS: A, B Occupational health specialty practice focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment. It involves the prevention of adverse health effects from occupational and environmental hazards. It provides for and delivers occupational and environmental health and safety services to workers, worker populations, and community groups. It is an autonomous specialty, and nurses make independent nursing judgments in providing health care. All nurses should engage in health promotion and disease prevention, and many specialties provide care in the community. Several specialties (such as advanced practice nurses) are required to be nationally certified to be employed.

1. Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.) a. A 16-year-old who is living on his own (not with his parents) b. A pregnant adolescent c. An adolescent in an emergency situation d. An adolescent whose diagnosis has a serious prognosis

ANS: A, B, C Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the mature minors doctrine. This allows youths 15 years of age and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated.

4. After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older friend asks the nurse, Im really scared of getting cancer. What can I do to avoid that kind of cancer? Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Avoid smoking or much alcohol. b. Choose poultry or fish rather than red or processed meat. c. Eat lots of fruits, vegetables, and fiber each day. d. Try to get at least 8 hours of sleep a night.

ANS: A, B, C Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer.

1. Which of the following activities are included in the Centers for Disease Control and Preventions 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.

1. A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) a. The nurse can assess the family environment. b. The family will feel more comfortable. c. Families typically welcome others into their home. d. More family members can typically be involved.

ANS: A, B, D Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the familys home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.

2. Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) a. Agencys policies regarding eligibility for services b. Familys feelings about the home visit and willingness to continue c. Nurses perception of the amount of time needed to complete required tasks d. Reimbursement policies of third-party payers

ANS: A, B, D Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the familys willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurses time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurses perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available.

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.

1. A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.) a. The family wont have to travel. b. It is cheaper for the family because of reimbursement requirements. c. Meeting at home is much more convenient for the family. d. The nurse wont be distracted by other clients or responsibilities. e. It would save money for the nurse and the clinic.

ANS: A, C Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurses employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

2. Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.) a. Assess schools and day care centers for environmental friendliness. b. Share nutritional information with all students in the school. c. Develop home and environmental assessment guides. d. Teach all school personnel how to use rescue inhalers.

ANS: A, C Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day-care centers for lack of asthma triggers.

3. Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a. Why the data are needed b. How best to interview each individual in the family c. The most convenient time for you to visit the family d. The rationale or purpose of the visit

ANS: A, C, D Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. It can be assumed that the nurse would already know agency policies. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual). Therefore, the preferred time to visit is when most family members will be available. Similarly, it is more informative to see the family in their home setting than to establish a different site for the visit.

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.

5. A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.) a. The reason for the visit b. Everything the nurse knows about the family c. How many visits will be planned d. The cost of the visit and how this may be paid

ANS: A, D The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the familys situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the familys willingness for a home visit. If the family does not have a phone, mail can be used to share information.

3. A new students 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 dont 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 nurses 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 wont resolve the problem and it is illegal, immoral, and unprofessional to enter false information in a students record.

15. Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associates degree in nursing and RN licensure d. Eligibility for certification as a home health nurse

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

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.

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.

10. The school nurse has arranged for volunteers to help check each childs 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.

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

ANS: B Delivery of primary prevention services to employees is directed toward promoting health and averting a problem. Primary prevention is attempting to avoid harm through protecting measures, in this case reducing ear damage due to high noise levels and eye damage from flying particles or fluids.

19. Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up

ANS: B Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider.

19. The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepares food will probably prepare meals based on the diet plan for all the family. d. The family member who prepares food will probably prepare special meals for the newly discharged member.

ANS: B Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. However, if family members are supportive, they will want to try to help the ill member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill members needs without making drastic changes in the overall eating patterns of the family.

15. Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurses plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurses plan. d. Nurse has informed family how to complete the required actions.

ANS: B Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The plan cannot be the nurses choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.

11. Which of the following best describes the use of genomic health care? a. Assists with understanding family relationships b. Assists with determining familial health risks c. Useful in learning about environmental risk factors d. Useful in detecting risk for developing cancer

ANS: B Genomic health care can give health care providers the tools that they need to use a persons unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a persons risks for the same diseases that other family members experienced. Genomic health care is broader than detecting risk for developing cancer.

6. The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The familys basic needs are being met. c. The couples in-laws are unavailable to share their expertise about child care. d. The married couple is excited about their first baby.

ANS: B In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

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.

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

ANS: B Interventions aimed at disability limitation are intended to prevent further harm or deterioration, and they include referral for counseling and treatment of an employee with an emotional or mental health problem whose work performance has deteriorated and removal of workers from heavy metal exposure who manifest neurological symptoms.

13. A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family

ANS: B It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure.

14. A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

ANS: B It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family.

15. An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? a. Avoidance of alcohol b. Regular physical exercise c. Daily consumption of calcium-rich foods d. Monthly self-breast and testicular exams

ANS: B Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

4. Which of the following is of the greatest concern for the nurse who works with high school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex

ANS: B Motor vehicle related injuries and violence are the leading causes of morbidity and mortality for adolescents. Thus, this would be the greatest concern for the nurse working with high school students.

24. Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families? a. Understanding of same sex marriage laws within the state b. Understanding of personal feelings of working with members of this community c. Assessment of the family structure within the LGBT family d. Assessment of sexual orientation in a safe environment

ANS: B Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.

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

ANS: B Secondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible moment in its course and elimination or modification of the hazard-producing situation.

5. In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

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

1. A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a. I make most of the decisions so the kids dont notice much difference. b. My daughter is pretty independent; shes active in both sports and theater. c. My son is old enough to get a job and help pay all these medical bills. d. My wife taught our daughter how to cook simple meals.

ANS: B Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

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.

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

ANS: B The Occupational Safety and Health Act of 1970 had as its purpose to ensure safe and healthful working conditions for working men and women.

16. A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

ANS: B The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of pre-conceptual counseling.

5. A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the familys strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional

ANS: B The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used. Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the familys strengths gives the nurse assets on which to draw in planning care.

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! Youve obviously made an error. Which of the following would be the best response by the nurse? a. Im sorry youre 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. Im sure youre correct; one of my volunteers probably made an error. Ill 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.

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 nurses 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 schools policies or ask community organizations to help make the childrens schools healthier places.

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 wont know if someone doesnt 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.

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 nurses 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.

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

ANS: B Workers compensation acts are important state laws that govern financial compensation of employees who suffer work-related health problems. Each state sets rules for the reimbursement of employees with occupational health problems for medical expenses and lost work time associated with the illness or injury. Workers compensation claims and the experience-based insurance premiums paid by industry have been important motivators for increasing the health and safety of the workplace.

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

ANS: B, C All business organizations are classified within the North American Industry Classification System (NAICS) with a numerical code. This code, usually a digit to digit number, indicates a companys product and, therefore, the possible types of occupational health hazards that may be associated with the processes and materials used by its employees. NAICS codes are used to collect and report data on businesses. For example, illness and injury rates of one company are compared with the rates of other companies of similar size with the same NAICS code to determine whether the company is having an excess of illness or injury. By knowing the NAICS code of a company, a health care professional can access reference books that describe the usual processes, materials, and by-products of that kind of company.

5. A nurses mother leans forward and says, My best friend fell the other day and now shes in the hospital. Im really worried about getting osteoporosis. What do you think I should do? What should the nurse recommend? (Select all that apply.) a. Ask your doctor for hormone replacement therapy. b. Continue to abstain from alcohol and not use tobacco. c. Eat foods high in calcium such as fortified skim milk. d. Eat lots of green leafy vegetables.

ANS: B, C It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limiting alcohol consumption; and avoiding smoking.

4. A nurse enters a familys home for the first time. Which of the following goals should the nurse have? (Select all that apply.) a. Assessing each family member in detail both physically and psychologically b. Collaborating with the family to establish goals and a plan for meeting them c. Determining the exact relationship between each member of the family d. Exploring the familys perception of their problems and needs

ANS: B, D During the beginning phase of the nurse-family interaction, three activities occurmutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.

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.

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

ANS: B, D Legislation at the federal and state levels has had a significant effect on efforts to provide a healthy and safe environment for all workers. OSHA employees have distributed citations to companies that do not meet minimal occupational health and safety standards. Criminal charges have been filed against business owners when preventable work-related deaths have occurred. Another important stimulus for health and safety programs is the desire to avoid the cost of liability and workers compensation claims and other expenses when employees are injured or killed.

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.

7. A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? a. I cant visit my husband in the hospital when Im at work all day. How can I be sure hes all right? b. My husband always handled our finances. Now that hes gone, Ill have to learn how to do this. c. I dont know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children. d. What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?

ANS: C A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.

12. Which of the following families is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b. A man knows that his grandfather, father, and older brother all died of cardiac disease. c. A man is currently unemployed and despairs about finding a position. d. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

ANS: C A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

20. A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a. Confirm the reason for the assessment. b. Demonstrate culture awareness. c. Take time to build trust. d. Understand the family dynamics.

ANS: C Assessment is interactive. As you are evaluating families, they are evaluating you. Too much disclosure during the early contacts between the family and nurse may scare the family away. Slow the process down, and take time to build trust.

8. A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a. An advance directive b. A living will c. A durable medical power of attorney d. The Patient Self-Determination Act

ANS: C Durable medical power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so.

19. A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? a. Determine the familys willingness for another home visit b. Establish the purpose of the visit c. Review the familys learning and other accomplishments of the visit d. Review the family record and reason for referral

ANS: C During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The other options listed occur during the pre-visit phase.

7. A nurse focuses on the care of the individual while viewing the clients family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurses view represent? a. Client b. Component of society c. Context d. System

ANS: C Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the family as context concept, the family serves as either a resource or a stressor to individual health and illness.

3. In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System

ANS: C Family structure refers to the characteristics and demographics (gender, age, number) of individual members who make up the family. Structure defines the roles and the positions of family members.

21. Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent b. Has not had a PSA test c. Has a father or brother who has had prostate cancer d. Has benign prostatic hypertrophy (BPH)

ANS: C Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer.

12. A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse does not yet know the community, which of the following programs would be good to plan first? a. Alcohol and tobacco cessation programs b. Cancer screening programs c. Cardiac health education programs d. Exercise for life programs

ANS: C Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurses second focus.

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 nations schools met that standard. The new objective is that 44.7% of the countrys 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).

MULTIPLE CHOICE 1. A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be most effective? a. Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b. Increase nutrition programs in schools that teach children to make healthy food choices. c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d. Provide after-school and summer camps that focus on diet and exercise.

ANS: C Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant.

9. Which of the following best describes a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

ANS: C Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.

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.

10. A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a. A broken line b. A dashed line c. A solid line d. Two parallel lines

ANS: C Marriage is indicated by a solid line on a genogram.

3. A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a. Anti-alcohol program b. Anti-smoking program c. Careful driving program d. Safe sex program

ANS: C Motor vehicle accidents are the leading cause of death among children and teenagers.

5. A mother says, My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and other activities. Do you think I should let him have a car? Which of the following statements would be the best response by the nurse? a. Absolutely, it will help him recognize the cost of gas and maintenance. b. Certainly. Most young men want their own car, and peer pressure can be painful. c. It depends on whether you trust your son to drive safely. d. No, adolescent males cannot be trusted with an automobile.

ANS: C Motor vehiclerelated injuries and violence are the leading causes of morbidity and mortality for adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son.

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

ANS: C Nonfatal violence in the health care workers workplace is a serious problem that seems to be underreported. Much of the study of health care worker violence has been in psychiatric settings and emergency departments.

14. Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

ANS: C Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesnt move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.

2. Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a. What helps you to cope with situations involving your wifes cancer? b. How has your childs illness affected the behavior of your other children? c. Tell me about any illnesses your other family members have. d. Who do you turn to for support outside your immediate family?

ANS: C Physiological health involves issues related to physical wellness or illness. Other components of health in Neumans model include psychological health, sociocultural health, developmental health, and spiritual health.

17. A nurse is providing pre-conceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a. Iron b. Calcium c. Folic acid d. Vitamin C

ANS: C Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects by 50% to 70%. A recommendation was made that women capable of or planning a pregnancy take 0.4 to 0.8 mg of folic acid daily

6. A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? a. Did any of the hunters in your family kill a deer this year? b. How do you keep your rifles safe from curious children? c. Where do you shoot with your handguns? d. Where do you keep your rifles locked when it is not hunting season?

ANS: C Risk reduction is a complex process that requires knowledge of risks and families perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the familys perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

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 cant 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.

7. If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a. Alcohol b. Guns c. Tobacco d. Unprotected sex

ANS: C Smoking has been identified as the most important preventable cause of morbidity and mortality in the United States.

30. A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? a. Developing lifestyle improvement programs for women at risk for diabetes b. Presenting lifestyle management presentations at womens conferences c. Monitoring blood glucose levels closely and modifying diet accordingly d. Screening glucose levels of women at risk for development of diabetes

ANS: C Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes.

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).

31. A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: C Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability.

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.

2. The Elizabeth Poor Law of 1601 is similar to which current law? a. Welfare b. Food stamps c. Medicaid d. Medicare

ANS: C The Poor Law guaranteed medical care for poor, blind, and lame individuals, similar to Medicaid.

17. A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, My mom said she couldnt see you and you should go away. Which of the following actions should be taken by the nurse? a. Demand the child let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch with the nurse . d. Point out that legally once an appointment has been made the mother needs to be seen.

ANS: C The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

10. A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a. Family systems b. Structural-functional c. Family developmental d. Interactionist

ANS: C The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.

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

ANS: C The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of company and community. The nurse is often a key person on the disaster planning team. The potential for disaster must be identified; this is best achieved by completing an exhaustive chemical and hazard inventory of the workplace. The MSDSs and plant blueprints are critical for correctly identifying substances and work areas that may be hazardous. Worksite surveys are the first step to completing this inventory.

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. Ill get the names to you and the involved teachers immediately. b. Let me get the parents consent, and then Ill 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 dont 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.

10. Which of the following situations would most likely indicate elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparents house breaking items. c. A young man repeatedly steals money from his grandmother. d. An elderly person demands that the family come for dinner.

ANS: C Theft or mismanagement of money or resources is an element of abuse.

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

ANS: C This does not meet the criteria for injury prevention because the injury has already occurred. The nurse is engaging in secondary prevention when providing treatment for the injury. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the foreign body from developing.

15. Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia is considered to have more medical complications than anorexia.

ANS: C Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight, purging is associated with bulimia, and anorexia is considered to have more complications than bulimia.

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

ANS: C Various control strategies are used to eliminate or reduce exposure and hence risk. Engineering controls can reduce worker exposure by modifying the exposure source. Administrative controls reduce exposure through job rotation, workplace monitoring, and employee training and education. Personal protective control is the last resort and requires the worker to actively engage in strategies for protection such as use of gloves, masks, and gowns to prevent blood/body fluid exposure. External controls the way equipment is built or manufacturing processes are established are controllable and much more effective than asking a great many individuals to engage in behaviors that they may not want to do (such as using personal protective equipment). Humans are much less programmable than external controls.

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

ANS: C When health data are considered collectively, the nurse may determine some patterns in risk factors associated with the occurrence of particular injuries and illnesses in a total population of clients. There is no mention of consent, so the nurse should not be collating research data. Grants for funding typically require current client data rather than trends.

8. A nurse asks a family member, What has changed between you and your spouse since your childs head injury? Which of the following focuses of the family is the nurse assessing? a. The context b. The client c. A system d. A component of society

ANS: C When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions.

18. A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a. Assess the family and the home setting for both strengths and problems. b. Determine the familys expectations of a home visit. c. Establish rapport between the nurse and the family. d. Engage in extended social interaction as would be expected from any guest.

ANS: C With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurses self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the clients expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

1. Which of the following aspects of a home health agency would most likely be examined during the accreditation process? (Select all that apply.) a. Cost of each service rendered b. Credentials of each employee c. Organizational structure d. Outcomes of care

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

2. In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) a. Conferring appropriate social status b. Educating the younger members c. Ensuring physical and mental health d. Fostering interpersonal relationships and support

ANS: C, D Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, conferring social status. Today, however, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health.

3. The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) a. A reassessment of resources should be done if the plan does not work. b. Individual family members must all be willing to make the plan their first priority. c. Goals must be realistic and feasible. d. Ongoing negotiation is central to the process.

ANS: C, D In contracting, an important aspect is obtaining the familys view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The familys inability to change as easily and quickly as they had hoped does not mean the plan is not workableonly that more time and effort may be necessary.

2. A family is concerned about the medical bills of their father, age 63, who is unemployed and has almost no savings. Which of the following statements by the nurse accurately explain how Medicaid and Medicare would work in this familys situation? (Select all that apply.) a. All your fathers medical bills will be paid by whichever program is appropriate. b. Choose any physician and just show them your Medicare or Medicaid card. c. Your father must be homebound to qualify for Medicare assistance but less so for Medicaid. d. Medicare is a federally funded program, but Medicaid is administered by your state.

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

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

ANS: C, D Of the approximately 2 million known chemicals in existence, less than 0.1% have been adequately studied for their effects on humans. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. A variety of chemicals are found in the body tissues of the general population. Daily, low-level doses of chemicals may be below the exposure standards but may still carry a potentially chronic and perhaps cumulative assault on workers health. Predicting human responses to such exposures is further complicated because several chemicals are often combined to create a new chemical agent. Human effects may be associated with the interaction of these agents rather than with a single chemical. Another concern about occupational exposure to chemicals is reproductive health effects.

3. A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best assist them with healing? (Select all that apply.) a. Advocating for increased support for elderly persons b. Eliminating signs and symptoms of disease c. Managing any chronic diseases to prevent complications and delay deterioration d. Maximizing self-care capacity

ANS: C, D With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity.

20. Which of the following behaviors results in men being less healthy than women? a. Concentration on sports, hunting, and other dangerous recreational choices b. Employment in stressful positions more so than women c. Preference to spend money on priorities other than health care d. Reluctance to visit physicians

ANS: D A major obstacle to improving mens health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of U.S. men see a doctor, nurse practitioner, or physician assistant compared with 74% of women

13. A nurse is performing a health assessment on a young adult female. Which of the following comments by the client would cause the nurse to be concerned? a. I cant believe I didnt get that promotion. I thought I was the best candidate. b. I cant believe they didnt admit me to that graduate program with my good undergraduate grades! c. I cant believe how lonely it is around the house since my spouse died. d. I cant believe how little I care about anything anymore since that diagnosis.

ANS: D A number of factors contribute to depression, including being female, having a family history of depression, unemployment, and chronic disease. All the options represent a loss, either potential or actual, but the statement about not caring about anything represents an actual symptom of depression.

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

ANS: D A significant increase in the number of health promotion and employee assistance programs offered has occurred. Health promotion programs focus on lifestyle choices that cause risks to health such as obesity or smoking. Employee assistance programs are designed to address personal problems (e.g., marital/family issues, substance abuse, financial difficulties) that affect the employees productivity. Such efforts are cost effective for businesses.

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

ANS: D All of these questions are appropriate during a routine physical for a person who has retired, because they relate to current problems, recreation, and mental health. However, the most crucial question is, Where were you previously employed and what did you do there? The occupational health history is an indispensable component of the health assessment. All persons should be questioned about their employment history. To describe only a current status of retired may lead to the omission of needed data. Even for retired persons, the nurse must ask about employment history, because many problems take years to manifest in signs and symptoms.

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

ANS: D All of these questions are appropriate during a routine physical. However, the question often omitted is, Where do you work and what do you do there? The occupational health history is an indispensable component of the health assessment of individuals. Because work is a part of life for most people, including an occupational health history in all routine nursing assessments is essential.

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

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

22. A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? a. Apply for emergency financial assistance on the familys behalf. b. Arrange for community members to assist with child care. c. Invite the mother to join a cancer support group. d. Teach the family how to navigate the health care system.

ANS: D Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

18. A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

ANS: D Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.

16. Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy

ANS: D Government actions that have a direct or indirect effect on families are called family policy.

5. A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities

ANS: D Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

28. An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice

ANS: D Hospice would be the best form of care for a person in the last stages of dying.

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

ANS: D In 2010, sprains, strains, and tears were by far the most frequent disabling conditions, accounting for 46.9% of days away from work (Bureau of Labor Statistics, 2011).

24. Which of the following will provide the highest benefit to an older adults well-being? a. Eligibility for Medicare and Social Security b. Higher socioeconomic status, income, and education c. Senior citizen privileges such as senior citizen centers and senior citizen discounts d. Social networks that give support and meaning to life

ANS: D Medicare, Social Security, senior privileges, and high socioeconomic status, income, and education are all extremely helpful to older adults. However, social networks that give support and meaning to life are a major factor that can contribute to ongoing health and vitality. One of the biggest dangers is social isolation.

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

ANS: D Most adults spend about one third of their time at work. Every single industry grapples with serious hazard. No work is completely risk free.

1. The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the mans married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the family? a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c. There is no family here, only three adults sharing resources between themselves and two biologically related children. d. The family includes whoever the adults state are family members.

ANS: D Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A family may range from the traditional nuclear model with extended family to such postmodern family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

22. Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty

ANS: D Poverty is a strong and underlying current factor that affects all special groups.

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

ANS: D Rehabilitation strategies such as return-to-work programs after a heart attack or limited duty programs after a cumulative trauma injury are examples of tertiary prevention. Tertiary prevention is intended to restore health as fully as possible and assist individuals to achieve their maximum level of functioning.

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.

9. A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a. Personal Responsibility and Work Opportunity Reconciliation Act b. Womens Health Equity Act (WHEA) c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA)

ANS: D The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member.

17. A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss

ANS: D The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.

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

ANS: D The employee will only be safe if the employee uses the PPE. If the employee doesnt use the PPE or uses only part of the equipment, then the employee will be at risk. The primary determination of whether the PPE is used correctly and used all the time is the psychosocial norms of the setting. If others are careless in PPE use, then such carelessness is the norm. If everyone is extremely careful to use their PPE, then that is the norm in that setting.

25. A family member asks a home health nurse to explain the concept of hospice care. Which of the following would the nurse need to include as the fundamental underlying philosophy of hospice? a. Enabling the client to die at home b. Ensuring that the clients living will is upheld c. Placing experts in the position of power of attorney d. Providing comfort measures before death

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

21. Which of the following best describes one of the outcomes of the incentives and pressures for cost control and improved health outcomes? a. Expansion in alternative health care agencies b. Improvements in client teaching materials c. Public pressure to improve health professionals education d. Development and increased use of telehealth technology

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

2. The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. How many children do you have, and who is the father of each? b. Is there a register of families who are members of this commune? c. Tell me about your significant other. d. Who are the members of your and your childs family?

ANS: D The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning.

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

ANS: D The nurse may conduct an assessment of the workplace itself, which is known as a worksite walk-through or survey. Direct observation allows the nurse to learn about the work processes and the materials; the requirements of various jobs; the presence of actual or potential hazards; and the work practices of employees. Such information is directly useful in planning programs, assessing their effectiveness, and reinforcing safety with individuals who have been seen behaving in a less than safe manner.

9. Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental theory b. Structural-functional theory c. Family role theory d. Family systems theory

ANS: D The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory.

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 students 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 students 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 schools 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.

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

Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. The workforce will become older, including many employees with chronic health problems. By the year 2020, minorities are projected to constitute 20.6% of the workforce and women approximately 47% of the workforce (Toossi, 2012). The U.S. economy was once based on agriculture, then primarily on manufacturing, and now on highly technological positions. Currently, service-providing positions account for virtually all job growth; soon almost one of every two worker jobs will be in service positions.

16. A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurses commitment to the family and enter the home quickly. d. Drive away and notify the family from a safer location.

NS: D Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

15. Which of the following actions best represents public health nursing? a. Assessing the effectiveness of the large high school health clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic

ANS: A A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population.

10. A registered nurse was just employed as a public health nurse. Which question would be the most relevant for the nurse to ask? a. Which groups are at the greatest risk for problems? b. Which patients should I see first as I begin my day? c. With which physicians will I be most closely collaborating? d. With which nursing assistants will I partner the most?

ANS: A Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals.

1. Which of the following best describes community-based nursing? a. A philosophy that guides family-centered illness care b. Providing care with a focus on the groups needs c. Giving care with a focus on the aggregates needs d. A value system in which all clients receive optimal care

ANS: A By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community.

9. A nurse is considering accepting the parish nursing position within his congregation. Which of the following educational preparation is crucial for the nurse to have received? a. Baccalaureate education including community health nursing experience b. Graduate education in community health nursing c. Passing the national certifying exam for parish health nursing d. Worship experiences for the process of ministry

ANS: A Current educational preparation for the parish nurse includes the successful completion of extensive continuing education contact hours or designated coursework in parish nurse preparation at the baccalaureate or graduate level, as well as a thorough grasp of the scope and standards of the practice. These basic programs provide an orientation to the role and functions of the parish nurse, as well as worship experiences for the process of ministry. The parish nurse must be a member of the faith community and be comfortable with worship practices and traditions to function.

9. Which of the following would have been the focus of a school nurse in the early 20th century? a. Investigating causes of absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an autonomous practice d. Providing medical treatment to enable children to return to school

ANS: A Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

1. Which of the following best describes the primary difference between parish nursing and all other nursing positions? a. Affiliation with a church or congregation b. Incorporation of spiritual aspects into nursing care c. Provision of holistic nursing care d. Residence within the community of service

ANS: A In 1998 the American Nurses Association accepted parish nursing as the most recognized term for the practice of nurses working with congregations or faith communities. All nurses may choose to incorporate spiritual aspects into holistic nursing care.

16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed

ANS: A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs.

16. A nurse would like to maximize her autonomy in her parish nursing practice. Which of the following models of parish nursing would most likely be preferred by the nurse? a. Congregation-based model b. Institution-based model c. Teamwork model d. Partnership model

ANS: A In the congregation-based model, the nurse is usually autonomous. The development of a parish nurse/health ministry program arises from the individual community of faith. The nurse is accountable to the congregation and its governing body.

1. A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing? a. Its autonomy and independence b. Its focus on acute care and immediately visible outcomes c. Its collaboration with other health care professionals d. Its flexibility and higher wages

ANS: A In-patient acute care nurses (not public health nurses) focus on acute care with outcomes known fairly quickly. Unlike in-patient nursing, in which there are other health care professionals and staff with whom to interact, public health nursing is known for its autonomy and independence.

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.

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 clients 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.

17. Research reveals that people who pray more frequently score lower in physical functioning and score higher in their level of pain. Which of the following conclusions has been drawn from these findings? a. As persons become more disabled, they pray to retain their mental health and obtain comfort. b. Everyone prays more as they get older or become ill. c. Praying decreases physical functioning and increases pain. d. Research findings are sometimes inaccurate due to extraneous variables.

ANS: A The Evidence-Based Practice box gives the example of a research study that explored the participants use of CAM, including reasons and benefits from CAM use. Clients participating in the study most commonly used prayer for health reasons (91%, n = 95), prayed for their own health (88%, n = 92), and had others pray for their health (86%, n = 90). This was followed by participation in group prayer (38%), deep breathing exercises (30%), and meditation (30%). Participants reported that prayer was used to give thanks for support of others and for themselves, whereas others reported that prayer allowed them to share their burden with a higher power. A few participants equated prayer with meditation, which evoked a calming state. Some participants did not equate prayer with being religious or with church attendance. This study affirms the use of prayer for health reasons, to facilitate relaxation, and to enhance emotional and physical well-being. The study affirms the protective results of prayer on the persons mental health.

16. A nurse orienting to the home health role states, I dont understand why we have to collaborate with so many other disciplines; this conflicts with the concept of nurses providing all direct care to the client in the home? Which of the following would be the best response? a. The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care. b. Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible. c. Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base. d. Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration.

ANS: A The responsibilities and functions of other health professions in home care are dictated by Medicare regulations, professional organizations, and state licensing boards. Many of these services can be provided on a consulting basis. The plan of care should be implemented and reinforced by all involved disciplines. Therefore, interdisciplinary collaboration is required in the home health setting. Such collaboration does not conflict with the concept of providing direct care services. Direct care refers to the actual physical aspects of nursing careanything requiring physical contact and face-to-face interactions. In home care, direct care activities include performing a physical assessment on the client, changing a dressing on a wound, giving medication by injection, inserting an indwelling catheter, or providing intravenous therapy. Direct care also involves teaching clients and family caregivers how to perform a certain procedure or task.

5. Why did American citizens become interested in establishing government-controlled boards of health? a. They were afraid of infectious diseases such as yellow fever. b. The government could force the poverty-stricken to accept care. c. Such boards could tax and thereby ensure adequate funds to pay for care. d. Such a system would allow for accurate records of births and deaths.

ANS: A Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health.

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.

2. Which of the following actions demonstrate(s) effective public health nursing practice in the community? (Select all that apply.) a. Epidemiologic investigations examine the environment for health hazards. b. New services are organized where particular vulnerable populations live. c. Partnerships are established with community coalitions. d. Staff members at the public health agency continue to increase in number.

ANS: A, B, C Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies.

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 publics 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.

3. How did nursing education change in the 1950s? (Select all that apply.) a. Baccalaureate nursing programs typically included public health nursing concepts. b. Diploma schools of nursing continued to expand their student numbers. c. Junior and community colleges began offering nursing programs. d. Nurses were strongly encouraged to have a scientific basis for their practice.

ANS: A, C In the 1950s public health nursing became a required part of most baccalaureate nursing education programs. In 1952 nursing education programs began in junior and community colleges.

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.

3. Why are nurses increasingly providing care in clients homes rather than in hospitals? (Select all that apply.) a. Home care is less expensive. b. It is much more efficient to give care in the home. c. Nurses prefer to give home care with individual attention. d. People prefer to receive care in their homes rather than in hospitals.

ANS: A, D An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

19. A parish nurse is implementing a primary prevention measure related to obesity among the school-age members of the church. Which of the following activities is most likely being used by the nurse? a. Establishing a walking program that is sufficiently challenging yet not too strenuous for those who are obese b. Partnering with youth camp cooks to ensure that food is nutritious c. Supervising height and weight measurements taken by clinic assistants d. Working with parents of obese children to implement family lifestyle changes

ANS: B An example of primary prevention is encouraging healthy snacks and meals for youth outings and at educational hour and parenting sessions. The other options all deal with secondary prevention activities, which are focused on decreasing obesity.

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.

8. Which of the following public health nurses most clearly fulfills the responsibilities of this role? a. The nurse who met with several groups to discuss community recreation issues b. The nurse who spent the day attending meetings of various health agencies c. The nurse who talked to several people about their particular health concerns d. The nurse who watched the city council meeting on local cable television

ANS: B Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

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 masters degree would be even more useful, but for many, advanced education may not be feasible.

2. To help congregation members better meet their nutritional needs, the parish nurse organized members to participate in activities that focused on fellowship while providing healthy meals to homebound members and serving healthy heart church suppers. Which of the following activities is being completed? a. Entitlement programs b. Health ministries c. Partnerships d. Pastoral care practices

ANS: B Health ministries are those activities and programs in faith communities organized around health and healing to promote wholeness in health across the life span. These services include activities such as visiting the homebound, providing meals for families in crisis or when returning home after hospitalization, organizing prayer circles, serving healthy heart church suppers, and holding regular grief support groups.

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

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

2. A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. Which of the following best describes this type of nursing? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing

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

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

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

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 states 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.

5. A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Increase the communitys knowledge about hospice care. b. Promote healthy lifestyle behavior choices among the community members. c. Encourage employers to have wellness centers at each industrial site. d. Ensure timely and effective medical intervention and treatment for community members.

ANS: B Public health approaches could help prevent about 70% of early deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment.

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.

17. A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice

ANS: B The Healthy People documents propose a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases.

10. A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which of the following accomplishments of today was started within this organization? a. Requiring that public health nurses have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing nursing cooperatives d. Opening the Henry Street Settlement

ANS: B The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.

15. A parish nurse is using the institution-based model to plan care for a client with a chronic illness. Which of the following activities would the nurse most likely implement? a. Bringing in family members to work with the client and nurse in decision making b. Partnering with outlying health care centers for coordinating optimal care c. Pulling from the collective strengths of faith-based community members for social support for the client d. Relying on congregational prayer as a component of healing

ANS: B The institution-based model includes greater collaboration and partnerships. The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions. Therefore, although the nurse may do all of these things, the item that is related to the institution-based model is partnering with outlying health care centers.

13. A parish nurse is evaluating health programs that provide holistic care across the life span. Which of the following methods would be the most appropriate approach? a. Bringing families together to plan programs to meet the needs of individuals b. Establishing a wellness committee to assist in the evaluation process c. Matching financial resources with program objectives and goals d. Revisiting assessment data to be certain that planning reflects actual problems observed

ANS: B The nurse and members of the congregation assess, plan, implement, and evaluate programs. The process of providing holistic care is enhanced by an active wellness committee or health cabinet. The other options deal with factors other than program evaluation.

14. Which of the following statements by a parish nurse exhibits a lack of understanding of the concept of pastoral care? a. By working with my clients to help them identify their spiritual strengths, I am drawing on pastoral care aspects of practice. b. To incorporate pastoral care, I should involve the pastor in ministering to the members of the congregation. c. I use pastoral care when I emphasize the spiritual dimension of nursing when providing care. d. When I lend support to my clients during times of joy, as well as during their times of sorrow, this illustrates an important aspect of pastoral care.

ANS: B The nurse fulfills the role of pastoral care through stressing the spiritual dimension of nursing, lending support during times of joy and sorrow, guiding the person through health and illness throughout life, and helping identify the spiritual strengths that assist in coping with particular events. Pastoral care is a service ministry formalized by a church or faith community, not necessarily involving the pastor.

8. A group of parish nurses affiliated with a number of faith-based communities located in different regions across the state are attending a quarterly meeting. Which of the following statements made by one of them indicates a lack of understanding of parish nursing? a. I always make sure to have new clients sign a release of information form to obtain their health record from their previous parish nurse. b. Because I work for and within the church, I am immune from civil laws. c. The pastor and I work together for the spiritual health of the community. d. Yes, I am happy to pray with my clients and help them worship.

ANS: B The nurse must personally and professionally abide by the parameters of the nurse practice act of the jurisdiction and maintain an active license of that state.

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.

1. Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.) a. Economic turmoil and demand for high-technology care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism

ANS: B, C, D As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services.

4. How did health care and its delivery change during the 1980s? (Select all that apply.) a. Funding to public health increased as funding for acute hospital care decreased. b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco. c. Nurse practitioners were increasingly used to provide care. d. Public health programs suffered reduced political support, financing, and effectiveness.

ANS: B, C, D During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.

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 healths need for additional funding and resources c. The unrecognized importance of nurses in lowering health care costs d. Lack of adequate vaccines to meet communitys 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.

2. A nurse working with Mary Breckinridge would have likely assisted with: (Select all that apply.) a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Ensuring positive outcomes for pregnancies among women in the Appalachian region

ANS: B, D Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement.

1. How did Florence Nightingale help bring about community health nursing? (Select all that apply.) a. She convinced socially prominent wealthy women to volunteer to give care. b. She focused on all soldiers and their environment. c. She interacted with each individual person, assessing his or her needs and acting to meet those needs. d. She kept careful records on what was done and what were the results.

ANS: B, D Nightingale progressively improved the soldiers health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes.

12. A nurse is considering joining the American Public Health Association. What information about this organization should be considered when making this decision? a. APHA focuses on the public health concerns of the medical profession. b. APHA represents concerns of nursing specialty practices. c. APHA provides a forum for nurses to discuss their public health concerns. d. APHA focuses on providing health promotion education to the public.

ANS: C APHA was formed to facilitate interprofessional efforts and promote the practical application of public hygiene. The Public Health Section within APHA provides nurses with a forum to discuss their concerns and strategies. It also serves as a focus of leadership and policy development for community/public health nursing.

5. A young woman had been away from home several years before she returned home sick and disheartened. Her mother called a nurse to help. Which of the following behaviors would suggest that the caregiver who arrived was a parish nurse? a. Advanced nursing practice education and skills b. Compassionate, skilled, dedicated touch c. Offered a prayer with the daughter and mother d. Willingness to do whatever was needed by mother or daughter

ANS: C Although all options hopefully would occur, the spiritual dimension of health care is central to the practice of parish nursing. Both nursing functions and pastoral care functions are performed by parish nurses, whose visits often involve prayer and reference to scripture, symbols, sacraments, and liturgy of the faith community.

4. Which of the following principles is central to the role of the parish nurse? a. Advanced nursing practice education and skills b. Faith consistent with the community and its leadership c. Spiritual dimension of care d. Willingness to serve anyone in need

ANS: C Although all options would be helpful, the spiritual dimension of health care is central to the practice of parish nursing.

9. Which of the following best defines aggregate? a. A large group of persons b. A collection of individuals and families c. A group of persons who share one or more characteristics d. Another name for demographic group

ANS: C An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.

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.

17. A nurse completes a self-assessment of performance as part of the home health nurses annual evaluation. Which of the following terms best describes this activity? a. Collaboration b. Quality of care c. Performance appraisal d. Resource utilization

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

13. A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the best approach for the nurse to take? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

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

3. How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate? a. Economic and political wars resulted in frequent death and injuries. b. Incredible plagues consistently and constantly swept the European continent. c. Migration and urbanization resulted in increased demand for care. d. Caregivers could easily find other employment, so they demanded to be paid.

ANS: C Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care.

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.

6. Which of the following statements best describes how clients and parish nurses typically perceive spiritual health? a. It exists at the point that cure is attained. b. It has a tangential relation to well-being. c. It is part of an ongoing dynamic process. d. It is usually unchanging across the life span.

ANS: C Health, spiritual health, and healing are considered parts of an ongoing, dynamic process. Because spiritual health is central to well-being, influences are evident in the total individual and noted in a healthy congregation. Well-being and illness may occur simultaneously; spiritual healing or well-being can exist in the absence of cure.

12. A faith community nurse is partnering with a local public health department to develop programs for primary, secondary, and tertiary prevention activities. Which of the following should be used as the primary guide for development? a. Contemporary articles in nursing journals b. Evidence-based practice guidelines for treatment of disease c. Healthy People 2020 goals and objectives d. Preferences of partners who are funding the programs

ANS: C Healthy People 2020 guidelines are basic to the planning of health care. Evidence-based practice is for treatment, not for program development.

12. A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurses current focus? a. Outcome identification b. Planning c. Implementation d. Evaluation

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

4. Which of the following is responsible for the dramatic increase in life expectancy during the twentieth century? a. Technology increases in the field of medical laboratory research b. Advances in surgical techniques and procedures c. Sanitation and other public health activities d. Use of antibiotics to fight infections

ANS: C Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy from less than 50 years in 1900 to more than 77 years in 2002.

10. Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her family than to meet the needs of a dying adult? a. Children dont understand what it means to die. b. A childs death is harder for anyone to accept. c. Society does not expect death to occur in children. d. Families are not prepared to deal with death.

ANS: C It is true that families are rarely prepared to deal with death. It is also true that children have only a limited understanding of dying. However, the needs of the dying child and family are unique because society does not expect death to occur to the young or to have the child die before the parent.

7. What was the outcome of the Shattuck Report? a. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated. b. Environmental sanitation efforts became an immediate priority. c. Guidelines for modern public health organizations were eventually developed. d. Local and state governments established boards of health after its publication.

ANS: C It took 19 years for the first of Shattucks recommendations to be implemented, but his report was the first effort to create a modern public health organization.

8. Which of the following nurses is famous for creating public health nursing in the United States? a. Florence Nightingale b. Frances Root c. Lillian Wald d. Mrs. Solomon Loeb

ANS: C Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades.

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.

7. Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies

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

15. A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? a. Comprehensive assessment and planning done in the community b. Documented needs of the local community c. Federal funding for priority diseases or groups d. Nursing staffs expertise and skills

ANS: C Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort is focused locally.

6. Which of the following is a basic assumption of public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority in government planning and funding. c. The health of individuals cannot be separated from the health of the community. d. The government is responsible for lengthening the life span of Americans.

ANS: C Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy.

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

ANS: C Public health is based on scientific knowledge but is not a core function. The definition does not fit the terms assessment or policy development.

14. Which client would have been most likely to receive care from the Frontier Nursing Service? a. An injured soldier b. A homebound, elderly male c. A woman in labor d. A child with measles

ANS: C The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

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.

4. Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for extensive documentation? a. Advances in medical technology and pharmacology b. Increased number of lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s

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

4. A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed? a. Establishing schools of nursing b. Developing vaccines to administer to large numbers of people c. Collecting vital statistics and improving sanitation d. Developing public housing and almshouses

ANS: C The other choices are events that happened after the colonial period.

9. Which of the following is the primary focus of hospice care? a. Curing or controlling the clients chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves

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

11. When meeting with a client and family, the home health nurse says, We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve. In which of the following phases of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning

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

1. A parish nurse has been using pastoral activities when providing care to clients. Which of the following interventions is the nurse most likely using? (Select all that apply.) a. Helping families plan healthy nutritious meals and get plenty of rest b. Giving health education classes to the congregation c. Using hymns and scripture as a source of guidance and comfort d. Helping identify spiritual strengths that may assist in coping

ANS: C, D All the activities listed represent nursing functions. However, when the nurse fulfills pastoral care, the nurse stresses the spiritual dimension, lends support during times of joy and sorrow, guides the person through health and illness, and helps identify the spiritual strengths that assist in coping with particular events.

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.

14. Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC NOC c. Nursing Diagnosis Taxonomy d. The Omaha System

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

14. The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals

ANS: D Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.

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

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

7. Which of the following actions would most likely be performed by a public health nurse? a. Asking community leaders what interventions should be chosen b. Assessing the community and deciding on appropriate interventions c. Using data from the main health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment

ANS: D Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment.

11. A father confides to the parish nurse that his wife has been hurting their 3-year-old daughter. The nurse examines the daughter and finds evidence of physical abuse. In the parish nurse role, which of the following actions should the nurse take first? a. Contact the pastor for guidance in handling this situation. b. Recommend that the family be removed from the faith community. c. Refer the family to pastoral services for counseling. d. Report the findings to child protective services.

ANS: D As an advocate of client and group rights, the nurse identifies and reports neglect, abuse, and illegal behaviors to the appropriate legal sources. This is necessary regardless of the feelings of the pastor or the father because the nurse is bound legally to report abuse to a child, confirmed or suspected. Referral for counseling is appropriate; however, the childs present state of well-being is paramount. Parish nurses must obey the nurse practice act and laws of the state.

2. Which of the following best describes community-oriented nursing? a. Focusing on the provision of care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. Having the goal of health promotion and disease prevention

ANS: D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions.

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.

13. The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a. To increase the groups self-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups

ANS: D Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a with the peoplenot a to the people or for the people approach to planning.

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 nations health.

10. A family shared their concerns, including sexual issues, in strictest confidence with a faith community nurse. When the nurse returned to the church office, the pastor asked why the family wanted to see her. Which of the following statements would be the best response by the nurse? a. Because you are my supervisor, I will summarize what was said for you. b. I will include that information in my report to our churchs wellness committee. c. They just wanted me to assess their health needs and make some suggestions. d. The family had some issues they wanted to discuss in confidence, which I will keep in confidence.

ANS: D Issues of privacy and confidentiality as well as record management should be discussed upon accepting a position. Regardless, if the nurse agreed to keep the information confidential, the nurse is morally obligated to do so. If the practice is to share all information with the pastor, then the family must be told this before they choose to share any information with the nurse.

13. Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders? a. Creating such a service was the morally correct thing to do. b. Employing nurses directly was less expensive than paying taxes to the city for the same purpose. c. Having the companys nurses make home visits increased worker morale. d. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company.

ANS: D Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of children. The insurance company attributed this improvement and the associated reduced costs to the visiting nurses.

11. Why were nurses so unprepared for public health nursing in the early twentieth century? a. Community health nursing had not yet been created as a field. b. No one would teach the nurses how to engage in public health activities. c. Nightingales textbook did not include content on public health nursing. d. Nurses were educated in diploma schools, which focused on hospital nursing.

ANS: D Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for home visiting.

18. Which of the following best describes when the home health nurse must document required Outcome and Assessment Information Set (OASIS-B1) data? a. Before any episode of hospitalization b. After each home health visit c. For all incidences of error or mistake in care d. On first admission to home health care

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

18. Although a particular congregations need was obvious, there simply wasnt enough money to support a parish nurse position. Which of the following community groups would have most likely had a need and funds available to contribute to a shared parish nurse position? a. Childcare center b. Community elementary school c. Community high school d. Elderly housing complex

ANS: D Parish nurses are frequently employed by senior living complexes and nursing homes to offer a spiritual focus to the nursing practice within various levels of living arrangements for elders, in addition to serving one or more congregations in the community.

6. A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely have completed? a. Setting policy on quarantine legislation for immigrants b. Establishing hospital-based programs to care for the sick at home c. Identifying and improving environmental conditions d. Providing health care for merchant seamen

ANS: D Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities.

12. When talking to a womens group at the senior citizens center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a. Ensure that the women did not expect the nurse to solve their problem b. Demonstrate that the nurse understood the womens concerns and needs c. Express empathy, support, and concern d. Help the women engage in political action

ANS: D Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action.

18. A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts? a. To promote the nursing profession b. To increase funding for public health nursing c. To address the concerns of nurses d. To help improve health care access

ANS: D Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life.

7. Which of the following statements suggests that faith community nursing is a nationally recognized specialty of nursing? a. Academic programs now offer a clinical specialty in parish nursing. b. Faith community nurses are increasingly receiving salaries for their efforts. c. Faith community nursing is being adapted in other countries and to non-Christian faiths. d. Scope and standards of faith community practice have been developed and revised.

ANS: D The 2005 Faith Community Nursing: Scope and Standards of Practice revised the original 1998 document in describing the who, what, where, when, why, and how of the practice of faith community nursing. The most recent edition, released in 2012, focuses on faith community nurses but is also aimed at other healthcare providers, spiritual leaders, families, and members of faith communities. Specialty areas within professional nursing achieve a major milestone when the standards and scope common to that practice are recognized.

16. A nursing student during World War II would likely join which group? a. The Public Health Service of New York City b. The Marine Nurse Corps c. The Frontier Nursing Service d. The Cadet Nurse Corps

ANS: D The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

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.

3. Which of the following is the primary focus of public health nursing? a. Families and groups b. Illness-oriented care c. Individuals within the family unit d. Promotion of quality of life

ANS: D The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nursesor public health nursesprovide health care to promote quality of life.

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.

6. A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident. Which of the following types of care will he most likely receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

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