Pop Health Exam 2 Questions

13. When developing the plan of care for a client receiving home health care services, which of the following would be the most important goal? A) Promotion of client independence B) Complete resolution of the problem C) Detecting family conflicts D) Ensuring access to resources

: A Feedback: The most important goal of home health care is to promote independence and selfmanagement. Every effort is made to develop the capacity for self-care so that the home team can safely withdraw. Complete resolution of the problem in many cases is unrealistic. Detecting family conflicts and ensuring access to resources are areas that the nurse addresses and intervenes if necessary to promote the ultimate goal of self-care.

20. After teaching a group of students about the various types of epidemiologic research studies that can be done, the instructor determines that the teaching was effective when the students describe a community trial as which of the following? A) A type of experimental study conducted at the community level B) An inexpensive type of analytic research study C) A study that gathers volunteers for the experimental group D) A way to locate health problems in a variety of communities

: A Feedback: A community trial is conducted as an experimental study design with large populations. Some of the community receives a treatment, while the other part does not. This is probably the most expensive type of experimental study. It involves a great number of subjects, the support of the governmental forces as well as the population involved, a large number of staff over a long period of time, and the cost of the intervention itself. When a whole community is involved, individuals are not approached to be volunteers. What makes it a community study is that the entire community is part of the study. The health problem is identified prior to the implementation of the study. The introduction of an intervention in one community with no introduction in a similar community forms the study population, and the health problem being studied is then monitored between the two populations. The health problem has to be identified first in this type of study.

8. Which one of the following statements about assessment (one of the core public health functions) and how it can be applied to environmental health is most accurate? A) Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs. B) Assessment is least valuable when related to where the person attends school. C) It is not necessary for nurses to have a background in the environmental health sciences. D) Assessment should be limited to the general population and should not include the increased vulnerability of certain groups.

: A Feedback: Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs. With assessment, priority should be given to locations where people spend the majority of their time (home, work, school). Where persons attend school is too limiting as many people do not go to school and the priority should be given to home and work. The ability to perform critical assessments for environmental health requires background in the environmental health sciences. Public health nurses must also be aware of the increased vulnerability of certain groups.

16. A community health nurse is preparing to work in a country in which women are viewed as weak and ineffectual. Which of the following would the nurse need to do first? A) Determine his or her own position and beliefs about this view B) Develop a basic plan to change the view of women C) Become aware of possible areas that might impact care D) Avoid situations involving the care of women

: A Feedback: Community health nurses first, need to determine their own position on this issue and come to terms with it, realizing that it may impact their care. Once aware, the nurses can then prepare appropriately for situations in which their care may be affected. It would be inappropriate and probably impossible to attempt to change the view or avoid situations involving the care of women.

8. A community health nurse suspects Munchausen syndrome by proxy when a child A) experiences "seizures" only when a parent is present, not if a third party is present. B) has stunted growth and shortened limbs that have been noticeable since birth. C) has a noticeable limp when wearing shoes but not in bare feet. D) has periods of "acting out" and misbehaving, especially when there is company.

: A Feedback: Experiencing seizures only when a parent is present would be a "red flag" for this syndrome if it were occurring in a child. Stunted growth, limp, or acting out are not associated with Munchausen syndrome by proxy.

16. As part of a group exercise, students are to compare and contrast home care and hospice care. The instructor determines that the activity was successful when the students identify which of the following as reflective of home health care? A) Emphasis on rehabilitation B) Focus on health of the whole family C) Expert use of opioids for suffering D) Management of symptoms

: A Feedback: Home health care emphasizes rehabilitation and stabilization of the client whereas hospice emphasizes the quality of life and comfort. Focusing on the whole family, expert use of opioids for suffering and management of symptoms are features associated with hospice care. In contrast, home health care focuses on the health of the client; opioids are used hesitantly to reduce suffering; and symptom management may require hospitalization if unmanageable.

6. When reviewing the trends in communicable diseases for a county, the community health nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan for prevention and control integrating the understanding that this disease is most likely transmitted by which mode? A) Vector B) Airborne C) Vehicle-borne D) Direct

: A Feedback: In the United States, vector-borne illnesses have received renewed attention with accumulating information about Lyme's disease, transmitted to humans by a tick vector. Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host such as through touching, biting, kissing, or sexual intercourse.

20. When assessing a family in crisis, which of the following would the community health nurse need to do first? A) Assess the nature of the crisis B) Determine client's perception C) Define available supports D) Assess coping abilities

: A Feedback: Initially, the nurse must assess the nature of the crisis and the client's response to it. Next, the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is available for support to the individual or family. Finally the nurse assesses the clients' coping abilities.

19. An occupational and environmental health nurse recently treated approximately 20 employees for hand injuries. The employees all work on the factory assembly line. The nurse decides to implement a program for primary prevention. Which of the following activities would be appropriate? A) Institute an orientation for employees about the equipment B) Conduct hearing screening tests of the employees C) Institute whirlpool treatments for injured extremities D) Ensure adherence to physical therapy regimen for injured workers

: A Feedback: Instituting an orientation program reflects primary prevention, that is, preventing an illness or injury from occurring. Conducting hearing screening would reflect secondary level of prevention. Whirlpool treatments and physical therapy would reflect tertiary level activities.

22. Which of the following statements about confidentiality, privacy, and discrimination is the most accurate? A) It is permissible for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. B) It is permissible for a community health nurse to tell the contacts of a person who is infected with a communicable disease which disease they have been exposed to and the name of the source. C) It is permissible for any health care provider to report any cases of known or suspected communicable diseases to the news media. D) Only the identity of the index case of a communicable disease needs to be protected.

: A Feedback: It is permissible and necessary for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. It is important that the contacts of a person who is infected with a communicable disease which disease they have been exposed to but is not acceptable for the community health nurse to reveal the identity of the source. It is permissible and often helpful for a community health nurse to involve the news media in informing the public of information about the specific disease including mode of transmission, prevention, and treatment options but not the identity(ies) of the cases. It is important to assure the individual being interviewed that the information will be maintained in a confidential manner, and the goal is care and treatment.

28. Which of the following statements about nurse entrepreneurship in community/public health practice is most accurate? A) It allows for innovation in meeting needs of the community. B) Nurse entrepreneurs are most commonly associated with institutions. C) It is very easy for a nurse to become an entrepreneur. D) It is most likely to fail.

: A Feedback: Nurse entrepreneurship allows for innovation in meeting the needs of the community. Nurse entrepreneurs are not most commonly associated with institutions. It is very difficult for a nurse to become an entrepreneur. There may be failure in nurse entrepreneurship but without the risk of failure, it is not possible to advance.

2. centers to a group of students, which of the following would the instructor emphasize? A) Use as a vital safety net health care provider B) An alternative to primary care for insured persons C) Focus on the individual in the community D) Affiliation with a local acute care facility

: A Feedback: Nurse-managed health centers have emerged as a vital safety net health provider in America's health care delivery system. A "safety-net provider" is defined as a provider that by mandate or mission organizes and delivers a significant level of health care and other healthrelated services to the uninsured, Medicaid recipients, and other vulnerable populations. The distinctiveness of these centers is the community orientation. The centers can be a freestanding business or may be affiliated with universities and other service institutions.

4. The nursing student reads the textbook in preparation for a class meeting about primary, secondary, and tertiary prevention related to families in crisis. The student determines which one of the following statements as most accurate regarding the levels of prevention? A) Often people in crisis are temporarily helpless and unable to cope on their own but are receptive to outside influence. B) Secondary prevention interventions include taking action to prevent the unwanted event from occurring. C) Tertiary prevention focuses on moving past the crisis and returning to the precrisis state. D) Primary prevention is the least effective level of intervention in terms of promoting client's health and containing costs.

: A Feedback: Often people in crisis are temporarily helpless and unable to cope on their own, but understand the need for outside help and are receptive to other people's suggestions. Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted event from occurring. Tertiary prevention focuses on moving past the crisis, although returning to the precrisis state may not be possible. Primary prevention is the most effective level of intervention in terms of promoting client's health and containing costs.

14. A school nurse functions to promote a healthy school environment. Which of the following would be most appropriate for the nurse to do? A) Advocating for proper nutrition and exercise to prevent and reduce the incidence of obesity in school-age children B) Providing care for children with asthma C) Developing individualized health plans D) Engaging in incidental teaching about scoliosis

: A Feedback: Promotion of healthful school living emphasizes planning a daily schedule for monitoring healthful classroom experiences, extracurricular activities, school breakfasts and lunches, emotional climate, discipline programs, and teaching methods. It also includes screening, observing, and assessing to identify needs early and report illegal drug use, suspected child abuse, and violations of environmental health standards. Health promotion involves the nurse in supporting the physical, mental, and emotional health of school personnel by being an accessible resource to teachers and staff regarding their own health and safety. Providing asthma care and developing individualized health plans are examples of providing health services. Engaging in incidental teaching reflects the function of health education.

14. communicable disease would quarantine be most effective? A) Susceptibility stage B) Subclinical disease stage C) Clinical disease stage D) Resolution stage

: A Feedback: Quarantine is the isolation of persons who are susceptible to a communicable disease and have been exposed to that communicable disease until the incubation period of the subclinical disease stage has passed. Quarantining persons during the susceptibility stage itself is not indicated as individuals have not been exposed. The proper action for persons who are in the clinical disease stage and beyond is isolation until the danger of spreading the communicable disease has passed.

12. A community health nurse has identified the index case. The nurse is involved in which of the following? A) Contact investigation B) Screening C) Isolation D) Quarantine

: A Feedback: The index case (diagnosed person) results from contact investigation and partner notification. Screening describes programs that deliver a testing procedure to detect disease in groups of asymptomatic apparently health individuals. Isolation refers to the separation of the infected person from others for a period of communicability to limit transmission; quarantine refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period. Contact investigation and notification is one of two approaches to secondary prevention of communicable diseases.

18. A school nurse is providing care to a group of children with severe food allergies. Which of the following would be most important for the nurse to include in the child's plan of care? A) Ensuring that the child has ready available access to EpiPen B) Advising teachers to call the child's parents in case of a reaction C) Teaching other students how to administer the EpiPen D) Administering daily medication to control the allergies

: A Feedback: Severe food allergies can lead to anaphylactic shock. School nurses coordinate and work with students and their families, along with school personnel to raise awareness and enlist caution. They also work with families and health care providers to ensure that epinephrine via an autoinjector EpiPen is available for the child in case of emergencies. School nurses also work with teachers and lunch room personnel to alert them of the allergy, explain what can happen in a case of anaphylaxis, and provide training on how to use the EpiPen or other needed medication. Calling the child's parents in case of a reaction would be important but prompt treatment with epinephrine is the priority. Responsible adults, not other children should know how to administer the epinephrine. Daily medication usually is not required for children with food allergies, however, avoidance of the allergen is.

10. Which of the following would the community health nurse identify as an act of sexual exploitation of a child? A) Child pornography B) Child molestation C) Fondling of child's genitals D) Vaginal penetration with an object

: A Feedback: Sexual exploitation of children includes conduct or activities related to pornography that depict minors in sexually explicit situations and promotion of prostitution by minors. Sexual assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration of the genital or anal opening by a foreign object, and child molestation.

4. A community health nurse is preparing a presentation for a community group about tuberculosis (TB) and its current epidemic status. Which of the following would the nurse include in the presentation about this disease? A) TB kills about 1.7 million people each year. B) All persons who are infected by the causative organism become ill and can spread the causative organism to others throughout the remainder of their lifetime. C) Three fourths of the world's population is thought to be currently infected by the causative organism. D) The highest number of deaths is in Eastern Europe.

: A Feedback: TB kills approximately 1.7 million people each year. Only 5 to 10 of those infected become ill or can spread the causative organism to others within their lifetime. One third of the world's population is thought to be currently infected by the causative organism (tubercle bacillus). The highest number of deaths occur in Africa.

23. Which organization would be most appropriate for the community health nurse to contact for assistance when dealing with countries shattered by war and ethnic violence? A) Center for International Humanitarian Cooperation B) CARE C) Global Health Council D) International Council of Nurses

: A Feedback: The Center for International Humanitarian Cooperation (CIHC), founded in 1992, promotes healing and peace in countries shattered by war, regional conflicts, and ethnic violence. CARE intervenes by responding to famines and disasters worldwide with emergency food, supplies, and rehabilitative efforts. The GHC advocates for needed policies and resources, builds networks and alliances among those working to improve health, and shares innovative ideas, knowledge, and best practices in health. The ICN represents the global interests and concerns of the nursing profession.

8. help achieve a reduction in the number of measles deaths worldwide? A) Integrated Management of Childhood Illness (MCI) B) Global Alliance for Vaccine and Immunization C) Oral rehydration therapy D) Geographical information systems

: A Feedback: The MCI is the intervention considered to have the greatest impact in reducing measles. It provides wide immunization coverage, rapid referral of serious cases, prompt recognition of secondary conditions, and improved nutrition and vitamin A supplementation. The Global Alliance for Vaccine and Immunization is an interagency initiative that seeks to protect every child against vaccine-preventable diseases. This initiative addresses all of these types of diseases. Oral rehydration therapy has been used to reduce mortality associated with diarrheal diseases. Geographical information systems is not a program but a means to monitor diseases.

16. on the use of nursing home services and the common diagnoses of those using these services. Which source of information would be most appropriate for the nurse to investigate? A) National Center for Health Statistics B) Consumer Product Safety Commission C) Environmental Protection Agency D) Cancer disease registries

: A Feedback: The National Center for Health Statistics furnishes valuable health prevalence data from surveys of Americans. Among the information available is the National Nursing Home Survey, which provides information on those who are using these services and the diagnoses and other characteristics. The Consumer Product Safety Commission and Environmental Protection Agency would provide information about environmental issues. Cancer disease registries would provide information specific to the diagnosis of cancer.

2. When applying the Universal Imperatives of Care, which of the following would be the priority? A) Mortality B) Daily functioning C) Decision making D) Cost

: A Feedback: The Universal Imperatives of Care include mortality, morbidity, daily functioning, decision making, and cost. This paradigm underscores the notion of first things first. That is, one must be alive and well before interventions focus on functioning or decision making.

21. After teaching a class of community health nursing students about the World Health Organization, the instructor determines that the teaching was successful when the class identifies which of the following as the highest governing body? A) World Health Assembly B) WHO Collaborating Centers C) The European Union D) U.S. Agency for International Development

: A Feedback: The World Health Assembly is the highest governing body within WHO. WHO Collaborating Centers are networks of centers focusing on specific areas of expertise and carry out the work of the member countries in these areas. The European Union is an organization that provides funding for many projects including health. The U.S. Agency for International Development is an independent bilateral agency of the executive branch that works to enhance long-term and equitable economic growth.

9. A public health nurse working with several communities to develop appropriate programs for health surveillance. Which agency would the nurse contact to obtain information on this topic? A) Centers for Disease Control and Prevention B) National Institutes of Health C) Agency for Health Care Research and Quality D) Food and Drug Administration

: A Feedback: The nurse would contact the Centers for Disease Control and Prevention that is responsible for health surveillance and the prevention of disease and bioterrorism. The National Institutes of Health provide medical research. The Agency for Health Care Research and Quality is responsible for research on health care quality and effectiveness. The Food and Drug Administration works to ensure the safety of food, medication, medical procedures, and equipment.

24. A community health nursing student is interviewing several occupational and environmental health nurses about their experiences. Each of the nurses works in a small organization and is the only nurse for the company. Which of the following would the student most likely note as being similar among the nurses? A) Use of critical thinking skills B) Collegial relationships C) Decrease in workload D) Role certainty

: A Feedback: The occupational and environmental health nurse, especially in smaller organizations, may be the only nurse in the company. As a result, she or he has none of the on-site consultation and direction that are needed for comfortable, competent, and independent decision making. Nurses who use critical thinking skills to develop a framework for independent problem-solving enhance their efficiency. In addition, the nurse may feel isolated because of being the only health professional. The corporate culture and leadership may foster work overload, be nonsupportive, and have limited career opportunities for the nurse. The nurse may experience role ambiguity due to a lack of professional preparation or inadequate orientation and continuing education.

4. Which of the following activities best reflects a public health nurse's role in the public health function of assessment? A) Prioritizing the issues of a community to determine appropriate interventions B) Evaluating for potential safety hazards in a childcare center C) Ensuring that children in a day care center are properly immunized D) Working with officials to develop a program for solving a problem

: A Feedback: The public health function of assessment is reflected when a public health nurse identifies the problems in a community and then prioritizes which issue to address first by deciding which issue impacts the most people and what interventions will help the population thrive. Evaluating for potential safety hazards and ensuring proper immunizations reflect the assurance function of public health. Working with officials to develop programs reflects the function of policy development.

10. When providing home health care, which individual is responsible for coordinating the care? A) Registered nurse B) Social worker C) Physician D) Dietician

: A Feedback: The registered nurse is considered the coordinator of care. The social worker is another clinical staff member but is not the coordinator of care. The physician directs the skilled care to clients by agreeing (signing the nurse-generated paperwork) with the plan of care established by the registered nurse who coordinates the care. The dietician is another clinical staff member but is not the coordinator of care.

8. After teaching a group of students about public health nursing and the U.S. Public Health Service Commissioned Corps, the instructor determines that the students need additional instruction when they state which of the following is necessary to qualify for a position in the Corps? A) Age over 45 years B) Bachelor's degree in nursing C) Valid nursing license D) U.S. citizenship

: A Feedback: To qualify as a nurse in the Commissioned Corps, one must be a U.S. citizen, <44 years old, able to pass a physical examination, possess a bachelor's or higher degree from an accredited nursing program, pass the National Council Licensure Examination (NCLEX), and hold a valid nursing license from one of the 50 states, the District of Columbia, Puerto Rico, Guam or the U.S. Virgin Islands.

7. A community health nurse is integrating the epidemiology of wellness into practice. Which of the following would the nurse include? A) Lifestyle with its self-created risks B) Communicable disease control C) The natural history of disease D) Vital statistics and reportable diseases

: A Feedback: Today there is an increased focus on lifestyle behaviors and how they relate to a person's state of wellness or illness. It is a basic component of a wellness model. Communicable disease control focuses on an illness state, not a wellness state, and is not part of a wellness model. The four states of the natural history of a disease or health condition is not part of the wellness model. Vital statistics and reportable diseases are not part of the wellness model.

5. An instructor is describing the various types of home health care agencies and uses the visiting nurse association as an example of which of the following types? A) Voluntary nonprofit B) Hospital-based C) For-profit proprietary D) Noncertified

: A Feedback: Visiting nurse associations are examples of voluntary nonprofit agencies. Hospital-based agencies are those involving a hospital operating a separate department as a home health agency. It may be nonprofit or generate revenue for the hospital. For-profit proprietary agencies can be governed by individual owners, but many are part of large, regional, or national chains that are administered through corporate headquarters. Many agencies providing services in the home remain outside the federal Medicare system that reimburses skilled nursing. These noncertified agencies are usually private and derive their funding from direct payment by the client or from private insurers.

20. Which of the following statements about the prevention of sexually transmitted diseases is true? Select all that apply. A) Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. B) Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. C) The proper use of condoms prevents transmission of all sexually transmitted infections. D) Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other sex partners if sexual contact is only practiced when the person does not have any visible sores.

: A, B, D Feedback: Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection transmission but does not eliminate the transmission of all sexually transmitted infections. It is possible for a person who has HSV-2 infection to transmit the infection to other sex partners if sexual contact is practiced even when the infected partner does not have a visible sore.

3. Which of the following statements accurately describes important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply. A) Review the information received from the news media reporter for completeness B) Review disease information including the reservoir, incubation period, infectious period, symptoms, and treatment C) Take all appropriate treatments to the interview site D) Investigate only laboratory confirmed communicable diseases E) Eradicate the disease

: A, B Feedback: Steps to take prior to contacting an individual regarding communicable disease include reviewing the information received from the reporters for completeness (this refers to the individual reporting the communicable disease to the public health agency and not the news media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition; review the disease information (including reservoir, incubation period, infectious period, symptoms, and treatment); and identifying the specific questionnaire for the reported disease or using a generic disease investigation form and reviewing the questionnaire. It is not appropriate for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding communicable disease is one of the first steps in the process of investigation.

15. The community health nurse determines that the adult population in the community has an increased incidence of vaccine preventable disease. Which of the following are factors that may contribute to low vaccination levels among adults? Select all that apply. A) Lack of comprehensive vaccine delivery systems to the public and private sectors for adults (similar to the Vaccines for Children program for children) B) Lack of statutory requirements for vaccination of adults C) Health care providers may lack current information about recommended adult immunizations and may miss opportunities to vaccinate adults during contacts in offices, outpatient clinics, and hospitals. D) Adults fear injections for immunizations but do not worry about adverse effects after vaccination. E) A multitude of comprehensive vaccination programs exist in settings where healthy adults congregate such as workplaces and other locations.

: A, B, C Feedback: Low vaccination levels among adults are associated with several factors: limited comprehensive vaccine delivery systems that are available; lack of statutory requirements for vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts in offices, outpatient clinics, and hospitals. Additionally there is a lack of comprehensive vaccination programs in settings where healthy adults congregate; and clients and providers may fear adverse reactions after vaccination.

20. Which of the following statements about the International Council of Nurses (ICN) are accurate? Select all that apply. A) ICN represents the global interests and concerns of the nursing profession. B) The mission of ICN is to maintain the role of nursing in health care through its global voice. C) ICN has, as members, nursing organizations from 130 countries representing 13 million nurses. D) ICN is a governmental organization. E) ICN employs Regional Nursing Advisors.

: A, B, C Feedback: The following statements about ICN are accurate: ICN represents the global interests and concerns of the nursing profession; the mission of ICN is to maintain the role of nursing in health care through its global voice; and ICN has, as members, nursing organizations from 130 countries representing 13 million nurses. ICN is a nongovernmental organization. Regional Nursing Advisors are employed at the international level of the World Health Organization.

23. Which of the following would the school nurse who is dealing with a primarily adolescent school population focus on? Select all that apply. A) Substance abuse B) Eating disorders C) Suicide prevention D) Sexual activity E) Dental sealants

: A, B, C, D Feedback: Many of the health issues that modern adolescents face are a result of their own choices and high-risk activity; for example, sexual activity, substance abuse, injury, and violence. Eating disorders are most prevalent in adolescent females. Dental sealants are more appropriate for elementary school children.

26. Which of the following are adverse working conditions that may impact the health status of nurses. Select all that apply. A) Physical hazards B) Radiation hazards C) Biological hazards D) Chemical hazards E) Low pay

: A, B, C, D Feedback: Nurses may be exposed to physical, radiation, biological, and chemical hazards. Nursing is not considered to be a low-paying job.

15. Which of the following roles would be critical to a faith community nurse to assume to achieve the goals of this practice? Select all that apply. A) Advocate B) Health educator C) Volunteer coordinator D) Health counselor E) Case manager F) Direct care provider

: A, B, C, D Feedback: The faith community nurse assumes seven diverse nursing roles as essential for practice including: health educator, health counselor, advocate, referral agent, developer of support groups, coordinator of volunteers, and integrator of faith and health. Case manager and direct care provider are not considered roles of the faith community nurse.

14. Which of the following are variables that occur in nature and could have a negative impact on humans? Select all that apply. A) The effect of climate change upon weather extremes (droughts, floods, and storms) B) Changes in rainfall and water supply for soil C) Ecology of microbial growth D) Risks for waterborne and food-borne pathogens in drinking water, seafood, and fresh produce because of climate variability E) There is adequate food supply and always will be.

: A, B, C, D Feedback: The variables related to the food supply that occur in nature and could have a negative impact on humans include the effect of climate change upon weather extremes (droughts, floods, and storms); changes in rainfall and water supply for soil; ecology of microbial growth; risks for water-borne and food-borne pathogens in drinking water, seafood, and fresh produce because of climate variability. There are currently food shortages in parts of the world, and this is likely to continue and may worsen.

13. Which of the following groups of persons have increased vulnerability to environmental hazards to human health related to food? Select all that apply. A) Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins to the unborn fetus. B) Persons who have altered immunity are more likely to be affected by food exposures. C) Middle-aged males D) Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size. E) Adult women who are nonchildbearing

: A, B, D Feedback: Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins to the unborn fetus. Persons who have altered immunity are more likely to be affected by food exposures. Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size. Middle-aged males and adult women who are nonchildbearing are not especially vulnerable to environmental hazards to human health.

23. Which of the following Medicare definitions prevent people who could benefit from home care services from receiving those services, even when it would be most cost effective for the client to receive home care rather than more expensive emergent and inpatient interventions? Select all that apply. A) Home-bound status B) Medical necessity C) Prospective payment D) Skilled nursing

: A, B, D Feedback: The entire model for service provision in the home must change to a health care delivery system that continuously serves those living with disabling and terminal illness to maximize well-being at home, anticipate and prevent crises, and minimize emergent and inpatient interventions. The Medicare definitions of homebound, medical necessity and skilled nursing must become extinct.

3. A nursing student is considering a career in international community health nursing. Which of the following statements are accurate regarding the context of international community health nursing? Select all that apply. A) Global community health care is complex and is affected by multiple factors relating to geography, history, politics, culture, religion, and economy. B) The types of services that can be provided include a range from providing clinical services to policy making at an international level. C) People's conception of health, wellness, and illness are static from culture to culture. D) By looking through a computer window, the student is able to see almost anyplace, connect to about any person, and access information about almost any concept. E) The ways in which people view nurses and other health care providers are affected by their attitudes toward women, their culture, and belief systems.

: A, B, D, E Feedback: The following statements are true: Global community health care is complex and is affected by multiple factors relating to geography, history, politics, culture, religion, and economy; The types of services that can be provided include a range from providing clinical services to policy making at an international level; By looking through a computer window, the student is able to see almost anyplace, connect to about any person, and access information about almost any concept; The ways in which people view nurses and other health care providers are affected by their attitudes toward women, their culture, and belief systems. The statement that people's conceptions of health are static from culture to culture is false. Indeed, people's conceptions of health, wellness, and illness vary from culture to culture.

2. Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that apply. A) Immunization of children and adults B) Disease investigation and case/contact finding C) Diagnosing cases of communicable diseases D) Prescribing treatment for communicable diseases E) Environmental interventions F) Community Education

: A, B, E, F Feedback: Appropriate interventions that may be implemented by community health nurses include immunizations of children and adults, environmental interventions, community education, screening programs, and disease investigation and case/contact finding.

9. Which of the following would lead a community health nurse to suspect possible child neglect? Select all that apply. A) 15-year-old Lucy misses school once a week to watch her baby sister while mom works. B) 6-year-old Sam plays in the yard with a sweater on when it is 60 degrees outside. C) Twins, Bobby and Billy arrive at school in dirty and smelly clothing most school days. D) 11-year-old Samantha comes to school without lunch or lunch money each day. E) 9-year-old Tommy misses school two or three times a month due to asthma attacks. F) 14-year-old Jennifer watches her neighbor's 2- year-old every Saturday.

: A, C, D Feedback: Educational neglect involves Lucy missing school to watch her baby sister and general neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how hard and long he is playing—he may be comfortable. Although Tommy is missing a number of days of school, he has a legitimate excuse. Fourteen is an appropriate and legal age to babysit.

12. Which of the following statements about risk is true? Select all that apply. A) Risk is the probability that a disease or unfavorable health condition will develop. B) Risk means that the person who has the most negative influences will definitely develop the disease or unfavorable health condition. C) Risk refers to positive and negative influences on a person's likelihood of developing a specific disease. D) Risk can be measured using the relative risk ratio, which is based on the ratio of incidence in an exposed group to incidence rate in unexposed group. E) Risk is unimportant when determining the most effective points for community health intervention.

: A, C, D Feedback: Risk is the probability that a disease or unfavorable health condition will develop. Risk also refers to positive and negative influences on a person's likelihood of developing a specific disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an exposed group to incidence rate in unexposed group. Risk does not mean that the person who has the most negative influences will definitely develop the disease or unfavorable health condition, but it refers to the probability that the person will develop the disease or unfavorable health condition. The relative risk ratio assists in determining the most effective points for community health intervention in regard to particular health problems.

14. When providing palliative care to a client receiving hospice care, which of the following would be important? Select all that apply. A) Assume nothing about what is wrong B) Use the most complex interventions first C) Believe what the client is reporting D) Be persistent in trying different strategies E) Wait until the symptoms recur to relieve them

: A, C, D Feedback: When providing palliative care, the nurse should make no assumptions about what is wrong; believe the client's report of symptoms; anticipate the symptoms and relieve them before they recur; choose the least complex and most manageable interventions that clients and families can manage themselves at home; and never give up, but persist in trying different palliative strategies.

5. Which of the following statements apply to the concept of causality? Select all that apply. A) Causality is the relationship between cause and effect. B) The chain of causation is the most recent theory of causality. C) The web of causation theory is the most recent theory of causality. D) The chain of causation clearly explains causation in noninfectious disease. E) Epidemiology has changed its view of causality over time.

: A, C, E Feedback: Causality is the relationship between cause and effect. The web of causation theory is the most recent theory of causality. Epidemiology has changed its view of causality over time. The chain of causation was the first theory of causality. The chain of causation could not sufficiently explain causation in noninfectious disease because the chain of causation is too linear.

10. A community health nurse is enacting policy development by preparing a presentation for a group of state health officials about the issue of water pollution in the United States. Which of the following would the nurse include? Select all that apply. A) Globally, the availability of clean water is becoming a very serious threat to human survival. B) Water pollutants consist solely of chemicals. C) Recently, there has been an increase in the concern about pharmaceuticals contaminating water supplies. D) All water that is to be consumed is regulated through the EPA. E) The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised.

: A, C, E Feedback: Globally, the availability of clean water is becoming a very serious threat to human survival. Recently, there has been an increase in the concern about pharmaceuticals contaminating water supplies. The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised. Water pollutants consist of organic and inorganic chemicals, contamination with microbes, pharmaceuticals, pesticides and insecticides, and radionuclides. The EPA only regulates public water systems.

12. A home health care nurse reviews the most common conditions managed at home. Which of the following are the most common conditions managed at home? Select all that apply. A) Chronic skin ulcer B) COPD C) Heart failure D) Terminal cancer E) Diabetes

: A, C, E Feedback: The most common diagnoses managed at home are diabetes, chronic skin ulcer, essential hypertension, heart failure, and osteoarthritis

2. A community health nurse is preparing a presentation for a community center group about crisis. Which of the following concepts about situational crises should be included in the presentation? Select all that apply. A) A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. B) Situational crises can be predicted, expected, and planned. C) Situational crises are never positive. D) Situational crises often occur without warning. E) Situational crises occur to people because of where they are in time and space.

: A, D, E Feedback: A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur to people because of where they are in time and space. Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.

4. Which of the following entities would the community health nurse know are required to report known or suspected cases of reportable diseases in every state in the United States? Select all that apply. A) Physicians, dentists, and nurses B) Laboratory directors C) Any individual who knows of or suspects the existence of a reportable disease D) Medical examiners E) Administrators of schools and child care centers

: A, D, E Feedback: In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors; and any individual who knows of or suspects the existence of a reportable disease.

19. A corrections nurse is working to develop programs for inmates and reviews the demographics of this population to determine potential issues. Which of the following would the nurse expect to find? A) Greater portion of inmates who are white B) Increasing numbers of women in prisons C) Equal distribution of socioeconomic backgrounds D) Incarceration primarily for commission of minor crimes

: B Feedback: Looking at the demographics of inmates, there are many differences from the general population. First, inmates have all committed some type of crime, with nearly half (52%) being violent crimes. National statistics indicate a larger portion of Black (3,042 per 100,000) and Hispanic (1, 261 per 100,000) male inmates than White male inmates (487 per 100,000). Although males are still the majority population (88.6%), trends show an increase in the number of women in state or federal prisons. In addition, the inmate population is drawn disproportionately from lower socioeconomic backgrounds when compared with the general public.

7. After a community health nurse implements an educational program for a local community group about food safety, which statement indicates that the teaching was successful? A) "Handwashing is unnecessary if we use gloves." B) "After cooking the meat, we'll put it on the same platter that we used for the raw meat." C) "Our cooked foods should be cooled quickly." D) "If we peel the carrots, we don't need to wash them before eating."

: B Feedback: Cooked foods should be cooled quickly. Surfaces, hands, and utensils should be washed in warm soapy water (even when gloves are used as gloves do not prevent cross-contamination by themselves). Foods when cooked should not come in contact with dishes, utensils, or containers used when the foods were raw and uncooked. Foods that are to be eaten raw and uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are to be peeled that grow on the ground or come in contact with soil.

18. A community health nurse is preparing to carry out an experimental epidemiologic study. Which of the following would be most important for the nurse to do? A) Focus the study on evaluating the cause of a disease B) Ensure carefully controlled conditions during the study C) Expose both groups to the same factor or condition D) Ensure that there are a substantial number of subjects

: B Feedback: Experimental studies are carried out under carefully controlled conditions. In human populations, experimental studies should focus on disease prevention or health promotion rather than testing the cause of disease. The investigator exposes an experimental group to some factor and simultaneously observes a control group similar in characteristics to the experimental group but without the exposure factor. An experimental study need not be elaborate to provide important data.

21. After teaching a group of community health nursing students about the trends affecting occupational and environmental health nursing, the instructor determines that more teaching is needed when the students identify which of the following as a trend? A) Continued escalation of health care costs B) Upturn in the global economy C) Increase in worldwide competition D) Increase in technologic hazards

: B Feedback: Four critical issues affect the practice of occupational and environmental health nursing. First, the downturn in the global economy, and in the economy of the United States specifically, has skeletonized many worksites, shut down companies, eliminated night or evening shifts, or moved companies to less expensive communities. Second, increasing worldwide competition requires businesses to remain competitive by reducing or controlling operating costs at the lowest level possible. Third, there has been an increase in technologic hazards that require a sophisticated approach as well as knowledge of toxicology, epidemiology, ergonomics, and public health principles. Fourth, health care costs continue to escalate at faster rates than most company profits do.

6. A public health nurse who uses the upstream approach would likely focus on which one of the following contributors to unhealthy diets in the community? A) Consumer preference for sweet, greasy, and salty foods B) Marketing strategies of fast food businesses C) Busy lifestyles within the community D) Individual acceptance of obesity

: B Feedback: A public health nurse who uses the upstream approach would likely focus on factors that are at the institutional and system level rather than looking solely at healthy lifestyle issues. Consumer preference for sweet, greasy, and salty foods; busy lifestyles within the community and individual acceptance of obesity are lifestyle issues. The marketing strategies of fast food businesses are one root cause of unhealthy diets in the community.

10. The nurse educator knows that a nursing student understands the basics of immunity when the student nurse states A) herd immunity only pertains to cows. B) active immunity can be attained via the use of vaccines. C) passive immunity can be attained via the use of vaccines. D) cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a completely different infectious agent.

: B Feedback: Active immunity can be attained via the use of vaccines. Passive immunity is immunity that is given to a person, either by maternally provided protection for newborn infants or from antibody products that provide temporary resistance. Herd immunity describes the immunity level that is present in a population group. Cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a related infectious agent.

22. When describing the role of hospice nurses to a group of students, a hospice nurse identifies which of the following as most important? A) Speaking the truth B) Sustaining oneself C) Encouraging choice D) Strengthening the family

: B Feedback: Although speaking the truth, encouraging choice and strengthening the family are key interventions of a hospice nurse, sustaining oneself is the priority. Effective hospice nurses understand that to care for others, they must care for themselves because without a healthy nurse, the client cannot thrive.

1. As a guest speaker for a group of community health nurses who are considering corrections nursing as a career, a corrections nurse provides an overview of the history of corrections nursing. Which of the following would the nurse describe as the historic view of corrections nursing? A) Health care to inmates occurred primarily as emergency treatment. B) Inmates were viewed as not deserving care paid by public dollars. C) The emphasis was on corrections, not punishment. D) Prisons provided safe havens from communicable diseases.

: B Feedback: Although the correctional system of prisons and jails has been around for a very long time, it historically provided minimal, if any, health care to inmates. Prison was a punishment, and the inmates were viewed as not deserving of care that was being paid for from public dollars. Communicable diseases were and continue to be a major health issue.

14. A community health nurse is working with an international agency in Australia. The nurse would most likely encounter which type of health care system? A) Entrepreneurial B) Welfare-oriented C) Comprehensive D) Socialist

: B Feedback: Australia subscribes to a welfare-oriented health care system in which statutory programs drive these systems to support the cost of health care for all, or almost all, of the population through their "national health insurance." An Entrepreneurial Health Care System, found in the United States, is one in which the country's health care system is based, in part, on its political economy. A Comprehensive Health Care System is a step away from the welfare-oriented type in that substantial modifications exist in delivery and financing that result in universal entitlements. These systems are found in Scandinavian countries, Great Britain, and New Zealand. Socialist Health Care Systems came about through social revolutions that abolished free- market economies and replaced them with socialism where the health care system is also socialized. They are found in countries such as Russia, Eastern Europe, Albania, Bulgaria, Czechoslovakia, East Germany, Hungary, Poland, Romania, Yugoslavia, and China.

6. Which one of the following factors has resulted in the Era of Chronic Long-Term Health Conditions? A) Decreased usage of tobacco by young populations B) Despite programs of control, many infectious diseases persist with many people surviving to experience chronic, long-term conditions secondary to the infectious disease. C) Shorter life expectancies due to chronic diseases D) Death from infectious diseases results in a decrease in degenerative diseases.

: B Feedback: Despite the programs of control, many infectious diseases persist. However, populations now survive and also experience chronic, long-term conditions. These conditions affect mortality and morbidity, daily functioning, decision making, and cost. Thus, the longevity that has resulted from meeting the challenges of the Era of Infectious Diseases compounds the more recent emergence of chronic diseases in the many countries. The emergence of multidrug resistant diseases, continued persistence of infectious disease, and urbanization with deforestation have resulted in new and emerging infectious diseases and conditions.

13. While visiting a family in their home, a community health nurse hears a parent screaming who says, "Everything you do is wrong. Can't you do anything right ever?" The nurse suspects which of the following? A) Neglect B) Emotional abuse C) Sexual abuse D) Physical abuse

: B Feedback: Emotional abuse involves psychological mistreatment or neglect and may involve verbal abuse such as statements like, "Everything you do is wrong. Can't you do anything right?" Neglect occurs when physical, emotional, medical, educational resources necessary for healthy growth and development are withheld or unavailable. Sexual abuse involves acts of sexual assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain, physical injury, or death.

11. Which of the following statements about faith community nursing is most accurate? A) Nurses are uniquely able to focus on the spiritual influences on health. B) Faith community nursing is one of the newest nursing specialties, and one of the oldest means of health care delivery. C) Faith community nursing is restricted to Christian religious institutions in the United States. D) For hundreds of years, deaconesses, sisters, and lay members of religious communities have been engaged in health promotion.

: B Feedback: Faith community nursing is one of the newest nursing specialties, and one of the oldest means of health care delivery. Nurses have the unique ability to bridge the disciplines of medicine and religion and assist the client in understanding the physical and spiritual influences on health. The parish nursing movement soon spread outside of Christian religious institutions and beyond the borders of the United States to Canada, Australia, and New Zealand. For hundreds of years, deaconesses, sisters, and lay members of religious communities have been involved in ministering to the sick.

8. Which of the following statements about funding sources for nurse-managed health clinics is most accurate? A) All nurse-managed health clinics can be reimbursed by Medicaid and managed care medical insurance plans. B) Grants can be used as a source of initial start up funding and/or to support ongoing activities. C) It is common for nurse-managed health clinics to receive funding from one primary source. D) Contracts are awarded based on competition and are renewable when goals and objectives are not met.

: B Feedback: Grants can be used as a source of initial start up funding and/or to support ongoing activities. In comprehensive primary care centers, advanced practice nurses provide primary care services that are usually reimbursable under Medicaid and managed care medical insurance plans. Most nursing centers operational and salary budgets entail a combination of funding sources. Contracts are usually noncompetitive and renewable when goals and objectives are met.

15. The family of a hospice client is holding a vigil at the client's bedside. During a visit, a hospice nurse participates in this vigil and encourages each of the family members to say their good-byes. The nurse is demonstrating which of the following? A) Palliative care B) Guided letting go C) Connecting D) Responsive use of self

: B Feedback: Guiding letting go is a truly unique nursing practice that involves helping the client to let go of former activities and hopes, including life itself. This involves listening to intense emotions and helping the person and family find resolution. Sometimes it involves participating in a vigil at the bedside of the dying person and encouraging loved ones to say their final words of farewell. Palliative care involves the relief of suffering without curing the underlying disease. Connecting refers to the centrality of relationships in providing hospice care as the nurse seeks to understand the emotional and spiritual distress common to the end of life. Responsive use of self is the process expert nurses use to understand the lives of vulnerable clients in the community resulting in stereotypes and assumptions being overturned.

5. A community health nurse is presenting a program about hepatitis prevention and risk reduction to a local community group. The nurse determines that the group has understood the program when they identify which method as the major mode of transmission for hepatitis B? A) Oral-fecal route B) Exposure to contaminated blood C) Airborne droplet nuclei D) Infected rodents, such as mice and rats

: B Feedback: Hepatitis B can occur in certain high-risk groups, including injected drug users, heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal-oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is transmitted via infected rodents.

4. When evaluating a client's eligibility for Medicare-reimbursed home care, which of the following is crucial? A) The client needs visits by a homemaker. B) The client is homebound. C) The client is a veteran. D) The client is terminally ill.

: B Feedback: Homebound status is a requirement and means the person can only leave the home with difficulty and only for medical appointments or adult day care. Medicare requires that the recipient of reimbursable services need skilled services. The services of a homemaker are not considered a skilled service and are not a requirement for receiving services. There are no requirements that the client be associated with the military, either now or in the past. A client must be considered terminally ill to receive hospice services reimbursed by Medicare but not home health care—the person would just require skilled services.

17. A home health care nurse is assigned to visit a client's home. The nurse identifies the area as a problem neighborhood. Which of the following would be most appropriate for the nurse to do? A) Perform the visit via telephone B) Have another nurse buddy along C) Reschedule the visit for another time D) Leave the cell phone at home

: B Feedback: If there is a question of safety, the nurse should have another nurse accompany him or her on the visit. It would be inappropriate to perform the visit over the telephone. The nurse needs to physically see the client to perform the assessment. The agency typically has policies about how soon after a referral the client must be seen. So, rescheduling the visit may not be an option. In addition, rescheduling the visit does nothing to address the safety issues. The nurse should carry his or her cell phone but leave any valuables, such as cash, wallet, or purse locked in the care.

20. When describing the major functions of an occupational and environmental health nurse, which of the following would the nurse identify as being the most time consuming? A) Activities involving safety education B) Care of injured employees C) Programs for improved working conditions D) Teaching activities for healthy nutrition

: B Feedback: In addition to emergency care and nursing of ill employees, the activities of many industrial nurses involved safety education, hygiene, nutrition, and improvement of working conditions. Yet, a significantly high number of industrial injuries and sick employees kept many nurses too busy to do anything but care for the ill.

27. After discussing the effects of shift work on workers' health, the nurse educator knows that the nursing students understand this concept when the nursing students make which of the following comments? A) "It is beneficial for workers to have their circadian rhythms disturbed." B) "Rotating shifts negatively impacts sleep and rest cycles." C) "Shift work interferes with a person's social life." D) "Insufficient sleep is associated with respiratory problems and weight loss."

: B Feedback: Rotating shifts negatively impacts sleep and rest cycles. It is not beneficial for workers to have their circadian rhythms disturbed. Shift work may interfere with a person's social life but that is not a primary effect on health. Insufficient sleep is associated with obesity and diabetes.

5. Which one of the following statements best illustrates the similarities and differences between public health nursing and other types of nursing? A) The priorities are the same for both public health nursing and other types of nursing. B) In hospital nursing, nurses must address the issues that come to them. Whereas in public health nursing, it is necessary for the nurse to actively seek out and identify potential problems and situations. C) Nurses whose main practice is in the hospital are required to collaborate more effectively than public health nurses. D) Nurses who work in public health do not use the nursing process as a foundation for their work.

: B Feedback: In hospital nursing, nurses must address the issues that come to them. Whereas in public health nursing, it is necessary for the nurse to actively seek out and identify potential problems and situations. The priorities vary for both public health nursing and other types of nursing and certainly within different communities that a public health nurse practices. Nurses who work in public health must collaborate as must nurses who work in the hospital. However, the types of people and agencies that a public health nurse must collaborate with vary from the types of people and agencies that a hospital nurse must collaborate with. Nurses who work in public health use the nursing process as a foundation for their work, just as nurses who work in hospitals do. In public health nursing, the community is the client but the nursing process may also be applied to individuals and families.

6. Which of the following would be the most likely source of funding for services provided in a comprehensive primary care center? A) Government grants B) Medical insurance plans C) Another nurse-managed care center D) Private contracts

: B Feedback: In the comprehensive primary care centers, advanced practice nurses provide primary care services. Such services are usually reimbursable under Medicaid and managed care medical insurance plans. In wellness centers, public health nurses and other interdisciplinary team members provide a range of primary and secondary prevention strategies. These services are usually not reimbursed by insurance plans, but are often covered by grants and contracts. Often one nurse-managed care center partners with one or more nurse-managed care centers or other community based organizations to provide strength to the proposal for funding.

11. Which one of the types of services that may be available in a school-based health center may be controversial and not be supported by all parents and community members? A) On-site sexually transmitted infections testing and treatment B) On-site provision of contraceptives C) Well-child care D) Sick-child care

: B Feedback: Many school-based health centers do not provide contraceptive services on the school site because of school district policy or state law.

2. After a class describing the contributions of Florence Nightingale to epidemiology, the instructor determines that the class needs additional instruction when they state which of the following is associated with Nightingale? A) Establishment of the need for a clean environment B) A sophisticated coding system for medical conditions C) Proper wound cleansing and bandaging techniques D) Separation of infected individuals from those injured

: B Feedback: Nightingale's colleague, William Farr, is credited for developing a more sophisticated system for coding medical conditions. Nightingale's contributions included establishing the need for a clean environment, properly cleaning wounds and bandaging them, and separating infected soldiers from those who were injured.

4. Which of the following statements about the focus of nurse-managed health centers is most accurate? A) The focus is providing clinical experiences for nursing students. B) They are truly community oriented. C) They all have the same practice models. D) They only focus on health promotion and wellness.

: B Feedback: Nurse-managed health centers are truly community oriented. They may provide clinical experiences for nursing students but this is not their focus. They vary in practice models. They provide a range of services from health promotion and wellness to conventional primary care.

24. Which one of the following statements about the common roles and functions of public health nurses, school nurses, and corrections nurses is most accurate? A) Emphasis is placed on the treatment of disease and disability. B) Nurses in all of these areas serve the population as client as opposed to individuals as clients. C) All of these specialty nursing fields are paid very well because their setting is supported through public funds. D) Public health nurses can influence the health of vulnerable populations more than any of the other specialties.

: B Feedback: Nurses in all of these areas serve the population as client as opposed to individuals as clients. Emphasis is placed on prevention of disease or disability. These community nurses all work in settings that are supported by public funds but the amount of pay varies. All of these specialties of nursing can influence the health of vulnerable populations.

11. A community health nurse instructs a local community group on how to prepare homemade oral rehydration solution. Which of the following ingredients would the nurse include? A) Sea water B) Table salt C) Baking soda D) Crushed bananas

: B Feedback: Oral rehydration solution consists of 1 L of safe water to which is added half small teaspoon of salt, and four large spoons of sugar. In addition, bananas or green coconut water are encouraged to compensate for the loss of potassium.

1. An instructor is discussing the worldwide distribution of AIDS. Which term would the instructor use to describe this situation? A) Epidemic B) Pandemic C) Endemic D) Pathogenicity

: B Feedback: Pandemic is the term used to describe an epidemic that is distributed worldwide. An epidemic refers to a disease occurrence that clearly exceeds the normal or expected frequency in a community or region. Endemic is used to describe the continuing presence of a disease or infectious agent in a given geographic area. Pathogenicity refers to an agent's capacity to cause disease in a host.

11. A community health nurse is working with the local health departments to educate the citizens about the effects of radon exposure and its link to possible illness. Which of the following would the nurse identify as being a major health concern associated with radon? A) Skin cancer B) Lung cancer C) Diarrhea D) Cardiovascular disease

: B Feedback: Radon is a leading cause of death from lung cancer. Skin cancer is associated with sun exposure. Diarrhea and cardiovascular disease are not associated with radon exposure.

2. A nurse is considering a career in public health nursing. The nurse determines the need to obtain which of the following for entrylevel practice? A) Associate's degree in nursing B) Bachelor's degree in nursing C) Master's degree in nursing D) Post-master's degree certification

: B Feedback: The American Nurses Association recommends that an entry-level PHN should have a bachelor's degree in nursing. Some states, such as California, require nurses to take additional classes and obtain certification beyond a bachelor's degree if the BSN program does not offer specific content (e.g., child abuse, public health didactic and practicum). PHNs working with specific populations, or in administration, should hold a master's degree. A PHN with a master's degree in community/public health nursing may take a national certification examination offered by the American Nurses Credentialing Center.

13. Which of the following agencies was instrumental in developing the first Scope and Standards of Parish Nursing Practice? A) International Parish Nurse Resource Center B) Health Ministries Association C) American Nurses Association D) Parish Nurse Institute

: B Feedback: The Health Ministries Association provides additional resources and support for faith community nursing practice and was instrumental in developing the first Scope and Standards of Parish Nursing Practice. The International Parish Nurse Resource Center, formed in the 1980s, has provided educational programs and resources for nurses seeking to practice as a parish nurse for over two decades. The American Nurses Association in conjunction with the Health Ministry Association has developed the Scope and Standards of Practice for this field of nursing. The Parish Nurse Institute is an organization dedicated to the education and support of registered nurses who wish to practice nursing as Parish Nurses or Faith Community Nurses.

7. A home health care nurse performs an initial visit to a client and determines that the client meets the criteria for services with Medicare reimbursement. The nurse understands that this service will be reimbursed for which period? A) 30 days B) 60 days C) 90 days D) 120 days

: B Feedback: The Medicare prospective payment system (PPS) pays an agency for a 60-day "episode of care." All services and many medical supplies must be provided under the payment amount adjusted to geographic location and determined by the client's clinical and functional status at the start of care, as well as the projected need for services over the anticipated 60-day period.

24. Which one of the following Medicare policies prevent people who could benefit from hospice services from receiving those services, even when it would be most cost- effective for the client to receive hospice rather than inpatient interventions? A) Controlled cost at the expense of assuring quality of life and comfort B) That a person must discontinue treatment in order to receive hospice service. C) Education and support for clients and family caregivers D) Refusing to pay for homemaking and personal care that might keep a person at home as long as possible

: B Feedback: The Medicare requirement that patients receiving hospice benefits must have discontinued treatment in order to receive hospice service. It is not appropriate for there to be controlled cost at the expense of assuring quality of life and comfort. Education and support for clients and family caregivers is important, and homemaking and personal care might keep a person at home as long as possible that would reflect a cost savings in the long run.

12. During a class, an instructor reviews the impact of the Supreme Court decision regarding Estelle v. Gamble. The instructor determines that the students understand the material when they identify which of the following about this decision? A) It created the need for cleaner, less crowded facilities. B) It led to major reforms including establishment of inmates' rights. C) It required the use of managed care organizations for service. D) It mandated care to be provided in a timely fashion.

: B Feedback: The Supreme Court ruled that not providing medical services inflicted pain and denied inmates of their Eighth Amendment rights. This decision led to major reforms in the corrections health system. Medical providers were hired and inmates' rights were established. The decision did not address facilities or use of managed care organizations. Treatment in a timely fashion was not part of this decision. However, later lawsuits involve this issue.

25. Which of the following statements regarding WHO Collaborating Centers is most accurate? A) One or two Regional Nursing Advisors carry out the work of a region that might be the home to thousands of nursing personnel. B) The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas. C) It is referred to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles. D) It focuses on professional issues to support the development of particular health-related practitioners.

: B Feedback: The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas. Regional Nursing Advisors work in collaboration with WHO Collaborating Centers to accomplish the work within each region. Primary Health Care is referred to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles.

24. Which of the following statements about the World Health Organization is accurate? A) The World Health Organization does not provide technical support for interventions or provide assistance developing nursing knowledge and skills. B) The World Health Organization can help a member state determine the drugs that are essential and will assist in developing health policy, project plans, and programs. C) The World Health Organization provides medicines and other tangible resources to its member states. D) The World Health Organization focuses on professional issues to support the development of particular health-related practitioners, such as nurses.

: B Feedback: The World Health Organization can help a member state determine the drugs that are essential and will assist in developing health policy, project plans, and programs. The World Health Organization does focus on providing technical support related to the interventions and provides assistance developing nursing knowledge and skills. The World Health Organization does not provide medicines and other tangible resources to its member states but does help member states determine the drugs that are essential and assist in developing health policy, project plans, and programs.

13. While visiting a family's home, the community health nurse finds out that the two children in the home were exposed to chickenpox. Assessment of the children reveals no signs of fever or lesions. The nurse determines that the children may be in which stage of the disease? A) Susceptibility B) Subclinical disease C) Clinical disease D) Resolution

: B Feedback: The children have been exposed but have not yet developed the signs of chickenpox. Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is not present and individuals have not been exposed. During the clinical stage, signs and symptoms are beginning to develop. During the resolution stage, the disease causes sufficient anatomic or functional changes to produce recognizable signs and symptoms.

19. An instructor in community health nursing teaches a group of students about the role of the World Health Organization and global health, reviewing the importance of the Declaration of Alma-Ata. The instructor determines that the students have grasped the importance when they describe it as which of the following? A) The beginning of the Carter Center's work in disease prevention and agriculture B) A formal document written by 134 nations in 1978 to achieve "health for all" C) Participatory development activities, working in partnership with voluntary organizations D) Alliance building and communicating best practices for global health development

: B Feedback: The declaration represents the work of 134 nations during a WHO/UNICEF conference in 1978 to achieve primary health care for all. The Carter Center was founded in 1986 and is not related to the work at Alma-Ata. Participatory development activities describe the work of the United States Agency for International Development (USAID). Alliance building and communicating best practices describe the Global Health Council, which is a leading private, voluntary, American nongovernmental organization.

3. Which of the following concepts is used by public health professionals to illustrate that the determinants of health interact to affect health? A) Precautionary principle B) Ecological perspective C) Sustainability D) Upstream focus

: B Feedback: The ecological perspective is used by public health professionals to illustrate that the determinants of health interact to affect health. The precautionary principle states that in the absence of clear data that indicates the safety of an action, chemical or material that poses a threat to human health, it should not be used. Sustainability is "the ability to meet the needs of the present without compromising the ability of future generations to meet their own needs." Upstream focus identifies the root causes of disease and manufacturers of illness.

16. A faith community health networks with a local transportation service to provide service to several clients in the community needing rides to health care appointments. The nurse is functioning in which of the following roles? A) Developer of support groups B) Referral agent C) Advocate D) Health counselor

: B Feedback: The faith community health (FCN) nurse functions as a referral agent through networking with community agencies to assist and guide the client through the health care system and connect the client with needed community resources. As a developer of support groups, the faith community nurse develops groups tailored to the faith community needs such as coping with loss and grief, cancer, caregiver stress, chronic illness, single parenting, addiction recovery, and more. The FCN may lead or facilitate the support groups or may train others to fulfill those positions. As an advocate, the FCN uses knowledge of the health care system and awareness of safe and effective care practices to facilitate appropriate, timely intervention. In the health counseling role, the nurse seeks to understand the individual's perceptions, fears, and barriers that prevent the person from taking action.

4. Which of the following statements about an upstream focus is the most accurate? A) The upstream approach does not focus on socioeconomic factors and the environmental origins of disease and health problems. B) The focus of an upstream approach is the institution and system level. C) The upstream approach pertains to the purity of water supplies. D) The focus of an upstream approach is healthy lifestyle issues.

: B Feedback: The focus of an upstream approach is the institution and system level, and not just healthy lifestyle issues. The upstream approach does focus on socioeconomic factors and the environmental origins of disease and health problems. The upstream approach does not pertain to the purity of water supplies.

5. After teaching a class about family and domestic violence directed toward children as a community health problem, which of the following if stated by the class indicates to the instructor that the teaching was effective? A) Family violence is new and occurs as a result of our fast-paced technological society. B) Family violence has occurred in most countries for centuries as children have been thought of as the property of their parents. C) Family violence occurs mostly in the urbanized areas of the United States mostly in the urbanized areas where exposure to crime is more prevalent. D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

: B Feedback: The history of family and domestic violence is long. For centuries, children were thought of as the property of their parents, and any treatment doled out by the parents was their prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned and begun to do something about family violence. Family violence is brought to the attention of officials more frequently today than in yesteryear, especially in urban areas where more people live, but it occurs throughout the world—in urban, rural, and remote areas with no signs of decreasing. Family violence in the United States occurs mostly in the urbanized areas where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

16. A school nurse is describing the responsibilities associated with this specialty to a group of students. Which of the following would the school nurse identify as a primary responsibility? A) Providing care to children with special health needs B) Preventing illness among the school community C) Performing health screenings D) Assessing acute health problems

: B Feedback: The primary responsibilities of the school nurse are to prevent illness and to promote and maintain the health of the school community. The school nurse serves not only individuals, families, and groups within the context of school health but also the school as an organization and its membership (students and staff) as aggregates. Caring for children with special health needs, performing health screenings, and assessing acute health problems are aspects associated with the primary responsibilities of preventing illness and promoting and maintaining the health of the school community.

8. The nurse is examining the possibility that multiple factors are involved in the development of a disorder. The nurse is applying which of the following? A) Chain of causation B) Web of causation C) Strength of association D) Temporality

: B Feedback: The web of causation is being used to apply the concept of multiple causes to explain the existence of health and illness states. It was a refinement of the chain of causation, such that it looked at the combination of multiple factors as implicated in the development of poor outcomes. The chain of causation focuses on one factor in the development of a condition. The strength of association is an element of causation in noninfectious disease that refers to the ratio of disease rates in those with and without the causal factor. Temporality, also involved with the causation of noninfectious disease, is an element in which the exposure to the suspected factor must precede the onset of the disease.

14. Faith community nurses engage in seven diverse nursing roles. Which one of the roles is distinctly unique to faith community nursing? A) Advocate B) Integrator of faith and health C) Coordinator of volunteers D) Developer of support groups

: B Feedback: To achieve the goal of faith community nursing, seven diverse nursing roles are central to incorporate into practice: Health educator, health counselor, advocate, referral agent, developer of support groups, coordinator of volunteers, and integrator of faith and health. A distinctly unique role of the FCN is as integrator of faith and health.

11. The nurse educator has just discussed education of aggregates using mass media with targeting health messages. Which of the following statements by the nursing student would demonstrate the student's ability to analyze and apply the information? A) Television would be the most important venue of mass media to educate the aggregate as everyone has a television. B) The target audience must be assessed for educational level, salience of the issue, involvement in the issue, and access to the media channel used. C) Pamphlets should be assessed to make sure they are at a twelfth grade reading level. D) It is unnecessary to consider culture when planning the health message.

: B Feedback: To effectively deliver a health promotion and disease-prevention message, the message must reach the target (at-risk) population. This requires correct identification of the characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and access of the target audience to the media channels used. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease- prevention message to ethnic and racial minority groups. Television may not be the most important venue of mass media to educate the aggregate. Pamphlets may not be the best way to educate the aggregate, and the reading level of any literature must be specific for the target audience. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease- prevention message to ethnic and racial minority groups.

12. A group of families are attending a local community group for a class on Internet safety and children. Which of the following statements by the group indicates effective teaching? A) "It's not so much the time they spend but the sites they use." B) "We'll move the computer to the family room so we can easily observe the child's internet use." C) "We'll set the Internet browser feature to medium." D) "The firewall program that we have from 2 years ago should still be good."

: B Feedback: To promote Internet safety with children, the computer should be placed in a high traffic area in the home so that others can easily observe what is going on. Parents need to monitor the time as well as the sites that the child uses. The Internet security browser should be set to high. With the advances in technology, a firewall program that is 2 years old may not be adequate to protect the child. However, it would be better than no firewall program at all.

16. When discussing elder abuse with a senior citizen group, which of the following would the community health include? A) Older men experienced abuse at a higher rate than elderly women. B) Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. C) The majority of cases of elder abuse are perpetrated by persons unknown to the victim. D) Elders with dementia are less likely to be abused since they have less social interactions.

: B Feedback: Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder abuse may be either known or unknown to the elder. Some elders are especially vulnerable to elder abuse.

20. A corrections nurse is proactively working with the institution to develop programs for the facility to address problems to address the trends for the future. Which type of program would be most appropriate for the nurse to recommend? A) Treatment of typical disorders found in younger inmates B) Dealing with older, sicker, and longer periods of incarceration for many inmates C) Clinics to address acute disease conditions D) Education for release after shorter incarcerations

: B Feedback: Typically, inmates are older, sicker, and remain in prison longer than in previous years. Therefore, the nurse would need to develop programs to address older inmates with more chronic illnesses and longer incarcerations.

13. immunization is true? A) The World Health Organization estimates that a billion more lives could be saved each year with immunizations. B) Vaccines are one of the most cost-effective interventions found in public health. C) Half of the world's children are being reached with essential vaccines. D) In the United States, toddlers are thoroughly vaccinated.

: B Feedback: Vaccines are one of the most cost-effective interventions found in public health. The World Health Organization estimates that 3 million more lives could be saved each year with immunizations. Three fourths of the world's children are being reached with essential vaccines. In the United States, only 10% of toddlers are protected against measles, mumps, and rubella via vaccinations.

1. A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which of the following as developmental crises? Select all that apply. A) A windstorm that damaged 20 homes in a community B) Grandpa Jones dying at age 82 years C) A couple getting engaged D) The Smiths getting a divorce E) The Jones experiencing a home invasion F) Seven people dying in an automobile crash

: B, C, D Feedback: Developmental crises are periods of disruption that occur at transition points during normal growth and development. Developmental crises, as a rule, do not occur suddenly. They are more evolutionary than revolutionary. Even the advancing, age, illness, or death of a grandparent or parent is a developmental expectation. However, the actual event may occur suddenly. Experiencing damage from a windstorm, a home invasion, or an automobile crash are situational crises.

15. A school nurse who is not a nurse practitioner works in an elementary school (K-4) with 1,200 students. Which of the following would the nurse engage in with this group? Select all that apply. A) Screening for scoliosis B) Vision and hearing screening C) Teaching basic health practices D) Monitoring chronic illnesses E) Ordering medications F) Providing primary care

: B, C, D Feedback: Vision and hearing screening, teaching basic health practices, and monitoring chronic illnesses are appropriate school nurse activities for children in this age group. Scoliosis screening would be more appropriate for children in their early adolescent growth spurt years, not at this age. A school nurse would not order medications. A school nurse practitioner would provide primary care and if allowed by the state, prescribe medications.

18. Which of the following are the main categories of occupational health nursing practice? Select all that apply. A) Safety B) Compliance C) Health promotion D) Care

: B, C, D Feedback: Occupational health nursing practice can be divided into three main categories: compliance, care, and health promotion.

10. Community health nurses practice within the three levels of prevention. Which of the following would the community health nurse engage in at the primary level of prevention for communicable disease control? Select all that apply. A) Providing TB skin test to children entering kindergarten B) Administering immunizations to senior citizens C) Teaching kindergarten students to wash their hands D) Encouraging parents to complete their children's immunizations E) Providing chest x-rays to people with positive TB skin tests F) Administering prompt treatment for the symptoms of gonorrhea

: B, C, D Feedback: Primary prevention interventions include administering immunizations, teaching about hand washing, and encouraging adherence to the recommended schedule for childhood immunizations. Providing TB skin testing and chest x-rays, and promptly treating symptoms of gonorrhea are examples of interventions at the secondary level of prevention.

3. When describing the differences between public health nursing and nursing in general, which of the following would an instructor include as characteristic of public health nursing? Select all that apply. A) Acute care services B) Focus on the greater good C) Seek out of clients in need D) Community commitment E) Health restoration

: B, C, D Feedback: Public health nurses focus on the greater good, seek out clients in need, and are committed to the community. Public health nursing is grounded in social justice and focuses on health promotion and disease prevention. Public health nursing does not usually include acute care services or health restoration.

15. Which of the following are factors that influence populations' perceptions of health and health status and their receptivity to community health nursing programs? Select all that apply. A) Their perceptions of healthy food B) Their attitudes toward women C) Their culture D) Their belief systems E) Their geographic location

: B, C, D Feedback: The factors that influence populations' perceptions of health and health status and their receptivity to community health nursing programs include their attitudes toward women, their culture, and their belief systems. Their perceptions of healthy food or their geographic location would not have a direct bearing on their perception of health and health status or receptivity to community health nursing programs.

9. Which of the following statements about modes of transmission are true? Select all that apply. A) Direct transmission requires contact with a contaminated inanimate material. B) Indirect transmission is also known as vehicle-borne illness. C) Food- and water-related illnesses are considered to be spread by indirect transmission. D) Vector transmission requires contact with a nonhuman carrier such as an animal or insect. E) Airborne transmission commonly occurs from coughing and sneezing.

: B, C, D, E Feedback: Direct transmission occurs by immediate transfer of infectious agents from a reservoir to a new susceptible host. Indirect transmission requires contact with a contaminated inanimate material and is also known as vehicle-borne illness. Food- and water-related illnesses are considered to be spread by indirect transmission. Vector transmission requires contact with a nonhuman carrier such as an animal or insect. Airborne transmission commonly occurs from coughing and sneezing.

13. Which of the following health conditions would the corrections nurse expect to address as most prevalent? Select all that apply. A) Heart disease B) Tuberculosis C) Hepatitis C D) Asthma E) Substance abuse

: B, C, E Feedback: Communicable diseases such as tuberculosis and Hepatitis C are of great concern in the correctional community. In addition, drug abuse by inmates is very high. Heart disease and asthma rates vary.

17. Which of the following is true about incidence and prevalence? Select all that apply. A) Prevalence is the number of new cases of a disease or health condition. B) Incidence is the number of new cases of a disease or health condition. C) Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. D) Incidence refers to all of the people with a particular health condition existing in a given population at a given point in time. E) When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

: B, C, E Feedback: Incidence is the number of new cases of a disease or health condition. Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

17. A school nurse is reviewing the population of school age children for chronic conditions. Which of the following would the school nurse expect to find most often? Select all that apply A) Rheumatoid arthritis B) Asthma C) Diabetes D) HIV/AIDS E) Tuberculosis F) Seizures

: B, C, F Feedback: The four chronic conditions most often seen in school-age children are asthma, diabetes, seizures, and severe food allergies. Rheumatoid arthritis is not as common. HIV/ AIDS and tuberculosis are more commonly seen in correctional settings.

8. A community health nurse is teaching a group of clients about infection control and mentions the role of vectors in transmitting diseases. Which of the following would be examples of some common vectors? Select all that apply. A) Chemicals B) Mosquitoes C) Salmonella D) Fleas E) Roaches

: B, D, E Feedback: A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not vectors and Salmonella is an infectious agent.

7. The nursing student is preparing a report for class relating to Healthy People 2020 and environmental health. Which of the following should be included in this report? Select all that apply. A) The agency that prepared this initiative is the World Health Organization. B) The overall goal is to "promote health for all through a healthy environment." C) The document provides instructions for persons in the community regarding how to protect their own health. D) One of the six focus areas is global environmental health. E) The document provides guidance for nurses to identify targets for health.

: B, D, E Feedback: The overall goal of Healthy People 2020 is to "promote health for all through a healthy environment." The document does provide guidance for nurses to identify targets for health (not instructions for individuals). The six areas that are focused on include outdoor air quality, surface and ground water quality, toxic substances and hazardous wastes, homes and communities, infrastructure and surveillance, and global environmental health. The agency that prepared this initiative is the U.S. Department of Health and Human Services.

22. epidemiologic study from the first step to the last. A) Collect the data. B) Identify the problem. C) Analyze the findings. D) Disseminate the findings. E) Review the literature. F) Develop conclusions and applications. G) Design the study.

: B, E, G, A, C, F, D Feedback: The proper order of the steps in the epidemiologic study from the first step to the last is to identify the problem, review the literature, design the study, collect the data, analyze the findings, develop conclusions and applications, and disseminate the findings.

1. A community health nurse is presenting an in- service for a group of other community health nurses about ecological perspective of environmental health. Which of the following would the nurse incorporate into the program when describing this concept? A) The study of governmental and private sector regulations of the environment B) A technological view of strategies for preventing illness and injury C) Identification of not only the physical environment but also the social and cultural factors that exist for populations D) The role of the community health nurse in preventing injury, disease, and illness

: C Feedback: The ecological perspective identifies not only the physical environment but also the social and cultural factors that exist for populations. Nurses who display this type of approach provide a more comprehensive level of care. It is not a study of the governmental and private sector regulations, a technological view, or the nurse's role in preventing injury, disease, and illness.

1. After reviewing the history of nurse-managed health centers, the instructor determines that the teaching was successful when the students identify which of the following as the beginnings of today's model? A) 1920s B) 1940s C) 1960s D) 1980s

: C Feedback: Today's NMHCs trace their roots to changes in national health care laws begun in the mid-1960s. However, the nursing model of holistic care focusing on vulnerable populations and integrating primary care and public health dates back to the 19th century.

15. Which of the following would a community health nurse expect to assess in a perpetrator of intimate partner violence? A) Occasional marijuana use B) High academic achievement C) Belief in male dominance D) Desire for complacency

: C Feedback: Characteristics of perpetrators of intimate partner violence include a belief in strict gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement, and desire for power and control in relationships.

21. A corrections nurse is visiting a local nursing school to describe this career. Which of the following would the nurse include in the discussion? A) Lower salaries than other fields B) Primarily assessment oriented C) Extensive employee benefits D) Low safety risk

: C Feedback: Salaries depend upon the state, although they tend to be higher salaries than in other nursing fields. Moreover, corrections nurses usually receive extensive employee benefits and insurance packages as government employees. Corrections nurses must have good mental health and assessment skills. They must be able to communicate well and be strong nursing advocates and strong advocates for their clients. They work in an intense environment where their safety could be threatened, and they must deal with clients who may be noncompliant, combative, and manipulative. Corrections nurses must also be very flexible and knowledgeable about a variety of nursing specialties.

9. The core public health function of policy development related to environmental health includes which one of the following? A) Policy development is best left to legislators. B) To be an effective advocate for change, it is only necessary that the nurse speak out. C) There are many ways for public health nurses to participate in policy development related to environmental health. D) Public health nurses are public servants and therefore cannot advocate for public policy.

: C Feedback: There are many ways for a public health nurses to participate in policy development related to environmental health that start with the nurse being informed about the hazards in the community, existing legislation that protects people in the community, and governmental and nongovernmental groups in communities that can be partners in the efforts to protect health. They may write letters to their legislators, inform community members, and write letters to the editors of local newspapers and periodicals. Nurses can also present testimony at public forums or hearings. Policy development is not best left to legislators. It is important for nurses to advocate for policy development to care for the environment. Public health nurses are public servants and that is why they must advocate for policy development that favors the environment.

11. A community health nurse assesses a child during a home visit. Which of the following would lead the nurse to suspect that the child is a victim of sexual abuse? A) Bruising of the arms and back B) Evidence of numerous dental caries C) Complaints of pain on urination D) Burns on the hands and feet

: C Feedback: A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising on the arms and back and burns on the hands and feet would suggest physical abuse. Numerous dental caries may suggest neglect.

12. A community health nursing instructor is developing a class plan about faith community nursing for a group of community health nursing students. Which of the following would the instructor expect to include? A) One of the oldest nursing specialties B) One of the newest means of health care delivery C) Diversity in activities and interventions D) Differences from parish nursing

: C Feedback: Activities and interventions used by faith community nurses are as diverse as their faith communities. Faith community nursing is one of the newest nursing specialties and one of the older means of health care delivery. Nurses practicing in the faith community may be referred to a faith community nurses (FCN), parish nurses, health ministry nurses, or congregational nurses depending upon preference and the traditions of the faith community.

9. The nurse is reviewing a research article that describes the use of the bacille CalmetteGuerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to leprosy. The individuals did not develop the leprosy. The nurse interprets this as most accurately demonstrating which type of immunity? A) Herd immunity B) Passive immunity C) Cross-immunity D) Active immunity

: C Feedback: Cross-immunity refers to a situation in which a person's immunity to one agent provides immunity to a related agent as well. This immunity can be active or passive. Herd immunity describes the immunity level present in a population group. Passive immunity refers to shortterm resistance acquired naturally or artificially. Active immunity is long-term and can be acquired naturally or artificially.

6. Assessment of a client in the home reveals that his or her services will be paid by a government source. Which of the following would be a possible source of payment? A) Insurance company B) Health maintenance organization C) Medicare D) Preferred provider organization

: C Feedback: Government payers include Medicare, Medicaid, the military health system (TRICARE), and the Veterans Administration system. Corporate payers include insurance companies, health maintenance organizations (HMOs), preferred provider organizations (PPOs), and case-management programs.

14. If an agency discards used needles and syringes in plastic milk jugs, which of the four key elements of an infectious waste management program that are applicable to community practice would the agency be violating? A) Health professionals must be able to correctly distinguish biohazardous waste from biomedical waste. B) The waste management program must have administrative support and authority to institute practice guidelines. C) Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture. D) An enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

: C Feedback: Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture; they should have sufficient strength to prevent rupture or tearing under normal conditions; and they should be sealed to prevent leakage. Containers for sharps must also be puncture resistant. Other key elements of an infectious waste management program that are applicable to community practice include that health professionals must be able to correctly distinguish biohazardous waste from biomedical waste; the waste management program must have administrative support and authority to institute practice guidelines; and an enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

25. Which of the following about the educational preparation for occupational and environmental health nursing is most accurate? A) Any licensed nurse can provide the services necessary. B) Because it is a specialty of nursing, a Bachelor's degree in nursing is required. C) Ideally, a nurse would be prepared for these specialties at the graduate level. D) This career option is restricted to advanced practice nurses.

: C Feedback: Ideally, a nurse would be prepared for these specialties at the graduate level. It is a minimum requirement that the nurse be licensed but there is a special knowledge set and skill set required for this position. A Bachelor's degree in nursing is not required for this job but would be a good start. This career option is not restricted to advanced practice nurses.

17. Which of the following statements about immunization is most accurate? A) Immunization is helpful in the spread of all communicable diseases. B) Immunization cannot provide herd immunity. C) Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. D) Immunization is the process of administering antibodies to a person.

: C Feedback: Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. There are many communicable diseases that a vaccine is not known for. Immunization can help to promote herd immunity. Immunization does not involve the administration of antibodies to a person.

7. Which of the following criteria must a nurse- managed health center meet to ensure designation as a Federally Qualified Health Center? A) Located in a densely populated area B) For profit status C) Consumers comprise the majority of the board of directors. D) Care provision to women and children exclusively

: C Feedback: In order to qualify, the centers must: be located in a medically underserved area or serve a medically underserved population; have a nonprofit, tax exempt, or public status; have a board of directors, a majority of whom must be consumers of the center's health services; provide culturally competent, comprehensive primary care services to all age groups; and offer a sliding scale fee and provide services regardless of ability to pay.

10. Which party is usually required to describe detailed plans for sustainability after the award period ceases? A) The client B) The funder C) The providing organization D) The insurer

: C Feedback: In the past, funders were often confronted with the task to help organizations find and secure other resources, or extend their own financial support, to ensure the continuity of services. More recently, both public and private funders are stipulating that organizations describe detailed plans for sustainability after the award period ceases in their application submitted for funding.

6. After teaching a group of students about abuse and families, the instructor determines that the students have an understanding of this issue when they state which of the following? A) Less than 10% of women worldwide reported being physically abused by an intimate partner at some point in their lives. B) A woman's risk of intimate partner violence decreases during pregnancy, but increases once the baby is born. C) Intimate partner violence is a leading cause of morbidity and mortality in women worldwide. D) Intimate partner violence is a private matter and not a public health issue

: C Feedback: Intimate partner violence is a leading cause of morbidity and mortality in women worldwide and is a public health issue. It is estimated that between 10% and 52% of women report being physically abused by an intimate partner at some point in their lives worldwide. A woman's risk of intimate partner violence increases during pregnancy with 44% to 48% of all women being abused at least once during the pregnancy.

18. A home health care nurse is invited as a guest speaker to talk to a group of students about challenges of working in the home. As part of the discussion, the nurse describes medication safety. Which of the following would the nurse include as a measure to address this issue? A) Asking the client what he or she takes the drug for B) Throwing out any medications over 1 month old C) Reconciling drugs in the home with those on the discharge sheet D) Setting up medication boxes to organize the medications

: C Feedback: It is important for the home health care nurse to reconcile the medications in the client's home with those on the discharge sheet. If there are any discrepancies, then the nurse should contact the client's primary care physician to clarify any differences and confirm the orders. Asking the client what he takes the drug for provides limited information. The nurse needs to know if he or she is taking it currently, and if so, the frequency and dosage. Throwing out any medications that are over 1 month old is inappropriate. A medication may have been ordered previously but was inadvertently missed on the discharge sheet. The nurse must always double check the order and with the physician about any medication. Setting up medication boxes are helpful to organize the medications, but the nurse still needs to verify that the client should be taking the medication.

9. A home health care nurse is working with informal caregivers. Which of the following is most important? A) Include the client's spouse or significant other in the plan B) Visit frequently to manage and maintain equipment C) Focus on caretaker abilities, not their limitations D) Use nurse's intuition to determine what to teach first

: C Feedback: Keeping a positive attitude that is focused on abilities, not limitations, of the caregivers is most important. The home health care nurse includes all family members and caregivers in the plan, teaches family members and caregivers how to manage and maintain equipment, and chooses an area to teach first that the client or caretaker is motivated to learn.

1. The nurse educator knows that the nursing student understands the contributions that Lillian Wald made to home care when the nursing student makes which one of the following statements? A) "Lillian Wald made the earliest known effort to care for the sick poor at home." B) "Lillian Wald trained nurses so that wealthy women would hire them as visiting nurses." C) "Lillian Wald began home visiting in New York City and is famed for professionalizing visiting nurses." D) "Lillian Wald approached congress with the idea of Medicare Home Health Benefit."

: C Feedback: Lillian Wald began home visiting in New York City and is famed for professionalizing visiting nurses. It was the Ladies Benevolent Society in Charleston, South Caroline who made the earliest known efforts to care for the sick at home. It was Florence Nightingale who trained nurses so that wealthy women would hire them as visiting nurses. Lillian Wald did establish insurance coverage for home care with the Metropolitan Life Insurance Company but this was in the early 1900s and the Medicare Home Health Benefit did not exist until 1965.

19. The community health nurse observes an increase in the development of multidrugresistant tuberculosis. The nurse understands that a major reason for this occurrence for individual clients would most likely be A) political and social response to declining rates of TB over the past decade. B) a reduction in funding for surveillance and research. C) noncompliance with the therapy for the full, recommended period. D) a premature sense that TB has been defeated.

: C Feedback: On an individual case basis, the most common means by which resistant organisms are acquired is by noncompliance with therapy for the full, recommended period. Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include the political and social response to declining rates of TB over past decades, which has resulted in funding cuts for surveillance, treatment, and research, and a premature sense that TB was defeated.

11. When visiting a client in the home for the first time, which of the following is absolutely critical to remember? A) There may be dangers lurking around every corner. B) Clients are glad to have the nurse in their home. C) The nurse is a guest in the client's home. D) The nurse knows what is best for the client.

: C Feedback: Once the nurse arrives at the client's home, there is the challenge of getting through the closed door and making the connection. The nurse must always remember that he or she is a guest in the home. Although there may be dangers, the nurse must focus on the client while maintaining a watchful eye. Clients may be apprehensive or suspicious about a nurse coming to visit, wondering why or what they did. Not all clients are welcoming. The nurse needs to start where the client and family are, not what the nurse thinks is best.

16. A community health nurse would recommend pneumococcal vaccine for which group? A) 1-year-old children B) 30-year-old adults who have simple respiratory tract infections C) Adults over age 65 who have COPD D) Healthy adults in their 50s

: C Feedback: Primary prevention includes a pneumococcal vaccine, especially for the high-risk groups, ages 2 years old and up, including those with chronic diseases, immune-suppressing health conditions, or those who are asplenic. Reimmunization is recommended only for high-risk children, or adults over 65 years old who had their first vaccination before age 65. The vaccine is not effective in children younger than 2 years of age and is not recommended for the healthy population between the ages of 2 and 65 years.

3. Which one of the following statements about primary prevention for family violence is most accurate? A) The cycle of violence within the family cannot be interrupted. B) Persons who have been victims of family violence will repeat the behavior with others. C) Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. D) It is not possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

: C Feedback: Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. The cycle of violence within the family can be interrupted, and persons who have been victims of family violence can learn to use more appropriate coping strategies. It is possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

3. When applying the epidemiologic triad model to a community's plan of care, which of the following would the community health nurse address? A) Incidence, prevalence, and case fatality B) Health, illness, and injury C) Host, agent, and environment D) Immunity, causation, and risk

: C Feedback: The purpose of this model is to demonstrate the relationship among host, agent, and environment. Each component has to be present to a certain degree in order for any disease, illness, or injury to exist or happen. If one component is missing, illness or injury will not occur. Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are terms used in epidemiology but do not refer to the epidemiologic triad model.

10. A community health nurse is advocating for the development of school-based health centers in the community high schools as a means to accomplish which of the following? A) Maintain the current absentee rate B) Provide contraceptive services C) Increase ready access to health care services D) Promote increased use of emergency services

: C Feedback: School-based health centers (SBHC) provide ready access to health care for large numbers of children and adolescents during school hours, reducing absences from school due to health care appointments. SBHCs provide a variety of services in a user-friendly manner at a convenient location. Many SBHCs do not provide contraceptive services on the school site due to school district policy or state law. These centers also are a cost-effective way to decrease visits to the emergency department.

9. After discussing nurse-managed care centers with a group of community health nursing students, the instructor determines that the teaching was effective when the students identify which of the following as one of the main challenges? A) Ensuring adequate populations for services B) Exerting a positive influence on community's health C) Continuing services after funding has stopped D) Managing the multitude of services provided

: C Feedback: Sustainability, or the ability to carry on services and health promotion activities when funding is no longer available, is one of the main challenges of NMHCs. The populations served are vast and not predicted to decrease in light of the current status of health care. Nurse-managed health centers have much to offer toward resolving the national health care crisis facing vulnerable populations who are uninsured or underinsured and exerting a positive influence on the community's health. Management of the multiple services may be challenging, but the sustainability of the center is paramount.

20. After teaching a group of students about hospice and its view of end-of-life care, which statement by the students indicates a need for additional teaching? A) Care should attend to the body, mind, and spirit. B) Death is not considered a taboo topic. C) Medical technology should be used widely. D) Clients have a right to truthful discussion.

: C Feedback: The hospice movement has emphasized four major changes in end-of-life care: (1) care should attend to body, mind, and spirit; (2) death must not be a taboo topic; (3) medical technology should be used with discretion; and (4) clients have a right to truthful discussion and involvement in treatment decisions.

23. When implementing an epidemiologic research study, which of the following would the community health nurse complete as the final step? A) Analyze the data B) Design the study C) Disseminate findings D) Review the literature

: C Feedback: The last step in the research process is to disseminate the findings. After identifying the problem and reviewing the literature, the researcher designs the study, collects the data, analyzes the findings, and develops conclusions and applications.

1. When reporting the identification of a communicable disease and need for investigation, which of the following must be notified first? A) Centers for Disease Control (CDC) B) State health department C) Local health department D) National Reported Disease list

: C Feedback: The local health department is the initial point of notification of a communicable disease investigation. Each local health department or agency will investigate the specific disease. The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as the guidance for State reportable diseases.

7. When reviewing statistics about illnesses worldwide, which of the following would the nurse identify as the most common and a leading cause of mortality? A) Tuberculosis B) Smallpox C) Acute respiratory tract infection D) Infectious diarrheal disease

: C Feedback: The most common illness in the world and a leading cause of mortality is acute respiratory tract infection (ARI). Three million deaths annually are attributed to ARI among children younger than 5 years of age, usually from pneumonia. Tuberculosis is considered epidemic today. Smallpox has been eradicated. Infectious diarrheal disease has been reduced due to oral rehydration therapy and improvements in water and sanitation.

2. After reviewing the various events associated with the history of home health care, the students demonstrate understanding of the events when they state which of the following as the most significant influence on the growth of home care agencies? A) Creation of the visiting nurse associations B) Era of the Medicare Home Health Benefit C) Enactment of the Balanced Budget Act D) Discharge of nonacute clients

: C Feedback: The number of Medicare-certified home care agencies grew rapidly until enactment of the Balanced Budget Act of 1997 that sought explicitly to reduce federal payments for home health care by changing the payment from reimbursement for each visit to the Medicare Prospective Payment System that determined Medicare payment rates based on client characteristics and need for services. Visiting nurse associations, discharging of nonacute clients, and the Era of the Medicare Home Health Benefit had no effect on the growth of agencies.

6. A community health nurse is explaining the chain of causation to a family that includes a child who has developed Lyme disease. The nurse correctly describes the opening in the child's skin caused by the actual tick bite as the A) reservoir. B) mode of transmission. C) portal of entry. D) host.

: C Feedback: The opening in the child's skin caused by the actual tick bite is the portal of entry in the chain of causation. The mode of transmission would be the tick biting the child. The reservoir would refer to the tick. The host would be the child who has been bitten by the tick.

19. When describing the philosophy of hospice care to a group of students, which of the following would the instructor include? A) The right to die and euthanasia B) Working with people in their last year of life C) Holistic and family-centered care to terminally ill clients D) Weaving hospice concepts around curative treatment

: C Feedback: The philosophy of hospice care includes holistic and family-centered care to terminally ill clients. Hospice care is delivered to terminally ill people with the recognition that death is a human experience. Euthanasia is not part of the care. Hospice care can be initiated after a physician has declared that a person has 6 months or less to live. Hospice care is initiated in the final phase of a person's illness when he or she is not receiving curative treatment.

23. Which of the following would an occupational and environmental health nurse need to keep in mind when selecting the field of nursing? A) The workplace is very similar to a health care institution. B) The nurse focuses on health not workforce productivity. C) Production or service is a primary goal. D) The nurse functions in a supervisory position.

: C Feedback: Unlike hospitals or ambulatory care centers, the workplace is a non-health care institution in which production or service (not health care) is the primary goal. The occupational and environmental health nurse participates in the organization's goals through activities that contribute to the productivity of the workforce. An occupational and environmental health nurse in the organization is in a staff position, taking on the role of a consultant, educator, or role model in the workplace, but has no supervisory responsibilities or power to hire or fire workers.

15. The nurse is reviewing actual census data for information for use in an epidemiologic study. Which of the following would the nurse be least likely to find? A) Occupational status B) Housing quality C) Births recorded D) Educational level

: C Feedback: Vital statistic data provides information about the number of births recorded. Census data includes information about age, sex, race, ethnic background, type of occupation, income gradient, marital status, educational level, and other standards such as housing quality. If the nurse is reviewing actual census data, the nurse would be least likely to find births recorded, which is vital statistics.

2. When applying the ecological perspective to environmental health, a community health nurse integrates which of the following concepts as most essential? A) Primary prevention is limited in this area. B) The need for foresight in designing innovations C) No one factor can be viewed in isolation. D) Implications of scientific advances are fully understood.

: C Feedback: With the ecological perspective, no one factor can be viewed in isolation. The preventive approach involves all three levels of prevention, of which primary prevention is the most important. This approach also requires foresight in designing innovations and involves implications associated with the unprecedented advances in science and technology.

17. Place in order, the steps involved in creating a faith community nursing position within a faith community. A) Seek support of the faith community members and staff. B) Seek formal approval from the organization's governing body. C) Assess the community the nurse plans to serve and identify the health needs of the faith community and the roles of the faith community nurse that meet those needs. D) Solicit input from the staff and spiritual leaders of the faith community.

: C, A, D, B Feedback: First the faith community nurse must assess the community the nurse plans to serve and identify the health needs of the faith community and the roles of the faith community nurse that meet those needs. Then the faith community nurse must seek support of the faith community members and staff. Then the faith community nurse must solicit input from the staff and spiritual leaders of the faith community. Finally, the faith community nurse must seek formal approval from the organization's governing body.

8. home health care agency. Which of the following would the agency want to achieve higher percentage rates? A) Hospital admissions B) Urgent unplanned medical care C) Deteriorating wound status D) Decreased pain with movement

: D Feedback: A home health care agency would want to achieve higher percentages of the measure involving decreased pain with movement. A higher percentage indicates that the clients are improving with care. The agency would want to achieve decreased or lower percentages for hospital admissions, urgent unplanned medical care, and deteriorating wound status.

11. When assessing several populations, the nurse notes each population's relative risk. Using the relative risk ratios below, which population would require a major emphasis for risk reduction intervention? A) 0.59 B) 1.13 C) 1.79 D) 2.45

: D Feedback: A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group. Therefore, interventions to reduce this population's risk would be most important.

3. After describing the various models for nurse- managed health centers, the instructor determines that the student understand the information when they identify which organization structure as being partnered legally with a human services organization? A) Academic nursing center B) Freestanding center C) Subsidiary center D) Affiliated center

: D Feedback: An affiliated center is one in which there is a legal partnership with a health care or human services organization. An academic nursing center is located within a School of Nursing. A freestanding center is an independent center with its own governing board. A subsidiary center is part of a larger health care system.

18. A family member has developed tuberculosis (TB) and the remainder of the family members are undergoing tuberculosis skin testing to determine their status. The nurse assesses the indurations and determines that a family member with which size induration is positive for TB? A) 2 mm B) 3 mm C) 4 mm D) 5 mm

: D Feedback: An induration of 5 mm or more is considered positive for individuals in close contact with others who have TB. Indurations <5 mm are not considered positive.

14. When describing the cycle of violence to a group of students, the instructor includes which of the following as occurring as the cycle continues? A) Frequency of the cycle slows B) Tension-building occurs less often C) Loving reconciliation lasts longer D) Acute battering occurs more often

: D Feedback: As the cycle of violence continues, the frequency of the cycle increases, with the tensionbuilding phase and the acute battering incident occurring more often, and elimination of the loving reconciliation phase. Without intervention, this shorter, more violent cycle becomes increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner, incarceration, or death of a partner.

22. A school nurse is addressing the dental health issues of the local community of school children. Which activity would be most appropriate at the community level? A) Educating parents about the importance of oral health B) Teaching children how to brush and floss properly C) Assisting with finding resources for those without dental insurance D) Advocating for the fluoridation of drinking water

: D Feedback: At a community level, school nurses can educate the public about the benefits of dental fluoride treatments. They can advocate for fluoridation of drinking water, school-based fluoride rinses or gels, and dental sealant programs. At the classroom level, school nurses can provide dental education and provide toothbrushes, toothpaste, and floss to ensure that students are able to practice good dental hygiene habits. At an individual level, school nurses can assist in finding resources for those with no dental health insurance. Finally, school nurses can successfully educate parents regarding the importance of oral and dental health.

19. A community health nurse is participating in a case-control observational study. Which of the following would most likely explain this type of study? A) Description of patterns of occurrence of illness and injury in a population B) Investigation of development of health-illness conditions over a long period of time C) Studying of a cohort with evaluation of variables associated with the disease or injury D) Comparison of persons with and without a health-illness condition

: D Feedback: Comparing persons with and without a certain condition is known as a case-control study. A study that describes patterns of occurrence in a population is a descriptive study. Following people over a long period of time is a longitudinal study. And cohorts are groups studied over time.

21. When using descriptive epidemiology, which type of study would the community health nurse expect to include? A) Prevalence study B) Case-control study C) Cohort study D) Count study

: D Feedback: Descriptive epidemiology includes investigations that seek to observe and describe patterns of health-related conditions that occur naturally in a population. The simplest measure of a description is a count. Prevalence, case-control, and cohort studies are types of studies involved with analytical research.

12. Communicable disease is a global health concern with a primary goal of eradicating communicable diseases worldwide. Achievement of this goal would involve A) interrupting disease in a limited, defined geographic area. B) reducing the incidence and/or prevalence of communicable diseases. C) establishing primary health care services for all people on the globe. D) interrupting transmission and reservoir of infection to prevent further cases.

: D Feedback: Eradication is an ambitious and expensive goal and has occurred with smallpox in 1977 and is under way with other diseases such as poliomyelitis, guinea worm, leprosy, and measles so that many diseases can be eradicated early in the 21st century. One major means of eradicating communicable diseases is to interrupt the transmission and reservoir, thereby preventing the development of new cases. Interrupting disease in a limited area may be a starting point, but more widespread involvement is needed. Reducing the incidence or prevalence would provide indications about the effects of attempting to eradicate the disease. Establishing primary health care services is the goal of Alma-Ata "health for all."

22. Which activity would an occupational and environmental health nurse expect to perform in the future based on current trends? A) Supervise care for emergency illnesses B) Counsel employees about health risks C) Perform periodic health assessments D) Suggest cost-effective in-house health services

: D Feedback: Future occupational health nurse activities will involve recommending more efficient and cost-effective in-house health services. Supervising care for emergency illnesses, counseling employees about health risks, and performing periodic health assessments are current occupational and environmental health nursing activities.

19. Which of the following would be least appropriate for a community health nurse to include in a plan of care at the secondary prevention level for families who may need to respond in a case of crisis in the future? A) Teaching social problem-solving skills B) Helping women develop assertiveness skills C) Providing parenting classes D) Helping to reestablish as sense of safety

: D Feedback: Helping to reestablish a sense of safety would be appropriate at the secondary level of prevention. Teaching social problem-solving skills, helping women develop assertiveness skills, and providing parenting classes are appropriate primary prevention level activities.

7. In preparation for an examination on the history of family violence, a group of students reviews the various laws enacted for protection. The students demonstrate understanding when they identify which of the following as one of the earliest laws enacted? A) Child Abuse Prevention and Treatment Act B) Family Violence Prevention and Services Act C) Keeping Children and Families Safe Act D) Child Abuse Prevention and Treatment and Adoption Reform Act

: D Feedback: In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as the Keeping Children and Families Safe Act.

21. A community health nurse is developing a plan of care for families in crisis. Which of the following would be most appropriate for the nurse to include? A) Encourage clients to suppress feelings to minimize pain B) Avoid correcting distorted facts to reduce stress C) Allow clients to blame others for the crisis D) Help clients confront crisis

: D Feedback: In a crisis, the community health nurse encourages clients to accept help by acknowledging the problem. The nurse should encourage clients to express their feelings openly, assist them in finding facts (distortions create additional tension that may lead to maladaptive responses), and avoid blaming others to promote responsibility for problem solving

17. Which of the following statements about the personal and professional perceptions that nurses bring to providing community health nursing interventions within an international context is most accurate? A) Community health nurses are not susceptible to preconceived perceptions and biases. B) It is not necessary for community health nurses to face their own beliefs. C) Community health nurses are universally opposed to female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment. D) It is critical for community health nurses to face their own beliefs when confronting female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.

: D Feedback: It is critical for community health nurses to face their own beliefs when confronting female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment. Community health nurses are as susceptible as any other group of people to preconceived perceptions and biases. Community health nurses may not be universally opposed to female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.

5. A nursing instructor is preparing a group of students for a clinical rotation in a nursemanaged health center. Which of the following would the instructor include when describing the students' role? A) Clinical supervision B) Passive participation C) Use of tertiary-level activities D) Implementation of best practices

: D Feedback: Nurse-managed health centers implement evidence-based practice via best practices or the application of the best available evidence to improve practice. Thus students also would follow this approach. Students' roles are similar to their staff mentors; faculty roles would involve clinical supervision. Students assigned to these centers are active participants in the vital activities of the center.

9. Which one of the following statements about poliomyelitis is the most accurate? A) Polio is not endemic in any countries at present. B) Polio has been eliminated worldwide. C) Rotary International has contributed no funds but many hours of manpower to eradicate polio. D) Polio has been eliminated from the Western hemisphere.

: D Feedback: Polio has been eliminated from the Western Hemisphere. It is now almost eliminated worldwide. Polio is endemic in Afghanistan, India, Pakistan, and Nigeria. Rotary International has contributed over $900 million dollars to help eradicate this disease.

5. A community health nurse has identified noise as an environmental hazard. Using the Blumenthal classification, the nurse would identify this as which of the following class? A) Infectious agents B) Asphyxiates C) Poison D) Physical agents

: D Feedback: The Blumenthal classification lists classes of environmental hazards. They include infectious agents (e.g., bacteria and viruses), respiratory fibrotic agents (e.g., coal dust), asphyxiates (e.g., carbon monoxide), poison (e.g., pesticides), physical agents (e.g., noise), psychological agents (stressful synergisms such as crowding combined with noise), mutagens (e.g., dioxin), teratogens (e.g., cadmium), and carcinogens (e.g., cigarette smoke).

15. An instructor is reviewing the evolution of environmental health and the development of various agencies designed to protect health. As part of the review, the instructor includes the Environmental Protection Agency (EPA), describing its primary goal as which of the following? A) Identify and address world health issues B) Protect occupational safety and health C) Monitor food and drug production and availability D) Set standards and monitor and enforce environmental protection

: D Feedback: The EPA was established for the purpose of standard setting, monitoring, and enforcement of environmental protection. The World Health Organization (WHO) identifies and addresses world health issues. The Occupational Safety and Health Administration (OSHA) protects occupational safety and health. The Food and Drug Administration (FDA) is responsible for monitoring food and drug production and availability.

7. A public health nurse is employed by the Indian Health Services. This nurse is working at which of the following levels? A) Local B) Community C) State D) Federal

: D Feedback: The Indian Health Service is an agency headed by the Department of Health and Human Services, a federal agency. Thus the nurse would be working at the federal level.

21. A client will receive hospice care under the Medicare Hospice Benefit. The nurse understands that which of the following is true? A) The client denies terminal prognosis. B) The client has a prognosis of at least 6 months of life. C) The client chooses life-extending care. D) The hospice acts as clinical and financial case manager.

: D Feedback: The Medicare Hospice Benefit requires that a client, who has a prognosis of 6 months or less, must sign up for the comfort-focused hospice benefit and waive the regular hospice benefit. This mandates that the client acknowledge a terminal prognosis and choose comforting care instead of life-extending care. When this choice is made, the hospice coordinates care in all settings, functioning both as clinical and financial case manager.

22. A group of students are reviewing for an examination on nongovernmental organizations that provide global interventions. The students demonstrate the need for additional study when they identify which of the following as an example? A) Global Health Council B) CARE C) Carter Center D) World Bank

: D Feedback: The World Bank is an agency that focuses on economic development. It partners with countries, WHO, and other organizations. It is not a nongovernmental organization. Examples of nongovernmental organizations include Global Health Council, The Center for International Health and Cooperation, CARE, and the Carter Center.

17. A community health nurse is designated as a "mandated reporter." Which of the following best describes this designation? A) The nurse must witness abuse and neglect before being mandated to report. B) The nurse commands that battered women report the abuse. C) The supervising community health nurse is responsible for reporting only known cases of elder abuse. D) The nurse must report any case of known or suspected abuse and neglect in children or elders.

: D Feedback: The abuse or neglect simply needs to be suspected in order for the nurse to report. In most states the nurse can receive a jail sentence and a fine for not reporting suspected abuse. Reporters may never witness the actual abusive event, but they can often see the resulting damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects according to the community's laws.

3. Which one of the following statements best describes the family caregiver burdens of providing home care? A) Family members are expected to contribute financially to cover all of the costs of home care. B) Individuals recovering from severe illness or living with debilitating chronic illness rely on family members for unpaid assistance. C) Informal caregivers assume a considerable physical, psychological, and economic burden in the care of their loved one at home. D) Caregivers often describe themselves as emotionally and physically drained.

: D Feedback: The best description of family caregiver burdens is that caregivers have other responsibilities but that their caregiver tasks compete for time, energy, and attention leaving them emotionally and physically drained. Informal caregivers assume a considerable physical, psychological, and economic burden in the care of their loved one at home. Individuals recovering from severe illness or living with debilitating chronic illness rely on family members for unpaid assistance. The other two statements describe the burden in part but the best description is where caregivers often describe themselves as emotionally and physically drained.

21. Which one of the following statements is true about the consequences of biologic terrorism with anthrax and smallpox? A) Anthrax is not usually spread by person to person contact and so is not a good agent of biological terrorism. B) Smallpox is globally eradicated and therefore does not present a problem. C) Most adults are immune to smallpox due to routine immunization. D) As many as one in five persons who become ill with cutaneous anthrax die and inhalation anthrax can cause death in 3 to 5 days.

: D Feedback: The case-fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and expected death within a matter of days. Anthrax is not usually spread by person to person contact, but it has been demonstrated to be an agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist attacks. Many adults are not immune to smallpox as it has not been used for routine immunization for 40 years.

1. When describing the global framework, which of the following would the community health nurse be least likely to include? A) Population B) Provider C) Procedure D) Physician

: D Feedback: The global framework is bounded by a context and includes three parts, the three "Ps." These are the population, the provider, and the procedure. Physician would be included as a provider.

4. Which of the following would the community health nurse identify as a key component of the host? A) Infectivity B) Antigenicity C) Virulence D) Inherent resistance

: D Feedback: The host, a susceptible human or animal, can sometimes have an ability to resist pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are characteristics of the agent.

6. After teaching a group of students about the federal agencies involved in public health, the instructor determines that the teaching was successful when the students identify which agency as the main organization that is involved in public health? A) Environmental Protection Agency B) Department of Homeland Security C) Department of Agriculture D) Department of Health and Human Services

: D Feedback: The main organization involved with public health is the Department of Health and Human Services (DHHS). Other federal agencies that also impact public health include the Environmental Protection Agency (EPA), the Department of Homeland Security, the Department of Agriculture, the Department of Education, and the Department of Veterans Affairs.

10. A community health nurse is reading a journal article about global health and communicable diseases. The article states that elimination is the goal. The nurse interprets this to mean which of the following? A) There are no further cases of the disease anywhere. B) No further preventive efforts are necessary. C) The disease is no longer a public health threat. D) The disease has been interrupted in a geographic area.

: D Feedback: The term elimination is used when a disease has been interrupted in a defined geographic area. In 1991, WHO defined elimination as a reduction of prevalence to less than one case per 1 million population in a given area. Eradication means interruption of person-to- person transmission and limitation of the reservoir of infection so that no further preventive efforts are required; it indicates a status whereby no further cases of a disease occur anywhere. The term control indicates that a specific disease has ceased to be a public health threat.

13. The three main approaches to the tertiary prevention of communicable disease include which of the following? A) Education, immunization, and screening B) Screening, immunization, and isolation and quarantine C) Case and contact investigation, notification, and treatment D) Care and treatment, isolation and quarantine, and safe handling and control of infectious wastes

: D Feedback: The three main approaches to the tertiary prevention of communicable disease include care and treatment, isolation and quarantine, and safe handling and control of infectious wastes. The primary prevention techniques for communicable disease include education, immunization, and screening. The secondary prevention techniques for communicable disease include case and contact investigation, notification, and treatment.

5. When the public health nurse uses an upstream approach to improve heart health, the nurse would examine which one of the following factors? A) Unhealthy diets B) Decreased physical activity C) Smoking tobacco D) Lack of safe places to exercise

: D Feedback: The upstream approach focuses on the factors at the institutional and system level rather than looking at healthy lifestyle issues. Healthy diets, increased physical activity, and smoking cessation are all healthy lifestyle issues. The root causes of the decreased physical activity would include lack of safe places to exercise.

12. During a community program about food safety, a participant asks, "I know it is important to use safe food practices to avoid microbial contamination, but what other possible risks are there with our food supply?" Which response by the nurse would be most appropriate? A) "Nothing is more of a problem than foodborne illness." B) "Risks occur only at food production and not handling or consumption." C) "Radiating food is something that really doesn't occur in the United States." D) "A recent concern has been raised about genetically modified foods being marketed."

: D Feedback: There are many possible risks to the food supply, some even having more serious effects than food-borne illness. Risks occur at all points from food production to food consumption. Radiating food does occur in the United States. A recent concern has been raised about genetically modified foods being marketed. Genetically modified foods may interfere with the safety of food for human consumption and also questions about the ecological impact and sustainability have been raised.

18. Community health nurses need to be knowledgeable about the World Health Organization because its mission reflects which of the following? A) Collaboration in health development to free the world from poverty B) Service as an independent agency providing economic and humanitarian assistance overseas C) Representation of the global interests and concerns of the nursing profession D) Global health promotion by supporting development efforts of governments, organizations, and universities throughout the world

: D Feedback: WHO's mission reflects global health promotion by supporting development efforts of governments, organizations, and universities throughout the world. Collaboration to free the world from poverty reflects the mission of the World Bank. Service as an independent agency for economic and humanitarian assistance describes the mission of the United States Agency for International Development (USAID). Representation of global interests and concerns of nurses describes the mission of the International Council of Nurses (ICN).

18. A community health nurse is providing a community education program about suicide. Which of the following would the nurse include as a common method used by women? A) Hanging B) Firearms C) Vehicle crash D) Overdose

: D Feedback: Women usually choose less violent methods, such as overdosing on medications. Men choose more violent forms of suicide, such as hanging, use of firearms, or vehicle crashes.