NRS416 Exam 2 Practice Questions

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A nurse is assisting an employer who has hired an individual who was recently diagnosed with HIV. Which of the following interventions would be most appropriate for the nurse to implement? a. Educate about how to reduce the risk of breaching the employee's confidentiality b. Explain how to inform coworkers about avoiding HIV transmission c. Facilitate obtaining medical insurance coverage for the HIV-infected employee d. Describe the early signs and symptoms of HIV infection

ANS: A

A nurse is implementing interventions to improve the health of the community. Which of the following approaches would be taken by the nurse? a. A bottom-up approach with multisectoral planning and action for health b. A bottom-up approach with facilitation of communication c. A top-down approach with rational-empirical problem solving d. A top-down approach with community practice planned by experts

ANS: A

A state public health (PH) region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Only four cases of meningitis in this age group were reported to the PH region during the previous year. Based on this information, the relative frequency of meningitis in the region at this time can best be described as: a. Epidemic b. Attack rate c. Endemic d. Pandemic

ANS: A

Epidemiology examines the occurrence and distribution of health-related states or events in which of the following? a. Populations b. Families c. Groups d. Individuals

ANS: A

What is the goal of the Healthy Communities and Cities initiative? a. Promoting health through community participation b. Reorganizing the current healthcare system c. Improving the quality of care in communities d. Maximizing the cost-benefit ratio of health care

ANS: A

Why is active involvement in the development of health policy an important activity for nurses to participate in? a. Government and policy have a large impact on nursing and health b. Nurses must interpret laws to fit their practice c. Policy dictates nursing values as set forth by Florence Nightingale d. Political science is a course of study that parallels nursing

ANS: A

ANS: A A rate is a measure of the frequency of a health event in a defined population in a specified period of time. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 × 1000 = 0.0833/1000.

The relationship between nursing practice, health policy, and politics can best be described as nursing: a. advocacy. b. policy process. c. process. d. profession.

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

When conducting an environmental risk assessment, the nurse explores the economic risk and social risk of the family. To capture social risk assessment data, the nurse can best use which of the following? a. Community assessment and ecomap b. Genogram and ecomap c. Genogram and history d. Double ABC-X model

ANS: A An assessment of environmental risk typically includes information about the relationships that the family has with others such as relatives and neighbors and their connections with other social units, the flow of energy in those relationships, and the characteristics of the neighborhood and community in which the family lives. This information can be obtained through the use of assessment tools such as an ecomap and community assessment.

A case manager employed by a health maintenance organization is charged with discontinuing home health services for a disabled home-bound elderly client in an effort to reduce costs. The case manager reviews the client's record and determines that home health services are still indicated for this client. What ethical dilemma does the case manager facing? a. Beneficence b. Justice c. Nonmaleficence d. Veracity

ANS: A Beneficence—"doing good"—becomes an ethical dilemma when the insurer's goal of containing costs supersedes the case manager's duty to improve health and relieve suffering. This ethical tenet of nursing practice to act in the best interest of the client also involves fidelity to the nurse-client trust relationship.

A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: A Endemic refers to the constant presence of a disease within a geographic area or a population. Epidemic refers to the occurrence of disease in a community or region in excess of normal expectancy. Pandemic refers to an epidemic occurring worldwide and affecting large populations.

During a family crisis, the visiting nurse helps the family with coping mechanisms. Which action does the nurse take to help the family use external resources for coping? a. Assist the family in reaching out to their religious leader. b. Encourage the family to use trustworthy Internet sites. c. Help family members reframe the situation. d. Teach the family some active listening strategies.

ANS: A External sources for assistance in coping include community links, social supports, and religious support.

What was the most significant impact The Family and Medical Leave Act (FMLA) of 1993 has had on families? a. Enabled individuals to have both a family and a career b. Called for paid adoption leave c. Provided eldercare services d. Provided life insurance benefits

ANS: A FMLA allows covered employees to take up to 12 weeks of unpaid leave of absence each year for certain family and medical reasons such as their own serious medical illness; the illness of a child, spouse, or parent; and the birth or adoption of a child. Employees' medical benefits remain intact during the unpaid leave, and they are guaranteed that their old position or a similar one will be available to them once they return to work. The most significant impact of FMLA was to ensure that an individual could have both a family and a career and would not have to choose between the two. Americans could now meet the needs of their families while maintaining employment.

A nurse in a nurse-managed health center providing a tertiary prevention intervention to a population of women who are HIV positive will most likely do which of the following? a. Educate about self-care and the women's rights as employees. b. Establish a partnership with a community to initiate a community health center. c. Help identify new cases and ensure that clients receive proper treatment. d. Teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes.

In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. What process does this refer to? a. Collaboration b. Communication c. Cooperation d. Negotiation

ANS: A In case management, the activities of many disciplines (social workers, nurses, physicians, insurers, physical therapists, etc.) are needed for success. Clients, the family, significant others, payers, and community organizations contribute to achieving the goal. Collaboration can include working with communities, local, state and federal resources, providers, team members, payers, and family to name a few.

Nurses working with communities to implement the CHPM are most effective when they do which of the following? a. Begin where the community is and then work to facilitate implementation of all nine steps. b. Serve in the role of expert resource, spearheading the community's work. c. Teach basic community and public health concepts before teaching the Health Communities Model. d. Work with community leaders to begin with step one and progress through step nine of the model.

ANS: A Nurses should begin where the community is. Nurses help facilitate implementation of the model, coaching community leaders so they understand and implement all steps of the model. Nurses are most effective when they serve as facilitators and coaches.

What does the nurse understand when considering whether a geographic area is rural or urban? a. Rural and urban areas occur on a continuum. b. Rural regions have fewer than six persons per square mile. c. Rural residents feel isolated. d. Rural areas are recreational communities.

ANS: A Rural and urban residencies are not opposing lifestyles. Rather, they occur on a rural-urban continuum ranging from living on a remote farm, to living in a village or small town, to residing in a larger town or city, to living in a large metropolitan area with a core inner city.

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

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

The public health nurse is concerned about a possible multi-state outbreak of a foodborne illness. What resource will the nurse consult? a. PulseNet b. Healthy People 2020 c. CDC Yellow Book d. National Healthcare Safety Network

ANS: A The Foodborne Diseases Active Surveillance Network (FoodNet) is a CDC sentinel surveillance system targeting 10 sites across the country and collecting information from laboratories on disease caused by 9 enteric pathogens transmitted commonly through food. This is the resource the nurse would consult if worried about a multi-state outbreak.

An American spends several days in Mexicoeating fresh raspberries from a nearby vendor and drinking bottled water. What entity is potentially being altered? a. Agent-host-environment interaction b. Circadian rhythms c. Herd immunity d. Host resistance

ANS: A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. These three factors are known as the epidemiologic triangle. Changes in the characteristics of any of these factors may result in disease transmission.

A community health nurse is serving as a case manager for premature infants receiving home health care. The case manager arranges for an in-home apnea monitor and daily home visits by a registered nurse who specializes in high-risk pediatrics. The case manager is demonstrating which of the following case manager roles? a. Coordinator b. Liaison c. Monitor d. Standardizer

ANS: A The case manager is responsible for fulfilling a variety of roles. Roles include assessor, planner, facilitator, coordinator, monitor, evaluator, and advocate. This nurse is serving as a coordinator by arranging both medical equipment and a visiting nurse.

The Healthy Communities and Cities (HCC) movement can best be described as which of the following? a. International movement of communities and cities focused on mobilizing local resources to improve the health of the community. b. Movement that began in the United States that targets health promotion in community practice. c. Movement that focuses on the effective development and use of public policy as the primary means for improving health. d. Program that uses the principles of primary, secondary, and tertiary prevention to mobilize citizens to improve the health of their communities.

ANS: A The goal of this international movement was to promote health through community engagement and collaboration to activate and diffuse local changes that support good health. The premise was that community members must be involved in identifying the need for health programs and in developing programs to meet those needs.

A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. What evidence-based action by the nurse would be best? a. Educating migrant lay health workers b. Establishing a farmworker advocacy group c. Fundraising for a mobile health unit d. Lobbying local politicians for more funding

ANS: A The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.

A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

What is the underlying reason for the use of universal precautions? a. Blood and body fluids of all clients need to be handled as if they were infected. b. Effective infection control surveillance programs are in place but not reliable. c. Health care settings are reservoirs of infection and precautions prevents spread. d. Health care workers do not always effectively use hand hygiene.

ANS: A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other bloodborne pathogens.

Primary health care seeks to provide affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns. Which principle does is this model of primary health care incorporate? a. Appropriate technology b. Community participation c. Equity d. Multisectoral participation

ANS: A The principles of primary health care and the Ottawa Charter for Health Promotion were influential in the development of the HCC movement. The principles of primary health care include equity, health promotion, community participation, multisectoral cooperation, appropriate technology, and international cooperation. Appropriate technology refers to the provision of affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns.

A nurse will be starting a new job serving a rural, Native American reservation. What supplies or equipment does the nurse anticipate having the highest need for? a. Diabetic testing supplies b. Oximeter and sensors c. Suicide prevention pamphlets d. Water purifiers

ANS: A While all supplies are needed, Native Americans have a high rate of diabetes so diabetic testing supplies would be most needed. This aggregate has less need for oximeters and sensors, thermometer covers, and water purifiers than other aggregates. For instance the oximeter would be the priority in coal mining towns.

The aspects of the locality development model or bottom-up approach that have been integrated can best be described as which of the following? (Select all that apply.) a. Emphasizing consensus and cooperation b. Building a sense of community c. Using a rational-empirical approach d. Producing fundamental social change e. Rational-empirical problem solving by outside experts

ANS: A, B Different models of community practice exist. The locality development model is a process-oriented model that emphasizes consensus, cooperation, and building of group identity and a sense of community. The social planning (top-down approach) model stresses rational-empirical problem solving, usually by outside professional experts. Social planning does not focus on building community capacity or fostering fundamental social change. The social action model concentrates on increasing the problem-solving ability of the community through concrete actions that attempt to correct the imbalance of power and privilege of an oppressed or disadvantaged group in the community. The Community Health Improvement Model aims at creating partnerships within the community and focuses on community leadership development for health while using a bottom-up approach like the locality development model. This multisectoral cooperation (primary health care principle) by all parties in a community, from local government officials to grassroots community members, creates a stronger foundation for health-promoting public policy development, the highest-priority health-promotion action identified for producing sustainable community health change.

Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression? (Select all that apply.) a. Elevated levels of poverty b. Geographic isolation c. Insufficient mental health services d. Lack of awareness e. Tolerance for destructive coping mechanisms

ANS: A, B, C There appears to be persistent, endemic depression among rural residents. Factors that relate to this level of depression are the high rate of poverty, geographic isolation, and insufficient mental health services.

The nurse case manager in a migrant farmworker clinic assesses this population for occupational and environmental risks related to which problems? (Select all that apply.) a. Contaminated water b. Fear of injury reporting c. Inadequate sewage d. Pesticide exposure e. Traffic accidents

ANS: A, B, C, D Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing with inadequate sewage and lack of heating or air conditioning. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.

Government health care functions include which of the following? Select all that apply. a. Direct service b. Policy c. Information d. Public Protection e. Financing

ANS: A, B, C, D, E

Research articles that include epidemiologic determinants and distribution would include which questions? (Select all that apply.) a. Who is affected most by pesticide exposure? b. Where in the city are lead levels highest? c. How does herbicide runoff affect drinking water? d. What season of the year sees the most trauma? e. Why do children get injured on playgrounds?

ANS: A, B, C, D, E "Who," "what," "when," and "where" questions address epidemiologic distribution. "How" and "why" questions address epidemiologic determinants.

Community and public health nurses (PHNs) practicing in rural locales consistently note which of the following characteristic of their practice environments? a. Broad scope of practice b. Independence and autonomy c. Inter-generational practice d. Opportunity for community involvement e. Respect and visibility

ANS: A, B, C, D, E Characteristics of nursing practice in rural environments include broad, diverse, and/or intergenerational scope of practice, greater independence, public status and autonomy, and a greater opportunity for community involvement than in many urban practice environments.

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

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

During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. What are the case manager's most logical next steps? (Select all that apply.) a. Identify and arrange for the resources to provide needed services. b. Research the client's health care coverage and its provisions. c. Discuss with the family their ability to provide daily visits to the client. d. Gather information on local support groups. e. Reassess the client at discharge to ensure needed care is not overlooked.

ANS: A, B, D Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care the client needs to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers. If necessary services or equipment is not covered by insurance, the nurse may act as an advocate and connect the client with other resources in the community if available. The nurse will want to reassess the client, but that is not part of the next steps.

Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) a. Environmental changes b. Host behavior c. Improved surveillance d. Microbial adaptation e. Public health infrastructure deterioration

ANS: A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel.

A case manager is negotiating a conflict about care goals among various individuals. When negotiating, an agreement was reached that provided mutual advantages rather than an individual gain. Which type of outcome was arranged? a. A competing outcome b. An integrated outcome c. An aligned outcome d. A distributive outcome

ANS: B

A nurse is investigating the role of the agent in the cause of an illness. Which of the following best describes what the nurse is examining? a. Insect bite b. Virus c. Host resilience d. Infectiousness

ANS: B

A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation when counseling clients and avoids this topic with clients. Which of the following is the most likely outcomes of this avoidance? a. The nurse will be violating the laws in several states b. Potential risks and risky behaviors will not be identified c. Transmission of sexually transmitted infections (STIs) will remain unchanged d. Clients will develop a trusting relationship with healthcare providers

ANS: B

A nurse is using population management as part of the nursing care that is provided. Which of the following activities is the nurse most likely completing? a. Census taking to determine the total number of people in the population b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually

ANS: B

The time interval between invasion by an infective agent and the first appearance of signs and symptoms of the disease is called which of the following? a. Endemic period b. Incubation period c. Infectiousness d. Communicable period

ANS: B

Which of the following best describes the probability an event will occur within a specified time period? a. Epidemiology b. Risk c. Rate d. Epidemic

ANS: B

Which term best describes the ability of an agent to produce a severe pathologic reaction? a. Invasiveness b. Virulence c. Antigenicity d. Toxicity

ANS: B

A community-oriented nurse wants to begin a program to reduce health inequality. What action by the nurse would be most successful? a. Conduct research on the prominent causes of inequity within the community. b. Gather a group of acute and community health care providers to brainstorm solutions. c. Invite a cross section of health professionals and lay people to join the action team. d. Use a successful model and divide the tasks among volunteers in the community.

ANS: B A cross-sectoral approach would be the best way to work on this problem. This means that nurses and other health professionals must partner with stakeholders outside of traditional public health and health care delivery systems to design multi-level solutions for improving health. Effective cross-sectoral work is collaborative. When diverse people and organizations collaborate, they work together in inter-connected ways to achieve a common goal.

The nurse knows that which individual would be considered correctly defined? a. Agricultural day laborer: A migrant or seasonal farmworker with a second part time job b. Migrant farmworker: Travels to do farm work unable to return to a permanent home in the same day. c. MSFW: A foreign worker employed seasonally in agriculture who is also a migrant d. Seasonal worker: Individual who travels around the country working crops in seaso

ANS: B According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day.

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

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition.

A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach? a. Assessment b. Case management c. Geriatrics d. Tertiary prevention

ANS: B Case management is a client-professional partnership that can be used to arrange a continuum of care for rural clients, with the case manager tailoring and blending formal and informal resources. Collaborative efforts between a client and the case manager allow clients to participate in their plan of care in an acceptable and appropriate way, especially when local resources are few and far between.

In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. Which approach to communicable disease control does this approach exemplify? a. Health education b. Multisystem approach c. Improved public health infrastructure d. Reduction of environmental hazards

ANS: B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed.

A public health nurse (PHN) has identified a need to make amendments to an existing health-related law. The nurse knows the amendment of any existing laws would ultimately be decided by which of the following? a. Executive branch of government b. Legislative branch of government c. Local representative d. Senate hearings

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

A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.

ANS: B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease.

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

ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions.

Which of the following is the best example of action by a case manager that might be associated with potential liability risk related to experimental treatment and technology? a. Inappropriately recommending that treatment be curtailed when treatment was actually needed b. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy c. Substituting the case manager's clinical judgment for that of the insurer's medical director d. Upcoding intensity of care or intervention requirements

ANS: B For case managers, liability concerns exist when three conditions are met: (1) the provider had a duty to treat (i.e., provide reasonable care); (2) a breach of contract occurred through an act of omission; and (3) the act of omission caused injury or damage to the client. Five general areas of risk are liability for managing care, negligent referrals, use of experimental treatment or technology, breach of confidentiality/security, and fraud and abuse. With regard to the use of experimental treatment and technology, the case manager is obligated to apply the contractual definition of "experimental" treatment found in the client's insurance policy (certificate of coverage), because this a legally binding document between the insurer and the insured.

A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are natives of which country? a. Guatemala b. Haiti c. Mexico d. Panama

ANS: B Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel).

Health policy can best be defined as a set course of action to do which of the following? a. Administer public health programs for disaster preparedness, response, and recovery. b. Obtain a desired health outcome for an individual, family, group, community, or society. c. Support publicly funded health care programs at the local, state, and national levels. d. Support health care development and research to improve the health status of citizens.

ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policy is a settled course of action to be followed by a government or institution to obtain a desired end.

The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. What is important for nurses to understand about WHO policy statements? Such statements: a. apply only to underdeveloped countries. b. are guides for in-country initiatives and priorities. c. carry the weight of international law. d. provide mandates for in-country legislatures.

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

A nurse is assessing a family's ability to provide home care for their 6 year old, who is a quadriplegic as a result of an automobile crash. The nurse teaches the parents body mechanics and transfer techniques. The nurse also determines the parents' physical ability to safely lift the child. The nurse's actions relate to which of the five interacting variables of Neuman's Systems Model? a. Developmental b. Physiological c. Psychological d. Sociocultural

ANS: B Neuman's Systems Model, a wellness-oriented model, defines family health in terms of system stability as characterized by five interacting sets of factors: physiological, psychological, sociocultural, developmental, and spiritual. The nurse draws on family strengths and resources to keep the system stable while it adjusts to stress in the face of change. The nurse is answering the question, "Are the parents physically able to transfer the child from bed to wheelchair and from wheelchair to car or shower seat?" This question assesses the physiological variable of family health.

During an assessment of a family of four, the nurse completes a genogram. What does the nurse use this assessment tool to identify? a. Behavioral health risk b. Biological health risk c. Nonnormative life events d. Normative age-related risk

ANS: B One of the most effective techniques for assessing patterns of health and illness in families is construction of a genogram covering three generations of family history. Major illnesses can be listed and patterns can be quickly identified to provide a guide for the health interviewer.

An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how health status can be related to: a. barriers to access. b. chronic stress. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

The population group that is likely to be the most vulnerable is which of the following? a. Children with a family history of sickle cell disease b. Homeless pregnant teens in a substance abuse program c. Native Americans at risk for diabetes d. Overweight children

ANS: B Populations most vulnerable to risk include poor or homeless persons, pregnant adolescents, migrant workers, severely mentally ill individuals, substance abusers, abused individuals, people with communicable diseases, and people with sexually transmitted diseases.

A 6 year old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

ANS: B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2 to 4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs).

The nurse knows the Ottawa Charter identified the most effective health-promotion action as: a. creating supportive environments. b. developing health-promoting public policy. c. reorienting health services. d. strengthening community action.

ANS: B The Ottawa Charter for Health Promotion (World Health Organization, 1986) lays the foundation for the HCC movement definition of health promotion. In order of priority, the Ottawa Charter identifies developing health-promoting public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services as the key strategic health-promotion action for achieving health for all. Health-promoting public policy supports health in a broad ecological sense that includes environmental, physical, social, and mental well-being. Although efforts to change individual behavior are important, the contributions of policies that affect the broader environment are thought to be more effective in achieving social change. Good examples of such impacts are statewide seat belt laws, helmet laws, and local nonsmoking ordinances.

The nurse continues the assessment of a family's ability to provide home care for their 6 year old, who is a quadriplegic as a result of an automobile crash, noting that the parents are in good physical health with no genetic or lifestyle risks, live in a safe neighborhood with caring neighbors, are dealing with grief and stress as they adjust to their child's injury, and are concerned that their insurance benefits may not adequately cover their child's expenses. The family's current health risk appraisal identifies the following risks: a. biological and life-event risks. b. economic and life-event risks. c. life-event and social risks. d. social risks and biological risks.

ANS: B The family is facing a nonnormative life-event risk: their child's sudden significant permanent injury. They are also facing an economic risk, because their financial resources, including their insurance coverage and personal finances, may not be adequate to meet their needs. Currently, they do not have a biological risk in terms of genetics or lifestyle patterns. They also are not facing a social risk such as racial discrimination, pollution, or living in a high crime area.

The HCC model process relies on a problem-solving approach to achieve goals. The best example of this approach is which of the following? a. Community activists lobbying their state legislature to mandate increased primary care access b. Community-oriented nurses using the nine-step Community Health Promotion Model (CHPM) to encourage and empower community members to take responsibility for change c. Health care professionals working independently to determine priorities for their community and then educating their community about these health-promotion needs d. Teachers using health-promotion curricula to reduce teenage smoking in their community

ANS: B The goal of the CHPM is to encourage community members to take responsibility for the changes they wish to see happen. The model focuses on community involvement in every step of the process. Health care providers can best act as facilitators, educators, and promoters of the model, not "experts" who dictate solutions to the community.

A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability

ANS: B The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important.

When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis.

Contracting with families represents a shared effort by the client(s) and the community health nurse to increase healthful choices. This method of shared effort and active equal involvement of the nurse and family is appropriate for which types of families? (Select all that apply.) a. All families b. Families capable of taking responsibility c. Families oriented toward self-care d. Families seeking ambitious goals e. Families with poor coping skills

ANS: B, C Contracting may not be effective when the nurse is working with families from cultures that expect health care providers to give directive guidance and feedback. Families from cultures outside the United States, as well as some families in the United States, may expect their health care provider to "tell them what to do." Part of the initial nursing assessment should include discussing with family members their expectations and value system before initiating a contract. Also, families must have the competencies and capabilities to participate and take responsibility, must have realistic expectations, and must be willing to renegotiate. Contracting is therefore not for all families.

The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps

ANS: B, C, D Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policy makers at local, state, and national levels are necessary actions that nurses are prepared to undertake.

Which of the following interventions are appropriately matched to the home visit phase? (Select all that apply.) a. Initiation phase: Initiate contact with the family. b. Pre-visit phase: Review referral and/or family recorded. c. In-home phase: Introduce self and professional identity. d. Post-visit phase: Plan for next visit. e. Termination phase: Terminate the family from the system-wide.

ANS: B, C, D There are five phases to a home visit. The initiation phase is when the nurse clarifies the source of the referral, clarifies purpose for home visit, and shares information on reason and purpose of home visit with family. During the pre-visit phase, the nurse does the following: initiate contact with family, establish shared perceptions of purpose with the family, determine family's willingness for home visits, schedule the home visit, and review referral and/or family record. During the in-home phase, the nurse introduces self and professional identity, interacts socially to establish rapport, establishes a nurse-client relationship, and implements the nursing process. During the termination phase, the nurse reviews the visit with the family and plans for future visits. The post-visit phase consists of record the visit and planning for the next visit.

Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. No difference in access or outcomes d. Worse health outcomes despite access

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

What does a community-oriented nurse newly assigned to a rural community learn about the characteristics of rural and small town life? a. Fractured family and social systems b. Informal social and professional relationships c. Openness to people new to the community d. Role of churches as socialization centers e. Work of many residents in high-risk occupations

ANS: B, D, E The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").

A nurse is assisting clients to improve their health status. Which of the following types of management is being used by the nurse? a. Disease management b. Care management c. Demand management d. Case management

ANS: C

Which term best describes existing factors, exposures, characteristics, and behaviors used to determine patterns of disease? a. Analytic epidemiology b. Descriptive epidemiology c. Determinants d. Distribution

ANS: C

Healthy People 2020 has a number of objectives aimed at reducing which trend in infectious diseases? a. Identification of multi-state outbreak of Escherichia coli 0157:H7 b. The failure of the multisystem approach to containing diseases c. A rapid and serious rise in health care-associated infections d. Emergence of a new strain of severe acute respiratory syndrome

ANS: C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff.

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

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

A rural health nurse who is planning programs to address the population's needs should recognize that, in general, rural populations: a. engage in physical activity during leisure time. b. engage in preventive health behaviors. c. perceive their overall health as less favorable. d. use seat belts.

ANS: C In general, people in rural areas have a poorer perception of their overall health and functional status than those in urban areas.

A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2016 = 2/100,000; 2017 = 3/100,000; 2018 = 1/100,000 b. 2016 = 4/100,000; 2017 = 8/100,000; 2018 = 6/100,000 c. 2016 = 12/100,000; 2017 = 8/100,000; 2018 = 31/100,000 d. 2016 = 16/100,000; 2017 = 24/100,000; 2018 = 9/100,000

ANS: C In this community's report, the incidence of hepatitis A in 2018 was more than double the incidence in 2016. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated.

A community health nurse involved in care management would most likely do which of the following? a. Develop, conduct, and evaluate health teaching programs in primary care. b. Manage the staff at a free clinic. c. Monitor the health status, resources, and outcomes for an aggregate. d. Provide immunizations to migrant workers.

ANS: C It is an enduring process in which a population manager establishes systems and processes to monitor the health status, resources, and outcomes for a targeted aggregate of the population—a targeted segment of the population or group.

An undocumented migrant farmworker has been diagnosed with TB. The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.

ANS: C Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.

In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle and which of the following as the priority? a. Communicable diseases b. Educational level c. Housing arrangements d. Pesticide exposure

ANS: C Migrant farmworkers and their families often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.

The local hospital emergency department has recently noted an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of the rise in cases and schedules an assessment of which of the following? a. Bars frequented by migrant workers b. Farm fields employing migrant workers c. Housing for migrant workers d. Restaurants frequented by migrant workers

ANS: C Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.

After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. Frequently vulnerable people do not have the time or energy for coping with processes that are confusing, complicated, or include long wait times.

A nurse expands a community exercise program to include a senior exercise program targeted at strength and balance training in response to the HCC initiative to address the needs of free-living elders in the local community. The nurse is most likely applying the Ottawa Charter for Health Promotion priority health-promotion activity of: a. developing personal skills. b. establishing health-promoting public policy. c. reorienting health services. d. strengthening community.

ANS: C Nurses participating in a CHPM collaborative partnership can redirect community health services toward local priorities and plans based on the HCC committee's desired actions for health. This redirecting of community health services is an example of "reorienting health services," a priority health-promotion action of the Ottawa Charter for Health Promotion.

Which is an example of secondary prevention of infectious disease? a. Malaria chemoprophylaxis b. Immunizations c. Quarantine d. Restaurant inspection

ANS: C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza.

A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.

ANS: C Secondary prevention usually encompasses interventions designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. However, nurses often use health education interventions when caring for individuals with a diagnosed health problem with the aim of preventing further complications or exacerbations.

The nurse knows that which of the following is one of the primary contributors to vulnerability? a. Gender b. Race and ethnicity c. Resource limitations d. Urban or rural residency

ANS: C Social determinants of health include a range of social, political, and economic factors that include socioeconomic status, living conditions, geographic location, social class, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk.

What entity governs nursing practice? a. Boards of nursing established by the U.S. Department of Health and Human Services. b. Nurse practice acts promulgated by federal and state legislative boards. c. Nurse practice acts created by state legislatures and operationalized by state boards of nursing. d. Nurse practice acts written by the states in conformity with broad federal guidelines.

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

Which is an example of tertiary prevention related to HCC? a. Assessing the need for programs to treat alcohol addiction b. Assessing the strengths of local schools' adolescent pregnancy prevention programs c. Initiating an evaluation of a program to address endemic hepatitis A in a community d. Organizing a community forum to explore health-promotion priorities

ANS: C Tertiary prevention includes initiation of community action when problems have occurred, and evaluation of progress and effectiveness of programs and policies.

A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. What is the best source for this information? a. American Public Health Association's guidelines b. Website of the Centers for Disease Control and Prevention c. Healthy People initiatives d. Pan American Health Organization's mission statement

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

ANS: C The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 × 100,000 = 46.42/100,000.

A nurse is providing education to a mother about the importance of having her child vaccinated against measles, mumps, and rubella. Which of the following best describes the type of immunity that will be provided? a. Acquired b. Natural c. Passive d. Active

ANS: D

During a family assessment, a nurse completes a genogram. What does the nurse use this assessment tool to identify? a. Normative age-related life events b. Non-normative life events c. Behavioral health risk d. Biological health risk

ANS: D

Which health risk category is one of the foremost predictors of health? a. Social b. Lifestyle c. Biological d. Economic

ANS: D

Which statement best describes the effects of life events on family health risk? a. Normative events require very little change in family structures and roles b. Positive events are unlikely to place stress on a family c. Negative life events require change and place stress on a family d. Normative and nonnormative events pose potential risks to the health of families

ANS: D

A community health nurse is prioritizing health-promotion activities with the local rural community. An understanding of the health status and health risks of the rural community would lead the nurse to give priority to which activity? a. Aerobic exercise classes b. English as a second language program c. Mentoring program to increase adult literacy d. Motor vehicle and farm accident prevention

ANS: D All of the health-promotion activities mentioned would be helpful for a rural community. However, health-promotion activities should be prioritized according to the most common causes of morbidity and mortality for the population served. Rural residents are at increased risk of injury and death secondary to motor vehicle crashes and farm-related occupational injuries.

A new nurse is starting a job in public health working with vulnerable populations. What advice by the nurse manager would be most beneficial? a. "Be mindful of your documentation; we don't want reimbursement issues." b. "I'd encourage you to attend county board meetings." c. "It's important for you to get out there and network." d. "The first thing you need to do is to establish trust with clients."

ANS: D Due to disappointing encounters with health care providers and services in the past, many vulnerable people lack trust in the system. It is imperative that the nurse creates a trusting environment and relationship with his or her clients.

A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, non-metropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding? a. Apple grower who lives in a 100-square-mile county with a population of 19,900. b. Client who lives next to a ranch in a town of 1200 people. c. Soybean grower and spouse who live in a 400-square-mile county with a population of 39,200. d. 70-year-old client residing in an assisted living facility in a rural area.

ANS: D Farm residency denotes living outside "city limits" and involvement in agriculture. Frontier regions have fewer than six persons per square mile; rural communities have fewer than 20,000 residents or fewer than 99 persons per square mile. "Non-metropolitan" statistical areas are regions without a central city of 50,000 or more citizens. The soybean grower and spouse make their living in agriculture (farm resident), and the county where they live has fewer than 99 persons per square mile (rural).

During a home visit, a nurse teaches a client who is recovering from a stroke and the spouse how to modify their home environment to prevent falls. This education represents: a. primary prevention. b. secondary prevention. c. secondary and tertiary prevention. d. tertiary prevention.

ANS: D Health-risk reduction is based on the assumption that decreasing the number of risks or the magnitude of risk will result in a lower probability of an undesired event. After a stroke, clients are often unstable when ambulating. Tertiary prevention includes assessing the home to prevent further complications from preventable injuries.

A nurse has decided to use a bottom-up approach of HCC to meet Healthy People 2020 goals for elders in the community setting. Which would be the most appropriate intervention? a. Design and implement a health-promotion activity that can be scheduled at a senior center. b. Organize a meeting of local politicians, clinicians, and community members to prioritize needs for elderly clients with diabetes. c. Recruit the mayor and city council to designate an annual Elder Health day. d. Include community members in multisectoral meetings to choose, design, and implement a culturally appropriate health-promotion activity for older adults.

ANS: D Healthy People 2020 goals include establishment of educational and community-based programs that focus on disease prevention and health promotion. Goals for community settings and select populations include culturally appropriate community health- promotion and disease-prevention programs. Increasing the proportion of older adults participating in organized health-promotion activities is also a goal. Following the implementation steps of the Community Health Improvement Model: Development of Community Structure for Health Promotion, the nurse working to achieve Healthy People 2020 goals should mobilize local political, health professional, and community members, including members of the target population, to prioritize, design, and implement culturally appropriate health-promotion activities for seniors in the community.

John Snow played a critical role in the development of modern disease surveillance when he did which of the following? a. Devised a more statistically valid method of analyzing epidemiologic data b. Discovered causal agents for anthrax, tuberculosis, and cholera c. Tracked the incidence of tuberculosis in the tenements of New York City d. Used geographic mapping to demonstrate the connection between water supply and cholera

ANS: D John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river.

Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends.

ANS: D Long-term patterns of morbidity or mortality rates (i.e., over years or decades) are called secular trends. Secular trends may reflect changes in social behavior or health practices.

A nurse wishes to become involved in outreach to migrant farmworkers. What activity by the nurse would be consistent with this service? a. Assisting migrant farmworkers to understand their rights b. Developing policies and assuring funding for services c. Reaching migrant communities for primary prevention d. Training lay health workers for health education

ANS: D Migrant health programs have recruited current or former migrant workers to serve as outreach workers or community health workers (often referred to as promotores or promotoras) to assist in outreach and health education of the workers. Nurses can be part of the planning and training of health workers for outreach and educational programs. Evaluation to determine successful outreach educational methods can be undertaken by nurses.

Members of an extended family are in conflict over the treatment plan for the family's 90-year-old matriarch, who has advanced dementia. The case manager is using conflict resolution strategies to allow the parties involved to develop trust, credibility, and distance from the issue at hand, as well as to retain personal dignity. What strategic process is the nurse demonstrating? a. Advocating b. Clarifying c. Cooperating d. Negotiating

ANS: D Negotiating is a strategic process used to move conflicting parties toward an outcome. A major focus is to reach agreement where parties feel results are fair, equitable, free of bias, and satisfactory.

What causes nurses practicing in rural communities to often observe that protecting client confidentiality is a unique challenge? a. Close-knit atmosphere among residents b. Difficulty keeping one's business private c. "Everyone knows everything already" d. Social informality and respect

ANS: D Nurses practicing in rural areas are obligated to maintain client confidentiality just as they would in an urban setting. However, nurses are often asked for health information and advice in nonclinical settings. This social informality is part rural characteristic and partly due to respect for the nurses. Nurses must be especially sensitive and exercise creativity to maintain client confidentiality when approached in public settings.

The best example of a government-sponsored program that can promote health and prevent illness for middle-income, subsistence-level families is which of the following? a. Medicaid b. Medicare c. Supplemental Security Income d. Women, Infants, and Children (WIC)

ANS: D Nutritious diets are important to preventing illness and promoting health. The WIC program of the U.S. Department of Agriculture is a government-sponsored nutrition program. Women, infants, and children from families living at a subsistence level may meet the eligibility criteria for this nutrition program. Women who participate in WIC programs during pregnancy have healthier babies. Infants and children who participate in the WIC program are more linked to the health care system than children who are not WIC participants. Children who participate in the WIC program receive both preventive and curative care more often than children who do not participate in the program.

A home health case manager is charged with identifying opportunities for health promotion and illness prevention. How would the case manager demonstrate fulfillment of this charge? a. Collaborates with a local chaplain to ensure that the spiritual needs of cancer clients are addressed. b. Refers a new diabetic client to a nutrition counselor for dietary teaching. c. Teaches a school nurse how to care for a client who will be returning to school and will require new asthma treatments. d. Tracks the immunization status of clients and facilitates access to immunization when needed.

ANS: D Population management includes wellness and health promotion, illness prevention, acute and subacute care, chronic disease, rehabilitation, end-of-life care, care coordination, and community engagement. Nurse case managers and nurse care managers play a pivotal role in population health delivery. The only option that addresses wellness and health promotion is through vaccinations.

The collaborative partnership best practice of "identifying specific community and system changes to be sought to effect widespread behavior change and community health improvement" would best apply to which concept of the Ottawa Charter for Health Promotion strategic framework? a. Creating supportive environments b. Establishing health-promoting public policy c. Reorienting health services d. Strengthening community action

ANS: D The Ottawa Charter for Health Promotion identified the strengthening of community action as a priority health-promotion action. The strengthening of community action refers to promoting the community's capacity, ability, and opportunity to take appropriate action to protect and improve the health of the community

A community health nurse is the case manager for a home-bound client recovering from a hip replacement. The nurse works with the client and his family to prioritize needs and services, and to address these care needs. These activities represent which step in the nursing process? a. Assessment b. Diagnosis c. Implementation d. Planning/outcome

ANS: D The case management process function of problem prioritizing and planning to address care needs is complementary to the planning/outcome step of the nursing process

A nurse uses the social-ecological model to guide care is planning an interpersonal level program for community-dwelling elders who frequent a community senior center. What program will the nurse plan? a. Bus transportation to the center b. Telehealth visits c. Volunteer opportunities d. Weekly social events

ANS: D The interpersonal level of this model includes personal relationships and social networks and support systems that influence behavior and create circumstances that encourage or impeded health attainment. Family, friends, partners, peers, and formal or informal social networks reduce isolation. Isolation has shown to have the same health impact as smoking 15 cigarettes a day.

A nurse performing home hospice case management notes the increasing number of hospice clients who lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals larger picture issues such as which of the following? (Select all that apply.) a. Community cost concerns b. Community conflict resolution skills c. Community satisfaction d. Community weaknesses in quality of services e. Community weaknesses in quantity of services

ANS: D, E Case management activities with individual clients and families very often reveal the larger picture of health services and health status of a community. General community weaknesses in the quality and quantity of services often are discovered. The nurse can then intervene at the community level to initiate changes. In this case, the nurse identified a deficiency in the quality of hospice services to individuals who did not have a caregiver in the home environment and the parallel concern of the lack of hospice-related facilities to meet the needs of these clients to achieve a quality dying process.

The nurse working with migrant farmworkers and their families understands that which of the following are true statements regarding the health and well-being of the migrant children? (Select all that apply.) a. Are not eligible for Medicaid or state health insurance. b. Generally attend school despite moving frequently. c. Have a federal safety net of limited overtime until age 18. d. May be exposed to "take home" chemicals. e. Often suffer from anxiety-related problems.

ANS: D, E Children of migrant farmworkers can be exposed to chemicals when the parent comes home from work or picks them up to hold or carry them. Children of migrant farmworkers suffer frequently from anxiety-related problems.

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