LP 12: Mental Health Nursing; Environmental Hazards & Emergency Preparedness

Stress reactions in the community (Disaster) Four community phases are commonly recognized:

-Heroic -Honeymoon -Disillusionment -Reconstruction (USDHHS, 2000)

Disasters (General Overview)

-Level 1: local -Level 2: Surrounding (Regional) -Level 3: State/Fed Internal vs External Natural (fire, flooding) vs Man-made (chemical spill, terrorism) -Joint Commission requires Emergency Preparedness Planning x2/year

Housing Concerns: Air quality

-Secondhand smoke (cancer, otitis, asthma) -Carbon monoxide (HA, N/V, Dizziness, lethargy)

Continuous Quality Improvement (CQI)

A continuous improvement in the quality of the product or service being delivered

Housing Concerns: Radon

A gas that arises from the earth where radioactive materials are present. -Carcinogenic -2nd leading cause of lung cancer -Radon Test, Place in lowest part of home x48 hours and send to lab -Odorless, tasteless

Housing Concerns: Asbestos

A long, thin, fibrous silicate mineral with insulating properties, which can cause cancer when inhaled. -Can cause mesothelioma -S/S show later in years

case management

A nursing care pattern; a case manager (an RN) coordinates a person's care from admission through discharge and into the home setting

The public health nurse is most likely to use what types of surveillance systems? A: Active B: Passive C: Sentinel D: Syndronic

A: Active B: Passive Although all of the systems are important, the public health nurse is most likely to use the active or passive systems. A passive system may use the state reportable disease system to complete a community assessment or MAPPS. The active system is used when several schoolchildren become ill after eating lunch in the school cafeteria or at the local hot dog stand, to investigate the possibility of food poisoning, or to follow up the contacts of a newly diagnosed client with tuberculosis or a sexually transmitted infection (STI) at the local homeless shelter.

The Clean Air Act of 1970 was amended in 1990 to meet unaddressed or insufficiently addressed problems that included which of the following? A: Addressing acid rain B: Addressing excessive noise and heat or cold extremes C: Addressing ground-level ozone D: Addressing stratospheric ozone depletion E: Tracking 75,000 industrial chemicals

A: Addressing acid rain C: Addressing ground-level ozone D: Addressing stratospheric ozone depletion

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? A: Bed-wetting episodes B: Desire to return to school C: Fantasies of denial D: Increased playfulness with peers E: Thumb sucking

A: Bed-wetting episodes C: Fantasies of denial E: Thumb sucking The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to parents or have nightmares and fantasies that the disaster never occurred. School-related problems may also develop, and the child may not be able to concentrate or may even refuse to attend school.

In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. This statement relates to the sequential process of: A: Collaboration B: Communication C: Cooperation D: Negotiation

A: Collaboration Collaboration is achieved through a developmental process that occurs in a sequence, yet it is reciprocal between those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required in all aspects. It requires the synergy of all parties involved. The goal of communication in the collaborative development process is to promote respect for, understanding of, and the accuracy of all team members' points of view. Cooperation is the ability to understand and meet the needs of others. Negotiation generally occurs in a situation involving conflict.

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

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

What terms are used to describe healthy families? A: Families with strengths B: Dysfunctional C: Functional families D: Resilient families E: Resistant families

A: Families with strengths C: Functional families D: Resilient families Families with strengths, functional families, and resilient families are terms often used to refer to healthy families. Research has been conducted about healthy families, but it is clear that the issues examined all relate to those of relational needs. This means that in healthy families, the basic survival needs are met. The traits ascribed to healthy families are based on attachment and are affectionate in nature.

Which of the following barriers are specific to the educator? A: Fear of public speaking B: Low literacy C: Limited experience with the topic D: Lack of motivation E: Lack of experience with gaining participation

A: Fear of public speaking C: Limited experience with the topic E: Lack of experience with gaining participation Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes.

Which educational method has been shown to be most effective in fostering treatment adherence? A: Internet-based education B: In-person counseling C: Telephone counseling D: Self-directed learning

A: Internet-based education Educating people through the Internet has been shown to be more effective in fostering treatment adherence than in-person counseling, telephone counseling, or self-directed learning. It is important to be aware that people increasingly are using the Internet as a source of health information. Clients may ask nurses to provide them with information about ways to evaluate the quality and reliability of this information.

The hospital infection control practitioner reports new cases of tuberculosis to the public health department. Of what type of surveillance system is this an example? A: Passive B: Active C: Sentinel D: Special

A: Passive Surveillance systems in use today are defined as passive, active, sentinel, and special. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems.

A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? A: Repetition B: Integration C: Participation D: Sequencing

A: Repetition Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group.

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? A: Use of films B: Small group interaction C: Use of games D: Session timing E: Session space

A: Use of films B: Small group interaction C: Use of games D: Session timing E: Session space Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics. Also consider the learner's knowledge, skills, and motivation to learn, as well as what resources are available to support and possibly prevent learning. Resources include printed, audio or visual materials, equipment, agencies, and other individuals. Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support.

The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges: A: adapting and coping responses. B: intellectual capacity. C: socioeconomic status. D: spiritual awareness.

A: adapting and coping responses. Eighty-five percent of all elderly people live in homes alone, with spouses or other family or friends. For many families, the caregiving experience is a positive, rewarding, and fulfilling one. Nursing intervention can facilitate good health for older persons and their caregivers and contribute to meaningful family relationships during this period.

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

A: advocacy and management Clients are a part of larger systems: the family, the work environment, and the community. Each system interacts with the client to shape available options through resources, needs, and desires. The practice of advocacy may entail the ability to focus attention on the magnitude of problems caused by diseases affecting a segment of the population. Advocacy often stimulates a community's self-determination to find innovative actions to correct gaps in service.

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

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

In applying the developmental theory, a family nurse determines the developmental stage of the family based on: A: age of the eldest child B: family strengths C: individual growth patterns. D: overall tasks of the family.

A: age of the eldest child Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development.

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: A: an andragogical approach B: a behavioral approach C: operational approach D: a pedagogical approach

A: an andragogical approach Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation.

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: A: assess the literacy level of the group B: see how many plan to attend C: see whether the group is ready to learn D: secure a good space for a group meeting

A: assess the literacy level of the group Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels.One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States.

A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be: A: community forums B: focus groups C: key informants D: surveys

A: community forums Community forums have the advantage of being low in cost and capturing the perspectives of a large number of persons. Focus groups and key informant methods limit the number of persons expressing their perspectives. Surveys are expensive and technically demanding.

The major sources of information for program evaluation are: A: community indexes B: media reports C: program clients D: program providers E: program records

A: community indexes C: program clients E: program records Major sources of information for program evaluation are program clients, program records, and community indexes. The program participants, or clients of the service, have a unique and valuable role in program evaluation. Whether the clients, for whom the program was designed, accept the services will determine to a large extent whether the program achieves its goal. Thus their reactions, feelings, and judgments about the program are important to the evaluation.

A government agency is conducting an audit of all active clients in the local hospice program to ensure that hospice criteria for care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: A: concurrent audit B: outcome audit C: retrospective audit D: peer review

A: concurrent audit Staff/peer review processes are a specific approach to quality assurance that often use audit tools to determine quality of care. The concurrent audit is a process of audit that evaluates the quality of ongoing care by looking at the nursing process. A retrospective or outcome audit evaluates quality of care following the discharge of a client. Both audits are conducted in nursing peer review.

The nurse engaging in formative program evaluation would most likely: A: conduct medical record audits for quality assurance. B: make a home visit before a client is discharged from the program. C: participate in new client evaluation. D: write policy for risk management.

A: conduct medical record audits for quality assurance. Quality assurance audits are prime examples of formative program evaluation in health care delivery. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. This type of evaluation is an example of formative evaluation of processes, which occurs on an ongoing basis while the program exists. Progress evaluation occurs primarily while implementing the program. The nurse who completes a daily or weekly log of clinical activities (e.g., number of clients seen in the clinic or visited at home, number of phone contacts, number of referrals made, number of community health-promotion activities) is contributing to progress evaluation of the nursing service.

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: A: efficiency B: progress C: relevance D: sustainability

A: efficiency A program evaluation may be able to determine whether a program provides better benefits at a lower cost than does a similar program or whether the benefits to the clients or number of clients served justifies the costs of the program. This is a measure of the efficiency of a program. A reduction in teen pregnancies can represent significant cost savings to the overall health of the community. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed. Sustainability is the continuation of a program when resources are adequate.

The nurse in community health uses information about family structure, household composition, marriage, divorce, birth, death, adoption, and other family life events to forecast and predict stresses and developmental changes experienced by families and identify possible solutions to family challenges. This best describes the study of: A: family demographics B: family functions C: family health D: family resilience

A: family demographics Family demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing. Nurses must be knowledgeable about family structures, functions, processes, and roles. In addition, nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures.

The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: A: fosters equal family and provider commitment to success. B: facilitates outcomes-oriented family nursing research. C: decreases the need for nurse contact and intervention. D: removes barriers to needed services to achieve success.

A: fosters equal family and provider commitment to success. Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between the parents, or the indirect interaction between the parents and the child). The systems approach to family always implies that when something happens to one family member, the other members of the family system are affected.

The Omaha System is a client classification system developed by the Visiting Nurses Association of Omaha, Nebraska, that has the potential to improve the delivery of care by: A: improving the description of care B: minimizing the assessment required C: predicting the outcome D: decreasing the communication needs

A: improving the description of care The Omaha System is a comprehensive method for evaluating client care. The components include a classification system for assessing and categorizing client problems, a database, a nursing problem list, and anticipated outcome criteria for the classified problems. It has the potential to improve the delivery of nursing care, documentation, and the descriptions of client care that will enhance nursing assessment, planning, implementation, and evaluation of client care and allow the collection of more pertinent client information (relevant, consistent, and measurable) for more effective and efficient nurse productivity and communication.

The most common causes of preventable disease, disability, and death among children are: A: injuries and accidents. B: maintaining a healthful diet. C: physical activity. D: cardiovascular health.

A: injuries and accidents. Injuries and accidents are the most common causes of preventable disease, disability, and death among children. Unintentional injuries are any injuries sustained by accident such as falls, fires, drowning, suffocation, poisoning, sports, recreation, or motor vehicle accidents. Because of their size, growth and development, inexperience, and natural curiosity, children and teens are especially at risk for injury.

The Patient Self-Determination Act of 1990 requires that providers receiving Medicare and Medicaid funds give clients written information regarding: A: legal options for treatment choices in the event the person becomes incapacitated B: patient rights C: the cost of services D: patient privacy

A: legal options for treatment choices in the event the person becomes incapacitated The Patient Self-Determination Act of 1990 (PL 103-43) requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. A routine discussion of advance medical directives can help ease the difficult discussions faced by health care professionals, family, and clients. The nurse can assist an individual to complete a values history instrument. These instruments ask questions about specific wishes regarding different medical situations.

An underlying current throughout the special population groups with health disparities is: A: poverty B: aging C: minority groups D: children

A: poverty Health disparities present political implications and influence government actions. Certain groups have been recognized as experiencing health disparities and have become a priority for policy efforts. Poverty is a strong and underlying current throughout all of the special groups.

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

A: recidivism of the problem for the client If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. In the evaluation stage, the nurse should examine criteria that include the immediate and long-term responses of the client, as well as the recidivism of the problem for the client. Consideration of laws and policies in the community occurs in the planning phase. Examining the relationship between the disease and the environmental factors occurs in the diagnosis phase and coordinating actions to meet the needs of the client is a step in the intervention phase.

A nurse functioning in the role of a case manager performs which of the following functions in the care delivery process? A: risk analysis B: data mapping C: provision of illness care D: epidemiologic investigation of unexpected illnesses E: counseling and education

A: risk analysis B: data mapping D: epidemiologic investigation of unexpected illnesses The case manager is the architect for the target group's health in the care management delivery process. The building blocks used by the manager include risk analysis, data mapping, data monitoring, epidemiologic investigation of unexpected illnesses, multidisciplinary development of action plans and programs, and identifying case management triggers or events that promote earlier referrals of high-risk clients when prevention can have dramatic results. The case manager builds on the basic functions of the traditional role and adapts new competencies for managing the transition from one part of the system to another or to home.

Given recent vaccine shortages for the flu, the local nurses in community health form a group to evaluate the process of scheduling and operating flu vaccination clinics in the community and review the community's complaints from the previous season. The activity best represents the principle of: A: total quality management (TQM) to achieve continuous quality improvement (CQI). B: quality assurance (QA) to achieve continuous quality improvement (CQI). C: risk management to achieve quality. D: continuous quality improvement (CQI) to achieve total quality management (TQM).

A: total quality management (TQM) to achieve continuous quality improvement (CQI). Total quality management provides direction for managing a system of care, whereas continuous quality improvement using quality assurance and quality improvement focuses on the care a client receives within the system. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes. CQI focuses on the sources of differences in the ongoing process of health care delivery and seeks to improve the process. Risk management focuses on reducing financial risk.

Promotor

Advocacy role in which the nurse partners with the client and promotes the clients rights to make his or her own decisions

point source outbreak

All individuals affected are exposed at or around the same time. Cases occur after a MINIMUM and within 1 incubation time. This outbreak stops unless secondary spread occurs

Housing Concerns: Formaldehyde

An air pollutant that is a colorless chemical used to manufacture building materials and many household products, such as particleboard, hardwood plywood paneling, and urea-formaldehyde foam insulation. -Pickle-like odor -S/S Respiratory problems, burning eyes, exacerbation of asthma

propagated outbreak

An outbreak that does not have a common source, but instead spreads from person to person.

common source outbreak

An outbreak that results from a group of persons being exposed to a common noxious influence, such as an infectious agent or toxin. If the group is exposed over a relatively brief period of time, so that all cases occur within one incubation period, then the common source outbreak is further classified as a point source outbreak. In some common source outbreaks, persons may be exposed over a period of days, weeks, or longer, with the exposure being either intermittent or continuous.

Total Quality Management (TQM)

Approach to managing the quality of care through appraisal of the nursing process after the client's discharge from the health care system

A parent with two school-age children has just finished a family health assessment questionnaire. The parent asks the nurse why one of the questions asks whether there is a neighborhood playground. The nurse's best response would be: A: "Don't worry about it. We are going to talk about all this anyway." B: "It's important to good health to have adequate recreation resources." C: "We want to be able to report any dangerous playground equipment to the city." D: "We want to be able to report any dangerous playground equipment to the city."

B: "It's important to good health to have adequate recreation resources." The importance of social risks to family health is gaining increased recognition. A family's health risk increases if they are living in high-crime neighborhoods, communities without adequate recreation or health resources, in communities with major noise pollution or chemical pollution, or in other high-stress environments.

During a family nursing assessment, a parent questions whether God is punishing the family, because one of the children has just been diagnosed with leukemia. The most facilitative response by the nurse would be: A: "God is loving and doesn't punish people." B: "Tell me more about your family's spiritual beliefs." C: "That is not part of my religious belief system, so I don't know." D: "Why do you think your family needed to be punished?"

B: "Tell me more about your family's spiritual beliefs." The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change.

Nurses should review which of the following reports to determine what pollutants have been found in the drinking water of a community? A: Point source report B: Consumer confidence report C: Material Safety Data Sheet D: Environmental standards report

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

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: A: Anger B: Delayed stress response C: Inability to concentrate D: Insomnia

B: Delayed stress response Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations. Also, they may feel frustration and conflict if their needs seem inconsistent with those of their family and coworkers or if they have left the disaster site thinking that so much more could have been done.

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

B: During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. C: In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. E: The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. The first two phases, the Heroic and Honeymoon phases, are most often associated with response efforts. The latter two phases, Disillusionment and Reconstruction, are most often linked with recovery. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Survivors will gather to share experiences and stories. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. The last phase, Reconstruction, is the longest. Homes, schools, churches, and other community elements need to be rebuilt and reestablished.

What are the core competencies of the nurse participating in surveillance and investigation activities? A: Basic patient assessment skills B: Effective communication skills C: Ability to collaborate with community partners D: Leadership and systems thinking

B: Effective communication skills C: Ability to collaborate with community partners D: Leadership and systems thinking The national core competencies for public health nurses were developed from the work of the Council on Linkages Between Academia and Public Health Practice (2010) and by the Quad Council of Public Health Nursing Organizations (2009). To be a participant in surveillance and investigation activities, the staff nurse must have the following: o Analytic assessment skills o Ability to provide effective oral and written reports o Community dimensions of practice o Basic public health science skills o Leadership and systems thinking

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

B: Effects of stress on individuals The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings. Key actions by the nurse can assist others with dealing with the stress, help people cope, allay concerns and fears, identify feelings that they may be experiencing, assist others to think positively and move to the future, and prepare nursing personnel to be effective in a crisis/emergency situation.

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved? A: Cultural sensitivity B: Efficiency in client service C: Learning of new skills D: Distraction-free surroundings

B: Efficiency in client service In the education process, one of the important skills for educators to develop in selecting appropriate educational methods is realizing the benefits of group teaching, such as cohesiveness among members, increased number of clients seen, clients learning from one another, and cost effectiveness. Cohesive groups tend to be more productive and able to accomplish their goals; cohesion can be increased as members better understand the experiences of others and identify common ideas and reactions to various issues. Nurses facilitate this process by pointing out similarities, contrasting supportive differences, or helping members redefine differences in ways that make those dissimilarities compatible.

Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? A: Assessment of the individual's health does not determine the overall family system's health. B: Family functioning affects the health of individuals. C: Family system assessment specifically addresses the individual's health. D: The individual's health affects family functioning. E: Simultaneous assessment of individual family members and the family system as a whole is important to family health.

B: Family functioning affects the health of individuals. D: The individual's health affects family functioning. E: Simultaneous assessment of individual family members and the family system as a whole is important to family health. The bio/psycho/socio/spiritual approach to family health refers to individual members as well as the family unit as a whole. An individual's health (wellness-illness continuum) affects the entire family's functioning and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.

Which of the following statements are true regarding the health-related vulnerabilities of men? A: More males die at birth. B: Fewer health services are emphasized for men. C: Men are less likely to be honest about their symptoms. D: More males die from suicide. E: Men do not participate in health care at the same level as women.

B: Fewer health services are emphasized for men. C: Men are less likely to be honest about their symptoms. E: Men do not participate in health care at the same level as women. Although health policies, campaigns, and community health organizations offer services for men, women's health is more often emphasized. Several barriers to men reaching their full health potential have been identified. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Giorgianni et al, 2013). A study from researchers at Rutgers University found that men who held traditional beliefs about masculinity, such as toughness, bravery, self-reliant, and emotionally restrained, were less likely than women to seek medical help, more likely to choose a male provider, and less likely to be honest about their symptoms (in particular, minimizing their symptoms) (Himmelstein and Sanchez, 2016).

What are the purposes of disease surveillance in public health? A: Tries to identify terrorist attacks before they occur. B: Provides a means for nurses to monitor disease trends. C: Generates knowledge about disease or outbreak patterns. D: Allows the nurse to advocate for policy changes. E: Reduces morbidity and mortality and improves health through disease trend monitoring.

B: Provides a means for nurses to monitor disease trends. C: Generates knowledge about disease or outbreak patterns. E: Reduces morbidity and mortality and improves health through disease trend monitoring Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations). Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and to improve health. Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries as well as "environmental and occupational exposures" and personal health behaviors. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks.

What is the purpose of using an algorithm in the surveillance process? A: Tells the nurse who to call in the event of an outbreak. B: Provides the nurse with a step by step plan to identify events needing investigation. C: Provides the nurse with a system for telephone triage in an outbreak. D: It is a visual reminder of the epidemiologic triangle.

B: Provides the nurse with a step by step plan to identify events needing investigation. A quality surveillance system requires collaboration among a number of agencies and individuals: federal agencies, state and local public health agencies, hospitals, health care providers, medical examiners, veterinarians, agriculture, pharmaceutical agencies, emergency management, and law enforcement agencies, as well as 911 systems, ambulance services, urgent care and emergency departments, poison control centers, nurse hotlines, school, and industry. The type of information shared includes the use of an algorithm to identify which events should be investigated (i.e., using a precise step-by-step plan outlining a procedure that in a finite number of steps helps to identify the appropriate event).

A nurse doing a family assessment asks the client, "Have any of your blood relatives had mental illness?" The nurse is asking this question to: A: determine whether the family is stable. B: assess for biological risk factors. C: decide whether this family member needs medication. D: demonstrate open-mindedness about mental illness.

B: assess for biological risk factors. Healthy People 2020 (US Department of Health and Human Services, 2010) identified the following major categories as being: inherited biological risk, including age-related risks, social and physical environmental risks and behavioral risks as well as health care risks. Although single risk factors can influence outcomes, the combined effect of several risks has greater influence.

When acting as a mediator, the nurse advocate would: A: choose a new health plan for a client with limited funds. B: assist new parents in communicating with their health plan regarding well-baby coverage C: provide health education to teens who need knowledge about sexually transmitted diseases D: set up a doctor's appointment for an illiterate adult

B: assist new parents in communicating with their health plan regarding well-baby coverage Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The goal of the nurse advocate as mediator is to help parties understand each other on many levels so that agreement on an action is possible.

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

B: case management Case management is identified as one of the 17 interventions in the scope of practice in community health nursing. Case management is defined as the ability to optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Case management, in contrast to the definition of care management, refers to activities implemented with individual clients in a system. Care management includes the concept of disease management.

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: A: affective domain B: cognitive domain C: events of instruction D: principles of effective education

B: cognitive domain The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition in order of difficulty. The affective domain includes changes in attitudes and the development of values. This situation does not demonstrate events of instruction or educational principles.

A family nurse is working with a married couple that has decided to remain child-free. The nurse recognizes this decision as a: A: biological necessity. B: contemporary family function. C: religious belief decision. D: threat to family survival.

B: contemporary family function. In contemporary times, the traditional functions of families have been modified and new functions added. One of the traditional family functions was to procreate to ensure the survival of the species. Many married couples are electing to be child-free rather than to reproduce.

One specific approach to quality assurance is the use of Total Quality Management (TQM). A district public health department uses this approach and gives much attention to ensuring that studies are used to improve processes, remove management by objectives, and promote self-improvement. The major TQM guideline that would summarize these efforts would be: A: create, publish, and distribute aims and purposes. B: create a strong customer-oriented philosophy that is process-driven. C: eliminate barriers to pride of work/performance. D: understand the purpose of inspection.

B: create a strong customer-oriented philosophy that is process-driven. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes (Oakland, 2014). Under TQM, quality is defined as customer satisfaction. Quality assurance/quality improvement (QA/QI) is the promise or guarantee that certain standards of excellence are being met in the delivery of care.

The monitoring and public reporting of air quality in a local community to alert individuals with asthma or other respiratory conditions would illustrate: A: compliance and enforcement B: environmental epidemiology C: secondary prevention D: toxicology

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

A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: A: Centers for Disease Control and Prevention (CDC) reports B: epidemiologic data C: recent census data D: voter registration records

B: epidemiologic data A major source of evaluation is epidemiologic data. Mortality and morbidity data measuring health and illness indicators are probably cited more frequently than any other single index for program evaluation. Incidence and prevalence are valuable indexes used to measure program effectiveness and impact, and these data are readily available on the Internet. Major sources of information for program evaluation are program clients, program records, and community indexes.

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

B: individuals must ultimately recover on their own Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster. During the recovery period, all involved agencies pull together to restore the institutions and properly rebuild. In the end, all of the nurses and organizations in the world can only provide partnerships with the victims of disaster. Ultimately, it is up to the individuals to recover on their own.

Nurses often participate in field assessment teams during a disaster response. These assessments are crucial to best help: A: encourage good intentions of those giving aid B: match available resources to the population's emergency needs C: separate casualties and allocate treatment D: provide compassion and dignity

B: match available resources to the population's emergency needs Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features. Elements of a rapid needs assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions.

The problem of the working poor and uninsured places a major burden on the current health care system that affects those families and the community in general. Nurses in community health see this as a major: A: behavioral issue B: policy issue C: health risk issue D: social issue E: nursing issue

B: policy issue C: health risk issue D: social issue Economic risk is one of the foremost predictors of health. It is useful to know whether families' resources are adequate to meet their needs. The standard of living they are comfortable with is not the measure of risk. If the main wage earner is employed but receives no medical benefits, and the salary is not sufficient for health promotion or illness-related care, the family may qualify for available government-sponsored programs. This is a major policy issue of concern to nurses.

The community health nurse is aware that lesbian, gay, bisexual, and transgender (LGBT) adults are more likely to experience which of the following conditions? A: cardiovascular disease B: poor mental health C: obesity D: poverty

B: poor mental health Lesbian, gay, bisexual, and transgender (LGBT) adults represent a sometimes hidden special population, in part because of the social stigma associated with homosexuality coupled with the fear of discrimination. Several studies have documented health disparities by sexual orientation in population-based data and have revealed differences in health between LGBT adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, higher risk of disability, and excessive drinking.

A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best defined by this statement is: A: continuous quality improvement (CQI). B: quality assurance (QA). C: risk management D: total quality management (TQM).

B: quality assurance (QA). The goals of QA and QI are on a continuum of quality, and in public health they are: (1) to continuously improve the timeliness, effectiveness, safety, and responsiveness of programs, and (2) to optimize internal resources to improve the health of the community. Under a continuous quality improvement (CQI) philosophy, QA and QI are but two of the many approaches used to ensure that the health care agency fulfills what the client thinks are the requirements for the service. QA focuses on finding what providers have done wrong in the past (e.g., deviations from a standard of care found through a chart audit). CQI operates at a higher level on the quality continuum but requires the commitment of more organization resources to move in a positive direction. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes.

A nurse in community health is working with a single parent of three children, ages 4, 6, and 8. The 6-year-old has cerebral palsy. The 4-year-old has asthma. The maternal grandmother lives with the family and has diabetes. The nurse understands the importance of working within the context of the existing family structure and community resources because families are: A: resistive to outside intervention or involvement. B: responsible for providing/managing the care of their members. C: unable to manage the stress of complex health needs. D: restricted in their ability to identify interventions.

B: responsible for providing/managing the care of their members. Health care decisions are made within the family, the basic social unit of society. Families are responsible for providing and managing the care of family members. Families are significant members of health care teams because they are an ever-present force over the lifetime of care. Families are more responsible than ever for assisting in the health care of ill family members.

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: A: Provide an online test module B: Ask whether there are any questions C: Ask for a return demonstration D: Give a short paper-and-pencil quiz

C: Ask for a return demonstration Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given.

A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: A: Negotiation B: Cooperation C: Assertiveness D: Aggressiveness

C: Assertiveness Assertiveness is the ability to present one's own needs and is a behavior often seen in conflict situations. Negotiating is a strategic process used to move conflicting parties toward an outcome. Cooperation is the ability to understand and meet the needs of others. Aggressiveness is a behavior which may be exhibited in a conflict situation.

An elementary classroom of 28 students has had 13 children who have developed chicken pox over the last 3 weeks. What is the pattern of occurrence? A: Common source outbreak B: Point source outbreak C: Continuous source D: Mixed outbreak

C: Continuous source Patterns of occurrence can be identified when investigating a disease or event. These patterns are used to define the boundaries of a problem to help investigate possible causes or sources of the problem. Intermittent or continuous source cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. In a point source outbreak all persons exposed become ill at the same time, during one incubation period. A mixed outbreak (which was described while investigating a foodborne gastroenteritis caused by a Shigella sonnei virus) is a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza.

The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? A: Families are defined by genetic ties. B: Family names are needed to confer status. C: Members of a family are self-defined. D: Traditional family functions have been redefined.

C: Members of a family are self-defined. The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? A: Assessment Protocol for Excellence in Public Health (APEXPH) B: Health Evaluation Data Information System (HEDIS) C: Mobilizing for Action Through Planning and Partnership (MAPP) D: Planning Approach to Community Health (PATCH)

C: Mobilizing for Action Through Planning and Partnership (MAPP) MAPP is the newer approach to program planning in the public health arena. It is a strategic planning model that helps the community health workers be facilitators, as communities establish priorities in their public health issues and identify resources to address the issues. APEXPH addresses the three core competencies of public health: assessment, assurance, and policy development. PATCH is a health education model and HEDIS is not associated with program planning.

Which of the following systems of surveillance is used to monitor trends in commonly occurring diseases? A: Active B: Passive C: Sentinel D: Syndronic

C: Sentinel In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies.

A nurse in community health is conducting an assessment on a family of four. During the course of the assessment, the nurse collects information about previous generations of the family and siblings. The results are used to create a diagram for the family that displays the family unit across generations. Further discussions occur regarding the patterns of health and illness that relate to biological health risks. The diagram is called: A: an ecomap. B: a family plan. C: a genogram. D: a risk plot.

C: a genogram. A genogram is a drawing that shows the family unit of immediate interest and includes several generations, using a series of circles, squares, and connecting lines. Basic information about the family, relationships in the family, and patterns of health and illness can be obtained by completing the genogram with the family.

The deliberate release of viruses, bacteria, or other germs with the intent of causing illness or death is: A: event outbreak B: chemical terrorism C: biological terrorism D: surveillance

C: biological terrorism Biological terrorism is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations).

A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for: A: asthma B: attention deficit disorder (ADD) C: childhood obesity D: poisoning

C: childhood obesity Obesity among the youth of the nation has reached epidemic proportions. Many factors contribute to the likelihood that a child will become overweight or obese. Factors include genetics, family eating, and physical activity patterns and time spent inactive while viewing television, playing computer games, or using other electronic devices. The environment in which children live influences obesity.

A general approach to quality improvement where a qualified agent designates formal recognition to individuals or institutions that have met minimum standards of performance is best described as: A: accreditation B: charter C: credentialing D: licensing

C: credentialing General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. Credentialing is defined as the formal recognition by which individuals or institutions are designated by a qualified agent as having met minimum standards of performance. Licensure is typically viewed as recognition that a person has met a minimal set of standards to practice.

A particular chronic health problem that is a serious public health challenge and results in health complications that double medical costs is: A: stroke B: hypertension C: diabetes D: cardiovascular disease

C: diabetes Diabetes is a serious public health challenge for the United States. According to the National Diabetes Statistics Report 2014, one out of every 11 people of the United States population have diabetes (CDC, 2014). People with diabetes are at a higher risk for serious health complication, such as: blindness, kidney failure, heart disease, stroke, and loss of toes, feet, or legs. Due to these health complications, medical costs are twice a high for people with diabetes as those without diabetes. At least 18 of the goals of Healthy People 2020 are related to diabetes.

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

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

Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as: A: neglect B: incompetence C: exploitation D: self-determination

C: exploitation Neglect refers to a lack of services that are necessary for the physical and mental health of an individual by the individual or a caregiver. Older persons can make independent choices with which others may disagree. Their right to self-determination can be taken from them if they are declared incompetent. Exploitation is the illegal or improper use of a person or their resources for another's profit or advantage. During the assessment process, nurses need to be aware of conflicts between injuries and explanation of cause, dependency issues between client and caregiver, and substance abuse by the caregiver.

A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about child care. The next step in the program management process would be to: A: conduct a survey to determine how many children the fathers have. B: determine whether the fathers have benefited from this type of program before. C: meet with community members to form a planning body. D: provide the fathers with community resources.

C: meet with community members to form a planning body. The program management process is like the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. One is applied to a program, whereas the other is applied to clients. Following the assessment, planning for the program should occur.

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

C: monitor the health status, resources, and outcomes for an aggregate Care management is an enduring process in which a care manager establishes systems and monitors the health status, resources, and outcomes for an aggregate or a targeted segment of the population or a group. Care management strategies include use management, critical paths, disease management, demand management, and case management.

One member of an older couple has just retired. This is considered a: A: developmental stage that will help the family with stress reduction. B: nonnormative event that will have psychological impact on the family. C: normative event and can increase the family's risk for illness. D: normative event and will have little effect on the family' well-being.

C: normative event and can increase the family's risk for illness. Life events can increase the risk for illness. Normative events are those that are generally expected to occur at a particular stage of development or the life span. If the event is normative, families may be able to identify needed resources, make plans to cope with the change, learn new skills, and prepare for the event and its consequences. This kind of anticipatory preparation can increase the family's coping ability and decrease stress and negative outcomes. However, when the event is nonnormative, or unexpected, families have little or no time to prepare and the outcome can be increased stress, crisis, or even dysfunction.

The general approach to quality improvement known as licensure that grants control over who can enter into and who exists in a profession can best be described as a contract between the: A: consumers and the profession. B: legislature and the state board. C: profession and the state. D: public and the professional associations.

C: profession and the state. Individual licensure is a contract between the profession and the state whereby the profession (i.e., State Board of Nursing) is granted control over who can enter into and who exists in the profession. It requires written regulations to define the scope and limits of the profession's practice.

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

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

A traditional quality assurance program goal is to identify problems between the provider and client. Other goals of a traditional QA program are: A: intervention in problem cases. B: peer review of all cases that are problematic. C: provide feedback regarding interactions between client and provider D: provide documentation of interactions between client and provider.

C: provide feedback regarding interactions between client and provider Traditional QA programs can fit well with the CQI process. In most health care systems, the overall goal of specific QA approaches is to monitor the process and outcomes of client care. The goals of CQI are as follows: 1. To identify problems between the provider and client through QA methods 2. To intervene in problem cases 3. To provide feedback regarding interactions between the client and provider 4. To provide documentation of interactions between the client and provider Specific approaches are often implemented voluntarily by agencies and provider groups interested in the quality of interactions in their setting. Having peer review of all problematic cases is one step of the audit process for measuring quality.

Passive system of surveillance

Case reports are sent to local health departments by health care providers or laboratory reports of disease occurrence are sent to the local health department. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC or an international organization such as the World Health Organization

mixed outbreak

Common source followed by secondary exposures r/t person-to-person contact. Ex: influenza

National Health Security Strategy (NHSS)

Connected public health and medical preparedness, response, and recovery strategies.

Care Management

Coordination of a plan or process to bring health services together as a common whole in a cost-effective way.

Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? A: Life-cycle theory B: Family developmental theory C: Family systems theory D: Bioecological systems theory

D: Bioecological systems theory The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. Nurses use family systems theory to understand how a family is an organized whole as well as composed of individuals.

According to the Minnesota Model of Public Health interventions, what is the first step of surveillance for the public health nurse? A: Organize the data B: Analyze the data C: Interpret and disseminate the data D: Determine if surveillance is appropriate

D: Determine if surveillance is appropriate The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice (Centers for Public Health Nursing 2001, pp. 15, 16) suggests that surveillance is one of the interventions related to nursing practice in public health. The model provides seven basic steps of surveillance for nurses to follow: 1. Consider whether surveillance as an intervention is appropriate for the situation. 2. Organize the knowledge of the problem, its natural course of history, and its aftermath. 3. Establish clear criteria for what constitutes a case. 4. Collect sufficient data from multiple valid sources. 5. Analyze the data. 6. Interpret and disseminate the data to decision makers. 7. Evaluate the impact of the surveillance system.

The family systems theory encourages nurses to view both the individual clients as participating members of a whole family. What is the major weakness of the systems framework? A: Views families from both a subsystem and a suprasystem approach. B: Defines the direction of interactions. C: Views the family as an agent of change. D: Focuses on the interaction of the family with other systems.

D: Focuses on the interaction of the family with other systems. The major strength of the systems framework is that it views families from both a subsystem and a suprasystem approach. That is, it views the interactions within and between family subsystems as well as the interaction between families and the larger supersystems, such as the community and the world. The major weakness of the systems framework is that the focus is on the interaction of the family with other systems rather than on the individual, which is sometimes more important.

Nursing interventions and approaches for helping individuals and families to assume an active role in their care should focus on empowerment rather than on enabling. The underlying principle to empowerment is: A: Client dominance B: Decreased competence C: Professional competence D: Professional-client partnership

D: Professional-client partnership Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. For families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action.

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? A: Cognitive domain B: Events of instruction C: Principles of effective instruction D: Psychomotor domain

D: Psychomotor domain The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation.

In the event of a disaster, shelters are generally the responsibility of which of the following entities? A: Center of Disease Control and Prevention (CDC) B: Federal Emergency Management Agency (FEMA) C: Public Health Service (PHS) D: Red Cross chapter

D: Red Cross chapter Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress.

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

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

A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's: A: Efficiency B: Impact C: Relevance D: Sustainability

D: Sustainability A program can be continued if there are resources for it. Programs funded as a demonstration project or through outside sources require ongoing funding to survive after the initial funding or time frame for the demonstration project has ended. If the reason for the evaluation is to examine the efficiency of a program, it may occur on an ongoing basis as a formative evaluation. If the evaluation of impact is the goal, long-term effects such as changes in morbidity and mortality must be investigated. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed.

Many families have financial resources that allow them to maintain themselves but limit the quality of their purchasing power. Food high in fat and calories may be affordable, whereas fresh fruits and vegetables may not be affordable. A federal program that attempts to promote healthier diets for vulnerable populations is: A: Medicaid. B: Medicare. C: Supplemental Security Income (SSI). D: Women, Infants, and Children (WIC).

D: Women, Infants, and Children (WIC). Nutritious diets are important in preventing illness and promoting health. A US Department of Agriculture (USDA) study examined the effects of its Women, Infants, and Children (WIC) nutrition program. The study found that children who participated in WIC were more linked to the health care system than children who were not. Children in WIC were more likely to receive both preventive and curative care more often than children not participating in WIC.

A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: A: a formative evaluation B: an informal evaluation C: an ongoing evaluation D: a summative evaluation

D: a summative evaluation Summative evaluations assess program outcomes or are a follow-up of the results of the program activities and look at the end result. Formative evaluations are used to evaluate the progress of a program. An evaluation of program effectiveness may help the nurse evaluator determine both client and provider satisfaction with the program activities, as well as whether the program met its stated objectives.

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

D: beneficence Beneficence can be impaired when excessive attention to cost supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Justice, as an ethical principle for case managers, considers equal distribution of health care with reasonable quality. Veracity, or truth telling, is absolutely necessary to the practice of advocacy and building a trusting relationship with a client. Deontology is not an ethical principle that applies to this situation.

A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: A: community cost concerns B: community conflict-resolution skills C: community satisfaction D: community weaknesses in quality of services

D: community weaknesses in quality of services Case management activities with individual clients and families will reveal the larger picture of health services and health status of a community. Through a nurse's case management activities, general community weaknesses in quality and quantity of services often are discovered.

The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: A: assess the needs of potential outreach clients. B: recognize the special needs of vulnerable people in the area. C: identify how the problems of similar programs will not be repeated. D: identify the resources and activities that will help them meet their program objectives.

D: identify the resources and activities that will help them meet their program objectives. Systematic planning for meeting client needs assists in identifying the resources and activities that are needed to meet the objectives of client services. Today this type of planning is referred to as strategic planning and it involves the successful matching of client needs with specific provider strengths and competencies and agency resources.

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

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

A multidisciplinary quality assurance team has reviewed an organization's stated philosophy and objectives and developed a conceptual model for appraisal that integrates peer review and client satisfaction. The quality assurance program component that should be addressed next would be: A: action B: process C: structure D: outcome

D: outcome The components of a quality assurance program are structure, process, outcome, evaluation, interpretation, and action. Outcome is the most important ingredient of a program because it is the key to evaluation of providers and agencies by external agents.

A disease outbreak of severe acute respiratory syndrome has occurred and has spread over several countries outside the United States. This level of occurrence is said to be: A: hyperendemic B: sporadic C: epidemic D: pandemic

D: pandemic Pandemic refers to the epidemic spread of the problem over several countries or continents (such as severe acute respiratory syndrome [SARS] outbreak). If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. Sporadic problems are those with an irregular pattern with occasional cases found at irregular intervals. Epidemic means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period.

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

D: professional preparedness The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.

A nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: A: intercessor B: mediator C: obstructer D: promoter

D: promoter The nurse advocate makes the client's rights the priority. The goal of promoter for the client's autonomy and self-determination may result in a high degree of client independence in decision making. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The nurse advocate does not exhibit roles of intercessor or obstructer in this situation.

The purpose of recordkeeping in public health agencies is to maintain complete information on clients served and the extent and quality of service provided to those clients. The records also provide information for education and research. Another important use of the records is to: A: determine raises for personnel. B: explain cost overruns. C: foster independence in clinical practice. D: resolve legal issues in malpractice suits.

D: resolve legal issues in malpractice suits. Records are an important part of the communication structure of the health care organization. Accurate and complete records are required by law and must be kept by all agencies, both governmental and nongovernmental. In most states, the state departments of health stipulate the kinds of records to be kept and their content requirements for community agencies. Records provide complete information about the client (whether a family, group, population, or community), indicate the extent and quality of the services being given, resolve legal issues in malpractice suits, and provide information for education and research.

A nurse in community health decides to form a contract with a family. The contract states that the family will designate one night as a family night. The nurse is most likely using the contract to: A: make sure the family does what is expected. B: encourage the family to put plans in writing. C: let the family know that this is a legal agreement. D: shift the responsibility so that it becomes a shared effort.

D: shift the responsibility so that it becomes a shared effort. Contracting involves a shift in responsibility and control toward a shared effort by the client and professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, its ability to make healthful choices is increased. Contracting is a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional.

The school nurse is interested in providing an anti-smoking program in a local middle school and is aware that programs are more effective for this age group when they focus on short-term versus long-term effects of smoking. Besides including health risks and cosmetic effects, the nurse should also consider: A: behavior modification techniques. B: effects on the environment. C: laws regarding tobacco sales to minors. D: social skills instruction to resist pressure to smoke.

D: social skills instruction to resist pressure to smoke. Anti-smoking programs directed toward children and teenagers are more successful if the focus is on short-term effects rather than long-term effects. Developmentally, children and teenagers cannot visualize the future to imagine the consequences of smoking. Teaching should include how advertising puts pressure on people to smoke.

A nurse in community health is conducting a parenting class for prospective parents that will focus on the development of new skills, identification of needed resources, planning, and other preparations for the arrival of a newborn. This intervention is addressing a potential risk associated with: A: biology B: behavior C: environment D: transitions

D: transitions Transitions, or the 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. They require families to learn new skills; change behaviors, schedules, or patterns of communication; identify needed resources; and make plans.

The major factor that has increased the danger of natural disasters is: A: El Niño B: geography C: trade winds D: urbanization

D: urbanization The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms.

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

D: vulnerable populations When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.

chemical, biological, radiological, nuclear, and explosive (CBRNE) disasters

Describes the full spectrum of munitions used to create a human made disaster

environment justice

Equal protection from environmental hazards for individuals, groups, or communities regardless of race, ethnicity, or economic status. This applies to the development, implementation, and enforcement of environmental laws, regulations, and policies and implies that no population of people should be forced to shoulder a disproportionate share of negative environmental effects of pollution or environmental hazard because of lack of political or economic strength levels.

Emergency Support Functions (ESFs)

Fifteen functions used in a federally-declared disaster. Each function is headed by a primary agency.

rapid needs assessment

Form of assessment used in a disaster that immediately takes into account the scope of the problem and the needs of those affected as well as determining what resources are needed to intervene.

Reconstruction Phase of Disaster (last)

Is the longest, homes etc need to be rebuilt. Goal is to return to a new state of normalcy.

Disaster Operation Stages

Mitigation: prevention or minimizing effect Preparedness: plans and preparation Response: actions taken to save lives Recovery: return to normal or safer situation

sentinel surveillance

Monitoring of rate of occurrence of specific conditions to assess the stability or change in health levels of a population

delayed stress reactions

Occur after a disaster and can include exhaustion and an inability to adjust to postdisaster routines.

Disillusionment Phase of Disaster

Occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. -Exhaustion, sense of dispair. -Previous normal may not happen. -Nurses need to consider the psychosocial impact and the consequent emotional implications. -Recognize populations for burnout, exhaustion

Professional Review Organization (PRO)

Organizations established by law to monitor the delivery of health care to clients of Medicare, Medicaid, and Maternal and Child Health programs and to monitor the implementation of prospective reimbursement.

Heroic Phase of Disaster

Overwhelming need for people to do whatever they can to help others to survive. -First responders (Health & Medical Personnel) will overwork, put their health last. -Imported responders, unfamiliar with terrain and inherent dangers.

Housing Concerns: Lead (plumbism)

Primary Prevention -Sources: ceramics, paint, pipes -Prevention: Hand washing, diet high in Ca & Iron and low in fat Secondary Prevention -S/S: dev. delay, behavior, cognitive -Dx: Blood level test or history -5 mcg/dL: Investigate home (sources) -45 mcg/dL: Chelation oral treatment (binds with lead, removed from kidneys via urine) -70 mcg/dL: ethylene diamine tetra acetic acid (EDTA) IV Tertiary Prevetion -Rehab, ST etc...

Consumer Confidence Report (CCR)

Report that began in 1996 when Congress amended the Safe Drinking Water Act to add a provision that required all community water systems to deliver a brief annual water quality report to their customers. The CCR includes information on the water source, the levels of any detected contaminants, and compliance with drinking water rules, plus some educational material. The rationale for these reports is that consumers have a right to know what is in their drinking water. The reports help consumers make informed choices that affect their health.

Environmental epidemiology

Study of the effect on human health of physical, chemical, and biological factors in the external environment.

National Response Framework (NRF)

Successor to the national response plan. NRF presents the guiding principles to enable all response partners to prepare for and provide a unified national response to diseases and emergencies.

Honeymoon Phase of Disaster

Survivors may be rejoicing that their lives and the lives of loved ones has been spared. -Gather to share stories -Creates bonds with survivors

Disaster Medical Assistance Team (DMAT)

Teams of specially-trained civilian physicians, nurses, and other health care personnel who are sent to a disaster.

syndromic surveillance

The monitoring, usually by local or state health departments, of patients presenting to emergency departments and alternative care facilities, the recording of EMS call volume, and the use of over-the-counter medications.

Health Belief Model (HBM)

a non-stage theory that identifies three beliefs that influence decision making regarding health behavior: perceived susceptibility to a health threat, perceived severity of the disease or condition, and perceived benefits of and barriers to the behavior

problem-purpose-expansion method

a way to broaden limited thinking that involves restating the problem and expanding the problem statement so that different solutions can be generated.

Collaboration

the act of working together

chemical terrorism

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

biological terrorism (bioterrorism)

the unlawful use or the threatened use of microorganisms or toxins derived from living organisms to produce death and disease in humans, animals, or plants, had been recognized as a potential threat to the United States and other countries

Housing Concerns: Biological Contaminants

viruses, bacteria, parasites, fungi: the leading causes of foodborne illness -Bed bugs, cockroaches