NRS 4061 Exam 1

Benefits of an electronic health record in the public health system include: (Select all that apply.) a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. d. increased privacy. e. consistently reliable internet resources.

a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. Benefits of an electronic record in public health include 24-hour availability of records with downloaded laboratory results and up-to-date assessments; coordination of referrals and facilitation of interprofessional care in chronic disease management; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors. Drawbacks to new technology include increased legal liability, the potential for decreased privacy, too much reliance on technological advances, and the inconsistent quality of resources available on the Internet and other places. (ch 3, p. 47)

The American health care system will continue to evolve and change. Which of the following groupings of health care trends will have the greatest influence on the health care transformation process at the present time? (Select all that apply.) a. Aging of the population and medical technology advances b. Funding levels, political structure, and professional licensure requirements c. Longevity, population diversity, and funding sources d. Managed care, workforce shortages, and level of education of the population

a. Aging of the population and medical technology advances c. Longevity, population diversity, and funding sources Increases in the number of aging baby boomers as well as the longevity of the elderly, advances in medical technology such as telehealth, and electronic medical record keeping are currently having the greatest impact on the transformation of our health care system. This involves the reallocation of resources, standardization of information transfer, and funding challenges. As a percentage of gross domestic product (GDP), publically funded programs are outpacing the tax and revenue sources for these programs. (ch 3, p. 46)

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

a. Change for the benefit of the community-client must often occur at several levels. b. Changes in the health of individuals will affect the health of their communities. c. The idea of providing health-related care within the community is not new. d. The impact of the environment on health has long been established. The idea that health-related services are provided within a community is not new. At the turn of the century, most persons stayed at home during illnesses. As a result, the practice environment for all nurses (such as community health nurses, PBHs, and visiting nurses) was the home rather than the hospital. These roles continue to exist today. Early textbooks on public health nursing included lengthy descriptions of the home environment and tools for assessing the extent to which that environment promoted the health of the family members. By the 1950s, schools, prisons, industrial settings (occupational health), and neighborhood health centers were added to the list of sites for nursing practice. However, the practice became oriented toward direct-care services to individuals and families and began to lose the community/population focus. Today, direct-care services provided at the individual and family level are defined as community-based nursing practice if the target remains at the direct-care service level and the practice does not address overall community health issues (i.e., common community-related health problems). Presently, there is a resurgence in population-focused health care. Because of the findings from initiatives such as Healthy People 2010 and the World Health Organization's Healthy Communities and Cities, it is now understood that social change related to health behaviors and the use of health policy are more efficient and effective in improving health status overall. (ch 18, p. 398)

The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives? (Select all that apply.) a. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home b. Established public health nursing programs for military outposts in World War I c. Provided matching funds to establish maternal and child health divisions in state health departments d. Responded to the 1918 worldwide influenza pandemic in the United States e. Supported nurse employment through increased grants-in-aid for state programs of home medical care

a. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home b. Established public health nursing programs for military outposts in World War I d. Responded to the 1918 worldwide influenza pandemic in the United States The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care. (ch 2, p. 30)

The poor environmental conditions experienced by immigrants in tenement houses and sweatshops were familiar features of urban life across the northeastern United States and the upper Midwest. Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of the times? (Select all that apply.) a. Community health's focus on teaching and prevention b. Establishment of settlement houses c. Establishment of the town and country nursing services in large cities d. Lack of public interest in limiting disease e. Middle and upper class fear of diseases

a. Community health's focus on teaching and prevention b. Establishment of settlement houses e. Middle and upper class fear of diseases In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities. (ch 2, p. 28)

A group of six nurses is charged by the nurses' manager with evaluating current unit policies. One month later, the manager determines that the group is ineffective because of lack of cohesiveness. Which of the following group concerns or behaviors would be indicative of lack of cohesion? (Select all that apply.) a. Complaints about the degree of member participation b. Dissatisfaction about demands on their schedules c. Complaints about lack of administrative support d. Lack of a work plan for accomplishing the task e. Vying for leadership

a. Complaints about the degree of member participation b. Dissatisfaction about demands on their schedules c. Complaints about lack of administrative support d. Lack of a work plan for accomplishing the task e. Vying for leadership Cohesion is the attraction between individual group members and between each member and the group that allows them to identify themselves as a unit and work toward common goals, endure frustration for the sake of the group, and defend the group against outside criticism. This attraction increases when members feel accepted and liked by others, see similar qualities in one another, and share similar attitudes and values. Members of a highly cohesive group work toward their common goal, identify with the group, are willing to endure frustration to meet their goals, and recognize the needs of individual members. ch 16

A nurse overhears the doctor saying, "Let's not give the client codeine, he's Asian." The nurse reflects on the comment and determines that the doctor is which of the following? (Select all that apply.) a. Culturally competent b. Prejudiced c. Ethnocentric d. Unable to assess pain based on culture e. Planning care based on racial enzymatic differences

a. Culturally competent e. Planning care based on racial enzymatic differences Biological variations distinguish one racial group from another. These differences may occur in the areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from use of the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen his or her pain, and other pain-reducing medications should be explored. (ch 7, p. 143)

In developed countries, nurses have an important leadership role in primary health care initiatives. Commitment to which of the following best demonstrates nursing's advocacy role in primary health care? a. Equality of health care b. Higher education for nurses c. Provision of direct client care d. Quality of care

a. Equality of health care In developed countries, nurses are often viewed as one of the strongest advocates of primary health care through nursing's social commitment to health care equality. (ch 4, p. 67)

In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period? (Select all that apply.) a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use d. Targeting of efforts solely on environmental hazards e. Provision of supplemental food to low-income persons

a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of PHNs. (ch 2, p.36)

Primary health care (PHC) differs from primary care in which of the following ways? a. PHC encourages community participation. b. PHC focuses on prevention and cure. c. PHC is defined more narrowly. d. PHC is the primary method of health care delivery in the United States.

a. PHC encourages community participation. The definition of PHC is broad, incorporating a comprehensive range of services including public health, prevention, and diagnostic, therapeutic, and rehabilitative services. PHC is the mainstay of the public health system in the United States, with a main focus on prevention instead of cure. The provision of PHC is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods and is carried out at the community level with community participation encouraged. Although endorsed by the United States as a strategy for achieving the goal of health for all in the twenty-first century, it is not the chief means of delivery of health care in the United States. (ch 3, p. 54)

The WHO initiative Health for All in the 21st Century can best be described as which of the following? a. Social justice initiative b. Primary care initiative c. National initiative d. Environmental initiative

a. Social justice initiative The Health for All in the 21st Century initiative is not a single, finite goal, but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity to improve the economics and infrastructure of nations through a holistic approach to address determinants of health status and increase a community's responsibility for the health of its citizens. This may involve environmental initiatives and health promotion, education, and prevention initiatives aimed at the greater good of the population as a whole instead of serving the interests of individuals or select groups. (ch 4, p. 64)

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

a. assessment. Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status. (ch 1 p. 6)

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

a. assurance. The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices. (ch 1 p.6)

If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about: a. boundaries, parts, and dynamic processes of the client community. b. community health status and structure. c. community problems and problem correlates. d. role of the nurse and lay advisors in the community partnership.

a. boundaries, parts, and dynamic processes of the client community. In most definitions, the community includes three factors:people, place, and function. The people are the community members or residents. Place refers to both the geographic and time dimensions, and function refers to the aims and activities of the community. The parts of a community are interdependent, and their function is to meet a wide variety of collective needs. Therefore, the definition of community should also recognize the interaction among systems within the community. (ch 18, p. 398)

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

a. character development. The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. (ch 6, p. 127)

A nurse is conducting a diabetes self-management group-education session. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. An effective intervention is for the nurse to: a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. b. explain that everyone must learn to do foot inspection to manage their diabetes. c. loudly and slowly repeat the instructions for all participants to remove their shoes. d. stop the group session, pull the two gentlemen aside, and apologize to them.

a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups. (ch 7, p. 154)

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

a. clinical community health practice. Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies. (ch. 1 p. 15-16)

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

a. community-oriented care. Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings. (ch 1 p. 16)

The nurse is educating her Nigerian client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of: a. cultural accommodation. b. cultural brokering. c. cultural preservation. d. cultural repatterning.

a. cultural accommodation. Culture is defined as a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. Culture is important to nurses because it helps them to understand the beliefs and practices clients bring to the clinical setting, their expression of concerns, and the type of health care they are pursuing. Quality of care means that positive health care outcomes are achieved. Failure to focus care according to the client's values and ideas is likely to increase cost and decrease quality. Care that is not culturally competent may lead to increased cost of health care and decrease the opportunity for positive client outcomes. Techniques such as cultural accommodation can ensure that a positive health outcome is achieved while providing for the cost-effective use of limited resources. Failure of clients to keep scheduled appointments with clinics may reflect a cultural preference for the type and frequency of contact with the health care system. Understanding the type of health care service that the client is seeking can ensure that opportunities to negotiate compliance with treatment can occur to the satisfaction of both parties so that precious resources can be managed effectively. (ch 7, p. 159)

Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as: a. culture shock. b. prejudice. c. ignorance. d. racism.

a. culture shock. Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from those of the individual's own culture. There are cultures in which it is considered acceptable for men to hit their wives and/or children. The nurse can consult with the nursing supervisor or clinic social worker, who can intervene on the client's behalf with the cooperation of a community advocate from the client's culture of origin. (ch 7, p. 158)

During the Depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by: a. decrease in focus on the community as the unit of service. b. increase in the scope of fundamental services. c. increase in field experience. d. decrease in the need for training and supervision.

a. decrease in focus on the community as the unit of service. Some Depression-era federal programs, such as the Works Progress Administration, Relief Nursing Services, and Civil Works Administration (CWA), expanded the need for existing nursing services and created the need for new services in an effort to support employment of basic nurses while meeting the needs of the increasing ranks of impoverished individuals. More than 10,000 nurses were employed by the CWA and assigned to official health agencies. This facilitated rapid expansion of these programs and provided basic nurses with a taste of public health; but it also created a tremendous burden on existing public health staff to provide training and supervision. Basic nursing education focused heavily on the care of individuals, and students received very little training on working with groups and the community as a unit of service. A 1932 survey of public health agencies found that only 7% of nurses employed in public health were adequately prepared to practice in the community, which required considerable agency investment in orientation, training, and supervision. (ch 2, p. 32)

The community-oriented nurse best exemplifies the application of feminist ethics when the nurse: a. designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. b. designs health care programs for women that respect their dignity and autonomy. c. ensures that male providers do not use sexist terms when counseling clients and their spouses and when dealing with female colleagues. d. participates in political action committees that focus on women's rights and status in the community.

a. designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. Whereas feminism rejects the devaluing of women and their experiences, believes that the oppression of women is morally wrong, and demands social justice and political action, feminist ethics holds a broader worldview advocating just relationships for both men and women, adopts a feminist perspective that facilitates critical thought, and focuses on broad issues such as power, gender, and socioeconomic structures. (ch 6, p. 129)

The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who introduces her to the neighborhood residents she needs to partner with. The role of the pastor in this example is: a. gatekeeper. b. community health worker (CHW). c. professional service provider. d. stakeholder.

a. gatekeeper. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Gatekeepers can confer credibility to the nurse. CHWs are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. Stakeholders refer to anyone with a personal or occupational interest or concern in a community's life. Professional service providers who are community members such as school teachers, public safety officers, and agricultural extension agents play a large part in the overall health of the community. (ch. 18, p. 401)

A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. The nurse should first conduct: a. general cultural assessment. b. head-to-toe assessment. c. in-depth cultural assessment. d. nonverbal communication assessment.

a. general cultural assessment. The nurse proceeds with a systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practices of individuals and groups within a holistic perspective, which includes worldview, life experiences, environmental context, ethnohistory, language, and diverse social structure influences. Cultural assessments should focus on those aspects relevant to the presenting problem, necessary intervention, and participatory education. During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview. In-depth cultural assessments are conducted over a period of time. This gives the nurse and client time to get to know each other and is especially beneficial to the client because it allows the client to see the nurse in a helping relationship. (ch 7, p. 161)

A rural community health nurse has made sure that CHWs are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: a. influential with their insider status to engage community members. b. medical professionals within the migrant community. c. natural healers within their community. d. translators to help overcome language barriers.

a. influential with their insider status to engage community members. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. They can also serve as gatekeepers, using their own insider status to engage community members in the assessment process (ch. 18, p. 401)

A nurse who is ethnocentric in interacting with a client of a different culture: a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. b. is appreciative of the client's cultural beliefs. c. accommodates the client's cultural beliefs when planning care. d. imposes the nurse's value system on the client.

a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. Ethnocentrism, an inhibitor to developing cultural competence, is the belief that one's own cultural beliefs are the standards that should be used to judge people from other cultures. Ethnocentric nurses are unfamiliar and uncomfortable with that which is different from their own culture. Their inability to accept different worldviews often leads them to devalue the experiences of others and judge them to be inferior, treating those that are different from themselves with suspicion or hostility. The belief in one's own superiority, or ethnocentrism, may lead to "cultural imposition." Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. By developing an approach of "cultural relativism" nurses recognize that clients have different approaches to health care, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Nurses use "cultural awareness and knowledge" to overcome unfamiliarity and discomfort with cultures outside of their own. Nurses who may have ethnocentric beliefs can avoid inhibiting behaviors/actions such as cultural imposition by developing cultural competence. (ch 7, p. 157)

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

a. multiple factors affect the formulation and justification of ethical issues and dilemmas. The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified. (ch 6, p. 124)

A factor that strongly influences the success of a PHC system is: a. participation of the community members in the design, implementation, and evaluation of the initiative. b. assurance of access to care for every woman and child from pregnancy through childhood. c. each entity's sense of urgency regarding the evaluation of indicators. d. cure orientation of the private sector of health care delivery in the United States.

a. participation of the community members in the design, implementation, and evaluation of the initiative. PHC, the focus of the public health system in the U.S., is defined as the broad range of services including but not limited to, basic health services, family planning, clean water supply, sanitation, immunization, and nutrition education. It consists of programs designed to be affordable for the recipients of the care and the governments that provide them. The emphasis is on prevention, and the means of providing the care are based on practical, scientifically sound, culturally appropriate, and socially acceptable methods provided at the community level, accessible and acceptable to the community and inviting of community participation. (ch 3, p. 54)

The most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand to provide resource information to clients are that the Act: (Select all that apply.) a. transforms the health care system from a sick care system to health care system. b. uses piecemeal approach to strengthen the safety net. c. replaces the rational equitable health care system. d. provides insurance reform. e. increases access to affordable health care insurance.

a. transforms the health care system from a sick care system to health care system. d. provides insurance reform. e. increases access to affordable health care insurance. The Affordable Health Care for America Act of 2010 requires most Americans to have health insurance coverage, expands Medicaid, subsidizes private coverage for low- and middle-income people, transforms the current system from a sick care system to a true health care system, lowers mortality related to preventable causes, institutes health insurance reform, increases access to affordable health care coverage, and increases support for nursing workforce development programs. (ch 3, p. 56)

A clinic-based public health nurse (PHN) has launched an aggressive community health education media campaign to increase the number of fully immunized children within the health district. Which evaluation process would best assess the impact of this strategy at the overall community level? a. Analysis of the immunization clinic appointment rate over the next few months b. Analysis of the trend in childhood immunization rates for the health district c. Assessment of the immunization status of each child who visits the clinic d. Determination of the budgetary impact of the media campaign on the clinic's operations

b. Analysis of the trend in childhood immunization rates for the health district The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs. ch 16

Which objective includes all of the critical elements of an educational objective? a. After attending the diabetic education class, the client will prepare a meal plan. b. At the end of self-management training, the client will prepare a daily food plan that meets the 1800-calorie per day American Diabetes Association (ADA) diet guidelines. c. The diabetic client will prepare a list of the five food groups and the number of servings from each group that are necessary for an 1800-calorie diet following ADA guidelines. d. The client and his wife will attend all of the diabetic education classes to learn to prepare meals consistent with ADA diet guidelines.

b. At the end of self-management training, the client will prepare a daily food plan that meets the 1800-calorie per day American Diabetes Association (ADA) diet guidelines. Objectives are specific, short-term criteria that need to be met as steps toward achieving a long-term goal. Objectives are written statements of an intended outcome or expected change in behavior and should define the minimum degree of knowledge or ability needed by the client. They must be stated clearly and defined in measurable terms. Objectives are different from goals, which are broad, long-term, expected outcomes. ch 16

A nurse diabetic educator who recently returned from a professional conference decides to present current best practices and research findings at a gathering of newly diagnosed diabetic clients. In adopting this approach, the nurse may fail to provide health education effectively. This failure would relate to which domain of learning? a. Affective b. Cognitive c. Psychomotor d. Practice

b. Cognitive The domains of learning are the cognitive, affective, and psychomotor domains. For health education to be effective, the community-oriented nurse must first assess the cognitive abilities of the learner, so that the nurse's expectations and plans are directed to the correct level. Teaching above or below the client's level of understanding may lead to frustration and discouragement. ch 16

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

b. Confidentiality, when possible d. Advocacy for disenfranchised persons The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; maintaining trustworthiness; and advocating for disenfranchised persons within the community. (ch 6, p. 131)

A nurse in Mexico visits a village-based health post in her region to meet with the community volunteer and health committee that operate the health post. They intended to discuss the planning for next year's health promotion initiative and evaluate the recent family planning program. This best demonstrates the aim of the Declaration of Alma-Alta to emphasize which of the following? (Select all that apply.) a. Availability of chemotherapeutic agents b. Development of maternal and child health programs c. Involvement and training of community health workers d. Organized approach to health education e. Promotion and acceptance of traditional medicine

b. Development of maternal and child health programs c. Involvement and training of community health workers d. Organized approach to health education Primary health care in global health is historically based on the Declaration of Alma-Ata (1978). The WHO's and the United Nations Children's Emergency Fund still actively promote primary health care as the strategy for achieving the goal of Health for All in the 21st Century. Several major components are identified for implementation of primary health care: an organized approach to health education that involves professional health care providers and trained community representatives; aggressive attention to environmental sanitation; involvement and training of community health workers; development of maternal and child health programs that include immunization and family planning; initiation of preventive programs aimed at local endemic problems; provision of accessible and affordable services for treatment of common diseases and injuries; availability of chemotherapeutic agents; development of nutrition programs; and promotion and acceptance of traditional medicine. In this example, only three of those components are evident. (ch 4, p. 67)

A group's culture is created by the combination of its norms. The nurse supports helpful rules, attitudes, and behaviors in the group because group norms do which of the following? (Select all that apply.) a. Challenge the cohesiveness of the group b. Ensure movement toward the group's purpose and tasks c. Identify message pathways and member participation d. Influence members' perceptions and interpretation of reality e. Maintain the group through various supports to members

b. Ensure movement toward the group's purpose and tasks d. Influence members' perceptions and interpretation of reality e. Maintain the group through various supports to members Group norms set the standards for group members' behaviors, attitudes, and perceptions. All groups have norms and mechanisms to accomplish conformity. Group norms serve three functions: they ensure movement toward the group's purpose and tasks (task norms), they maintain the group through various supports to members (maintenance norms), and they influence members' perceptions and interpretations of reality (reality norms). Group norms combine to create group culture. Nurses working with groups should not dictate norms but support helpful rules, attitudes, and behaviors within the group. The role of the nurse becomes one of providing accurate information, confirming the possibility/attainability of the group's goals, and encouraging different/positive perspectives. ch 16

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

b. Evaluation can have unintended consequences. Evaluation of community health interventions can provide valuable information about an intervention's effectiveness and efficiency in obtaining the desired measurable outcome or its progress to date in reaching that desired outcome. Factors related to costs in money and time should also be addressed to determine if the intervention was worth carrying out. This is especially true given the fact that health care operates in a political environment in which competition for limited resources is a reality. The nurse must also recognize when selecting measurable outcomes in the planning phase that unintended outcomes may result from the intervention that may become evident upon evaluation. The success or failure of the intervention may carry unintended consequences. It may uncover new trends in the community. Finally, the evaluation process should identify whether the intervention was adequate and acceptable to the community. In this case, the change in the outcome measure was not sufficient to be acceptable, and the community's expectations were greater than the results delivered. The community decided to invest its limited resources elsewhere. The issue was not the power to design, judge, or institute change. The results of the intervention were not good enough in the community's eyes. Some of these challenges could have been addressed in the planning stages by exploring alternative approaches that would have ensured a better return on the dollar. This would have built community confidence in health interventions and fed success into the initiative. It may be harder to propose new initiatives when past initiatives produced such unintended consequences. (ch. 18, p. 418)

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

b. Evaluation of an outreach program for at-risk pregnant teenagers c. Community subpopulations with high rates of type 2 diabetes e. Prevalence of hypertension among various age, race, and gender groups Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community. (ch. 1 p. 12)

Health problems exist throughout the world. In the United States, a current health concern is the appearance of new viral strains such as Hantavirus in the Southwest. This is an example of the difference in health care concerns between countries such as: a. United States and Canada. b. Sweden and Indonesia. c. Australia and Japan. d. Bangladesh and Zaire.

b. Sweden and Indonesia. Although health problems exist throughout the world, the health care concerns of less-developed countries differ from those of developed countries. Less-developed nations such as Bangladesh, Zaire, Haiti, Guatemala, most countries in sub-Saharan Africa, and the island nation of Indonesia, have more exotic-sounding health problems like Buruli ulcer, leishmaniasis, schistosomiasis, pediculosis, typhus, yellow fever, and malaria as well as the ongoing problems of measles, mumps, rubella, and polio. Current health concerns for developed nations such as the United States, Canada, Japan, the United Kingdom, Sweden, France, and Australia are problems like hepatitis, the appearance of new viral strains such as hantavirus, and large social yet health-related issues such as terrorism, warfare, violence, and substance abuse. AIDS remains a major global concern for all countries, developed or less developed. (ch 4, p. 64)

The U.S. public health system is operated at three distinct levels with collaboration and interface across all levels. The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is the: a. Department of Homeland Security. b. U.S. Department of Health and Human Services (USDHHS). c. local health department. d. state department of health.

b. U.S. Department of Health and Human Services (USDHHS). The USDHHS is the agency most heavily involved with the health and welfare concerns of U.S. citizens. The USDHHS is charged with regulating health care and overseeing the health status of Americans. (ch 3, p. 50)

A community-oriented nurse understands that the most important use of the principles for effective advocacy is to: a. act as a friend and advocate for the target population served to promote research and data gathering. b. act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. c. ensure that public funds are spent only for the priorities stated in the legislation that authorized program funding and promote regulations and legislation. d. give more priority to the opinions and feelings of key community leaders than to data when determining program priorities.

b. act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. The six principles of effective advocacy include acting in the community's best interest, acting in accordance with the community's wishes, keeping the community informed, acting with diligence, maintaining impartiality, and maintaining confidentiality. Bateman's practical framework for advocacy places the advocate's core skills within the context of the six principles of effective advocacy. ( ch 6, p. 134)

A nurse helping to form a group to deal with ongoing industrial pollution within a community understands that effective groups: a. are larger and comprised of recognized community leaders. b. can have individuals with diverse interests and yet be influential in changing the larger community. c. must include members of all involved parties, including political, corporate, health, and environmental leaders. d. should be small with informal leadership and relationships within the group.

b. can have individuals with diverse interests and yet be influential in changing the larger community. Groups of individuals with diverse interests can influence and change the larger social community. Alliances or coalitions unite diverse interest groups who share a common interest in perceived threats to community health, and nurses may work with groups both for community analysis and vehicles for change. ch 16

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

b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs. (ch 1 p. 18)

A nurse integrates a structured exercise into her classroom presentation on effective handwashing that assists students in demonstrating and modeling good handwashing techniques. The principle followed by an effective educator that is best demonstrated by this approach is: a. create the best learning environment. b. encourage participatory learning. c. organize the learning experience. d. select the learning format.

b. encourage participatory learning. There are six principles that guide the effective educator: send a clear message, select the learning environment, create the best learning experience, organize the learning experience, encourage participatory learning, and provide evaluation and feedback. People learn better when they are actively involved in the learning process. Participation increases motivation, flexibility, and the learning rate. ch16

The most important contribution made by Florence Nightingale to community-oriented nursing was: a. development of the settlement house concept as a strategy to improve urban health standards. b. expansion of the role of nursing to include health-promotion practices. c. founding of the first district nursing association in England. d. introduction of professional schools of nursing in the United States.

b. expansion of the role of nursing to include health-promotion practices. Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness. (ch 2, p. 27)

In 1925, Mary Breckenridge established the Frontier Nursing Service (FNS) based on a system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support led to innovations in health care delivery in the twentieth century, especially for underserved populations. One of Breckenridge's innovative contributions to health care in the United States was: a. establishment of the Federal Emergency Relief Administration. b. introduction of the first nurse-midwifery training. c. introduction of the nursing process. d. introduction of occupational health nursing.

b. introduction of the first nurse-midwifery training. The unique pioneering spirit of the FNS influenced the development of public health programs to improve the health care of rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckenridge, the founder of the FNS, introduced the first nurse-midwives into the United States. (ch 2 p. 31)

A new group of migrant farmworkers has arrived in a community. The local public health nurse (PHN) realizes that an important step before scheduling clinic services is to: a. consult the public health staff regarding their scheduling preferences. b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. c. review written materials about the farmworkers' culture of origin. d. visit the farmworker camp and tell the camp leaders when clinic services will be available.

b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences. (ch 7, p. 154)

The Association of Community Health Nurse Educators has called for increased graduate programs to educate PHN leaders, educators, and researchers in such areas as: a. immigrant and migrant health. b. natural and human-made disasters. c. automobile safety for children. d. student health.

b. natural and human-made disasters. The Association of Community Health Nurse Educators calls for increased graduate programs to educate PHN leaders, educators, and researchers. Natural disasters (such as floods, hurricanes, and tornados) and human-made disasters (including explosions, building collapses, and airplane crashes) require innovative and time-consuming responses. Preparation for future disasters and potential bioterrorism demands the presence of well-prepared nurses. (ch 2, p. 39)

The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was: a. establishment of an FNS. b. provision of funding to support employment and education. c. provision of funding for research and investigation of disease. d. institution of a district nursing model.

b. provision of funding to support employment and education. Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses (PHNs). More than 1,000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of PHNs with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease. (ch 2, p. 33)

A major town in Zaire received a gift of retired intensive care unit monitoring equipment from a large specialty hospital in a developed country. Zaire was grateful for the donation because it would increase the technological capability to treat clients in the local hospital. However, over the next year, the monitors remained unused because personnel were not qualified to operate the monitors and no one was available to maintain or repair the equipment. This best explains the relationship between which two concepts? a. Disease prevention and health care planning b. Education and health promotion c. Global health and global development d. Primary health care and primary care

c. Global health and global development Access to services and the removal of financial barriers alone do not account for the use of health care services. The introduction of health care technology from developed nations to less-developed nations has led to less than satisfactory results. Attention must be given to the basic needs of less-developed countries and the resources and services that the country can successfully sustain. When the focus is on the public health needs of less-developed countries, the infrastructures of the countries (economic, industrial, and technological) can be encouraged to grow in a sustainable manner. (ch 4, p. 72)

A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby and presents the material. In terms of the sequencing of instruction, what should the nurse do next? a. Ask the mother about her previous experience with breastfeeding b. Demonstrate how to position the baby for breastfeeding c. Have the mother demonstrate breastfeeding d. Show the mother a video about breastfeeding

c. Have the mother demonstrate breastfeeding To facilitate skill learning, the nurse should teach and demonstrate the skill. The educator should allow learners to practice and immediately correct any errors in performing the skill. The basic sequence of instruction includes nine steps: gain attention, inform the learner of the objectives, stimulate recall of prior learning, present the material, provide learning guidance, elicit performance, provide feedback, assess performance, and enhance retention and transfer of knowledge. ch. 16

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

c. Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions Healthy People 2020 cites community partnership as key to meeting program goals. In community-oriented practice, the nurse and the community seek healthy change together. Community members who are equal proactive collaborators in prioritizing, designing, implementing, and evaluating community interventions are much more likely to support and assist in community programs. Programs developed using a community partnership approach (rather than the approach that "I'm the community health expert and I know best") are more effective in identifying and addressing health problems, and such programs are more likely to be sustained over the long term. (ch 18, p. 399)

The goal of the PHC system is to achieve the objective "Health for All in the 21st Century," set forth by the World Health Organization (WHO). The major barrier to achieving this objective in the United States is that: a. global indicators are not applicable to the United States. b. Healthy People 2020 is not consistent with the Declaration of Alma-Ata. c. PHC is not the primary delivery method for health care in the United States. d. the U.S public health system is not structured to provide PHC.

c. PHC is not the primary delivery method for health care in the United States. The WHO's Declaration of Alma-Ata (1978) identified "Health for All in the Year 2000" as its primary global goal. This was amended in 1998 to "Health for All in the 21st Century." Although the United States, a WHO member nation, has endorsed primary health care as the strategy for achieving the goal of health for all in the twenty-first century, PHC is not the primary delivery method for health care in the United States. This creates a significant barrier to the achievement of that goal, despite the leadership of the U.S. public health system in the Healthy People 2020 initiative. (ch 3, p. 54)

The local nurse-managed community health center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. This initiative best describes a system of: a. managed care. b. primary care. c. PHC. d. private health care.

c. PHC. Nurse-managed clinics or centers incorporate primary care and public health care; consequently, they provide PHC when the broad range of services focuses on prevention, basic health services, and education and is provided at the community level, typically serving underserved populations. (ch 3, p.45, 53-54)

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

c. State vital statistics bureau Community health is characterized by status, structure, and process dimensions. Status or outcome involves biological, emotional, and social attributes. The biological (or physical) aspect of community health is often measured by traditional morbidity and mortality rates, life expectancy indices, and risk factor profiles. Data gathering is the process of obtaining existing, readily available data. These data describe the demography of the community, but also include the vital statistics, such as mortality and morbidity data. The state bureau of vital statistics would be the best source, especially for rural counties that may not have biostatisticians at the county level. Raw data submitted to the state by the local community would be consolidated at the state level. All states have such bureaus. (ch. 18, p. 401)

The United States is engaged in a formal agreement with Indonesia to provide economic incentives and assistance in national defense in return for the protection of U.S. private investments in that region. Which bilateral organization is most likely involved in this agreement? a. Carnegie Foundation b. United Nations c. U.S. Agency for International Development d. U.S. Department of Defense

c. U.S. Agency for International Development Bilateral organizations or agencies operate within a single country and focus on providing direct aid to less-developed countries. All bilateral organizations are influenced by political and historical agendas that determine which countries receive aid. Incentives for engaging in formal arrangements may include economic enhancements for the benefit of both countries, national defense for one or both countries, or enhancement and protection of private investments made by individuals in these nations. The U.S. Agency for International Development is the largest of these and operates totally outside of the United States. (ch 4, p. 69)

A community-based hospice nurse has an Asian male client with terminal-stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care physician (PCP). Because this nurse is culturally competent with Asian clients, the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: a. cultural accommodation. b. cultural assessment. c. cultural brokering. d. cultural repatterning.

c. cultural brokering. Cultural brokering is an action used by nurses in delivering culturally competent care. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of the client. (ch 7, p. 159)

A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include: a. administration of Medicare reimbursement rates and eligibility determination. b. programs involving citizens in the local community, including sanitation and communicable disease contact tracing. c. disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes. d. monitoring of drugs and over-the-counter products available for sale and use by consumers.

c. disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes. The public health system at the state level is responsible for standing ready to prevent or respond to disasters, both human caused and natural; overseeing health care financing and the administration of programs such as Medicaid and the State Children's Health Insurance Program; providing mental health and professional education; establishing health codes; licensing facilities and personnel; regulating the insurance industry; and providing direct assistance to local health departments, such as ongoing health needs assessment. (ch. 3, p. 53)

A nurse has worked for years in an intensive care unit and decides to take a position as a community health nurse directing a local public health unit. Her first assignment is to perform an assessment of the community's migrant farmworker population. The nurse's most appropriate next step is to: a. begin the community assessment using a survey tool proven effective in previous public health unit assessments. b. perform a literature review to study assessment data for similar populations. c. enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. d. form a relationship with the farmworkers' community leaders and other key informants.

c. enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population. (ch 6, p. 129)

A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands the need for the client to use traditional healing practices. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.

c. environmental control. The nurse understands that in the client's culture, disease is often perceived as a disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. Clients may use the mind-body-spirit connection to heal from within. Such cultures rely on naturalistic solutions such as herbs, hot and cold treatments, and acupuncture to resolve or cure a cancerous condition. (ch 7, p. 145)

The most important aspect of the nursing community assessment phase can best be described as: a. analyzing and synthesizing data. b. collecting and gathering data. c. formulating a community nursing diagnosis. d. identifying problem correlates.

c. formulating a community nursing diagnosis. Community assessment is one of the three core functions of public health nursing and is the process of critically thinking about the community. It starts by defining the client in terms of person, place, and function. It is a logical, systematic approach for identifying community needs, clarifying community problems, and identifying community strengths and resources to address these problems. It involves collecting data to obtain usable information about the community and its health. Such data collection may include gathering existing data as well as generating new data. New data might be generated by performing secondary analysis of existing data, conducting surveys, and carrying out community reconnaissance. Both types of data are combined in a composite database that is then analyzed and synthesized to identify trends or themes. The analysis of data generates information about community health problems (needs for action) and community health strengths and abilities that can be drawn upon in tackling these problems. The nurse and the community, in partnership, identify the problems. This is the process of problem analysis, which seeks to clarify the nature of a given problem. The nurse identifies the origins and effects of the problem, the points at which interventions might occur, and the parties that have an interest in the problem or its solution. A community-of-interest focus group that contains both content and process experts, as well as the nurse, should review the information to identify problem correlates (factors that contribute to the problem) and explore the relationship between each factor and the given problem. Active community participation is critical for the data interpretation process, particularly problem identification. A community nursing diagnosis is the end product of assessment and clarifies who gets the care (community defined), states the community problem or risk, and lists the factors contributing to the problem (problem correlates); for example, "Risk of ___ among ____ related to _____." (ch 18, p. 418)

A terrorist bombing at a local church has sent many victims to the local emergency department and resulted in several deaths. Following the event, an emergency department nurse seeks out other nurses who are having difficulty performing their jobs to speak about the event. The nurse is demonstrating the disaster response strategy of: a. allaying public concern and fear. b. assisting victims to think positively and to move to the future. c. identifying feelings that individuals may be experiencing. d. preparing personnel to be effective in a disaster.

c. identifying feelings that individuals may be experiencing. During the aftermath of a disaster or terrorism event, nurses can feel fear, hopelessness, and loss or bias, hatred, vengeance, and violence toward ethnic or religious groups that may be associated with terrorism. These feeling may compromise their ability to provide care for these groups. Yet the International Council of Nurses' (ICN) Code of Ethics for Nurses (2000) affirms that nurses are ethically bound to provide care to all people. One strategy to use in response to a disaster or terrorism event is to assist in identifying the feelings that nurses or others may be feeling. To accomplish this, the nurse can (1) explain that feelings of fear, helplessness, and loss are a normal reaction to a disruptive situation; (2) work with people and help them think of what they did that helped them overcome fear and helplessness in previous situations; (3) encourage people to talk to others about their fears; (4) encourage others to ask for help and provide resources and referrals; (5) remember that those in the helping professions may find it difficult to seek help; and (6) convene small groups in workplaces with counselors/mental health experts. (ch. 4, p. 88)

The nurse recommends Parents Without Partners to a colleague who is experiencing the challenges of single parenthood in raising a teenager. The nurse is demonstrating an understanding of the group elements of: a. cohesion and task functioning. b. leadership and role structure. c. member interaction and group purpose. d. norms and maintenance.

c. member interaction and group purpose. Health-promoting groups may form when people meet in community and health care settings and discover common challenges to their physical and mental well-being. People often make changes with the support of a group that they are unable to make independently. Health-promoting groups like Alcoholics Anonymous and Parents Without Partners improve members' health and deal with specific threats to health. ch 16

From a historical perspective, the post-Depression shift in the U.S. Congress to the practice of categorical funding that provides federal money for priority diseases or groups has to this day produced a negative effect on the delivery of health care services that can best be described as: a. adoption of 2-year associate degree nursing programs. b. exclusion of home-based care from health insurance coverage. c. national preference service model that neglects emerging problems. d. rise in hospital-based care.

c. national preference service model that neglects emerging problems. The shift in the U.S. Congress to categorical funding provides federal money for priority diseases or groups rather than a comprehensive community health program. Thus local health departments designed programs to fit the funding priorities, which led to duplication of services among official health agency programs and a silo approach to program planning. When funding is directed by national preferences (silo programming), the ability of public health departments to respond to local and emerging problems is seriously impaired, because funding is earmarked for those national preferences only. (ch. 2, p. 33)

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

c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy. (ch. 1 p. 10)

The major factor that drives the current discussions about a Medicare shortfall in the middle of the twenty-first century is: a. diversity of the U.S. health care workforce. b. longevity of the U.S. population. c. percentage of elderly in the U.S. population. d. percentage of foreign-born in the U.S. population.

c. percentage of elderly in the U.S. population. Seventy-seven million babies were born between the years of 1946 and 1963, giving rise to the often-discussed Baby Boom generation (Centers for Disease Control and Prevention (CDC), 2009). The oldest of these Boomers reached 65 years of age in 2011, and they are expected to live longer than people born in earlier times. The impact on the federal government's insurance program for people 65 years of age and older, Medicare, is expected to be enormous, and this population is expected to double between the years 2000 and 2030, representing 20% of the total population. (ch 3, p. 46)

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

c. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area. (ch 1 p.16)

Canada is the leader in promoting a population health framework. Using such a framework, a state health department nurse with budgetary responsibility would determine that funding priorities should focus on: a. chronic disease surveillance and treatment programs. b. pediatric and adolescent primary care and nutrition programs. c. promotion of healthy lifestyles or improvement of social and physical environments. d. well and sick child clinics.

c. promotion of healthy lifestyles or improvement of social and physical environments. A key to the success of a population health framework is the identification and definition of health issues and of the investment decisions within a population that are guided by evidence about what keeps people healthy. Therefore, a population health approach directs investments that have the greatest potential to influence the health of that population in a positive manner. (ch 4, p. 67)

In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of: a. enforcing the department of health's rules and regulations. b. excluding infectious children from the school environment. c. providing and obtaining medical treatment for absent students. d. providing shoes and clothing for students.

c. providing and obtaining medical treatment for absent students. In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide follow-up care to children absent from school. (ch 2, p. 30)

A community-oriented nurse leader is working with community leaders and interested citizens to improve access to services for the underserved by planning an expansion of the local community health clinic. This is an example of which type of community partnership model? a. Coalition b. Democratic c. Passive d. Community member professional

d. Community member professional Community members who are recognized as community leaders, (whether professionals, pastors, government officials or interested citizens) possess credibility and skills that health professionals often lack. The community member-professional partnership approach specifically emphasizes active participation. Coalitions are formal partnerships in which individuals and organizations serve in defined capacities such as steering committees, advisory committees, and work groups. Coalitions are active partnerships, in which all participants share leadership and decision making to some degree. (ch 18, p. 400)

Which community attribute is an indicator of a community's health status? a. Mean educational level b. Location of health facilities within the community c. Ratio of police to citizens d. Suicide rate

d. Suicide rate Community health status (or outcome) involves biological, emotional, and social attributes. Biological attributes include morbidity and mortality. The social attributes of health status include crime rates and functional levels. The emotional attributes of health status include consumer satisfaction and mental health indices. The suicide rate is one of the measures used when compiling mental health indices. Educational levels are part of the structure dimension (social indices). The physical attributes of structure include measures of community health services and resources, such as use patterns and provider-to-client ratios. (ch 18, p. 403)

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

d. differentiate nursing practice from medical practice. The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics. ( ch 6, p. 128)

A nurse asks a couple who are new parents for their baby's full name. The parents reply that they are only supposed to give the baby its first name. The most appropriate response for the nurse is to: a. tell the couple that they are the child's parents and it is up to them to name their baby. b. explain to the couple the state's bureau of vital statistics deadline for completing the birth certificate. c. give the couple the paperwork and ask when the baby will have a name. d. express interest and ask the couple to share how their new baby will receive its name.

d. express interest and ask the couple to share how their new baby will receive its name. Dealing effectively with immigrant populations includes learning about how the community deals with common events and what their traditional practices are. In some cultures, it is not the parents but their spiritual leader or a more senior family member who gives a baby its name. Nurses should engage in cultural encounters to learn about a client's culture and practices. (ch 7, p. 155)

The North American Free Trade Agreement, passed in 1994, allowed increased importation of goods and eased the movement of people throughout the United States, Canada, and Mexico. A health impact of this agreement for southern Texas has included: a. decrease in illegal immigration into the United States as a result of the improved Mexican economy. b. decrease in tuberculosis, cholera, and tetanus as a result of economic development. c. improved nutrition as a result of plentiful fresh vegetables and fruits in local markets. d. increase in respiratory and diarrheal disease as a result of colonias settlements.

d. increase in respiratory and diarrheal disease as a result of colonias settlements. The colonias (colonies) are settlements of workers along borders in California, Arizona, New Mexico, and Texas. More than 40,000 Texans live in colonias along the southern Texas border. Environmental conditions in the colonias, such as lack of roads, transportation, water or electrical services, and access to primary care, have resulted in increased preventable infectious diseases (amebiasis, respiratory, and diarrheal diseases), environmental health hazards, and injuries associated with determinants of poverty, poor sanitation, and overcrowded conditions. (ch 4, p. 65)

Although nursing has a strong implicit heritage of ethical values and morality, it was not until the 1960s that several seminal events significantly shifted the focus to ethical decision making processes. One of those seminal events was the emergence of the field of bioethics and the other event was: a. adoption of the ANA's Code for Professional Nurses. b. adoption of the American Public Health Association's Public Health Code of Ethics. c. adoption of the International Council of Nurses' Code of Ethics for Nursing. d. issuance of the ANA's position statement on nursing education in institutions of higher education.

d. issuance of the ANA's position statement on nursing education in institutions of higher education. In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values to the explicit study of ethics and ethical decision making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs. (ch 6, p. 122)

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

d. opinions that nursing should focus on the provision of direct client care and services. Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation. (ch 1 p. 17-18)

A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using fragranced candles. The most appropriate intervention for the nurse is to apply the principle of: a. autonomy, in which the nurse leaves the matches and candles accessible to the client. b. beneficence, in which the nurse maintains the client's dignity and reinforces to the client how pleasant it is to use scented candles. c. nonmaleficence, in which the nurse counsels the client regarding the dangers of the use of candles and matches by someone with low vision. d. respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet.

d. respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet. The nurse applies the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others. (ch 6, p. 126)

The new director of a local public health unit reviews the personnel records of the unit staff and notes that none of the assigned public health nurses (PHNs) has academic training in community and public health nursing. The director's next step should be to: a. recognize that staff members have learned on the job through years of experience and that they will be able to teach their new director basic community and public health principles. b. make arrangements to hire new staff with appropriate formal training. c. realize that with the current nursing shortage the unit should be grateful to have long-term staff. d. review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training.

d. review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training. Both the American Nurses Association (ANA) Code of Ethics and the Public Health Code of Ethics state that the professional competency of all public health employees must be assured and address issues of the nurse's accountability to ensure competency in delivery of services to individuals, families, or populations. (ch 6, p. 130)

A nurse is working with an established group of parents of children with special needs. Several parents continually express frustration with the health care system and feelings of powerlessness to address their needs. The nurse uses group techniques to validate their experiences and explore options for action. The nurse reacts in this way to conflict within the group because conflict: a. means the group leader must ask the persons causing the conflict to excuse themselves from future meetings. b. means those with the dissenting opinion will change their stand to be more in line with the rest of the group. c. should be avoided. d. supports individual and group growth and change.

d. supports individual and group growth and change. The groups to which people belong influence health behavior. Through participation with others, meaning is confirmed, confounded, contradicted, or compromised. This is how social reality is created. Nurses frequently use groups to help individuals within a community. When conflict occurs in a group, the resulting tension can help move the group toward its goals. Group members are most effective and productive when conflict is acknowledged and individual concerns are expressed in a manner that respects other members of the group. Effective groups promote collaboration and support expression and resolution of conflict. ch 16

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

d. what society does collectively to ensure the conditions in which people can be healthy. In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health. (ch 1 p. 6)

Mortality rates do not accurately describe the health status of populations in the world. The World Health Organization (WHO), in 2009, and World Bank, in 2005, developed an indicator—the global burden of disease—that combines losses from premature death with losses of healthy life that result from disability. The indicator represents: a. costs to the world of treating communicable disease in less-developed countries. b. economic cost of preventable early deaths. c. impact of disability on the international economic forecast. d. years in lost contribution to economic growth.

d. years in lost contribution to economic growth. The global burden of disease indicator utilizes the unit of disability-adjusted life-year (DALY). This unit measures the combined time lived with a disability and time lost as a consequence of premature death. The time lost because of premature mortality is calculated using standard expected years of life based on gender, whereas the reduction in physical capacity as a result of morbidity (disability) is measured using a six-point scale from 0 (perfect health) to 1 (death) that reflects the degree of dependence of the young and older adults on the adults in the population. The DALY represents life-years lost that could have contributed to the economic growth of a family or country as a consequence of premature death, disability, or loss of caregiver potential productivity/contribution. (ch 4, p. 75)