Population Quizlet Finds Ch 1, 9, 10, 12, 13, 23, 18, 14, 37, 32, 33, 16, 22, 29 , and 4

A nurse is discussing the role of a vector in the spread of disease. Which of the following is the nurse most likely referring to? a. Contaminated water b. A tick c. A dirty needle d. An infected person

B Vectors are arthropods such as ticks and mosquitoes that transmit the infectious agent by biting or depositing the infective material near the host. Contaminated water, a dirty needle, and an infected person would be common vehicles.

Public health nursing is a specialty because: a. it has a distinct focus and scope of practice. b. it must be done by a registered nurse with a master's degree. c. it is focused on disadvantaged citizens. d. it performs interventions at the acute care level.

ANSWER: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty.

A nurse responds to a human-made disaster. Which of the following describes what the nurse is responding to? a. Structural collapse b. Communicable disease epidemics c. Mud slides d. Floods

A A structural collapse would be considered a human-made disaster. Communicable disease epidemics, mud slides, and floods are considered to be natural disasters.

HIV transmission can occur through: a. exposure to blood. b. insect bites. c. sharing of school supplies. d. toilets.

A HIV can be transmitted through exposure to blood. HIV is not transmitted by insect bites, sharing of school supplies, or toilets.

Which of the following is most likely to live in poverty? a. Those who work in high-risk jobs b. Those who have adequate nutrition c. Those who effectively manage stress d. Those who live in single family homes

A People who are poor are more likely to live in hazardous environments that are overcrowded and have inadequate sanitation, work in high-risk jobs, have less nutritious diets, and have multiple stressors.

What is implied by the web of causation model? a. Variables interact resulting in higher probability of illness. b. One disease causes another, especially in vulnerable populations. c. The greater the poverty, the more likely people are to have diseases. d. Immunizations are necessary because vulnerable populations spread disease.

A The web of causation model implies that not only are there more variables, but the variables interact, resulting in higher probability of illness. The relative risk for poor health is greater for vulnerable populations.

A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called: a. cross-sectional. b. ecological. c. case-control. d. cohort.

A A cross-sectional study collects information on current health status, personal characteristics, and potential risk factors or exposures all at once. A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. An ecological model considers the multiple factors that contribute to disease development.

Which statement about disasters is true? a. They can be natural or human-made. b. They can be relieved without assistance. c. There is always injury and death when a disaster occurs. d. The timing of a disaster does not influence the types of injuries that will occur.

A A disaster is any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance. Although natural incidents like earthquakes of hurricanes trigger many disasters, predictable and preventable human-made factors can further affect the disaster. In the disaster response phase, the incident type and time predict subsequent injuries and illnesses.

A nurse considers an audience's ability to read, comprehend, and act on medical instructions while preparing health education materials. Which of the following factors is the nurse considering? a. Health literacy b. Resilience c. Social justice d. Health disparity

A A measure of a patient's ability to read, comprehend, and act on medical instructions is health literacy. Resilience has to do with the factors that allow people to resist the effects of vulnerability. Social justice describes justice with respect to the concepts of egalitarianism and equality. Health disparity refers to the wide variations in health services and health status among certain population groups.

A nurse plans to contact a multilateral organization. Which of the following would the nurse most likely contact? a. United Nations (UN) b. United States Agency for International Development (USAID) c. Project Hope d. Catholic Relief Services

A A multilateral organization is one that receives funding from multiple governments and nongovernmental sources, which describes the UN. Project Hope and Catholic Relief Services are private voluntary organizations. USAID is funded by one country, the United States.

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

A Active immunity refers to the immunization of an individual by administration of an antigen (infectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host. Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual. Natural immunity refers to species-determined, innate resistance to an infectious agent. Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent.

A nurse schedules an appointment with a physician who has a practice in the community to learn more about the community's beliefs regarding childhood immunizations. Which of the following is being demonstrated? a. Informant interview b. Participant observation c. Active participation d. Windshield survey

A An informant interview is a method of community data collection that involves directed conversation with selected community members. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. Active partnerships are those in which all participants share leadership and decision making to some degree. Windshield surveys are a method of simple observation, providing a quick overview of a community.

Which of these statements is true about the DALYs in lesser-developed countries? a. Children are at great risk for an early death. b. Diarrheal disease and respiratory infections are rampant despite technology. c. Injuries account for most disability. d. Birth control methods are often lacking.

A Approximately 2.5 million neonatal deaths occurred in 2011 and over 20 million children under age 5 died during the same year in lesser-developed countries. Children are at great risk for an early death in these lesser-developed nations. If these children could face the same risks as those in developed nations, the deaths would decrease by 90%. Noncommunicable diseases such as respiratory, cardiac, musculoskeletal, and other conditions are problems in all countries.

A nurse is concerned about an event of bioterrorism. Which of the following would the nurse most likely be referring to? a. Outbreak of smallpox b. Bombed historic buildings c. Explosion of land mines d. Threats of war

A Bioterrorism is a term used to describe the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Bombing historical buildings, explosion of land mines, and threats of war may be part of terrorist attacks, but do not include the component of bioterrorism.

A nurse examines birth and death certificates during an epidemiologic investigation. Which of the following data categories is being used? a. Routinely collected data b. Data collected for other purposes but useful for epidemiologic research c. Original data collected for specific epidemiologic studies d. Surveillance data

A Birth and death certificates are considered to be vital records and are examples of data collected routinely. Data collected for other purposes would be hospital, physician, health department, laboratory, and insurance records. Original data is that which is collected by the National Center for Health Statistics for specific health surveys. Surveillance data is used to assess and prioritize the health needs of populations, design public health and clinical services to address those needs, and evaluate the effectiveness of public health programs.

A nurse is working in a temporary shelter for victims following a natural disaster. Which condition is the nurse most likely to encounter? a. Stress b. Communicable disease c. Depression d. Injuries requiring first aid

A Causes of stress can be the shock of the disaster itself, loss of personal possessions, fear of the unknown, living in close proximity to total strangers, and boredom. Illnesses requiring first aid and communicable diseases are not the primary concern of the nurse working in the shelter. Immediately following the disaster, it is unlikely that the victims will immediately encounter depression because of the shock of the disaster.

A nurse is caring for a preschool-aged child who has been exposed to environmental tobacco smoke (ETS) on a regular basis. Which of the following is the child at greater risk for because of this exposure? a. Middle ear infections b. SIDS c. Living in poverty d. Behavioral disturbances

A Children exposed to ETS experience increased episodes of middle ear infections, asthma, upper respiratory tract infections, and more missed school days. SIDS incidence increases with ETS exposure, but this is not a concern with a preschool-aged child.

A nurse is providing anticipatory guidance to parents who have a child under 1 year of age. Which of the following would be the most important topic to discuss? a. Occluded airway b. Burns c. Poisoning d. Falls

A Children under 1 year of age are most frequently injured by occluded airways. Burns, poisoning, and falls are risks for all age groups and are more likely to happen with children over age 1.

A public health worker had displayed a competency in disaster medicine and public health. Which of the following describes what the worker has done? a. Communicate effectively with others b. Get involved in the chain of command c. Use a set of preplanned activities for every disaster d. Implement a community assessment

A Communicating effectively with others in a disaster or public health emergency is one of the competencies demonstrated in disaster medicine and public health. Involvement in the chain of command, using a set of preplanned activities for every disaster, and implementing a community assessment are not part of these competencies.

Which health problem is in need of control in developed countries? a.Hepatitis b.Malaria c.Polio d.Smallpox

A Current health concerns in more developed countries are hepatitis, infectious diseases, and new viral strains such as hantavirus, SARS (severe acute respiratory syndrome), H1N1, and avian flu. Malaria, polio, and smallpox are more commonly found in lesser-developed countries.

A nurse is examining a child in the early stages of HIV infection. Which of the following would the nurse expect to find? a. Failure to thrive and developmental delays b. Kaposi's sarcoma and developmental delays c. Toxoplasmosis and oral candidiasis d. Fatigue and shortness of breath

A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays. Kaposi's sarcoma and oral candidiasis are common opportunistic diseases later in the disease process. Fatigue is a symptom seen with hepatitis and TB.

A public health nurse (PHN) is working with a community during the recovery phase of a disaster. Which of the following attributes would be most important for the nurse to possess? a. Flexibility b. Organization skills c. Personable d. Sense of humor

A Flexibility is key to a successful recovery operation. The role of the PHN in the recovery phase of a disaster is as varied as in the preparedness and response phases, but the PHN's connection to the community puts the PHN in an incredible position of knowledge and awareness on the inter-professional recovery team. The attributes of being organized, personable, and having a sense of humor are not as important as flexibility when dealing with this phase of the disaster.

Food intoxication is caused by: a. toxins produced by bacterial growth and chemical contaminants. b. bacterial, viral, or parasitic invasion of food. c. overcooking of meat and produce. d. adding too many spices or ingredients to food.

A Food intoxication is caused by toxins produced by bacterial growth, chemical containments, and a variety of disease-producing substances found naturally in certain foods such as mushrooms and some seafood. Bacterial, viral, or parasitic invasion of food is not a cause of food intoxication. Food intoxication is not caused by overcooking meat or adding too many ingredients to food.

What is the best method for preventing health care-associated infections? a. Perform good hand washing before and after approaching every patient. b. Prevention is almost impossible due to the high infection rates in hospitals. c. Isolate every patient having surgery. d. Use contact isolation for every patient at risk.

A Hand washing is the best way to prevent infection. If good hand washing is in place, it is not necessary to isolate patients or implement contact isolation. Prevention is possible with the use of good hand washing.

Which type of hepatitis would likely be found where sanitation is inadequate? a. A b. B c. C d. D

A Hepatitis A would likely be found where sanitation is inadequate. Hepatitis B and C are spread through blood and body fluids. Hepatitis D can only exist in people who are already infected with Hepatitis B.

A nurse is providing education to a parent-teacher organization about substance use and abuse among children. Which of the following information would the nurse most likely include in this presentation? a. Inhalants are among the first drugs that young children use. b. Implementing the Drug Abuse Resistance Education (DARE) program is the most effective way to prevent drug use. c. Underage drinking is not a problem in most communities. d. Early experimentation with substances decreases the likelihood of future abuse.

A Inhalants are among the first drugs that young children use. The primary abusers of most inhalants are adolescents who are 12-17 years of age. Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use. Underage drinking is seen as the most serious drug problem for youth in the United States. The younger a person is when beginning intensive experimentation with drugs, the more likely dependence will develop.

A nurse is caring for a client who has been diagnosed with tuberculosis (TB). Which of the following medications would the nurse most likely administer? a. Isoniazid b. Nevirapine c. Amodiaquine d. Bacille Calmette-Guérin (BCG)

A Isoniazid is one of several chemotherapeutic medications used to treat TB. Nevirapine is used to decrease the likelihood of maternal transmission of HIV-AIDS. Amodiaquine is one of several medications used to treat malaria. BCG is a vaccine that has been promoted as effective in inducing active immunity against TB.

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

A It is important that nurses be able to discuss these topics to help prevent and control STDs. Without discussion of these topics, it is possible that clients will not be aware that they have an STD and may transmit it to others. Thus, the transmission of STDs may increase. A trusting relationship with a health care provider may or may not develop and is not dependent on whether these issues are discussed. There are not laws that mandate nurses to discuss sexual behavior and sexual orientation with clients.

John Snow is called the "father of epidemiology" because of his work with: a. cholera. b. malaria. c. polio. d. germ theory.

A John Snow investigated the spread of cholera in the mid-nineteenth century. John Snow did not investigate the other examples.

A riverfront community builds a retaining wall to divert flood water away from the town. Which term describes what has happened? a. Mitigation b. A natural disaster c. Community resilience d. Rapid needs assessment

A Mitigation is defined as actions or measures that can either prevent the occurrence of a disaster or reduce the severity of the effects. A natural disaster, such as an earthquake or hurricane, causes disruption, destruction, and/or devastation requiring external assistance. Community resilience is defined as the sustained ability of a community to withstand and recover from adversity. A rapid needs assessment is based on the traditional model of community assessment where there is a rapid appraisal of a sector or region's population, social systems, and geophysical features.

Which statement is true about mortality rates? Mortality rates: a. are informative only for fatal diseases. b. provide information about existing disease in the population. c. are calculated using a population estimate at year-end. d. reveal the risk of getting a particular disease.

A Mortality rates are informative only for fatal diseases and do not provide direct information about the level of existing disease or the risk of getting a particular disease. Because the population changes during the course of a year, typically an estimate of the population at midyear is taken as the denominator for annual rates, because the midyear population approximates the amount of person-time contributed by the population during a given year.

A nurse is using motivational interviewing when communicating with a family about improving their eating habits. Which of the following questions would the nurse most likely ask when using this technique? a. "Do you feel comfortable restricting foods your child eats?" b. "Why do you choose unhealthy snacks?" c. "What changes would you like to make to improve your diet?" d. "Where do you do your grocery shopping?"

A Motivational interviewing is a focused communication strategy in which the parents are encouraged to set goals, identify personal barriers, and identify potential mechanisms to overcome the barriers to make safety and health promotion changes for their child. Nurses use open-ended questioning and reflection to encourage sharing from the child and parents. The other questions may be viewed as being judgmental from the perspective of the client and the client may not answer the question truthfully.

Multilateral organizations: a. receive funding from multiple sources. b. control the spread of disease. c. feed the people of the world. d. use nurses as their main source of information.

A Multilateral organizations are those that receive funding from multiple government and nongovernment sources. The other items are specific to the agencies listed, but do not include all of the organizations.

As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Multifactorial prevention

A Nurses are involved in epidemiologic surveillance by monitoring the potential for disease outbreaks. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention. Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Multifactorial prevention is not possible with a disease like influenza, which has one cause.

A nurse is actively participating in efforts to reduce gun violence among young people. Which of the following actions is most likely being taken by the nurse? a. Identifying populations at risk for violence b. Passing legislation to support gun control c. Searching lockers at school looking for weapons and contraband d. Caring for clients who have sustained gunshot wounds

A Nurses can identify populations at risk and target this population for aggression or anger management. The other responses are not activities community health nurses would engage in.

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

A Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees. Disclosing a worker's infection to other workers, terminating employment, and isolating an infected worker are examples of situations that have led to litigation between employees and employers. Thus, the priority will be to protect the employer from litigation.

A nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) test. Which of the following best describes the rationale for this test? a. To indicate the presence of the antibody to HIV b. To reveal whether or not the client has AIDS c. To isolate the HIV virus d. To confirm HIV after having a positive Western blot

A The EIA is used to indicate the presence of the antibody to HIV. To minimize false positive results, the Western blot is used as a confirmatory test to verify the results. The EIA does not isolate the virus, nor does it reveal whether the individual has symptomatic AIDS.

A public health nurse (PHN) is reviewing Healthy People 2020 to determine where to prioritize programming for the county health department. Based on Healthy People 2020, which of the following areas would the nurse most likely plan to implement programming? a. Reduce the rate of HIV transmission among adults and adolescents b. Eliminate sexually transmitted diseases (STDs) from developed countries c. Reduce deaths from gonorrhea d. Increase awareness about HIV in lesbian females

A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents. Eliminating STDs from developed countries, reducing deaths from gonorrhea, and increasing awareness about HIV among lesbian females are not addressed by Healthy People 2020.

Pelvic inflammatory disease (PID) is a common complication of: a. gonorrhea. b. syphilis. c. chlamydia. d. herpes.

A PID is a common complication of gonorrhea. PID is not a common complication of syphilis, chlamydia, or herpes.

A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. Which of the following best describes what is being measured? a. Prevalence b. Incidence c. Attack rate d. Morbidity rate

A Prevalence is the measure of existing disease in a population at a particular time. Incidence quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk who experience the event over some period of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Morbidity rate is the incidence of disease.

A school nurse is coordinating the implementation of a drug education program in the school. Which of the following levels of prevention is being implemented? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Primary health care prevention

A Primary prevention includes education about drugs and guidelines for their use, preventing the problem before it occurs. Secondary prevention aims for early detection and screening. Tertiary prevention addresses treatment and rehabilitation. Primary health care prevention is not a level of prevention.

A PHN conducts an immunization clinic for measles. Which of the following is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention. Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.

A nurse screens blood products, donor organs, and tissues for the hepatitis C infection. Which of the following best describes this nursing action? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Screening blood products, organs, and tissues for infection protects the population from exposure to hepatitis C, which prevents them from contracting the disease. Secondary prevention includes screening for diseases to ensure their early identification, treatment, and follow-up with contact to prevent further spread. Tertiary prevention focuses on chronic care and rehabilitation. Health promotion focuses on the primary prevention activities to promote health and prevent disease.

A nurse promotes the use of universal precautions by all health care workers. Which of the following best describes the action that was taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health care-associated infection

A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Tertiary prevention reduces complications through treatment and rehabilitation. Health care-associated infections are prevented through the use of good hand washing.

Which is a disease that was once isolated and rare but is now widespread throughout the world? a.Acquired immunodeficiency syndrome (AIDS) b.Smallpox c.Malaria d.Measles

A Smallpox has been eradicated; malaria and measles were not isolated and rare throughout the world. AIDS was once isolated and rare, but is now worldwide.

A nurse is caring for adolescents who have experienced substance abuse. Which of the following should the nurse recognize as a major influence in this population? a. Family-related factors b. Positive media messages c. Socioeconomic level d. Peer pressure

A Substance abuse among adolescents is influenced most by family-related factors, such as genetics, family stress, and parenting styles. Research suggests that successful social influence-based prevention programs may be driven by their ability to foster social norms that reduce an adolescent's social motivation to begin using ATODs. Peer pressure and socioeconomic level may play a role in the abuse of substances, but this has not been the major factor identified. Media messages promoting the use of substances may influence this population, but is not the major factor that has been identified.

A nurse is presenting information to the county health department about potential bioterrorism threats. Which of the following agents would the nurse discuss in this presentation? a. Smallpox b. West Nile Virus c. Severe acute respiratory syndrome (SARS) d. Novel influenza A (H1N1)

A Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20-40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and selected hemorrhagic viruses. West Nile Virus, SARS, and H1N1 are not viruses that would be used for bioterrorism.

An intervention that focuses on the tertiary level of prevention is implemented by the nurse? Which of the following did the nurse most likely complete? a. Rehabilitative job training b. Parenting education c. Testicular self-examination d. Family counseling

A Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Rehabilitative job training would be an example of tertiary prevention. Parenting education is an example of primary prevention. Testicular self-examination and family counseling are examples of secondary prevention.

A government agency is planning a project in hopes of receiving funding from the World Bank. Which of the following projects would most likely receive this funding? a. Development of a sanitation system b. Improvement of roads and bridges c. Creation of a national health insurance plan d. Recovery efforts following a hurricane

A The World Bank lends money to lesser-developed countries so that they might use it to improve the health status of their people. Projects include control and eradication of disease, providing safe drinking water and affordable housing, developing sanitation systems, and encouraging family planning and childhood immunizations. Improvement of roads and bridges, creation of a national health insurance plan, and recovery efforts following a hurricane would not be projects where World Bank funds would be used

A nurse is implementing the harm reduction model. Which of the following will be the focus of nurse when using this approach? a. Education b. Law enforcement c. Scare tactics d. Rehabilitation

A The harm reduction model accepts the reality that psychoactive drug use is endemic, and it focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug abuse and get treatment for addicts. The harm reduction model encourages nurses to seek the underlying roots of various health problems and plan action that is realistic, nonjudgmental, holistic, and positive. Law enforcement, scare tactics, and rehabilitation are not part of the harm reduction model

A nurse has collected a urine specimen from a client for drug testing. Which of the following best describes the purpose of a urinalysis? a. To assess whether a certain drug has been used in the recent past b. To determine the degree of intoxication c. To assess the extent of performance impairment d. To determine how much alcohol was consumed

A The nurse collects a urine specimen with the rationale that urinalysis for drug testing can be used to determine whether a certain drug has been used in the recent past. Urine testing indicates only past use of certain drugs, not intoxication. The extent of performance impairment cannot be determined with urine testing. Alcohol is not always included in a urine drug screen.

Which statement is true about the role of nurses in community health? a. The nurse provides direct services to children and their families. b. A major role of community health nurse is the provision of immunizations. c. Children are not the primary focus of community health, since they are often acutely ill. d. Complementary therapies and environmental toxins are often the focus of the health care of children.

A The nurse provides direct services to children and their families: assessing and managing care, education, and counseling. Provision of immunizations is not a major role of community health nurses. Children are not often acutely ill nor are complementary therapies and environmental toxins the focus of health care.

A nurse is triaging victims following a disaster. Which of the following describes the action the nurse would take? a. Allocation of treatment based on the victim's potential for survival b. Assignment of tasks to the appropriate disaster response personnel c. Determination of the level of disaster and agency involvement d. Participation in community preparedness for the disaster response

A The triage process in disaster involves separating the casualties and allocating treatment based on the victim's potential for survival. Assignment of tasks to the appropriate disaster response personnel, determination of the level of disaster and agency involvement, and participation in community preparedness for the disaster response are not part of the triage process.

A nurse is providing a health education program for the community about prevention of lead poisoning. Which of the following information would the nurse most likely include in the program? a. Universal screening for all children ages 1 and 2 years is recommended. b. Lead poisoning can lead to serious respiratory system complication. c. The most common exposure to lead occurs when children play with imported toys. d. Lead-based paints are found in all homes built before 1987.

A Universal screening is recommended for 1 and 2 year olds. Lead poisoning can cause significant neurological, cardiovascular, and renal disease. The most common exposure is through lead-based paints and lead-contaminated soil and dust in houses built before 1987. Lead-based paints may be found in some homes built before 1987, but not all.

A nurse is teaching members of the community about vertical transmission of a disease. Which of the following would the nurse most likely discuss? a. Transmission through breast milk b. Transmission through sexual contact c. Transmission from mosquito bites d. Transmission through contaminated food

A Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth. Transmission through sexual contact is horizontal transmission. Transmission from mosquito bites is vector transmission. Transmission from contaminated food is common vehicle transmission.

A nurse lobbies with legislators for the passage of legislation to prohibit smoking of tobacco products in public places. Which of the following levels of prevention is being implemented? a.Primary b.Secondary c.Tertiary d.Health promotion

A When using primary prevention, the focus is on health promotion and disease prevention. When using tertiary prevention, the nurse focuses on treatment and rehabilitation. Secondary prevention focuses on early detection and screening. Health promotion is not a level of prevention.

A PHN uses Assumption 2, "Public health nursing practice focuses on populations," to guide practice. Which of the following would be considered a population of interest? a. Healthy school children b. Homeless individuals c. A person recently diagnosed with diabetes d. Teenage parents

A A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population.

A PHN is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse most likely use? a. A 50-year-old woman receives annual mammograms b. School absences in a community decline c. Teachers have increased awareness of health problems d. Those in poverty utilize the free mammogram program

A Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual level.

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

A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is "Tune in": listen before starting to teach; the client's needs should direct the content. Thus, this should be done before the nurse does any demonstration, showing of audiovisual resources, or return demonstration.

Change for the community as a client must often occur at several levels because: a. health problems caused by lifestyle are multidimensional. b. most individuals can change their habits alone. c. aggregates are responsible for social change. d. geographic areas often have health risks that the nurse must identify.

A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels. Society must also be involved in the change by supporting individual choices. There may be certain geographic areas that have higher health risks than others, but this does not explain why care must occur at several levels.

What are the six "rights" of case management? a. Care, time, provider, setting, price, and outcomes b. Patient, medication, route, time, documentation, and evaluation c. Place, setting, patient, plan, outcomes, and documentation d. Disease process, time, place, beneficence, advocate, and care provider

A Care, time, provider, setting, price, and outcomes are used to judge the effectiveness of case management.

The levels of practice encompassed by the Intervention Wheel are: a. communities, individuals and families, and systems. b. assessment, diagnosis, and evaluation. c. primary, secondary, and tertiary. d. communities, populations, and aggregates.

A Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice.

A nurse is teaching a group of clients newly diagnosed with diabetes how to give themselves injections. Which of the following formats would be most appropriate for the nurse to use? a. Demonstration b. Health fair c. Lecture d. Non-native language session

A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done. Health fairs target specific populations and are held in a variety of locations. Non- native language sessions are a way to adapt the health fair to a population that does not speak English. Lecture is a non-interactive method of teaching.

A patient with a long history of asthma with many hospital admissions is referred to a case manager for disease management. Which of the following best describes the purpose of this referral? a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring

A Disease management activities target chronic and costly disease conditions that require long-term care interventions. Demand management seeks to control use by providing clients with correct information. Patients who cannot handle their disease or who need an advanced practice nurse instead of a physician do not explain the referral to disease management.

What is the purpose of the color-coded wedges on the Intervention Wheel? a. The interventions are grouped together in related wedges. b. The wedges consist of referral information for each wedge. c. The element of health teaching is the predominant feature of each wedge. d. Coalition building must be implemented with each wedge.

A Each wedge consists of related interventions. The other answers describe some of the individual wedges.

Which statement about education is true? a. It emphasizes the provider of knowledge and skills. b. It emphasizes the recipient of knowledge and skills. c. It is a process of gaining knowledge and expertise. d. It results in behavioral change.

A Education is the establishment and arrangement of events to facilitate learning. Education emphasizes the provider's role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and skills. Education does not necessarily result in change, as change is typically not easy for most people. Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise.

A community health nurse is caring for an individual who is experiencing crisis poverty. Which of the following characteristics would this individual most likely display? a. Episodic homelessness b. Physical disability c. Mental disability d. Drug abuse

A Episodic homelessness is a characteristic of crisis poverty. Physical disability, mental disability, and drug abuse would be considered in persistent poverty.

A nurse is providing care to populations who are from different socioeconomic and cultural backgrounds. Which of the following barriers should the nurse be aware of that may prevent full engagement in a relationship? a. Fears and misconceptions related to poverty b. Lack of tangible and emotional resources c. Lack of knowledge about people who live in poverty d. Perception that the poor don't need to be poor

A Fears and misconceptions of nurses related to poverty is a barrier that may prevent nurses from fully engaging in relationships with people who come from different socioeconomic and cultural backgrounds. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.

A nurse is referring to the federal income guidelines. Which of the following best describes why the nurse is completing this action? a. To determine financial eligibility for government assistance programs b. To calculate statistical occurrences in the community c. To identify those with inadequate resources for basic needs d. To provide guidelines for reform of social programs

A Federal income guidelines are used primarily to determine financial eligibility for government assistance programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The federal income guidelines do not identify those with inadequate resources for basic needs or provide guidelines for reform of social programs.

A leader of a support group introduces a nurse to its members and discusses the professional relationship he has with the nurse for the past several years. Which of the functions is the leader performing? a. Gatekeeper b. Insider c. Community health workers d. Advocate

A Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Insiders are those who grew up in the community, have personal ties to the people there or comes from a similar cultural or ethnic background. Community health workers are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. An advocate is someone who speaks up for and supports the needs of the community.

What is the purpose of providing education across the three levels of prevention? Education: a. enables clients to attain optimal health. b. identifies and treats health problems early to eliminate disability. c. enables populations to break into individuals. d. teaches people about Healthy People 2020.

A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of disability may not be possible. Health education does not teach about the Healthy People 2020 document or break populations into individuals.

Which group has the highest rate of poverty? a. Children b. Teenagers c. Women d. Older adults

A In 2012, 21.6% of those 18 years or less were living in poverty. Poverty is highest among children, and in 2012, it was 21.8% higher than any other age group.

A nurse is completing a community assessment. Which of the following actions would be most likely for the nurse to complete? a. Identify community needs and clarify problems b. Determine the weaknesses of a community c. Perform the core functions of public health nursing d. Assess individual needs within a community

A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources. The focus of the community assessment is on the needs of the community, not on individuals. The core functions of public health nursing are not all used during the community assessment process. The community assessment should identify both the strengths and weaknesses of the community.

A community health nurse is working with adolescents. Which of the following characteristics would most likely be displayed by an adolescent who is at increased risk to engage in risk-taking behavior? a. Poor academic performance b. High self-esteem c. Middle-class income d. Involvement in extracurricular activities

A Increased adolescent risk-taking behaviors include: poor academic performance, poor parental role models, low self-esteem, lack of a supportive social environment, and poverty.

A nurse is caring for a population that has experienced a health disparity. Which of the following best describes a health disparity? a. Low childhood immunization rates b. High dropout rates c. Unemployment d. Income below poverty level

A Low childhood immunization rates signify a health disparity. High dropout rates, unemployment, and income below poverty level are social conditions that may lead to health disparities.

A nurse who is using population management needs to be able to work with integrated care delivery systems. Which of the following describes the rationale for this competency? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary.

A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false.

A community health nurse is writing an objective. Which of the following would be most appropriate for the nurse to write? a. Each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials. b. The client will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.

A Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms. The objective "each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials" contains the components of a written objective. "The client will perform a blood sugar test on herself with an accurate blood sugar reading" does not provide any measureable terms. "The community will take their children to receive immunizations within 1 month of the immunization due date" does not provide a measurable percentage of the members of the community. "Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment" focuses on a long-term goal, rather than a short-term objective and does not provide a time frame for when this would be measured.

A client diagnosed with diabetes reports to the nurse that she has been learning more about controlling her blood sugars by reading information found on the Internet. Which of the following statements by the nurse would be appropriate? a. "Looking at the date the content was posted on the website is important." b. "The Internet is an unreliable source of information and should not be used." c. "The best sources of information are found on pharmaceutical websites." d. "Your physician will provide you better information than the Internet."

A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated. The Internet has reliable information, but the quality of the information must be assessed. Pharmaceutical websites may have biased information. Physicians are another source of information, but this may or may not be better than what is found on the Internet.

A nurse has identified a point source of air pollution. Which of the following has the nurse identified? a. A smoke stack b. The number of cars and trucks c. The amount of fossil fuel consumed in a community d. Ground ozone levels

A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack. Nonpoint sources come from more diffuse exposures, such as from cars and trucks. The amount of fossil fuel that is consumed and ground ozone levels do not identify sources of air pollution.

Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency (EPA). d. Many Americans live in areas that do not meet current national air quality standards.

A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments. Toxicologists do not often consult nurses about environmental pollutants. Pollutant exposures are not routinely reported by nurses. Although there may be problems with air quality standards in the United States, this would not be the primary reason why nurses should understand environmental health.

A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first "P"? a. Present work b. Potential exposures c. Personal protective equipment use d. Past work

A Present work is the first "P". Potential exposures are part of the "I"—investigate potential exposures. Personal protective equipment use is not part of the mnemonic. Past work is the second "P."

A nurse uses the leadership behavior of reflecting when providing education to community members about how to lead healthy lifestyles. Which of the following actions is most likely being taken by the nurse? a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussion

A Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points.

Resilience refers to the: a. resistance of certain groups to risk factors. b. increased susceptibility to cumulative risk factors among vulnerable groups. c. variability in the effects of stressors according to socioeconomic status. d. increased sensitivity of the very young and the very old to risk factors.

A Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. These populations do not succumb to the health risks that impinge on them.

A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied? a. Screening b. Referral and follow-up c. Surveillance d. Health teaching

A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

A nurse analyzes data from minutes at a community meeting when completing a community assessment. Which of the following methods of data collection is being used? a. Secondary data b. Informant interviews c. Primary data d. Windshield survey

A Secondary sources include published data about the community. The data is secondary because it is collected by someone else. An informant interview is a method of community data collection that involves directed conversation with selected community members. Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Windshield surveys are a method of simple observation, providing a quick overview of a community.

Which Core Competency of communication is used by nurses engaged in group work? a. Soliciting input from individuals and organizations b. Using simple language when presenting information c. Asking the group to develop the program of interest d. Presenting material to lay audiences

A Soliciting input from individuals and organizations is a communication competency. Various strategies should be used to present the information. The group should assist in determining the topic, but not developing the program. The material should be presented to professional and lay audiences.

Which statement about the Intervention Wheel is true? a. It provides a graphic illustration of population-based public health practice. b. It describes in detail the components of public health nursing. c. It demonstrates the practice of community health nurses for policy and lawmakers. d. It is a framework used by all health departments in the United States.

A The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all.

The intergovernmental organization that focuses its efforts on assisting countries in Latin America is the: a. Pan American Health Organization. b. World Bank. c. World Health Organization (WHO). d. United Nations Children's Fund.

A The Pan American Health Organization serves as a regional field office in Latin America for the WHO. The World Bank's major aim is to lend money to the lesser-developed countries so that they might use it to improve the health status of their people. The WHO addresses the wide scope and nature of the world's health problems. The United Nations Children's Fund is an advocate for the health needs of women and children under the age of 5.

A nurse is working with a family who is unable to find adequate health care coverage for the children in the family. Which of the following pieces of legislation will assist in provision of health care coverage for these children? a. Social Security Act b. Balanced Budget Act c. HIPAA d. ACA

A The Social Security Act provides funds to insure currently uninsured children. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The ACA of 2010 provides the opportunity for all to purchase health insurance.

Which federal program created support for older and poor Americans? a. Social Security Act b. Medicare Amendment c. Medicaid Amendment d. Hill-Burton Act

A The Social Security Act sought direct payments to eligible individuals to ensure a minimum level of support for people at risk of problems from inadequate financial resources. The Social Security Act encompasses the Medicare and Medicaid Amendment. The Hill-Burton Act provided funding to assist with building hospitals.

A public health nurse (PHN) is working with the chronically ill and families with young children needing age-specific health maintenance. Which of the following models of case management is being used? a. Client-focused b. System-focused c. Social service d. Long-term care

A The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. System focused models address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management.

A nurse is working with a group of clients diagnosed with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. Which of the following principles of effective education is the nurse using? a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidance

A The educator should have the learners recall previous knowledge related to the topic of interest. The principle of gaining attention should have been applied as the program started the week before. Recall should be done before new material is presented and before learning guidance is provided.

A nurse has identified the boundaries of the community. Which of the following steps should the nurse take next when completing a community assessment? a. Gather relevant existing data and generating missing data b. Plan interventions that benefit the entire community c. Formulate nursing diagnoses d. Evaluate the interventions that were used

A The first step of the community assessment is to define the community. In order to do this, geographic boundaries, the population within the boundaries, the purpose of the assessment, and a data collection plan will be identified. Those inhabiting the community are a primary focus of the assessment. A variety of strategies are used to identify this central core of the community. The next step involves gathering and generating data to learn more about the community. After the community has been completely assessed then nursing diagnoses can be formulated, interventions planned, and finally interventions evaluated.

The main characteristics of partnership are: a. awareness, flexibility, and distribution of power. b. rights, responsibilities, and consensus. c. commitment, participation, and articulation. d. collaboration, advocacy, and utility.

A The main characteristics of partnership are awareness, flexibility, and negotiated distribution of power. Rights, responsibilities, and consensus are not the main characteristics of partnership. Commitment, participation, and articulation are not the main characteristics of partnership. Collaboration, advocacy, and utility are not the main characteristics of partnership.

The process of moving conflicting parties toward an outcome is called: a. negotiation. b. conflict management. c. problem-purpose expansion method. d. brainstorming.

A The process of moving conflicting parties toward an outcome is called negotiation. Conflict management has the goal of mutual benefit with limited loss, which is directed toward getting all parties to work together. The problem-purpose-expansion method is a way to broaden limited thinking by restating the problem and expanding the problem statement so that different solutions can be generated. In brainstorming, as many alternatives as possible are generated without placing a value on them.

During a class on newborn care given at a local health department, a nursing student asks the participants to practice with baby dolls. Which of the following steps of promoting effective education is the student using? a. Eliciting performance b. Assessing performance c. Enhancing retention and transfer of knowledge d. Gaining attention

A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned. Gaining attention occurs at the beginning of the program. Assessing performance occurs at the end of the program. Enhancing retention and transfer of knowledge occurs as the learners are asked to apply the information to their lives and situations (not to the care of the dolls).

A nurse focuses intervention strategies on the structural dimension of community health. Which of the following best describes the focus of these strategies? a. Health services b. Primary prevention c. Health promotion d. Secondary prevention

A The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Health promotion activities are interventions focused on improving one's health.

The community health nurse is caring for a client who is living in persistent poverty. Which of the following best describes this client? a. Severe mental illness b. Transient homelessness c. Victim of domestic violence d. Temporary housing

A Those who are in persistent poverty typically are older, with physical and mental disabilities, alcohol and other drug abuse, severe mental illness, chronic health problems, and significant family difficulties. Transient homeless persons, victims of domestic violence, and persons with temporary housing would be considered in crisis poverty.

The basic science applied to understanding the health effects associated with chemical exposures is: a. toxicology. b. pharmacology. c. chemistry. d. environmental epidemiology.

A Toxicology is the study of the health effects associated with chemical exposures. Pharmacology is the branch of medicine concerned with the multiple aspects of drugs. Chemistry is the branch of science with deals with the way that matter is composed. Environmental epidemiology is concerned with the discovery of environmental exposures that cause or protect against illness or disease.

Which of the following is a characteristic of a vulnerable population? a. Have worse health outcomes and an increased sensitivity to risk factors than the general population b. Have a single risk factor but experience worse health outcomes than the general population c. Have multiple risk factors but equal health outcomes to the general population d. Have worse outcomes with better access to health care than the general population

A Vulnerable population groups are more sensitive to risk factors and have worse health outcomes. Vulnerable populations experience multiple risk factors. Vulnerable populations have worse health outcomes than the general population. Vulnerable populations have more problems accessing health care than the general population.

Which organizations offer volunteer opportunities in disaster work for nurses? (Select all that apply.) a. ARC b. Citizens Corps c. American Nurses Association d. National Public Health Training Centers e. Sigma Theta Tau International

A, B ARC and Citizens Corps offer volunteer opportunities. The American Nurses Association and National Public Health Training Centers offer education and training opportunities. Sigma Theta Tau International is an honor society for nurses.

MULTIPLE RESPONSE A nurse would like to take action to reduce the risk of liability. Which of the following interventions should be used by the nurse? (Select all that apply.) a. Provide accurate documentation of client visits b. Inform clients of their rights of appeal c. Refer clients to the providers of their choice d. Utilize care planning whenever possible e. Promote strong community partnerships

A, B To reduce risk exposure, it is important to provide clear documentation of client encounters and inform clients of their rights of appeal. Client choice is important when choosing a provider; however, the nurse is responsible for using reasonable care when selecting referral choices for a client. Although care planning may be helpful for establishing a plan with the client, it is not necessary in reducing the risk of liability.

Which populations are at greatest risk for disruption after a disaster? (Select all that apply.) a. Single-parent families b. Children c. Substance abusers d. Middle-class families e. Young adults

A, B, C Single-parent families, children, and substance abusers are all at greater risk for disruption after disaster than a middle-class family or young adults.

MULTIPLE RESPONSE A nurse is defining the community as part of the community assessment process. Which of the following best describes how the community may be defined? (Select all that apply.) a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern e. Individuals with certain interests

A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions. Individuals comprise a community, but would not be an accurate definition of a community.

MULTIPLE RESPONSE The cornerstones of public health nursing practice include which of the following? (Select all that apply.) a. Focus on the health of the entire population b. Reflect community priorities and needs c. Promote health through strategies driven by epidemiological evidence d. Are grounded in an ethic of collaboration. e. Provide a framework for ethical decision making

A, B, C Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring.

MULTIPLE RESPONSE A PHN working with a family living in poverty is concerned about their exposure to environmental hazards. Which of the following factors should the nurse consider that may put the family at risk? (Select all that apply.) a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education e. Unsafe working conditions

A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Substandard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

MULTIPLE RESPONSE A nurse "sets the stage" when assessing members of vulnerable population groups. Which of the following interventions would be completed? (Select all that apply.) a. Creating a comfortable, non-threatening environment b. Providing culturally and linguistically competent assessment c. Collaborating with others as appropriate d. Providing financial and legal advice e. Developing a free clinic in a low-income neighborhood

A, B, C Nurses set the stage by creating a comfortable, non-threatening environment, providing culturally and linguistically competent assessment, and collaborating with others as appropriate. A nurse should not provide financial or legal advice. Developing a free clinic does not "set the stage."

A nurse is caring for a client who has a history of chronic alcohol abuse. Which of the following medical problems should the nurse anticipate? (Select all that apply.) a.Gastrointestinal disturbances b.Cardiac dysrhythmias c.Depression d.Organic brain syndrome e.Hepatitis B

A, B, C, D Gastrointestinal disturbances, cardiac dysrhythmias, depression, and organic brain syndrome are some effects of chronic alcohol abuse.

Which elements of surveillance does a nurse use? (Select all that apply.) a. Mortality registration b. Epidemic field investigation c. Laboratory reporting d. Individual case investigation e. Application of research

A, B, C, D There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them. Application of research is not part of the 10 basic elements of surveillance.

MULTIPLE RESPONSE What knowledge and skills are required in order to become a competent case manager? (Select all that apply.) a. Knowledge of community resources and financing mechanisms b. Written and oral communication skills c. Proficient negotiation and conflict-resolving practices d. Application of evidence-based practices and outcomes measurements e. Experience with ethical decision making

A, B, C, D The knowledge and skills required to achieve competency include knowledge of community resources and financing mechanisms, written and oral communication and documentation, proficient negotiating and conflict-resolving practices, and the ability to apply evidence-based practices and outcomes measures. Experience with ethical decision making is not part of becoming a competent case manager.

MULTIPLE RESPONSE A nurse is analyzing the media images that influence society's beliefs about poor persons. Which of the following is the nurse most likely to see? (Select all that apply.) a. Poor persons are often cast as lazy, shiftless folk. b. Poor people are shown receiving food at soup kitchens. c. Criminals are portrayed as poor, desperate persons. d. Homeless people are seen sleeping on park benches. e. Criminals are seen as individuals who have been discriminated against.

A, B, C, D The media is a powerful influence on how people view poverty. Media images of persons who are poor influence and are influenced by cultural attitudes and values. Poor persons may be cast in negative ways by the media, which influences what we believe to be true about poor persons.

A nurse is working to manage the public health aspects of a bioterrorist event. Which of the following does the nurse need to understand? (Select all that apply.) a. Medical management and public health measures b. The names and descriptions of the agent/disease c. The chemical features of the pathogens d. How to address mental health concerns e. The amount of risk that each type of event will have for the public

A, B, D Nurses need to understand the names of the pathogens and the disease they cause, the medical management and public health measures (so that accurate information can be disseminated), and how to help people cope with their feelings. The chemical features of the pathogens and the amount of risk that each type of event will have for the public would not be part of the nurses' role when managing the public health aspects of a bioterrorist event.

A nurse is counseling a family about the management of childhood obesity. Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Set goals related to having a healthier lifestyle, not dieting b. Have low-calorie, nutritious snacks available and ready c. Allow snacking in front of the TV for short periods of time d. Decrease computer time and replace it with activities and chores e. Invest in a gym membership at a local facility

A, B, D Setting goals for a healthier lifestyle; having low-calorie, nutritious snacks available; and decreasing computer time will assist in managing childhood obesity. Allowing snacking in front of the TV will not decrease childhood obesity. Purchasing a gym membership may be expensive and if not used on a regular basis will have limited effect on obesity.

MULTIPLE RESPONSE Which trends are occurring when providing care for vulnerable populations? (Select all that apply.) a. Community-based care and interorganizational partnerships b. Outreach and case finding c. Elimination of disparities d. Culturally and linguistically appropriate care e. Increased incidence of acute illnesses

A, B, D Community-based care and interorganizational partnerships, outreach and case finding, and provision of culturally and linguistically appropriate care are all trends to improve care among vulnerable populations. Elimination of disparities is not a trend related to caring for vulnerable populations. Increased incidence of acute illness is not a trend of care provision for vulnerable populations.

MULTIPLE RESPONSE A nurse is using basic educational principles when conducting an effective educational program. Which of the following principles would the nurse most likely be using? (Select all that apply.) a. Use a clear, succinct style b. Use an active voice c. Refer to Internet sources d. Use aids to highlight key points e. Repeat information several times

A, B, D Using a clear, succinct style, active voice, and using aids to highlight key points are all basic educational principles that should be used by the nurse. Reliable sources must be used, and information found on the Internet is not always reliable. Repeating information is not an education principle.

A nurse is educating parents about sports safety. Which of the following information would be included in the education? (Select all that apply.) a. Grouping children according to weight, size, and skill level b. Providing adequate supervision by competent teenagers if adults are not available c. Using appropriate-size equipment d. Encouraging attendance at events by medical personnel e. Having an automated external defibrillator (AED) onsite

A, C Grouping children by size and skill level and using appropriate-size equipment are the best actions to promote sports safety. Teenagers cannot adequately supervise children in sports activities, and medical personnel do not need to be present at all sports events. Having an AED onsite is ideal, but may not be realistic.

Which of the following do the Millennium Development Goals address? (Select all that apply.) a. Reduction of child mortality b. Eradication of communicable diseases c. Promotion of gender equality and empowerment of women d. Achievement of universal health care access e. Promotion of specialty practice by physicians

A, C The Millennium Development Goals address reduction of child mortality and promotion of gender equality and empower women. Other goals include eradicating extreme poverty and hunger; achieving universal primary education; improving maternal health; combating HIV/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnership for development. Eradication of communicable diseases, achievement of universal health care access, and promotion of specialty practice by physicians are not part of the Millennium Development Goals.

The nurse is counseling a female who has recently tested positive for HIV. Which of the following will the nurse educate that the client is responsible for? (Select all that apply.) a. Have regular medical evaluations and follow-ups b. Donate blood and plasma to others who are positive for the disease c. Inform health care providers about the HIV infection d. Consider the risk of perinatal transmission e. Disclose her HIV infection to her employer

A, C, D A person who is infected with HIV should have regular medical evaluations and follow-up appointments; not donate blood or plasma; inform health care providers about the HIV infection; and consider the risk of perinatal transmission and follow-up with contraceptive use.

A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care

ANS: C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge, but is not a core function.

A nurse is working in the community with an aggregate/population. Who is the nurse most likely to interact with? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who drink coffee

ANSWER: A A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. Members of a community who can be defined in terms of geography or a special interest can be seen as constituting a population. The clients in the first option share a geographical and special circumstance (school) characteristic. Christians around the world are too large of a geographical space. A patient cannot be an aggregate/population as there is no one to interact with. People who drink coffee share a common interest, but may not share a common geographical location to interact.

The purpose of public health core functions is to: a. clarify the role of the government in fulfilling the mission of public health. b. ensure the safety of populations in receiving quality health care. c. provide community-based individualized care to every person in the United States. d. unite public and private providers of care in a comprehensive approach to providing health care.

ANSWER: A As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government's role.

A PHN collects data and monitors the health status of the population. Which of the following core public health functions is being implemented? a. Assessment b. Prevention c. Assurance d. Policy development

ANSWER: A Assessment consists of systematic data collection and monitoring health status. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

The nurse manager makes sure that the staff members who work in a local clinic are competent in their job responsibilities. Which of the public health core functions is being demonstrated? a. Assurance b. Assessment c. Prevention d. Policy development

ANSWER: A Assurance refers to making sure a competent health care workforce is available. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the community as a whole. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice.

ANSWER: A By definition, the first option is correct. Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff PHN; however, this is not a requirement for public health nursing or community health nursing practices.

A nurse is working in a community health nursing practice setting. Which of the following is the nurse most likely to implement? a. Administrating a flu shot to a client in a physician's office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation center

ANSWER: A Community health nursing practice focuses on the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole. Administrating a flu shot to an individual is the only example that meets this criterion. Performing a client assessment focuses only on individual care and not the community. Providing supervision of staff does not focus on the community. Conducting a flu shot clinic at a community center focuses on protecting the community as a whole and would be considered public health nursing practice.

The nurse is investigating environmental health problems caused by contaminated ground water. Which of the following types of nursing practice is being used? a. Community-oriented b. Community-based c. Policy development d. Tertiary care

ANSWER: A Community-oriented nursing emphasizes the prevention of disease and disability. Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Policy development seeks to build constituencies that can help bring about change in public policy. Tertiary care focuses on highly specialized medical care.

A local senator has proposed changes to the health care delivery system in the United States. Based on current trends, which of the following is most likely to occur? a. There will be new opportunities provided for public health specialists. b. It will result in isolated care being provided to individuals. c. There will be an increased emphasis in specialty care. d. It will increase the utilization of acute care services.

ANSWER: A Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention.

A public health department is using the mission of public health as described by the Institute of Medicine when planning its health programming. Which of the following activities will most likely be implemented? a. Tracking avian flu outbreaks and doing surveillance in the United States b. Providing a flu shot for an elderly person at the health department c. Keeping track of alternative therapies in use in the United States d. Keeping snake anti-venom at the Centers for Disease Control and Prevention in Atlanta

ANSWER: A The Institute of Medicine's stated mission on public health is "to generate organized community and technical knowledge to prevent disease and promote health." Tracking avian flu outbreaks and doing surveillance applies this concept at a population level. Providing a flu shot for an elderly person only addresses individual care. Keeping track of the use of alternative therapies does nothing to prevent disease or promote health of the population. Keeping snake anti-venom is aimed at disease care for an individual, not health promotion or disease prevention.

A community health nurse collects data about the number and proportion of persons aged 25 or older with less than a high school education. Which of the following best describes this data? a. Sociodemographic characteristics b. Health status data c. Health risk factors d. Health care resource consumption information

ANSWER: A The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Health risk factors discuss proportions of populations who have particular health conditions or health risks. Health care resource consumption refers to spending on health care per capita.

One of the primary focuses of improving the health of the American people in the twenty-first century is to address: a. Bioterrorism and global health threats b. Delivery of individual care and hygiene c. The need for increased hospital and acute care d. Chronic disease and disability management

ANSWER: A There are new concerns, and of the most serious are bioterrorism and globally induced infections, such as the avian flu. These threats will divert health care funds and resources from other health care programs to be spent for public safety. The others are not related to public health or are concerns that have been present for many years.

A nurse is implementing quality performance standards in a public health department. Which of the following best describes the importance of this action? a. Quality performance standards are used to guide improvement in the public health system. b. Quality performance standards rigidly control public health. c. Quality performance standards guide administrators to monitor public health at the national level. d. Quality performance standards can be used as hiring guidelines for nurses.

ANSWER: A These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services (PHSs). These standards were developed around the 10 essential PHSs. They focus on the overall public health system rather than on single organizations and describe an optimal level of performance. They are intended to support a process of quality improvement. State and local communities can assess their performance using certain available tools. They are not meant to control public health or be used for hiring guidelines.

The public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management b. Workforce needs assessment c. Acute care services d. Curriculum development

ANSWER: A Workforce needs assessment, acute care services, and curriculum developments are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: (1) analytic/assessment, (2) policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems thinking.

MULTIPLE RESPONSE Which of the following are considered barriers to public health nursing? (Select all that apply.) a. The mindset that the only role for the nurse is at the bedside b. The structures within which nurses work and the process of role socialization within those structures c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health d. The steady decline in the number of job opportunities in the area e. The inability to equally distribute the increasing funds

ANSWER: A, B, C Barriers exist in thinking that nurses only work in a hospital at the bedside, the process of role socialization in public health which can be a very autonomous profession, and that few nurses have had advanced education in public health. The number of job opportunities continues to increase, but the amount of funding allotted to public health continues to decline.

The necessary basic preparation for public health nursing is a(n) _____ in nursing. a. associate's degree b. baccalaureate degree c. master's degree d. Doctor of Nursing Practice degree

ANSWER: B A bachelor of science in nursing (BSN) is the necessary basic preparation to function as a beginning staff PHN. An associate's degree is not enough for basic preparation. A master's degree or Doctor of Nursing Practice degree would be part of preparation for advanced practice.

A PHN has been prepared at the graduate level. Which of the following activities should the practitioner be able to complete? a. Teach public and community health nursing b. Assess and intervene successfully at the aggregate level c. Diagnose and treat disease and have prescriptive authority d. Run for political office as experts in public health policy

ANSWER: B According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine.

Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a. individuals. b. aggregates. c. communities. d. geographical regions.

ANSWER: B Aggregates are a defined population made up of individuals in communities of a specific geographical region. Population-focused practice is implemented with defined populations or subpopulations. This is larger than the scope of individual care, but may not address the larger needs of the entire community or geographical region.

The PHN compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is being implemented? a. Assurance b. Assessment c. Prevention d. Policy development

ANSWER: B Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

A nurse is implementing community-based nursing care. Which of the following nursing interventions is the nurse most likely to complete? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a community

ANSWER: B Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition. Assessing the health needs of a community, promoting the health needs of an entire community, and investigating environmental health problems in a community would be considered public health nursing practice.

Which of the following describes the consequence of the successful implementation of the Affordable Care Act? a. Americans will pay closer attention to their health status. b. The majority of the population will be covered by insurance. c. Public health departments will need to increase the number of nursing positions. d. The prevalence of obesity will decrease.

ANSWER: B One consequence of successful implementation of the Affordable Care Act might actually be that the majority of the population would be covered by insurance and public health agencies will not need to provide direct clinical services in order to assure that those who need them can receive them. The Affordable Care Act will not directly cause Americans to pay closer attention to their health status or decrease the prevalence of obesity.

PHNs are looking to improve population-focused care in the community. Which of the following best describes a key opportunity for the nurses to accomplish this goal? a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practice

ANSWER: B PHNs must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care.

To better address emerging public health issues, a PHN plans to complete continuing education in this area. Which of the following content areas should be included in the course that is chosen? a. Leadership b. Ethics c. Communication d. Finance

ANSWER: B Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: (1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory research, (5) policy, (6) law, (7) global health, and (8) ethics.

A population is best defined as a: a. high-risk group. b. those interacting within a school or institutional setting. c. collection of individuals who share at least one common characteristic. d. geographical location within a community.

ANSWER: C A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. High risk groups, school or institutional setting, and geographical location within the community all describe types of populations, not the definition of population.

A nurse provides for the availability of essential personal health services for people who would otherwise not receive health care. Which of the public health core functions is being used? a. Assessment b. Prevention c. Assurance d. Policy development

ANSWER: C Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

A community is concerned about the threat of bioterrorism. Which of the following best describes the basis for this concern a. Bioterrorism has the potential to dissolve community-based programs b. This threat could cause the health care system to collapse c. This threat of bioterrorism may divert funds from other public safety health care programs. d. Fear of bioterrorism will increase the need for shelters

ANSWER: C Bioterrorism may have an impact on the availability of resources for public safety health care programs. Because funds are diverted it is possible that community-based programs would be eliminated, the health care system could experience changes, and that there would be an increase in the need for shelter. However, all of these things would happen because of the diversion of funds.

Which of the following statements about public health is accurate? a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b. Expenditures and resources for public health have increased in recent years. c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior. d. Reform of the medical insurance system is the single change needed to improve the health of Americans.

ANSWER: C Fielding and Tilson have asserted that most of the increase in life span has been made through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. Medical treatment has not made as significant of an impact on the life span as public health measures. Funding for public health in recent years has been on a gradual decline. Although reform of the medical insurance system may help improve the health of Americans, there are many other factors that will need to be addressed.

The PHN analyzes data related to the number and type of United States Environmental Protection Agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional status

ANSWER: C Health risk factors discuss proportions of populations who have particular health conditions or health risks; breathing air of poor quality is a risk to health. The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Functional status refers to reports of good health status by members of the population.

A nurse is using a population focus when providing public health nursing care. Which of the following statements best describes the care that is being provided? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered.

ANSWER: C PHNs are concerned with the health of the entire population. Priority is given to the entire population, not just the group at highest risk or those outside of institutional settings. Direct caregiving is not the focus of public health nursing care.

A public health staff nurse has a clear understanding of population-focused practice. Which of the following characteristics would the nurse most likely display? a. Volunteering for a local community action coalition b. Able to perform interventions with individuals in the community c. Able to improve the effectiveness of care provided d. Considered a PHN specialist

ANSWER: C Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. PHN specialists are prepared at the master's level and function in an administrative role.

The public health nurse (PHN) must participate in the essential services of public health. Which of the following most accurately describes one of the essential services of public health? a. Monitoring health status by completing a community assessment b. Diagnosing and investigating health problems in the world c. Informing, educating, and empowering people about health issues d. Working in law enforcement to regulate health and ensure safety

ANSWER: C The PHN monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The PHN would not diagnose or solve "world" problems, or work in law enforcement. Rather, the PHN would participate with local regulators to protect communities and empower people to address health issues.

A nurse performs activities to meet the primary goals of public health. Which of the following is the nurse most likely to complete? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old woman

ANSWER: C The correct answer is concerned with the health of many people, while the other answers address individual interventions. According to the Core Functions Project, all levels of health care, including population-based public health care, must be funded or the goal of health of populations may never be reached.

A PHN provides a clinic for HIV-positive citizens in the community. Which of the following best describe this activity? a. Primary prevention b. Health education c. Tertiary prevention d. Policy making

ANSWER: C This clinic is for clients who already have a disease process; therefore, it is tertiary prevention (preventing deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care). Primary prevention is using general and specific measures in a population to promote health and prevent the development of disease (incidence) and using specific measures to prevent disease in those who are predisposed to developing a particular condition. Health education would involve providing specific education to this population. Policy making is formulating plans by an organization in order to make decisions.

A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse performing? a. Community-oriented b. Public health c. Community health d. Community-based

ANSWER: D Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the community as a whole. Community health nursing focuses on the health status of individuals and the effect of their health status on the community as a whole.

A PHN develops and implements local public health policies through partnerships with agencies, organizations, and consumers within the community. Which of the following core public health functions is being used? a. Assessment b. Prevention c. Assurance d. Policy development

ANSWER: D Policy development deals with developing and implementing health policies. Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection.

The nurse is interviewing a client who reports that he drinks alcohol when snorting cocaine. Which of the following best describes what is happening with this client? a. Drug addiction b. Polysubstance use c. Substance abuse d. Indiscriminate drug use

B A client who drinks alcohol when snorting cocaine is suffering from polysubstance abuse. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed. Substance abuse is the use of any substance that threatens a person's health or impairs his or her social or economic functioning. Indiscriminate drug use refers to careless use of drugs.

A nurse is working with an older person following a disaster. Which of the following emotions of the client should be anticipated by the nurse? a. Anger b. Fear of loss of independence c. Violence d. Regression

B A common reaction of older persons experiencing disaster may be fear of loss of independence. Young children may respond with regression. The community in general may respond will feelings of anger, sorrow, guilt, and perceived blame for the disaster or the outcomes of the disaster. Violence should not be anticipated with any of the populations discussed in the text.

A nurse is studying the characteristics of an agent as part of the epidemiologic triangle. Which of the following is the nurse most likely studying? a. Human population distribution b. Salmonella c. Genetic susceptibility d. Climate

B An agent includes infectious organisms, such as Salmonella, chemical agents, and physical agents. Genetic susceptibility is considered to be a characteristic of a host. Human population distribution and climate are considered to be characteristics of the environment.

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

B An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. Host resilience is a host factor. Infectiousness is the measure of the potential ability of an infected host to transmit the infection to other hosts. Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts, such as a bug bite.

An epidemiologist wants to know what caused severe diarrhea and vomiting in several people at a local banquet. Which of the following principles is being applied in this situation? a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants

B Analytic epidemiology is directed toward understanding the etiology of the disease. Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Distribution describes who has the disease and where and when the disease occurs. Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental.

A nurse is volunteering on a disaster medical assistant team as a first responder. Which of the following tasks would the nurse be prepared to perform? a. Set up immunization clinics b. Assist in triaging disaster victims c. Provide all the medical care for disaster victims d. Complete a needs assessment of the community

B As a first responder arriving on the scene, the plans for triaging of disaster victims should begin immediately. Setting up immunization clinics would not be a priority following a disaster. In responding to a disaster, it may be impossible to provide all of the medical care for disaster victims. It would not be appropriate to start with completing a needs assessment of the community following a disaster; this should be done before the disaster occurs.

A family with children has income too high to qualify for state health insurance, but does not have enough money to purchase private health insurance. Which program would a nurse refer this family to for the children to receive health care coverage? a. Medicare b. Children's Health Insurance Plan (CHIP) c. Medicaid d. Social Security

B CHIP is a federal and state partnership that is directed toward uninsured children and pregnant women in families with incomes too high to qualify for state Medicaid programs but too low to afford private coverage. Medicare is a government insurance program primarily offered to the elderly population. Social Security is not a health care insurance program.

An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is called: a. case management. b. care management. c. disease management. d. demand management.

B Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual's and family's comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system.

A community has residents who provide information to the city council so that decisions can be made about the health of the community. Which of the following characteristics is being displayed? a. Active partnerships b. Passive partnerships c. Gatekeeping d. Focus groups

B Coalitions are active partnerships in which all participants share leadership and decision making to some degree. Unfortunately, some community health efforts view community residents only as sources of information and receivers of interventions; this limits residents to passive participation. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants but to a small group rather than an individual.

A nurse is providing care for a family in which a nonaddict is experiencing a stress-induced preoccupation with an addict's life, leading to extreme dependence on the addict. Which of the following best describes what is happening? a. Obsession b. Codependency c. Enabling d. Addiction

B Codependency occurs when a person in a close relationship with an addict develops unhealthy coping mechanisms to continue the relationship. Obsession is a thought that continually preoccupies ones' thoughts. Enabling is the act of shielding or preventing the addict from experiencing the consequences of addiction. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.

Dependence is a term that refers to the: a. presence and severity of withdrawal symptoms. b. necessary use of drugs to prevent withdrawal symptoms. c. level of intoxication associated with addiction. d. amount of substance needed to satisfy cravings.

B Dependence refers to the necessary use of drugs to prevent withdrawal symptoms. This occurs because of a state of neuroadaptation (a physiological change in the central nervous system).

A nurse is working as a case manager and is in the process of performing interdisciplinary, family and client conferences. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Planning for outcomes d. Implementation

B Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of assessment include developing networks with target populations and dissemination of written materials. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions. Examples of implementation include contacting providers and coordinating care activities.

A client has not yet made a commitment to take action to change his health behaviors. Which stage of change is the client experiencing? a. Precontemplation b. Contemplation c. Preparation d. Action

B During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the preparation phase, the individual is prepared for action and may reduce the problem behavior but has not yet taken effective action. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.

A nurse is working in a community that is experiencing the Honeymoon Phase after a disaster. Which of the following is characteristic of this phase? a. First responders work tirelessly to save others. b. Survivors share their stories. c. Medical personnel experience exhaustion. d. Community organizations rebuild the community.

B During the Honeymoon Phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the Heroic Phase. Medical personnel experience exhaustion during the Disillusionment Phase. The community begins to rebuild during the Reconstruction Phase.

A nurse is engaging in the evaluation phase of community health program planning. Which of the following would be part of effective completion of this phase? a. Demonstrate the ability to improve the health of the participants b. Develop measureable objectives and goals before implementation c. Encourage full participation by community members d. Improve the health of the population through the program

B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed. Participation by community members and improvement of the health of the population may be measured through the evaluation phase, but would not demonstrate completion of this phase. The evaluation phase may determine if the participants' health improved, but improvement of health is not part of the completion of this phase.

A public health nurse (PHN) understands that the emergence of new infectious diseases is influenced by the: a. increased availability of immunizations. b. globalization of food supplies. c. decreased use of child care facilities. d. creation of sanitation systems in third world countries.

B Globalization of food supplies is one of the many factors that can influence the emergence of infectious diseases. The increased use of childcare facilities could contribute to the emergence of new infectious diseases. The lack of sanitation systems in third world countries could contribute to the emergence of new infectious diseases. The increased availability of immunizations should decrease the emergence of diseases.

The health priorities in HEALTH21 are based on the concept of: a.eradication of communicable disease worldwide. b.social justice and solidarity with an emphasis on the responsibility for health. c.world trade and knowledge sharing about health concerns. d.provisions for the creation of the United Nations Children's Fund (UNICEF).

B HEALTH21 is not a single, finite goal but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity with an emphasis on individual, family, and community responsibility for health. The concepts of eradication of communicable disease worldwide, world trade and knowledge sharing about health concerns, and provisions for the creation of UNICEF are not part of these health priorities.

A nurse is examining the route of HIV transmission for a newly diagnosed HIV client. Which of the following would most likely be discovered by the nurse? a. Having contact with an HIV-positive individual who is coughing b. An infant receiving breast milk from an HIV-positive mother c. Receiving a mosquito bite while in Africa d. Being near an HIV-positive individual who is sneezing

B HIV can be transmitted through breast milk. HIV is not transmitted by coughing, sneezing, or mosquito bites.

In comparison with HIV infection in adults, HIV infection in infants and children: a. has the same signs and symptoms. b. has a shorter incubation period. c. has a longer survival period. d. is detected by using the same tests.

B HIV infection in infants and children has a shorter incubation period. The physical signs and symptoms in children are different and include failure to thrive, unexplained persistent diarrhea, developmental delays, and bacterial infections such as tuberculosis (TB) and severe pneumonia. Detection is made through different tests in infants of infected mothers than from those who are over 18 months. The effectiveness of antiretroviral therapy in pregnant women and newborns in preventing transmission from mother to fetus or infant has made pediatric HIV rates decline sharply; thus, these children are less likely to contract the virus.

Acts of bioterrorism or natural disasters, such as earthquakes, will often have more casualties because: a. they cause the most widespread destruction. b. victims have little time to make evacuation preparations. c. those with chronic conditions cannot escape in time. d. the early warning systems are not effective.

B The use of weapons of mass destruction or natural disasters, such as earthquakes, will often have more casualties because victims have little time to make evacuation preparations. The other answers are false.

A nurse is working to improve the health status of a population in a lesser-developed country. Which of the following interventions would the nurse most likely support? a. Decrease the number of people who need outside resources b. Increase the number of children who can attend school c. Increase the monetary resources that can be used to treat disease and illness d. Improve the ability to pay debt to more developed countries

B Health status improvement in children can lead to better education that eventually helps the country's economic growth. Because children are educated, there is more economic growth. This allows for additional monetary resources to be spent on economic development rather than on treatment of illness and disease.

Immunity is a characteristic of the: a. agent factor. b. host factor. c. environmental factor. d. epidemiologic triad.

B Immunity refers to species-determined resistance to an infectious agent and is determined by the characteristics of the host. The agent is the infection that is causing the infection/disease. Environmental factors may influence the susceptibility of the host. The epidemiologic triad involves the interaction of the host, agent, and environment.

A nurse states that she has been reading about an epidemic that has been occurring in the world. Which of the following is she most likely referring to? a. "Bird" flu in China b. Adult obesity in the United States c. An isolated case of smallpox in Africa d. The nursing shortage in the United States

B It is estimated that 30% of the adults in the United States are obese. According to the Centers for Disease Control and Prevention, this is an epidemic. The other examples are not epidemics.

A nurse is working in a health department when a patient arrives who has been traveling to South America and has been diagnosed with malaria. Which of the following considerations should be made by the nurse? a. The Morbidity and Mortality Weekly Report should be consulted to investigate the rate of malaria in the United States. b. This is a disease that must be reported to the state health department. c. The nurse should take precautions to wear a mask and gown to avoid exposure. d. The patient is very ill and should be sent to the hospital immediately.

B Malaria is on the list of infectious diseases notifiable at the national level. The Morbidity and Mortality Weekly Report is published weekly with the rates of disease; however, this would not be the first consideration by the nurse. Malaria is not spread by direct contact, rather from a bite from an infected mosquito. Malaria begins with flu-like symptoms, or the client may have very few symptoms.

A nurse is advocating for increased funding for an international agency. Which of the following best describes how these funds will likely be used? a. Development and installation of technology b. Food relief, worker training, and disaster relief c. Support of dictatorships and corrupt governments d. Funding of local private organizations

B Many international organizations have an ongoing interest in global health. Despite the presence of these well-meaning organizations, it is estimated that the lesser-developed countries still bear most of the cost for their own health care and that contributions from major international organizations actually provide for less than 5% of needed costs. Recent reports indicate that the majority of funds raised by international organizations are used for food relief, worker training, and disaster relief.

Which statement about sudden infant death syndrome (SIDS) is true? a. SIDS occurs most often in female infants. b. Maternal cigarette smoking increases risk. c. Most deaths occur between 2 and 8 months of age. d. Most victims had a previous episode of cyanosis or apnea.

B Maternal smoking increases risk three to four times. SIDS occurs most often in male infants, most deaths occur between 1 and 5 months, and only a small number of victims have had a previous episode of cyanosis or apnea.

The leading cause of death for unintentional injuries among children and teenagers is: a. drowning. b. motor vehicle accidents. c. burns. d. poisonings.

B Motor vehicle crashes remain the leading cause of death for unintentional injuries in children and teens. Drowning, poisonings, and burns account for most of the other deaths.

A nurse is investigating an outbreak of a gastrointestinal illness from a food-borne pathogen. Which of the following terms is being applied? a. Attack rate b. Point epidemic c. Secular trend d. Event-related cluster

B One temporal and spatial pattern of disease distribution is the point epidemic. A point epidemic is most clearly seen when the frequency of cases is plotted against time. The sharp peak characteristic of such graphs indicates a concentration of cases in some short interval of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Secular trends are long-term patterns of morbidity or mortality rates. Event-related clusters are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.

Population health is an approach and perspective that focuses on: a. control of the spread of the HIV virus worldwide. b. the broad range of factors and conditions that influence health. c. community-based care for all citizens. d. prevention and diagnosis of disease worldwide.

B Population health is a holistic approach that considers the total health system. The focus of population health is broader than only considering spread of the HIV virus. Population health considers more than the community-based care in the community. Population health examines spread of disease on a smaller scale.

What happened in the United States as a result of prohibition? a. Substance abuse declined b. Violent crime and corruption increased c. The need for community health nurses declined d. Facilities to treat substance abuse improved

B Prohibition led to increased crime and corruption among law officials related to the illicit market. Because of the problems that were caused, prohibition was eventually recognized as a failure and repealed.

A nurse is giving advice using the acronym FRAMES. Which of the following actions would most likely be taken by the nurse? a. Offer a suggestion as to how the behavior should change b. Provide clear guidance to change risky behavior c. Refer the client to a local support group d. Emphasize the need for others to support the client's change

B Providing clear advice to change risky behavior is one of the elements of the FRAMES method of intervention, "A"—advice. The other FRAMES are feedback, responsibility, menu, empathy, and self-efficacy.

The probability an event will occur within a specified period of time is called: a. rate. b. risk. c. epidemiology. d. epidemic.

B Risk is the probability an event will occur within a specified period of time. Rate is a measure of the frequency of a health event in a defined population, usually in a specified period of time. Epidemiology is the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems. Epidemic occurs when the rate of disease, injury, or other condition exceeds the usual level of that condition.

A nurse assesses the playground safety at a new community center and notices rope swings and a trampoline. Which of the following actions should be taken by the nurse? a. No action is required. b. Explain to the staff that these items are not recommended for playgrounds. c. Supervise the children closely when they are using this equipment. d. Compose a letter to be shared at the next city council meeting.

B Rope swings and trampolines are not recommended for playgrounds. Action should be taken by the nurse because these items are dangerous. Close supervision will not prevent an accidental injury from occurring. Writing a letter to be shared at the next city council meeting is not a timely response by the nurse.

A nurse is teaching a client diagnosed with gonorrhea how to prevent reinfection and further spread. Which of the following describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary health care

B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention focuses on chronic care and rehabilitation. Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

A nurse administers a rabies immunization post-exposure to an animal bite. Considering the interventions used with infectious disease, which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Tertiary prevention reduces complications through treatment and rehabilitation. Assessment refers to the systematic collection of data.

A nurse offers a screening for hearing defects at a local community center. Which of the following best describes the action of the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Screenings are part of secondary prevention interventions. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.

A nurse is considering the potential for selection bias. Which of the following best describes the situation that is the nurse has encountered? a. Determining the population to be studied b. Considering how the participants will enter the study c. Studying cause and effect relationships d. Documenting results of the study

B Selection bias is attributable to the way subjects enter a study. It has to do with selection procedures and the population from which subjects are drawn. Determining the population to be studied relates to the design of the study. Studying cause and effect relationship has to do with ecological studies. Documenting the results of the study is completed at the end of the study after the participants have been selected.

Which factor has contributed to the problem of substance abuse? a. Increased knowledge about the use of drugs b. Social acceptability of certain drugs c. Recognition of substance abuse as a health problem d. Control of the content and strength of illegal drugs

B Social acceptance of certain drugs, such as caffeine, alcohol, and tobacco, contributes to the substance abuse problem. Not all substances that are abused are illegal.

The use of any substance that threatens a person's health or impairs his or her social or economic functioning is: a. drug dependence. b. substance abuse. c. drug addiction. d. illegal.

B Substance abuse is the use of any substance that threatens a person's health or impairs his or her social or economic functioning. Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed. Illegal means that it is against the law, not all substances are illegal.

A community health nurse has recently become involved in surveillance. Which of the following describes the situation that the nurse is in? a. Educating clients about influenza immunizations b. Collecting information about occurrence of measles c. Evaluating the effectiveness of an HIV/AIDS prevention program d. Advocating for changes in the national disease reporting requirements

B Surveillance gathers the "who, when, where, and what"; these elements are then used to answer "why." Nurses are frequently involved in surveillance by collecting data, making diagnoses, investigating and reporting cases, and providing information to the general public. Client education, program evaluation, and advocating for changes are not part of the surveillance process.

A community health nurse is investigating international diseases. Which of the following would the nurse track by using the global burden of disease (GBD)? a. The number of cases of HIV/AIDS in a country b. Losses from premature death and losses of healthy life that result from disability c. The economic impact of disability on lesser-developed countries d. The rate of disability in industrialized nations

B The GBD combines losses from premature death and losses of healthy life that result from disability. The GBD represents units of disability-adjusted life-years (DALYs). This statistic is not specific to a particular disease or a particular developmental stage of a country.

A bioterrorism attack has occurred in the United States. Which of the following programs would be used to provide large quantities of medications to the American public? a. Cities Readiness Initiative b. Strategic National Stockpile (SNS) c. Public Health Information Network (PHIN) d. Project BioShield

B The SNS has the capacity to provide large quantities of medicine and medical supplies to protect the American public in a public health emergency. The Cities Readiness Initiative aids cities in increasing their capacity to deliver medicines and medical supplies during a public health emergency. The PHIN helps ensure information access and sharing. Project BioShield is a program to develop and produce new drugs and vaccines against potential bioweapons.

A community health nurse is utilizing the health care system in the United Kingdom. Which of the following expectations should the nurse have? a. An equal employer-citizen share in cost of health care b. Ownership and operation of the system by the government c. Nurse practitioners as the primary providers of care in the system d. Primary care provided in hospitals

B The United Kingdom has a tax-supported health system that is owned and operated by the government. Services are available to all without cost or for a small fee. Physicians are the primary providers in this system; nurses and allied health professionals are also recognized and used. Services are made available through hospitals, private physicians and allied health professional clinics, health outreach programs such as hospice, boroughs, and environmental health services.

A nurse is assessing a refugee who fled the genocide in Darfur. Which of the following disease/disorder should the nurse anticipate finding? a. TB b. Post-traumatic stress disorder (PTSD) c. Chronic obstructive pulmonary disorder (COPD) d. Malnutrition

B The biopsychological changes seen following genocide include physical stress reactions (cardiovascular, neurological) and mental stress responses, especially PTSD and depression. The biopsychosocial changes are the major concern over any physical illnesses that may be present.

A case manager provides a formal communication link among all parties concerning the plan of care management. Which of the following roles of the nurse is being implemented? a. Facilitator b. Liaison c. Coordinator d. Negotiator

B The case manager providing a formal communication link among all parties concerning the plan of care management is performing the role of liaison. As a facilitator, the nurse supports all parties in work toward mutual goals. When working as a coordinator, the case manager arranges, regulates, and coordinates needed health care services for clients at all necessary points of services. The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator.

A nurse is assessing a child with chronic health problems and his family. Which of the following factors should be taken into account? a. The ability of the family to pay for expensive equipment b. The degree of impairment to the child's ability to develop c. How often recreational activities will take place d. Special needs "camp" placement for the child in the summer

B The degree of impairment to the child's ability to develop is a concern of the community health nurse. Financial resources need to be assessed and adaptations may need to be made to avoid expensive equipment. The frequency of other treatments and therapies should be considered in addition to recreational activities. A special needs "camp" placement may not be an appropriate suggestion for every child with chronic health problems.

The time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease is called: a. communicable period. b. incubation period. c. infectiousness. d. endemic.

B The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms. The communicable period is the interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person. Infectiousness is the measure of the potential ability of an infected host to transmit the infection to other hosts. Endemic refers to the constant presence of a disease within a geographic area or a population.

The leading cause of birth defects in the United States is: a. cigarette smoking. b. fetal alcohol syndrome. c. marijuana use. d. HIV from sharing needles.

B The leading preventable cause of birth defects in the United States is fetal alcohol syndrome, causing mental and behavioral impairment.

The most important predictor of overall mortality is: a. race. b. age. c. gender. d. income.

B The mortality curve by age drops sharply during and after the first year of life to a low point in childhood, then begins to increase through adolescence and young adulthood and then increases sharply through middle and older ages. Race, gender, and income are not the most important predictor for overall mortality.

One case of smallpox occurs in a population in which it was considered to be previously eliminated. Which of the following best describes what has occurred? a. Endemic b. Epidemic c. Pandemic d. Infectivity

B The occurrence of one case of smallpox in a population in which it was considered to be previously eliminated is an epidemic. Endemic refers to the constant presence of a disease within a geographic area or population. Pandemic refers to an epidemic occurring worldwide and affecting large populations. Infectivity is the ability to enter and multiply in the host.

The original goal of deinstitutionalization was to: a. reduce state costs of caring for the chronically mentally ill. b. replace state psychiatric hospitals with community-based treatment programs. c. modernize psychiatric hospitals. d. allow mentally ill persons to live on their own to test their life skills.

B The original goal was to replace large psychiatric hospitals with community-based treatments centers. However, federal and state governments failed to allocate the needed funds.

A nurse is examining the future of disaster management. Which of the following should the nurse anticipate? a.Vague and unorganized future due to constant emergence of new disasters b. Increasing sophistication in technology and surveillance c. Lack of involvement by national and state officials d. Decreasing need for public health workers to provide care

B The terrorist event of September 11, 2001, and the anthrax cases have increased the awareness for the need to plan for disasters. Technology and surveillance will continue to advance. Disaster management continues to change and become more organized as learning occurs after each incident, producing progressive best practices. National and state officials are very involved in disaster management. PHNs are particularly critical members of the multidisciplinary disaster health team given their population-based nursing focus and specialty knowledge in epidemiology and community assessment skills.

A nurse is utilizing the provisions created by the Ryan White HIV/AIDS Treatment Extension Act. Which of the following interventions is the nurse most likely performing? a. Increasing AIDS awareness in the community b. Determining available health care services for HIV-infected individuals c. Preventing the transmission of AIDS to children from their mothers d. Allowing persons in the final stages of HIV to die with dignity

B This act provides emergency services, services for early intervention and care, and drug reimbursement programs for HIV-infected individuals.

A nurse is educating intravenous (IV) drug users about sharing equipment. Which of the following information would be appropriate for the nurse to include in this education? a. Tell the clients to throw away their equipment after one use b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30 seconds c. Suggest limiting the number of people who share the equipment d. Provide clean needles and syringes to whoever wants them

B Using bleach on the needles and syringes is a way to decrease cross-contamination. This is the last-resort option. People who inject drugs are difficult to reach for health care services, so providing them education is important so that they can protect themselves and others as they most likely will not throw away their equipment, or be selective about whom they share their equipment with. Providing needles and syringes does not provide the appropriate education to prevent the spread of disease.

A nurse is caring for a client who has been diagnosed with West Nile Virus. Which of the following types of illness does the client have? a. Food-borne b. Vector-borne c. Water-borne d. Zoonoses

B West Nile virus is carried by a mosquito, which is a vector. Food-borne illnesses are carried by food. Water-borne illnesses are transmitted through water. Zoonoses are infections that are transmitted from vertebrate animal to a human under natural conditions.

Which part of the immunological system suffers the greatest damage as a result of HIV infection? a. Dendrite cells b. CD4+ T-lymphocytes c. Macrophages d. Monocytes

B When HIV enters the body, a person may experience a mononucleosis-like syndrome, referred to as a primary infection, which lasts for few weeks. This may go unrecognized. The body's CD4 white blood cell count drops for a brief time when the virus is most plentiful in the body. The dendrite cells, macrophages, and monocytes are not as severely damaged as the CD4 cells.

A PHN is conducting an assessment of the community's health. Which of the following is being accomplished through this activity? a. Define one problem that will be the focus for a year b. Assess a social network of interacting individuals usually in a defined territory c. Minimize the effects of health risks and hazards d. Intervene at the population level by changing laws and regulations

B A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase.

A nurse is working with multiple vulnerable groups. Which of the following would be most sensitive to adverse effects? a. Pregnant teenager living with her parents for financial support b. Poor, older woman with no means of transportation c. 2-year-old boy of underinsured parents d. Recently unemployed father of five

B A poor, older woman with no means of transportation has a combination of risk factors. A pregnant teenager, 2-year-old boy, and recently unemployed father are only displaying one risk factor, not multiple risk factors as the older woman displays.

A set of actions one undertakes on behalf of another is: a. social justice. b. advocacy. c. resilience. d. risk.

B A set of actions one undertakes on behalf of another is advocacy. Social justice describes justice with respect to the concepts of egalitarianism and equality. Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. Risk describes that some people have a higher probability of illness than others.

A nurse's excessive attention to cost containment impairs the nurse's duty to provide measures to improve health. Which of the following ethical principles is being influenced? a. Autonomy b. Beneficence c. Veracity d. Nonmaleficence

B Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Autonomy is the individual's right to choose a provider. Veracity is truth telling which is important to building trusting relationships with clients. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care.

A nurse is trying to break down the barriers between the health care professionals and people who live in poverty. Which of the following actions should be taken by the nurse? a. Maintain a strict professional demeanor b. Call the client by name c. Keep client appointments as scheduled d. Smile and be friendly to clients

B By calling the client by name, nurses can then begin the process of breaking down barriers of fear, isolation, uncertainty, and the unknown. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.

Which factor influences the growing number of poor persons in the United States? a. Increase in company earnings b. Changes in the labor force c. Better access to quality education d. Adequate welfare benefits

B Changes in the labor force affect the growing number of poor persons in the United States. Decreased company earnings, decreased access to education and job skills, and inadequate welfare benefits also influence the growing number of poor persons.

Environmental health is important to nurses because chemical, biological, and radiological materials are: a. a major cause of global warming. b. often found in the air, water, and products we use. c. frequently linked to the development of chronic illnesses. d. products that nurses work with on a daily basis.

B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use. These are not a major cause of global warming. They are not frequently linked to the development of chronic illnesses. These are not products that nurses work with on a daily basis.

A public health nurse (PHN) is working with a migrant farm worker who has experienced an exposure to a pesticide. When researching pesticides, the nurse looks at the "family" of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity

B Chemicals are grouped so it's possible to understand the actions and risks associated with each group. Although some common health risks exist within these families of chemicals, the possible health risks for each chemical should be evaluated individually when a potential human exposure exists.

The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, "Tell me more about how you will work full time and breastfeed." Which of the following aspects of the advocacy process is being used? a. Verification b. Clarification c. Amplification d. Affirmation

B Clarification is a process in which the nurse and client strive to understand meanings in a common way. Verification is the process used by the nurse advocate to establish accuracy and reality in the informing process. Affirmation is based on an advocate's belief that a client's decision is consistent with the client's values and goals. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client's decision.

A PHN is using collaboration, coalition building, and community organizing to develop a new program in the community. Which of the following strategies is the nurse most likely using? a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies

B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment.

A case manager submits documentation that a nursing visit was completed at a client's home, but it was never performed. According to the general areas of legal risk, how would this action best be categorized? a. Liability for managing care b. Fraud/abuse c. Negligent referral d. Confidentiality/security

B Fraud/abuse occurs when false statements of claims are made and filed. Confidentiality/security occurs when sensitive information is not secured. Negligent referral occurs when referrals or treatments are inappropriate. Liability for managing care occurs when case management is not used appropriately, when there is harassment, or when care is inappropriately delegated.

A nurse is developing a goal for a client who is learning how to care for an ostomy. Which of the following would be most appropriate to develop? a. The client will look at his stoma without disgust each time his ostomy bag comes off. b. The client will be able to independently take care of his ostomy bag within three months. c. The client will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. The client will successfully describe to the nurse how to care for his ostomy when he is asked.

B Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time. The other choices describe objectives.

A nurse is using health status indicators to complete a community assessment. Which of the following best explains what the nurse is doing? a. Interviewing key informants in the community b. Examining morbidity and mortality rates in the community c. Surveying local businesses in the community d. Observing community members

B Health indicators are numerical measures of health outcomes, such as morbidity and mortality, as well as determinants of health and population characteristics. Generally, these data are from secondary sources such as websites or printed materials. Interviewing key informants, surveying local businesses, and making observations are all methods of primary data collection.

A nurse uses Healthy People 2020 as a guide when planning health education in the community. Which of the following actions would be taken by the nurse? a. Focus on avoiding cigarette smoking and using alcohol in moderation b. Educate clients using primary and secondary levels of prevention c. Use Bloom's taxonomy when planning educational objectives d. Design health fairs aimed at individuals

B Healthy People 2020 focuses on implementing health promotion in priority areas using primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care. Health fairs targeted at specific populations can provide a venue for providing primary and secondary prevention.

A nurse is working with an individual who has a low literacy level. Which of the following barriers to learning should the nurse anticipate? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of anxiety d. Being overly dependent on others

B Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may focus on details and deal in literal or concrete concepts versus abstract concepts. They may select responses on a survey without necessarily understanding them and may be unable to understand math. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home. The level of anxiety may vary among these individuals; it is more common for these individuals to request to read it later.

A nurse wants to find more information about indoor air quality. Which of the following websites would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. "Right to Know" d. The Occupational Safety and Health Administration (OSHA)

B Indoor air quality is a growing public health concern in office buildings, schools, and homes and is reflected in the alarming rise in asthma incidence in the United States, particularly among children. Sources of information about indoor air quality include the EPA and the American Lung Association. The NIH is part of the U.S. Department of Health and Human Services (USDHHS) and is responsible for health and biomedical research. "Right to Know" is part of a workplace safety legislation. OSHA regulates safety in factories and businesses.

A community health nurse is conducting informant interviews in a small community. Which of the following would the nurse most likely contact? a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area

B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants. Key informants need not hold any formal title, but are generally viewed as community leaders by other community members and often have a long history in the community. The state department of health, surrounding communities, and CDC do not meet the definition of an informant.

A nurse has evaluated the learning needs of a community support group. Which of following steps should the nurse take when developing an educational program for them? a. Consider any potential barriers to learning b. Establish goals and objectives for the program c. Select appropriate materials for the program d. Assess the dynamics of the group

B Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the educational process are: (1) identifying educational needs, (2) establishing educational goals and objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5) evaluating the educational process.

Public health interventions are implemented with: a. legislators, policy makers, and community leaders. b. individuals and families, communities, and systems. c. children, adolescents, and adults. d. health departments, public health agencies, and visiting nurses associations.

B It is important to know that PHNs work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening.

A nurse is working with a vulnerable group experiencing multiple risk factors. Which of the following best describes this group? a. Smokers who use chewing tobacco as well as cigarettes b. Substance abusers who test positive for HIV c. Persons with limited access to care because they live in a rural area d. New mothers needing information about baby and child care

B Multiple risk factors are present in substance abusers, including contracting HIV and hepatitis B virus. Homelessness is another risk factor. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs.

Which is considered a non-point source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water

B Non-point sources come from more diffuse exposures to pollution. Animal waste is the only diffuse exposure given. The others are considered point sources; point sources are individual, identifiable sources such as smoke stacks.

A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-up

B One example of coalition building is promoting alliances among organizations for a common purpose. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

A leader controls members through rewards and often keeps members in the dark about the goals and rationale behind prescribed actions. What type of leadership does this describe? a. Democratic b. Patriarchal c. Socialist d. Paternal

B Patriarchal is authoritative, whereas one may control members through rewards and threats. Paternal leaders win respect and dependence through parent-like devotion. Democratic leadership is cooperative in nature and promotes and supports members' involvement in all aspects of decision making and planning. Socialist leadership supports community ownership and involvement of the community.

The public health nurse (PHN) is taking care of a poor family, whose parents, grandparents, and great-grandparents also have been poor. Which of the following terms best describes this family? a. Near poor b. Persistent poor c. Impoverished d. Neighborhood poverty

B Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants. The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.

A nurse is conducting a community assessment in a poor neighborhood. Which of the following is the nurse most likely to find? a. Fewer minority groups b. Increased exposure to environmental hazards c. More available health care services d. Lower rates of crime and substance abuse

B Poor neighborhoods are more likely to have exposure to environmental hazards. Lower socioeconomic neighborhoods have been linked with poorer general health status, chronic conditions, mortality, birth outcomes, disability, injury and violence, and other health indicators. They are more likely to have higher rates of crime and poorer access to health care services.

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

B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors. Population management does not include census taking, providing case management services for all, or repeating wellness programs on an annual basis.

A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. Which of the following types of data is being collected? a. Quantitative b. Qualitative c. Focus groups d. Participant observation

B Qualitative data is collected through interviews and observation. This data is the descriptions provided by these individuals through interviews. Quantitative data is the numbers that can be found about the community, such as crime statistics. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event.

A nurse is planning to evaluate an individual's progress toward a health goal. Which of the following components should be included in the evaluative process? a. Type of teaching strategy used b. Recognition of accomplishments in the group c. Conflict that occurred in the group d. The type of leadership in the group

B Recognition of accomplishments in the group and of the group is built into the evaluative process. The type of teaching strategies used, types of leadership, and conflict are not part of the evaluative process of the group.

A nurse is examining social determinants of health. Which of the following is the nurse looking at? a. Ethnicity b. Income c. Gender d. Marital status

B Social determinants of health are such factors as economic status, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk. Ethnicity, gender, and marital status are not considered social determinants of health.

A nurse upholds a client's right to make a choice and to act on the choice. Which of the following best describes the action being taken by the nurse? a. Affirming b. Supporting c. Informing d. Amplifying

B Supporters approve and support clients' actions. Affirming is based on an advocate's belief that a client's decision is consistent with the client's values and goals. Informing includes educating clients about the nature of their choices, the content of those choices, and the consequences to the client and is not a one- way activity. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client's decision.

An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. Government

B Systems level of practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by "The Wheel."

Which are examples of knowledge domains used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning and legislative change d. Grant application, bargaining contracts, and securing funding

B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research. The other domains listed are not used in case management.

A nurse is organizing a fundraiser for a philanthropic organization. Which of the following organizations is the nurse most likely working with? a. International Red Cross b. Carnegie Foundation c. Nestlé d. Johnson & Johnson

B The Carnegie Foundation is a philanthropic organization, receiving funding from private endowment funds. The Red Cross is a nongovernmental agency, and Nestlé and Johnson & Johnson are private voluntary organizations.

A health educator is trying to change a client's attitudes about smoking. Which of the following domains would be used? a. Cognitive b. Affective c. Psychomotor d. Developmental

B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning.

A case manager uses effective collaboration and team strategies to make arrangements for services. Which of the following roles is being applied? a. Broker b. Negotiator c. Liaison d. Facilitator

B The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator. The role of broker is used when acting as an agent for provider services that are needed by clients to stay within coverage according to budget and cost limits of the health care plan. When acting as a liaison, the nurse provides a formal communication link among all parties concerning the plan of care management. As a facilitator, the nurse supports all parties in work toward mutual goals.

A nurse is caring for the community as the client. Which of the following is most likely the focus of the nurse's care? a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community

B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education. Provision of care for aggregates and families does not address the larger scope of community as client.

A nurse is trying to provide effective nursing care to poor persons, families, and populations in a variety of settings. Which of the following actions should be taken by the nurse? a. Move to the area where people are living to understand their plight b. Understand the concept of poverty on many levels c. Take a trip abroad to see how poverty exists in other countries d. Become fully immersed in the concept of poverty for at least a year

B Understanding the concept of poverty with historical, social, political, economic, biological, psychological, and spiritual dimensions is the first step in providing effective care to this population. It is not necessary to move to the area, take a trip abroad, or become immersed in the concept of poverty in order to provide effective nursing care to this population.

The nurse is involved in a conflict resolution situation with the parents of a 2-year- old boy. The parents are deciding if "spanking" the child is a disciplinary method that they will employ. The mother says, "I do not believe in spanking. I see it as abusive and demeaning." Which of the following best describes the statement by the mother? a. Cooperation b. Assertiveness c. Bargaining d. Collaboration

B The mother's statement is an example of assertiveness, the ability to present one's own needs. Cooperation is the ability to understand and meet the needs of others. Bargaining is part of the negotiation process when debates include gathering facts based on reasoning that will generate understanding and promote relearning. Collaboration is a dynamic highly interactive and interdependent process in which people work together to share resources and a vision for a goal.

A nurse is working with a family who has an income above the federal income guidelines, but is unable to meet their living expenses. Which of the following terms best describes this family? a. Persistent poverty b. Near poor c. Impoverished d. Neighborhood poverty

B The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants. Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.

A nurse has collected data about the services available in the community and is using the seven "A"s to evaluate these services. Which of the following questions will the nurse most likely ask? a. Can the community members allocate resources to support the service? b. Can the community members afford the service? c. Will the community members allow strategies to be implemented to improve the service? d. Will the community members approve of the services provided?

B The seven "A"s include: Is the community aware of its needs and of the service? Is it accessible to community members? Is the service available when the community needs it? Can the community members af ord the service? Does the community find the service acceptable? Is the service adequate to meet the needs of the community? And, are the services appropriate to meet the needs of the community? The following questions do not address the seven "A"s: Can the community members allocate resources to support the service? Will the community members allow strategies to be implemented to improve the service? And, will the community members approve of the services provided?

Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client-focused b. System-focused c. Social service d. Long-term care

B The system-focused model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations. The concern in client- focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management.

When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Determining neighborhoods that have an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community

B The use of a GIS allows the PHN to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness. An electronic health record (EHR) would be the most appropriate place to record client data from a foot clinic. Evaluation of effectiveness of a farm safety program would need to be done through some type of assessment or evaluation method—GIS would not be useful to collect this data. GIS is not a scheduling system and would not be helpful when scheduling health promotion programs in the community.

The wide variations in health services and health status between certain population groups are called: a. vulnerable population groups. b. health disparities. c. disadvantaged populations. d. risk markers.

B The wide variations in health services and health status between certain population groups are called health disparities. Vulnerable populations are typically considered to be those who are at greater risk for poor health status and who have poor access to health care. Disadvantaged populations have fewer resources for promoting health and treating illness than does the average person in the United States. Risk describes that some people have a higher probability of illness than others.

A nurse is writing a nursing diagnosis at the community level using the North American Nursing Diagnosis Association (NANDA) system as a guide. Which of the following diagnoses would most likely be developed? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors, as evidenced by client crying and stating she has no support system

B There are three parts of the NANDA system: (1) identification of the problem or potential problem; (2) its relation to factors, stressors, or health issues; and (3) supporting data that documents the problem. The "risk of" identifies a specific problem or health risk faced by the community. "Among" identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. "Related to" describes characteristics of the community.

A nurse is planning to assist homeless clients at a local shelter with finding community resources to meet their health care needs. Which of the following actions should the nurse take before interacting with this population? a. Change personal views about homelessness b. Understand the concepts of homelessness c. Receive special training about where to locate homeless people d. Have experience in mental health nursing and counseling

B To implement effective nursing interventions for homeless clients, nurses need to be aware of their own beliefs and values about the homeless as well as understand the concepts of homelessness.

A nurse centers his practice around the principle of doing the greatest good for the greatest number. Which of the following ethical principles is being applied? a. Distributive justice b. Utilitarianism c. Social justice d. Health disparities

B Utilitarianism means doing the greatest good for the greatest number. Distributive justice means treating people fairly, and distributing resources and burdens equitably among the members of a society. Social justice means ensuring that vulnerable groups are included in the equitable distribution of resources. Health disparities are the inequalities that exist among different populations.

A nurse is working with a vulnerable population. Which of the following is the nurse most likely working with? a. Families earning more than $50,000/year b. Families earning less than $15,000/year c. Residents of urban areas d. African American physicians

B Vulnerable populations of concern to nurses are persons who are poor or homeless (families earning less than $15,000 per year would be considered poor), persons who have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

Which statement about homelessness is true? a. Homeless persons are not found in rural areas. b. Gentrification can lead to homelessness. c. Deinstitutionalization led to a small number of homeless. d. Community-based clinics provide much needed health care.

B When urban housing is upgraded, the supply of low-income housing drops. It is often said that when neighborhoods were "gentrified" or upgraded, they reduced the ability of the poor people to live in them because they became unaffordable for poorer former residents. Homeless can be found in both rural and urban areas. Deinstitutionalization of the chronically mentally ill individuals from public psychiatric hospitals in the 1980s increased the number of homeless persons. After this happened, federal and state governments failed to allocate the needed funds to provide community-based services.

A nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation. Which method of data collection is being used? a. Participant observation b. Windshield survey c. Focus group d. Informant interviews

B Windshield surveys are a method of simple observation, providing a quick overview of a community. By making observations of the community, the nurse is completing a windshield survey. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. An informant interview is a method of community data collection that involves directed conversation with selected community members.

A PHN is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse? a. Participating in the "Great American Smokeout" b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco products

B Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice. Participating in the "Great American Smokeout" occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual level of practice. Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not health teaching.

A nurse states that he has incorporated epidemiology into his practice and functions in epidemiologic roles. Which of the following best describes the actions taken by the nurse? (Select all that apply.) a. Policy making b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records e. Law enforcement

B, C, D Collection, reporting, analysis, and interpretation of data, environmental risk communication, and documentation on patient charts and records are examples of the use of epidemiology in practice. Policy making and law enforcement do not apply to epidemiology.

MULTIPLE RESPONSE A nurse is assessing for environmental health risks in the community. Which of the following approaches would be most appropriate for the nurse to use? (Select all that apply.) a. Ask legislators to provide a list of environmental pollutants in the area b. Develop a list of exposures associated with urban, rural, or suburban settings c. Assess the risk by medium such as air, water, soil, or food d. Divide the environment into functional locations: home, school, workplace, and community e. Recruit community members to sign a petition to decrease pollution

B, C, D Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by medium such as air, water, soil, or food, and dividing the environment into functional locations: home, school, workplace, and community are ways a nurse can assess the environment. Asking legislators for a list of pollutants or recruiting community members to sign a petition are not effective means to assess for environmental health risks.

MULTIPLE RESPONSE A nurse is assessing the safety in the community using primary data. Which of the following data would be useful for the nurse to collect? (Select all that apply.) a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurse's own observations e. Morbidity and mortality rates

B, C, D Other nurses, social workers, health care providers, community members, and the nurse's own observations are reliable sources of information about the safety of an area. The number of billboards would not be important data to collect when assessing for safety in the community. Morbidity and mortality rates would be considered secondary data.

MULTIPLE RESPONSE Why is it difficult to know the exact number of homeless persons? (Select all that apply.) a. Homeless people refuse to provide demographic information. b. Many homeless people refuse to be interviewed. c. It is difficult to generalize from one location to another. d. Some persons experience short intervals of homelessness. e. Homeless individuals are most likely hiding within the community.

B, C, D Those who are homeless are hard to find since they may sleep in boxcars, on building roofs, in doorways, or under freeways or pedestrian overpasses; temporarily stay with friends or family; refuse to be interviewed or deliberately hide the fact that they are homeless; have only short or intermittent episodes of being without a home; or may not fit in a general category.

A nurse is employed by an agency that addresses global health needs. Which of the following roles is the nurse most likely to provide? (Select all that apply.) a. Medications and vaccines for worldwide use b. Direct patient care for members of the community c. Knowledge and skill in countries where nursing is an organized profession d. Consultation to auxiliary personnel e. Facilitation of education and health promotion within the community

B, C, D, E Nurses perform many roles related to global health, including providing direct patient care, facilitating education and health promotional needs of the community, providing knowledge and skill in countries where nursing is an organized profession, and providing consultation to auxiliary personnel. Providing medications and vaccines for worldwide use would not be part of the role of the nurse in relation to global health.

During the twentieth century, a nurse participated in research that examined the epidemiology of various diseases. Which of the following best describes the factors that influenced these studies? (Select all that apply.) a. Increasing rate of poverty b. Declining child mortality rates c. Overcrowding in major cities d. Development of new vaccinations e. Advancements in medical equipment

B, D Factors contributing to the development and application of epidemiologic methods in the twentieth century were: improved nutrition, new vaccines, better sanitation, the advent of antibiotics and chemotherapies, and declining infant and child mortality and birth rates. A rise in the standard of living occurred for many following the Great Depression and World War II. The advancements in medical technology have not influenced the examination of the epidemiology of various diseases.

The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n): a. case-control study. b. cross-sectional study. c. cohort study. d. experimental study.

C A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. A case-control study uses a sample from the cohort rather than following the entire cohort over time. A cross-sectional study provides a snapshot of a population or group at one point in time. An experimental study is one in which the investigator initiates some treatment or intervention that may influence the risk or course of the disease.

A nurse responds to a natural disaster. Which of the following is the nurse most likely responding to? a. Transportation accident b. Pollution c. Communicable disease epidemic d. Fire

C A communicable disease epidemic would be considered a natural disaster. Transportations accidents, pollution, and fire are considered human-made disasters.

Voters have recently decided to have fluoride added to the city water system. Epidemiologists now want to study the effect of fluoride on dental caries in this population. Which of the following would be conducted by the epidemiologists? a. Ecological study b. Double-blind study c. Community trial d. Screening

C A community trial is similar to a clinical trial, but the issue is often health promotion and disease prevention rather than treatment of existing disease. An ecological model considers the multiple factors that contribute to disease development. A double-blind study is one in which neither the subject nor the investigator knows who is receiving the treatment. A screening involves the testing of groups of individuals who are at risk for a certain condition but are not yet symptomatic.

Which is referred to as a lesser-developed country? a.France b.Japan c.Indonesia d.Sweden

C A country that is not yet stable with respect to its economy and technological development is lesser developed, which describes Indonesia. France, Japan, and Sweden are considered developed countries.

A nurse is analyzing one of the components of a unit of DALYs. From which of the following individuals would the nurse be able to calculate this measurement? a. A woman who lives to be 100 years old b. A woman who contracts HIV after working as a prostitute c. A father with five children who dies at the age of 50 from malaria d. A woman who gives birth to a premature infant

C A male who dies from malaria at age 50 would represent 30 DALYs. Measurement is based on the potential limit for life, which has been set at 82.5 years for women and 80 years for men. In order to calculate this statistic, the nurse must know the client's age and the potential limit for life.

A person diagnosed with syphilis presents with signs and symptoms of rash, sore throat, and muscle and joint pain. Which of the following stages of syphilis is the client most likely experiencing? a. Congenital b. Primary c. Secondary d. Tertiary

C A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis. Primary syphilis occurs when the bacteria produce infection in the form of a chancre at the site of entry. Tertiary syphilis usually occurs several years after initial infection and is rare in the United States because the disease is usually cured in its early stages with antibiotics. Congenital syphilis is transmitted transplacentally.

A nurse is caring for a client who is experiencing a drug addiction. Which of the following is the client most at risk for having? a. Infant with a high birth weight b. Easily cured illness or disease c. Accident or committing suicide d. Problem finding employment

C ATOD abuse and addiction is associated with many problems, including neonates with low birth weights and congenital anomalies; accidents, homicides, and suicides; chronic diseases such as cardiovascular disease, cancer, lung disease, hepatitis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS); and mental illness.

A nurse is assessing persons arriving at an alternate care center following a disaster. Which of the following actions should the nurse take first? a. Assess the amount of equipment and medications needed for each client b. Determine if the client has a psychological condition requiring special attention c. Assess whether this type of facility is appropriate for the client d. Determine if the client has a support system to assist with additional care needs

C Alternate care centers may be used to shelter patients with medical needs designated as "non-ambulatory care/hospital overflow" e.g., care of non-ambulatory patients with less intense medical needs. After determination of the appropriateness of the facility, the nurse can then provide medical care as needed. It should not be necessary to initially determine if the client has a psychological condition or limit the amount of equipment or medications.

A nurse is providing education for a client who is living in an area of the world where malaria is endemic. Which of the following interventions would be appropriate to include? a. Receive a dose of intravenous (IV) quinine b. Avoid direct contact with individuals who have malaria c. Use insecticide-treated bed nets d. Apply dichlorodiphenyltrichloroethane (DDT) spray

C An effective antimalarial intervention is the use of insecticide-treated bed nets. Malaria is contracted by being bit by an infected mosquito; it cannot be passed by direct person-to-person contact. IV quinine is the drug of choice for treating malaria, not preventing it. Some mosquitoes are resistant to DDT, so this may not be effective.

A nurse is working with a client during a smoking cessation program. The client has developed an action plan for smoking cessation, but has not yet implemented it. Which stage of change is the client experiencing? a. Precontemplation b. Contemplation c. Preparation d. Action

C During preparation, the individual is prepared for action and may reduce the problem behavior but has not taken effective action yet. During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.

The nurse teaches food handlers to wash utensils after contact with raw meat. Which of the following best describes the focus of this education? a. Agent b. Host c. Environment d. Food handler

C Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts. Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment. An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. A food handler is an example of a host, which is a human or animal that can harbor an infectious agent.

The government is preparing for a bioterrorism event. Which of the following would be the best strategy to use? a. Threaten lesser-developed countries so they don't develop biological weapons b. Ban biological weapons worldwide c. Effectively detect pathogens and manage services d. Develop antidotes for biological agents

C Health care professionals and public health officials need to be able to effectively detect pathogens, manage services, and communicate during a bioterrorism threat. Any country can develop biological weapons that can be used for bioterrorism, not only lesser-developed countries. By effectively detecting pathogens, one is able to know what antidotes need to be developed.

A nurse is assessing a client for addiction. Which of the following primary symptoms of addiction should the nurse recognize? a. Anger b. Apathy c. Denial d. Violence

C In assessing for addiction, the nurse should be aware that a primary symptom of addiction is denial. Anger, apathy, and violence are not considered the primary symptoms of addiction.

A nurse has promoted the introduction of health care technology into lesser-developed countries, but this has led to less-than-satisfactory results. Which of the following best describes why this has happened? a. People do not want to use newer technology. b. The cost is so high that they cannot afford to use new technology. c. The community may not be ready for this technology. d. Technology is too complex for people in lesser-developed countries.

C It is not generally a lack of desire that is a barrier to use of the new technological systems, but the lack of knowledge about them. It is essential to conduct needs assessments to learn what a community has, what a community wants, and what it can sustain. Well-intended projects have failed because the most basic needs were not met, nor was recognition given to what resources and services the country could sustain.

Which statement about nicotine and smoking is accurate? a. Cigars contain higher doses of nicotine than cigarettes. b. Tolerance to nicotine takes days to develop. c. Sidestream smoke contains more toxic compounds than mainstream smoke. d. The harsher smoke of pipes and cigars is more hazardous than cigarette smoke.

C It is true that side-stream smoke contains greater concentrations of toxic and carcinogenic compounds than mainstream smoke. Pipes are less hazardous than cigarettes because the harsher smoke discourages deep inhalation. The body quickly develops tolerance to nicotine.

The most common vector-borne disease in the United States is: a. malaria. b. yellow fever. c. Lyme disease. d. Rocky Mountain spotted fever.

C Lyme disease is the most common vector-borne disease in the United States, with over 30,000 confirmed cases and probable cases reported to CDC in 2012. Yellow fever and Rocky Mountain spotted fever are both vector-borne diseases, but are not the most common. Malaria is most prevalent vector-borne disease worldwide.

A nurse is working with colonias. Which of the following considerations should be made by the nurse? a.They have developed roads, transportation, and electrical services. b.They are frequently driven off, only to return to the same area. c.Their settlements have led to an increase in several disease conditions. d.Their contributions have improved the local economy.

C Many immigrants have settled on unincorporated land, known as colonias, outside the major metropolitan areas in California, Arizona, New Mexico, and Texas. These colonies may not have developed roads, transportation, water, or electrical services. Conditions in these settlements have led to an increase in disease conditions such as amebiasis, respiratory, and diarrheal diseases. Environmental health hazards in the colonias are associated with poverty, poor sanitation, and overcrowded conditions.

A nurse is working in a lesser-developed country and is caring for the women in the local community. Which of the following would be an important consideration for the nurse? a. They are at risk for a vitamin D deficiency. b. They are likely to have one child. c. They are at risk for death during pregnancy and childbirth. d. They are viewed as the leader of the family unit.

C Most deaths to women worldwide are related to pregnancy and childbirth. Most of these deaths occur in lesser-developed countries. Common nutritional deficiencies in this population are zinc, iodine, vitamin A, folic acid, and calcium. One of the reasons this problem exists is because women are not seen as valued members of society. In developing nations there is a significant incidence of lack of prenatal care during pregnancy and high fertility rates, often due to a lack of access to contraception and other family planning and reproductive health services, as well as cultural belief systems that increase the lifetime risk of maternal death.

A nurse who is studying chronic disease considers the multifactorial etiology of illness. What does this imply? a. Genetics and molecular structure of disease is paramount. b. Single organisms that cause a disease, such as cholera, must be studied in more detail c. Focus should be on the factors or combinations and levels of factors contributing to disease. d. The recent rise in infectious disease is the main focus.

C Multifactorial etiology implies a focus on combinations and levels of factors. There are many factors to consider other than only genetics or single organisms with multifactorial etiologies. The focus of studying multifactorial etiology is on chronic disease.

A nurse is caring for a client who has been diagnosed with a parasitic infection. Which of the following information should the nurse know when caring for this client? a. The medication to prescribe to treat these infections b. The nature and symptoms of all parasitic illnesses c. What specimens to collect and how and when to collect them d. Public policy about parasitic infections

C Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use. Proper specimen collection is necessary so that the clinical diagnosis can be confirmed. It is not necessary for the nurse to know the signs and symptoms for all parasitic infections in order to provide care for the client. Public policy about parasitic infections is not important to know when providing care for the client.

A nurse is forced to evaluate his beliefs, values, and knowledge about poverty. Which of the following experiences most likely explains the situation the nurse is experiencing? a. A client asking for a small amount of money at a clinic b. Setting up a homeless shelter c. Making a home visit to a home that is unkempt d. Reading about poverty in a textbook

C Nurses' behaviors in situations are influenced by their relationship with clients. It is important to evaluate clients and populations in the context of the environment to develop nursing interventions. Reading a book is not adequate. Setting up a homeless shelter or having a client ask for money does not force the nurse to self-reflect as much as when the nurse is in the client's environment.

A nurse is planning to administer an immunization to a child. Which of the following factors would be a medical contraindication for the administration of immunizations? a. Religious beliefs b. Sore throat c. Leukemia d. Fear of side effects

C People with the following conditions are not routinely immunized and require medical consultation: pregnancy, generalized malignancy, immunosuppressive therapy or immunodeficiency disease, sensitivity to components of the agent, or recent administration of immune serum globulin, plasma, or blood. Leukemia would be a medical contraindication for receiving an immunization. Religious beliefs, sore throat, and fear of side effects are not medical contradictions.

A community health nurse visits a homeless shelter to provide directly observed therapy (DOT) to several clients who have been diagnosed with TB. Which of the following best describes the rationale for this nursing intervention? a. Homeless clients do not care about their health. b. Homeless clients do not have access to medications. c. Poor adherence can result in drug resistance. d. These medications are so powerful, clients must be observed for reactions.

C Poor adherence has led to antibiotic resistant strains. These clients may care about their health but may have difficulty adhering to the treatment regimen. Medications to treat TB are available to the homeless population. The concern with the antimicrobial treatment is with non-adherence, not with side effects.

The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the: a. sensitivity. b. specificity. c. positive predictive value. d. negative predictive value.

C Positive predictive value refers to the proportion of persons with positive test results who actually have the disease, interpreted as the probability that an individual with a positive test result has the disease. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Specificity indicates how accurately the test identifies those without the condition or trait. Negative predictive value is the proportion of persons with a negative test who are actually disease free.

A nurse is aware that there is a rising incidence of abusive head trauma (AHT). Which of the following would be a focus of the nurse? a. Taking at-risk babies out of violent households b. Placing babies under the care of community health nurses c. Educating and providing support to new parents d. Helping those affected seek proper legal representation

C Prevention strategies are necessary to reduce the incidence of AHT. Parental education and support is necessary to prevent child maltreatment. Taking at-risk babies out of violent households, placing babies under the care of community health nurses, and helping those affected seek proper legal representation are not prevention strategies.

A PHN implements a primary prevention intervention in the community. Which of the following is most likely being implemented? a. Pap smear b. Blood pressure screening c. Diet and exercise d. Physical therapy

C Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Blood pressure screening and pap smears are secondary prevention interventions. Physical therapy is a tertiary prevention intervention.

When a nurse is evaluating the components of an educational program. Which of the following best describes the action that is being taken by the nurse? a. Short-term evaluation b. Educational product c. Process evaluation d. Long-term evaluation

C Process evaluation means looking at the components of an educational program. The educational product is the outcome of the educational process. Short-term evaluation evaluates the immediate effects of a health program. Long-term evaluation is geared toward following and assessing the status of an individual, family, community, or population over time.

Requirements for disease reporting in the United States are mandated by: a. the Centers for Disease Control and Prevention (CDC). b. federal laws. c. state laws and regulations. d. the World Health Organization (WHO).

C Requirements for disease reporting in the United States are mandated by state laws and regulations. These diseases are then reported to the CDC. State public health officials collaborate with the CDC to determine which diseases should be nationally notifiable. The federal government and WHO are not involved in disease reporting.

The group with the lowest injury death rate is: a. infants. b. toddlers and preschoolers. c. school-age children. d. adolescents

C School-age children have the lowest death rate among younger age groups. Infants have the second highest injury rate of all groups of children; their small size contributes to some types of injury. Adolescents are at the highest risk of any age group for motor vehicle deaths and fatal poisonings.

A nurse is told that a screening test has high specificity. Which of the following is the best interpretation of this information? a. The test provides precise and consistent readings. b. The test accurately identifies those with the condition or trait. c. The test accurately identifies those without the trait. d. The test has a high level of false positives.

C Specificity refers to the test accurately identifying those without the trait. High specificity is needed when re-screening is impractical and when reduction of false positives is important. The test would have a low level of false positives.

Which health problem causes more deaths, illnesses, and disabilities than any other in the United States? a. Tobacco addiction b. Alcohol abuse c. Substance abuse d. Caffeine addiction

C Substance abuse is the number one national health problem, causing more deaths, illnesses, and disabilities than any other health condition. Tobacco addiction, caffeine addiction, and alcohol abuse are part of substance abuse.

The nurse teaches the family of an AIDS client about managing symptomatic illness by preventing deteriorating conditions, such as diarrhea, skin breakdown, and inadequate nutrition. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary health care

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

The nurse provides footwear and gloves to leprosy clients to prevent trauma to their insensitive and deformed hands and feet. Which of the following best describes the intervention used by the nurse? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Primary health care

C Tertiary prevention reduces complications through treatment and rehabilitation. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Primary health care is considered to be the essential health care services provided by physicians and other health care providers.

A nurse recommends to a school board that other methods besides the "just say no" approach be considered when providing drug use prevention education to the elementary students. Which of the following best describes the rationale for this recommendation? a. Children do not like to hear the word "no," and the approach is too negative. b. Project DARE is more effective and has decreased drug use. c. Children are naturally curious and may experiment with drugs. d. "Just say no" to drugs does not include smoking and alcohol abuse.

C The "just say no" approach does not help young people because children are naturally curious and drug experimentation is often a part of normal development, children from dysfunctional homes often use drugs to get attention and escape intolerable environments, and it does not address the powerful component of peer pressure. Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use.

A nurse is providing information to a local newspaper about the presence of infectious diseases in the United States. Which of the following statements by the nurse is accurate? a. "It is the goal of the WHO to prevent the transmission of the plague by avoiding direct contact with inflicted individuals." b. "Rabies is easily spread by contact with animals." c. "The United States is a certified polio free country." d. "The onset of tularemia is characterized by a distinct skin lesion often called a bull's-eye lesion."

C The Americas are certified polio free. The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lyme's disease is characterized by a bull's-eye lesion.

What is the purpose of the National Incident Management System (NIMS)? a. Create a new branch of government that deals with bioterrorism b. Establish a way for the Red Cross to carry out its mission c. Develop a nationwide all-hazards approach to domestic incident management d. Extend presidential power to act quickly upon acts of bioterrorism

C The National Response Framework is a unified, all-discipline, all-hazards approach to domestic incident management. It is built upon scalable, flexible, and adaptable coordinating structures to align key roles and responsibilities linking all levels of government and organizations. The Homeland Security Act of 2002 created a new branch of government that deals with bioterrorism, the U.S. Department of Homeland Security. The NIMS did not impact the Red Cross or extend presidential power to act upon bioterrorism.

A mother tells the nurse she is afraid to have her infant immunized. Which of the following statements would be the most appropriate response by the nurse? a. "It is normal to be concerned, as some immunizations have been linked to autism." b. "Researching the Internet will provide you more information as to the importance of immunizations." c. "Choosing not to vaccinate your child puts your child and others at risk." d. "Your infant received active immunity at birth, so immunizations are not indicated until 4 months of age."

C The child who is not immunized and others around the child are at risk if immunizations do not occur. Scientific studies have not found a relationship between immunizations and autism. Information that is researched on the Internet may not be a reliable source of information as the nurse has no control over the information the client receives. Infants receive natural passive immunity at birth through the placental transfer of maternal antibodies; this protection lasts for about 2 months.

What is the purpose of writing a community nursing diagnosis? a. To assist with developing the evaluation measures for program planning b. To clearly describe the strengths and weaknesses of the community c. To lead to the outcomes and strategies to address and improve the identified health problem d. To increase the likelihood that the problem will be solved

C The community nursing diagnosis, no matter which classification system is used, leads to expected outcomes and evidence- based health promotion strategies to address and improve the problem identified in the diagnosis. This becomes the nursing care plan. The expected outcomes and evaluations derived from the nursing diagnosis systems suggest subsequent evaluation measures for identified needs or problems. A community assessment describes the strengths and weaknesses of a community. The likelihood of solving a problem is not influenced by writing a community nursing diagnosis.

The most chronic blood-borne infection in the United States is: a. hepatitis A. b. hepatitis B. c. hepatitis C. d. HIV.

C The most chronic blood-borne infection in the United States is hepatitis C. Hepatitis A virus is most commonly transmitted through the fecal-oral route. Sources may be water, food, feces, or sexual contact. The hepatitis B virus (HBV) is spread through blood and body fluids and, like HIV, is a blood-borne pathogen. HIV is transmitted through exposure to blood, semen, transplanted organs, vaginal secretions, and breast milk. Although hepatitis B and HIV are both blood-borne pathogens neither are the most chronic infection like hepatitis C.

Public health professionals refer to three levels of prevention as tied to specific stages in the: a. epidemiologic triangle. b. web of causation. c. natural history of disease. d. surveillance process.

C The natural history of disease is the course of the disease process from onset to resolution. The three levels of prevention provide a framework commonly used in public health practice to depict this process. The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease. The surveillance process involves the systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population.

The oldest and most widely used psychoactive drug in the world is: a. marijuana. b. heroin. c. alcohol. d. cocaine.

C The oldest and most widely used psychoactive drug in the world is alcohol. Marijuana is the most widely used illicit drug in the United States.

A nurse is caring for a client who is HIV positive. Which of the following roles of the nurse would be the most important for the nurse to implement? a. Advocate, lobbying for AIDS research b. Counselor, discussing implications of future sexual activity c. Role model, providing supportive care d. Policy maker, addressing laws governing privacy rights of HIV-positive persons

C The priority role of the nurse should be role model, as nurses must be role models because many HIV-positive patients are stigmatized. The need to be an advocate and policy maker does not address the individual needs of the client. The nurse is able to counsel the client while providing supportive care.

A nurse is caring for a client with TB. Which of the following statements would the nurse recognize as being true? a. Meningitis is the leading cause of death from TB. b. Chemotherapy, if made widely available, could eradicate the disease. c. Many TB cases are associated with HIV. d. The TB bacillus is difficult to isolate.

C The rise in HIV has led to an increase in TB because the disease depresses the immune system. Chemotherapy is not always effective, especially in the new drug-resistant strains. Meningitis is not a leading cause of death from TB. TB is becoming more difficult to treat because of the new drug-resistant strains, but the TB bacillus is not difficult to isolate.

Why must nurses examine their attitudes about alcohol, tobacco, and other drug (ATOD) abuse and addiction before working with individuals with this health problem? a. Working with clients who have addiction problems often puts the nurse at risk for violence. b. The population of persons with drug and alcohol addiction is found in low-income neighborhoods. c. To be therapeutic, a nurse must develop a trusting nonjudgmental relationship with clients. d. Nurses are the primary persons who treat addiction problems.

C To be therapeutic, the nurse must develop a trusting, nonjudgmental relationship with clients. Therefore, nurses must examine their own attitudes ahead of time. Working with clients who have addiction problems does not put the nurse at risk for violence. People with drug and alcohol addiction can be found in any neighborhood. Nurses do not treat addiction problems.

A PHN would like to increase the immunization coverage of infants and toddlers. Which of the following strategies would be appropriate for the nurse to use? a. Read the Mortality and Morbidity Weekly Report to learn about vaccinations b. Require that children have all their immunizations before going to public school c. Track children known to be at risk for under-immunization d. Lead teams of health care workers to enforce laws related to immunizations

C Tracking children known to be at risk for under-immunization is a function of PHNs who work in health departments where immunizations are given and tracked. Reading the Mortality and Morbidity Weekly Report, requiring that children have all of their immunizations before attending school, and leading teams of health care workers would not be as effective in increasing immunization coverage for this population.

A community health nurse investigates an outbreak of pinworm at a local day care center. In order to minimize the spread of infection, which of the following suggestions would the nurse provide to the day care workers? a. Close the day care until all surfaces are cleaned. b. No action is necessary because it is easily treated with oral vermicides. c. Using good hand washing is important to prevent the transmission. d. Every child in the day care should be treated because they all are probably infected.

C Transmission of pinworm occurs through the fecal-oral route, so good hand washing after toileting is essential. It is not necessary to treat all children or close the day care. It is necessary that action be taken, as without any action being taken, the pinworm outbreak will continue.

A nurse is caring for a client who has been diagnosed with a bacterial sexually transmitted infection (STI). Which of the following infections does this client most likely have? a. Trichomonas b. HIV c. Syphilis d. Genital warts

C Trichomonas, HIV, and genital warts are caused by viruses. Syphilis is caused by bacteria.

A nurse partners with multiple agencies in the community to create a support group for those diagnosed with addiction in the community. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion

C When using tertiary prevention, the nurse focuses on treatment and rehabilitation. The support group for those with addiction is helping the addict and the addict's family, who already "have a problem." Primary prevention focuses on health promotion and disease prevention. Secondary prevention focuses on early detection and screening. Health promotion is not a level of prevention.

A nurse is using a critical path when providing care for a client. Which of the following most likely describes the situation that the nurse is in? a. Implementing the six "rights" of case management b. Demonstrating competencies required for practicing case management c. Attempting to achieve a measurable outcome for a specific client d. Effectively managing conflict resolution

C A critical path is a case management tool used to achieve a measurable outcome for a specific client case. The critical path details the essential and sequential activities in care, so that the expected progress of the client was known at a point in time. A critical path does not address the six "rights" of case management or demonstrate the competencies required for practicing case management. A critical path is not used for conflict resolution.

A nurse fulfills the environmental health competency of "assessment and referral." Which of the following actions has the nurse most likely completed? a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

C Assessment and referral states that all nurses should be able to successfully complete an environmental health history, recognize the potential environmental hazards and sentinel illnesses, and make appropriate referrals for conditions with probably environmental causes. Advocating for public policy changes is part of advocacy. Understanding policy framework and legislation is part of legislation and regulation. Describing the scientific principles of environmental health is part of basic knowledge and concepts.

A nurse tells a coworker that she has been working on a regular basis with a group that demonstrates cohesion. Which of the following groups is the nurse most likely to describe? a. A group with several leaders b. A group with diverse attitudes and values c. A group with a common goal d. A group with efficient members

C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members. A group with several leaders may have difficulty obtaining cohesion if each of the leaders has a different idea. Common attitudes and values among the group members will be important for the group to obtain cohesion. Efficiency does not play a role in developing cohesion.

A nurse lives in a community that demonstrates commitment. Which of the following would most likely be supported within this community? a. Creation of a community club by the city council to facilitate community involvement b. Collaboration among area restaurant owners to develop healthier menus c. Collaboration with the health department to build a new recreation center d. Development of a cooperative agreement with a neighboring city to share needed services

C Commitment to the health of the community requires a process of change at each appropriate level on the continuum. The most successful change processes often arise from collaborative practice models that involve the community and nurses in joint decision making. Participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision making. Collaboration by restaurant owners to develop healthier menus only addresses one population of the community and does not show involvement by nurses and the larger community. Creation of a community club by the city council does not engage the larger community in this decision. Developing a cooperative agreement with a neighboring city does not show commitment between the members of both communities.

A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated? a. Individual b. Systems c. Community d. Government

C Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by "The Wheel."

A person is already homeless and is receiving shelter. Which type of housing is being used? a. Low income b. Supportive c. Emergency d. Adequate

C Emergency housing is shelter for persons who are already homeless. These shelters typically are only open at night and in many cities only on extremely cold nights.

Epidemiology: a. is a science that studies the poisonous effects of chemicals. b. explains the association between learning disabilities and exposure to lead-based paint at the cellular level. c. helps nurses understand the strength of the association between exposure and health effects. d. is a method for tracking the prevalence of health outcomes.

C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects. Toxicology is the science that studies the poisonous effects of chemicals. Environmental surveillance provides data with which to track and analyze the incidence and prevalence of health outcomes. Epidemiology does not examine causes at the cellular level.

Which data source provides information about the function of the community? a. Local restaurant b. Elected officials c. County health department d. Civic groups

C Function refers to the aims and activities of the community. Civic groups and elected officials refer to people. Local restaurant refers to a place.

A nurse is implementing an educational program about the importance of being physically active. Which of the following steps would the nurse complete first? a. Provide learning guidance b. Present the stimulus c. Gain the learner's attention d. Ask learners to recall prior learning

C Gaining the learner's attention must happen first before learning can take place. The following steps of implementation include telling the learners the objectives of the instruction, asking learners to recall previous knowledge, presenting the essential materials, helping the learners apply the information, encouraging learning to demonstrate what they have learned, and providing feedback to help learners improve their knowledge and skills.

A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented? a. Collaboration b. Surveillance c. Health teaching d. Screening

C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities. Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

Which statement regarding the effects of homelessness on health is accurate? a. Peripheral vascular disease and hypertension are lessened by this lifestyle. b. The incidence and virulence of infections are decreasing. c. Trauma is a significant cause of death and disability. d. Crowded living conditions result in decreased risk for exposure to infections.

C Intended and unintended injuries such as traumas are a significant cause of morbidity and mortality in the homeless. Those who are homeless are at greater risk for peripheral vascular disease and hypertension. Because of their poor living conditions, a minor skin injury or infections left untreated can result in widespread infection.

A nurse is using life care planning when working with a client. Which of the following would be the most appropriate time for this to be used? a. When organizing a timeline of life events b. When documenting client information and requests c. When assessing present and future client needs d. When estimating future costs for medical care

C Life care planning is a customized, medically based document that provides assessment of present and future needs. Typically, a life care plan incorporates medical, financial, psychological, vocational, built environment, and social costs during the remaining life of the client. Life care planning is a tool used in case management. A life care plan assesses the current and future needs of a client for catastrophic or chronic disease over a life span.

A nurse is working with a group focused on improving the health of the community. Which of the following interventions should be used by the nurse? a. Make decisions for the group to move the process along b. Invite business leaders to participate in the group process c. Maintain members through recognition and encouragement d. Teach topics that are of national importance

C Maintaining members is an important intervention to facilitate group process. The topics that are taught should be of importance to the group. The group should be part of the decision-making process. The membership of the group should be maintained, inviting new members to the group may hinder the processes of the group.

A nurse is working in the community during the industrial revolution. Which of the following population groups would have been least likely to receive community assistance? a. Widowed women b. Orphaned children c. Mentally ill d. Injured laborers

C Mentally ill individuals were considered undeserving poor and did not receive any community assistance. Widowed women, orphaned children, and injured laborers were deserving poor because their poverty was considered to be beyond their control.

The greatest single source of air pollution in the United States is from: a. waste incineration. b. power plants. c. motor vehicles. d. molds.

C Mobile sources such as cars and trucks are the greatest single source of air pollution in the United States. Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.

Mutual benefit with limited loss for everyone is a goal of: a. negotiating. b. assertiveness. c. conflict management. d. cooperation.

C Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal. The process of moving conflicting parties toward an outcome is called negotiation. Assertiveness is the ability to present one's own needs. Cooperation is the ability to understand and meet the needs of others.

Which is a characteristic of persons living in poverty? a. Longer life expectancy b. Simple health problems c. Higher rates of chronic illness d. Fewer hospitalizations

C Not only do persons living in poverty have higher rates of chronic illness, but less access to care. They have a shorter life expectancy, more complex health problems, and hospitalization rates greater than those for persons with higher incomes.

A nurse works at the individual level to reduce pollution in the environment. Which of the following actions would most likely be taken by the nurse? a. Provide a tax incentive to factories that do not pollute b. Make laws related to allowed levels of pollution in the area c. Recycle paper, glass, cans, and plastic d. Move to an area with less pollution

C Nurses can reduce pollution by doing their part, which can include choosing to recycle paper, glass, cans, and plastic. Providing a tax incentive and creating laws would not be completed at the individual level to reduce pollution in the environment. Moving to an area with less pollution would not help to improve the problem.

A PHN is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits

C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed.

A nurse is providing primary prevention when working with the homeless. Which of the following best describes what is being implemented? a. Providing emergency housing aid b. Creating drug and alcohol treatment options c. Offering effective job training programs d. Evaluating comprehensive case management programs

C Offering effective job training programs is an example of primary prevention—attempting to prevent the problem before it occurs. Emergency housing is secondary prevention. Drug and alcohol treatment and comprehensive case management are tertiary preventions.

A PHN utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished? a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, systems, individuals, and families d. Utilizing primary, secondary, and tertiary prevention

C PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice. The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention.

A nurse reads the local community newspaper to gather data about the community. Which method of data collection is being used? a. Informant interview b. Focus group c. Participant observation d. Windshield survey

C Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. The nurse is deliberately sharing in the life of the community by reading the newspaper. An informant interview is a method of community data collection that involves directed conversation with selected community members. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Windshield surveys are a method of simple observation, providing a quick overview of a community.

What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources

C People, place, and function are the critical attributes in the definition of community. These attributes are found in most definitions of community. The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community.

A nurse is addressing the problem of air pollution in the community. Which of the following would be the first step the nurse would take? a. Setting standards b. Monitoring c. Permitting d. Compliance

C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water. Environmental standards may describe a permitted level of emissions, a maximum containment level, an action level for environmental cleanup, or a risk-based calculation. Monitoring is an ongoing process after an action has happened. Compliance refers to the processes for ensuring that permit/standard/regulatory requirements are met.

A nurse interviews the school nurses in a community to determine their roles in schools because this data is not available. Which of the following processes is the nurse using? a. Photovoice b. Spatial data c. Primary data d. Secondary data

C Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Spatial data involves looking at the locations of places within the community. Photovoice, also called photo elicitation, is a community assessment technique in which community members take photos to represent a topic or theme about community health. Secondary sources include published data about the community, such as census data.

A nurse is developing a one-stop service to meet the needs of a vulnerable group. Which of the following would the nurse most likely create? a. Wrap-around services where mental services are linked b. Giving all immunizations on a single clinic visit c. Providing multiple services during a single clinic visit d. Providing free services to the medically indigent

C Providing multiple services during a single clinic visit makes services more responsive to the combined effects of social and economic stressors. Wrap-around services provide comprehensive health as well as social and economic services, so it would include more than the linkage of mental health services. Administering all immunizations or providing free services would not provide a one-stop shop for all needed services.

Since the Intervention Wheel was first published in 1998, it has: a. guided national policy. b. been used as a tool in deciding licensure issues for State Boards of Nursing. c. been incorporated into the public health curricula of many nursing programs. d. gained wide acceptance internationally.

C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally, but is not used widely at the international level.

A nurse is promoting social justice. Which of the following actions would the nurse most likely take? a. Contacting lawmakers about environmental health issues b. Assisting at homeless shelters c. Advocating for policies to improve social conditions d. Serving on a local coalition to prevent obesity

C Social justice refers to providing equitable care and social supports for the most disadvantaged members of society. Nurses can function as advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health.

A PHN is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse? a. Involve the entire community in solving the health problem b. Identify health problems in the community c. Change laws, policies, and practices that influence population-based issues d. Provide outreach services to populations at risk

C Systems level practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems.

A nurse refers a client to an assistance program that requires the individual to find a job and/or enroll in job training program. Which program is being used? a. Aid to Families with Dependent Children (AFDC) b. Medicaid c. TANF d. Women, Infants, and Children (WIC)

C TANF requires participants to find jobs and/or enroll in job training programs. The current TANF program was formerly called AFDC. Medicaid provides health insurance to poor families, but does not require participants to find jobs. WIC provides food vouchers entitling participants to free nutritious foods and infant formulas from local grocers, but does not require participants to find jobs.

A nurse works with a group of abused women to enhance their levels of self-esteem. Which of the following levels of prevention is being performed? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Health promotion

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention aims to prevent disease and illness before it occurs. Secondary prevention focuses on screening and early detection. Health promotion is not a level of prevention.

A nurse refers a client with a neuromuscular disease to a vocational rehabilitation program. Which of the following best describes the action of the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Referral of a client with a disease is an example of tertiary prevention. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Health promotion is a specific primary prevention strategy.

A client is self-employed as a mechanic and has no health insurance coverage. Which of the following best describes the legislation that will assist this client in obtaining health insurance? a. Balanced Budget Act b. Health Insurance Portability and Accountability Act (HIPAA) c. Patient Protection and Affordable Care Act (ACA) d. Social Security Act

C The ACA of 2010 provides the opportunity for all to purchase health insurance. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The Social Security Act created the largest federal support program for elderly and poor Americans.

Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act

C The Clean Water Act sets basic structure for regulating pollutants to United States waters. The Safe Drinking Water Act authorized the EPA to establish safe standards of purity and required all owners or operators of public water systems to comply with primary standards. The Toxic Substance Control Act gives the EPA the ability to track the 75,000 industrial chemicals currently produced or imported into the United States. The Pollution Prevention Act focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials.

A nurse is discussing eligibility for federal food assistance with a family. Which federal guideline would a nurse refer to when considering financial eligibility? a. Poverty Threshold Guideline b. Consumer Price Index (CPI) c. Federal Income Poverty Guideline d. Temporary Assistance to Needy Families (TANF)

C The Federal Income Poverty Guideline is issued by the U.S. Department of Health and Human Services and is used to determine if a person or family is financially eligible for assistance or services from various federal programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The CPI is a measure of the average change over time in the prices paid by households for a fixed market basket of consumer goods and services. TANF is a program, not a guideline, that assists families in need.

Employees working with hazardous chemicals have the "Right to Know" about the chemicals they are working with through the creation of the: a. Material Safety Data Sheet (MSDS). b. Consumer Confidence Report. c. Hazard Communication Standard. d. EPA.

C The Hazard Communication Standard requires employers to maintain a list of all hazardous chemicals that are used on site. Each of the chemicals should have an associated chemical information sheet known as an MSDS, which is written by the chemical manufacturer. Consumer Confidence Reports summarize the results of the annual testing of the public water supply. The EPA sets forth policies, regulations, and public laws for the safety of the environment and the population.

The cognitive domain includes: a. changes in attitudes and the development of values. b. the performance of skills. c. memory, recognition, understanding, reasoning, and problem solving. d. memorization of one set of skills before moving on to the next.

C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain includes changes in attitudes and the development of values. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Memorization of skills is only one part of the cognitive domain.

A nurse is implementing a community health education program at a local church. Which of the following educational principles should the nurse implement when providing this education? a. Refer to trustworthy sources b. Use an active voice c. Create the best learning environment d. Accentuate the positive health behaviors of the participants

C The environment must be conducive to learning for educational programs to be effective. The environment should be free of distractions and consistent with the message. The other strategies may assist with the educational program, but are not one of the major educational principles discussed in the textbook.

Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature

C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil, etc.). The other examples do not contain an agent, host, and environment.

A nurse is completing the first phase of a risk assessment. Which of the following questions would the nurse most likely try to answer? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans): Is the chemical known to be associated with a negative health effect? The second step is determining if the chemical has been released into the environment: Has the chemical been released into the environment? The third step is estimating how much and by which route of entry the chemical might enter the human body: How much and by which route of entry can the chemical enter the body? The final step takes into account the previous steps: What is the prediction for potential harm?

A group member has taken on the role of the "gatekeeper." Which of the following actions would most likely be taken by this member? a. Seek and accept the authority or direction of others b. Guide and direct the group activity c. Control outsiders' access to the group d. Focus the movement toward the main work of the group

C The gatekeeper controls outsiders' access to the group. The follower seeks and accepts the authority or direction of others. The leader guides and directs group activity. The task specialist focuses or directs movement toward the main work of the group.

A case manager supports a client's decision to return home after having a total hip replacement rather than go to a skilled nursing facility. Which of the following phases of the nursing process is being used? a. Assessment b. Planning/outcome c. Implementation d. Evaluation

C The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and supports the client's decisions. The assessment/diagnosis phase is similar to the advocacy process of information exchange, gathering data, and illuminating values. The planning/outcome phase is similar to the advocacy process when generating alternatives and consequences and prioritizing actions. The evaluation phase is most similar to the advocacy processes of affirmation, evaluation, and reformulation.

A nurse is working with an individual who pursues neither his concerns nor another's concerns. Which of the following conflict management behaviors is being used? a. Accommodating b. Collaborating c. Avoiding d. Compromising

C The individual would be "avoiding." Avoiding is defined as when an individual pursues neither his or her concerns nor another's concerns. Accommodating occurs when an individual neglects personal concerns to satisfy the concerns of another. Collaborating is when an individual attempts to work with others toward solutions that satisfy the goals of both parties. Compromising occurs when an individual attempts to find a mutually acceptable solution that partially satisfies both parties.

What is the primary cause of vulnerability? a. Race b. Age c. Poverty d. Illness

C The primary cause of vulnerability is poverty. Race, age, and illness may cause populations to be vulnerable, but these factors are not the primary cause.

A nurse is caring for a homeless population. Which of the following characteristics should the nurse anticipate as a need of this population? a. Need more nursing care than other vulnerable groups b. Have no desire to seek medical care c. Have even fewer resources than poor people who have adequate housing d. Are living in despair with no hope or resilience

C Those who are homeless have even fewer resources than poor people who have adequate housing. Homeless and marginally housed people must struggle with heavy demands as they try to manage daily life because their resources are limited. These individuals must cope with finding a place to sleep at night and a place to stay during the day or moving frequently from one residence to another, as well as finding food, before even thinking about health care.

A bachelor's prepared nurse is providing case management services. Which of the following activities would most likely be provided by this nurse? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes

C Working with individuals would be the role of this nurse. Working with community aggregates, systems of disease, and outcomes management processes are implemented by an advanced practice nurse (APN).

A nurse is caring for a client who has a medical home. Which of the following best describes what is being used by the client? a. A building that houses multiple primary care providers and specialists b. A partnership between a community health nurse, a client, and a family c. A system that meets the needs of the individual, family, and community d. A collaboration of care provided by an inter-professional team

D A medical home emphasizes an integrated health system with collaboration of care from an interprofessional team of primary care physicians, specialists and subspecialists, other health professionals, hospitals and health care facilities, and public health and community working with children and families. The medical home may not necessarily all be housed in the same building. The partnership is bigger than only the nurse, client, and family. The medical home is specific to meeting the needs of the child and family.

A nurse refers a client to alcoholics anonymous (AA). Who will play the most important role in the treatment of alcoholism at this support group? a. Self b. Spouses c. Children d. Peers

D AA began a strong movement of peer support to treat a chronic illness. The fellowship, support, and encouragement among AA members provide a vital social network for the person recovering from an addiction.

The nurse is providing community health education about how alcohol affects the body. Which of the following individuals would the nurse describe as being most likely to have the lowest blood alcohol concentration? a. An individual who consumes a drink with a high concentration of alcohol b. An individual who drinks without consuming food c. An individual of the female gender d. An individual with a high body weight

D An individual with a high body weight would likely have the lowest blood alcohol concentration. Increased alcohol concentration, drinking without consuming food, and being a female are all factors that increase blood alcohol concentration.

A public health nurse (PHN) reports an attack rate. Which of the following has most likely been reported? a. Number of cases of cancer recorded at a medical center b. Number of people who died of Ebola in a given year c. Number of beef cattle inoculated against mad-cow disease on a farm d. Proportion of people becoming ill after eating at a fast-food restaurant

D Attack rates are often specific to exposures, such as food-specific attack rates. The number of cases of cancer, exposure to Ebola, and beef cattle are not significant without knowing the total number of people so that a proportion can be calculated.

A nurse is working with a religious organization to provide food to starving people in a lesser-developed country. Which of the following organizations is the nurse most likely working with? a. International Red Cross b. Church World Service c. Maryknoll Missionaries d. Catholic Relief Services

D Catholic Relief Services alleviates suffering and provides assistance to people in need affected by war, starvation, famine, drought, and national disasters without regard to race, religion, or nationality. The Red Cross is not a religious organization, and the Church World Service and Maryknoll Missionaries do other things besides providing food.

A nurse is working with a child who lives in poverty. Which of the following best describes this child? a. A child who has poor academic performance b. A child whose parents have a college education c. A child of Caucasian descent d. A child living in a single-parent household

D Characteristics that put children at risk for living in low-income families are parents without a high school degree, lack of parental employment, and living in a single-parent household.

Community preparedness is being used to plan for a disaster. Which of the following tasks is being implemented? a. Assembling emergency supplies b. Understanding the workplace disaster plan c. Taking a disaster training course d. Developing an evacuation plan to remove individuals from danger

D Community preparedness involves developing an evacuation plan to remove individuals from danger. Assembling emergency supplies is an example of individual preparedness. Understanding the workplace disaster plan is an example of preparedness in the workplace within the community. Taking a disaster training course is an example of professional preparedness.

A nurse is examining the income levels and social networks of individuals in a community. Which of the following is the nurse investigating? a. Culture b. Development c. Community d. Determinants

D Determinants are conditions and factors that are important considerations in population health. Culture refers to the beliefs and customs of a certain group. Development refers to something that is being created. Community is a group of people living in the same geographic location.

The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using: a. descriptive epidemiology. b. analytic epidemiology. c. distribution. d. determinants.

D Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental. Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Analytic epidemiology focuses on the investigation of causes and associations. Distribution describes who has the disease and where and when the disease occurs.

A nurse is participating in the preparedness stage of disaster management. Which of the following describes what is happening? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

D Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security in the community is part of the prevention activities. Purchase of personal protective equipment for all citizens and incorporation of provision of pets into local disaster plans are not realistic plans for preparedness.

A nurse is assessing the drug use patterns of a client. Which of the following questions would be most appropriate for the nurse to ask? a. Where was the drug acquired? b. Who gave the drug to you? c. Why do you use the drug? d. How often do you use the drug?

D During an assessment, all relevant drug-use history is collected and aids in the assessment of drug-use patterns. The nurse should note any changes in drug-use patterns over time. Thus, the most appropriate question is the nurse asking how often a client uses drugs.

A nurse is working for a public health department as the community health educator. Which of the following is a potential barrier that a nurse may experience? a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking knowledge about how to gain participation

D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information. Clients with low literacy levels and limited vocabularies are considered to be a learner-related barrier, not a barrier of the educator. Memorizing the information to teach may cause problems with the presentation but would not be a barrier for the educator.

To understand the causes of health and disease, epidemiology studies: a. individuals. b. families. c. groups. d. populations.

D Epidemiology monitors health of populations, understands determinants of health and disease in communities, and investigates and evaluates interventions to prevent disease and maintain health. Epidemiology does not focus on individuals, families, and groups.

A nurse is providing comprehensive education about HIV transmission for an injection drug user (IDU). Which of the following would be the most important information to include? a. How and where to acquire needles b. Proper needle usage and possible injection sites c. Spreading of the virus via homosexual activities d. Using bleach between needle uses

D IDUs represent the most rapidly growing source of new cases of AIDS, and they are the greatest risk for spread of the virus in the heterosexual community. Emphasis is being placed on reduction of the transmission of this disease through contaminated needles. Nurses should provide education on cleaning needles with bleach between uses to decrease the spread of the virus. Education on needle exchange programs is also appropriate; however, this population is not as likely to use these programs even when they are available.

A nurse is working in a public health center. A patient who has been newly diagnosed as HIV positive comes for counseling. By law, which of the following actions must be taken by the nurse? a. Give antiviral medications to the patient b. Ask the person to name all of his or her sexual contacts c. Refer the patient to the social worker as someone possibly needing case management d. Report the HIV-infected person to the state health department

D It is mandatory to report HIV cases by name in all states, although not all states require viral load and CD4 counts. There are not laws in place that mandate administration of medications, naming of sexual contacts, or referral to case management.

A community health nurse is caring for a client with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following should the nurse be aware of? a. Persons with MRSA usually have a chronic illness. b. MRSA is a hospital-acquired infection and not often seen in the community. c. Vancomycin-resistant Staphylococcus aureus (VRE) follows MRSA. d. MRSA is becoming more common in the community.

D MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations. MRSA is still largely a health care-associated infection, but it is becoming more common. VRE was found before MRSA. MRSA is not associated with chronic illness.

The most widely used illicit drug in the United States is: a. alcohol. b. heroin. c. cocaine. d. marijuana.

D Marijuana is the most widely used illicit drug in the United States. The oldest and most widely used psychoactive drug in the world is alcohol.

The case rate of new TB is highest among which ethnicity in the United States? a. African American b. Native American c. White American d. Asian American

D Of the new cases, 59% are foreign-born persons living in the United States, with Asians and Hispanics being the most common ethnic groups, representing 30% and 28% of national TB cases. The TB rates for African American, Native American, and White American are lower than the Asian and Hispanic populations.

A nurse is investigating a serious epidemic of influenza. Which of the following best describes the amount of cases that are being examined? a. 50 cases b. 100 cases c. 500 cases d. Unable to determine

D One cannot tell the degree of seriousness without a denominator, which represents the total population.

A nurse is responding to a disaster. Which of the following is the priority of the disaster response? a. Clean up the environment b. Handle the stress reaction of the victims c. Bring in as many aid workers and nurses as possible d. Reestablish sanitary barriers and focus on basic needs

D Reestablishing sanitary barriers and focusing on water, food, waste disposal, vector control, shelter, and safety are the first goals. After this has been established, the nurse can address the cleanup of the environment, the stress reactions of the victims, and the need to bring in additional workers.

A nurse is caring for a client who has had long-term marijuana use. Which of the following physical effects should be of priority concern to the nurse? a. Constipation b. Cardiac dysrhythmia c. Abdominal pain d. Respiratory tract damage

D Respiratory tract damage occurs from smoking the drug and is the greatest physical concern among chronic users. Cardiac dysrhythmias may be a concern of chronic alcohol use. Constipation and abdominal pain are not of priority concern.

A nurse implements a program that focuses on secondary prevention. Which of the following is most likely the topic of this program? a. Rehabilitation b. Avoidance of high-risk behaviors c. Immunization d. Mammogram

D Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Mammograms are a screening test. Avoidance of high-risk behaviors and immunizations are examples of primary prevention. Rehabilitation is an example of tertiary prevention.

A nurse is assessing the community for potential settings of drug experiences. Which of the following describes what the nurse would most likely identify? a. A back alley or abandoned building where people are using crack b. An area at the local high school where students are known to smoke cigarettes c. The individuals using the drug, including that individual's expectations d. The physical, social, and cultural environment within which the use occurs

D Setting is the influence of the physical, social, and cultural environmental within which the use occurs. All of these environments influence the use of drugs. A back alley, an area at the local high school, and individuals using the drug do not address all of the aspects of setting.

An example of a successful campaign against which of the following communicable diseases was carried out during the 1960s and 1970s? a. Tetanus b. Measles c. Pertussis d. Smallpox

D Smallpox was virtually eliminated throughout the world as a result of immunization. Tetanus, measles, and pertussis all continue to exist throughout the world.

A nurse experiences a stress reaction while working with the survivors of a disaster. Which of the following best describes what has happened? a. The nurse makes decisions to assist with care coordination of the survivors. b. The nurse tells the supervisor of the disaster the details of the care that was provided. c. The nurse cries after returning home at the end of the day. d. The nurse refuses to follow orders.

D Symptoms that may signal a need for stress management assistance include the following: being reluctant or refusing to leave the scene until the work is finished; denying needed rest and recovery time; feelings of overriding stress and fatigue; engaging in unnecessary risk-taking activities; difficulty communicating thoughts, remembering instructions, making decisions, or concentrating; engaging in unnecessary arguments; having a limited attention span; and refusing to follow orders.

Which of the following diseases is the leading killer of people with HIV? a. AIDS b. Malaria c. Hepatitis d. TB

D TB is the leading killer of people with HIV, and up to 80% of TB clients are HIV positive in countries with a high prevalence of HIV. AIDS, malaria, and hepatitis are not the leading killer of people with HIV.

A nurse is conducting a developmental screening to assess for domain-specific development, including gross and fine motor skills. Which developmental screening tool would the nurse most likely use? a. Pediatric Symptom Checklist b. Ages and Stages Questionnaire c. Parents' Evaluation of Developmental Status d. Denver II

D The Denver II screening tool assesses domain specific development (gross and fine motor, social, and language). The Pediatric Symptom Checklist assesses coping and mental health concerns, the Ages and Stages Questionnaire assesses social and emotional development, and the Parents' Evaluation of Developmental Status assesses general developmental and behavioral screening.

Which statement about poor people living in the seventeenth century is accurate? a. They were likely alcoholics or prostitutes. b. They were ashamed to be living in poverty. c. They traveled from community to community for food and shelter. d. They would be given assistance by their community.

D The Elizabethan Poor Laws began in seventeenth-century England by helping the poor receive help within the boundaries of their original community. Needy travelers would not be helped and were sent back to their original community where they would be helped by their own folk. It was no disgrace to live in poverty because nearly everyone was poor.

A nurse is developing and coordinating an emergency response plan for a community. With which of the following organizations would the nurse collaborate? a. American Red Cross (ARC) b. National Disaster Medical System (NDMS) c. Centers for Disease Control and Prevention (CDC) d. Emergency Management Agency (EMA)

D The EMA is responsible for developing and coordinating emergency response plans in a defined area. The ARC works with communities in the preparedness, response, and recovery phases of a disaster. The CDC studies the effect that disasters have on population health and continuously develops new prevention strategies. The NDMS provides nurses the opportunity to work on specialized disaster response teams.

The ability of an agent to produce a severe pathologic reaction is known as: a. antigenicity. b. invasiveness. c. toxicity. d. virulence.

D The ability of an agent to produce a severe pathologic reaction is known as virulence. Antigenicity is the ability to stimulate an immunological response. Invasiveness is the ability to penetrate and spread throughout a tissue. Toxicity is the ability to produce a poisonous reaction.

How much alcohol can the liver metabolize in an hour? a. 1 oz of whiskey b. 3 oz of wine c. 5 oz of wine d. 12 oz of beer

D The amount of alcohol the liver can metabolize per hour is equal to about 3/4 oz of whiskey, 4 oz of wine, or 12 oz of beer.

The interaction between an agent, a host, and the environment is called: a. natural history of disease. b. risk. c. web of causality. d. the epidemiologic triangle.

D The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The natural history of disease is the course of the disease process from onset to resolution. Risk is the probability an event will occur within a specified period of time. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease.

The key to achieving the goals of Health for All in the 21st Century (HEALTH21) is the worldwide: a.cure of communicable disease. b.technological development of all nations. c.availability of health care insurance. d.implementation of primary health care.

D The major key to attaining Health for All by the Year 2000 was the worldwide implementation of primary health care; this has extended into the next century with the document HEALTH21. The World Health Assembly in 1977 stated that all citizens of the world should enjoy a level of health that would permit them to lead a socially and economically productive life. Curing communicable disease, technological developments of all nations, and availability of health care insurance are not part of the key strategies to achieve the goals of HEALTH21.

The most common reportable infectious disease in the United States is: a. gonorrhea. b. syphilis. c. herpes. d. chlamydia.

D The most common reportable infectious disease in the United States is chlamydia. Gonorrhea is the second most commonly reported infectious disease. Syphilis and herpes are not among the most common reportable infectious diseases in the United States.

Which of the following groups would be most likely to receive an injection of prophylactic immune globulin for possible exposure to hepatitis A? a. Persons who have had direct contact with blood b. Those who ate at the same restaurant as the person with hepatitis A c. All health care workers d. All those who had household or sexual contact with persons with hepatitis A

D Those who have been in close contact with persons who develop hepatitis A should receive immune globulin. The other groups do not describe populations in direct contact with the person who has hepatitis A.

A collection of individuals who have one or more personal or environmental characteristics in common is the definition of a(n): a. community. b. group. c. family. d. aggregate.

D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. A community is a group of people that share something in common, such as geographic location, interests, or values. A group is people who are located close together. A family is considered parents and children living together in a household.

A city sets the standard of an acceptable level of emissions or a maximum contaminant level allowed for factories. Which of the following concepts is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard

D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed. Although this does help to control pollution, environmental standard is best applied in this example. Setting a standard for emissions does not impact waste minimization or land use planning.

A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. Which of the following concepts is being applied? a. Authoritarianism b. Learning style c. Pedagogy d. Andragogy

D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners. In pedagogy the teacher assumes full responsibility for making decisions about what will be learned, and how and when it will be learned. In authoritarianism the leader controls group movement and progress through interpersonal power. Learning style refers to how someone learns best.

A nurse is using the educational process of selecting appropriate educational methods when planning a community health program. Which of the following steps of the nursing process does this action most resemble? a. Assessment b. Evaluation c. Implementation d. Planning

D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. Planning is similar to selecting appropriate educational methods.

A nurse is working to remove barriers to receiving health care. Which of the following actions is the nurse most likely to support? a. Discrimination against certain groups b. Treatment of pets at the same facility c. Provision of free food at a food bank d. Providing services for a rural population by using a mobile clinic

D Barriers to access are policies and financial, geographic, or cultural features of health care that make services difficult to obtain or so unappealing that people do not want to seek care. Examples of removing barriers include providing extended clinic hours, low-cost or free health services for people who are uninsured or underinsured, transportation, mobile vans, and professional interpreters, which can help improve access to care.

A nurse is teaching a client about how to complete a wound dressing change. Which of the following conditions must be met before learning will occur? a. Must be able to memorize the instructions, relay this information to a partner, and demonstrate the dressing change b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to practice the dressing change

D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the necessary requirements of the learner.

A nurse is working as a case manager. Which of the following best describes the diagnoses that the case manager is most likely to encounter? a. Bankruptcy, financial distress, and depression b. Flu, colds, and frequent headaches c. Malaria, bird flu, and Dengue fever d. AIDS, spinal cord injury, and ventilator dependency

D Case-managed conditions include many chronic conditions. AIDS, spinal cord injury, and ventilator dependency are the only chronic conditions listed. The other options are acute or nonmedical conditions.

A nurse is trying to develop community partnerships. Which of the following interventions would be the most appropriate for the nurse to use? a. Involve the community residents b. Use nurses as the source of information and leadership c. Rely on the power of local officials d. Include a variety of disciplines

D Community partnerships occur when community residents and health workers come from a variety of disciplines. Partnerships should involve a variety of individuals from various backgrounds. There should be a balance of power and information sharing among all of the participants.

A PHN is conducting a community assessment. Which of the following is the best example of this action? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse cases

D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment.

A nurse operates a school-based clinic in a local school where multiple providers and disciplines offer care to children, making it easier for children to access health care. Which of the following best describes this approach? a. Advocacy b. Wrap-around services c. Social justice d. Comprehensive services

D Comprehensive services are health care services that focus on more than one health problem or concern. Stationary or mobile clinics that provide a wide array of health promotion, illness prevention, and illness management services in migrant camps, schools, and local communities are examples of this. Wrap- around services describe a system in which comprehensive health services are available and social and economic services are "wrapped around" these services. Advocacy refers to actions taken on behalf of another. Social justice describes justice with respect to the concepts of egalitarianism and equality.

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

D Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual's and family's comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant.

A facility is inspected after it has obtained a permit. The inspection is completed for the purpose of observing whether the plans submitted in the permit application are being implemented as approved. Which of the following environmental protection strategies is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring

D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved. Permitting is an important step in controlling pollution. Waste minimization and land use planning are activities aimed at prevention of pollution.

A nurse is implementing an intervention at both the primary and tertiary levels of prevention. Which of the following best describes the nursing intervention? a. Providing emergency shelter housing b. Offering physical and mental health services c. Developing a targeted case management program d. Establishing a needle exchange program

D Establishing a needle exchange program could be considered both primary (preventing a problem before it occurs by helping clients avoid disease transmission) and tertiary (working with a population who already has a "problem" of drug abuse). Providing emergency shelter housing and offering physical and mental health services are both secondary and tertiary prevention interventions. Developing a targeted case management program is secondary prevention.

A nurse plans on implementing a community-wide influenza immunization program. Which of the following factors should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The community's readiness to participate in the program

D The factors that influence implementation in the community are the nurse's chosen roles, the type of health problem selected as the focus for intervention, the community's readiness to take part in problem solving, and characteristics of the social change process. The community's readiness to participate is more important than public policy, the existence of formal groups in the community, and the number of community members who have already received the vaccine.

A nurse recognizes the importance of group norms when planning community health education. Which of the following provides the best explanation for why this is important? a. Allow for creativity and variety among group members b. Influence members' perception of community c. Are helpful in evaluating the effectiveness of the group d. Maintain the group through various supports to members

D Group norms serve to maintain the group through various supports to members. They are the standards that guide, control, and regulate individuals and communities. They suggest what a group believes is important, what it finds acceptable or objectionable, or what it perceives as of no consequence. Group norms may limit the creativity and variety among the group members. Members' perception of the community could be influenced by group norms, but this is not why this consideration should be made when planning community health education. Group norms are not used to evaluate the effectiveness of the group.

PHNs across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used? a. Describe the proper order of implementation b. Emphasize surveillance as the main focus of public health practice c. Guide practice and generate agency protocols d. Improve the health status of communities, systems, individuals, and families

D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice.

Care in a managed system is provided by less experienced providers. Which of the following ethical principles is being influenced in this situation? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice

D Justice calls for equal distribution of health care with reasonable quality. Autonomy is the individual's right to choose a provider. Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence- based practice, and monitoring processes in plans of care.

How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients

D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. Extrapolation by toxicologists and biomonitoring are modern methods. Completing a chemistry course does not show how to identify these possible relationships.

An established group requests a teaching and learning session on hypertension. Which of the following should the nurse expect with this type of group? a. The group membership will change from week to week. b. The members all have the same interests. c. They prefer lectures rather than demonstrations. d. The group already has operating methods that have been successful.

D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful. An established group would have a stable group membership. Learning occurs better in all groups with demonstrations instead of lectures. In an established group, they may be together because of a common interest, but may not share all of the same interests.

Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan. c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development.

A PHN is organizing a multidisciplinary team to address the issue of water pollution in the community. The most likely members that would be invited to address this issue would be: a. physicians, water sanitation workers, and occupational therapists. b. pharmacologists, radiologists, and epidemiologists. c. nurse practitioners, pharmacologists, and environmentalists. d. geologists, meteorologists, and chemists.

D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists. The other professionals are not experts in the area of water pollution in the community.

A nurse is providing secondary prevention when working with the homeless. Which of the following best describes what is being implemented? a. Employer incentives b. Safe sex education c. Comprehensive case management d. Soup kitchens

D Secondary preventive services target persons on the verge of homelessness as well as those who are newly homeless. An example of secondary prevention is a soup kitchen. Employer incentives and safe sex education are primary prevention strategies; comprehensive case management is a tertiary prevention strategy.

A nurse is planning and implementing care for vulnerable populations. Which of the following would be the most appropriate action for the nurse to take? a. Setting up multiple clinics in a wide geographic area b. Advising legal consultants on a variety of issues c. Making laws to protect the homeless d. Teaching vulnerable individuals strategies to prevent illness and promote health

D Teaching vulnerable individuals, families, and groups strategies to prevent illness and promote health is one of the ways nurses provide care for these populations. Setting up clinics, advising legal consultants, and making laws do not address the direct care provision role of the nurse.

The first stage of collaboration is: a. trust building. b. consensus. c. collegiality. d. awareness.

D The first stage of collaboration is awareness, when one makes a conscious entry into a group process. This is followed by tentative exploration and mutual acknowledgement, trust building, collegiality, consensus, commitment, and collaboration.

A case manager has contacted providers and has negotiated services and prices. Which of the following phases of the nursing process is being demonstrated? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation

D The implementation phase of the nursing process occurs when a case manager advocates for clients' interests and arranges for the delivery of service. Examples of assessment include developing networks with target populations and dissemination of written materials. Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions.

PHNs utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented? a. Systems b. Community c. Policy d. Individual

D The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by "The Wheel."

A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which of the following implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media

D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people. The other methods will take much longer for the information to spread to the community members.

Which statement about poverty is true? a. All cultures view poverty as a pitiful existence. b. Most cultures want to improve the plight of the poor. c. Dangerous environments are present in all cultures. d. Western cultures view poverty negatively.

D The meaning of poverty differs across cultures. Western cultures view poverty negatively, whereas other cultures often respect the poor.

The nurse is teaching a new diabetic client how to give himself an insulin injection. Which of the following domains would be used? a. Developmental b. Cognitive c. Affective d. Psychomotor

D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value.

A case manager is fulfilling the role of coordinator. Which of the following nursing interventions would most likely be completed? a. Providing information to all parties about the situations affecting the client b. Educating the client and providers in order to make informed decisions c. Supporting all parties to work toward mutual goals d. Arranging, regulating, and balancing needed health services for the client

D The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the client. Providing information to all parties about the client's situation is the role of the monitor/reporter. Educating the client and provider in order to make informed decisions is the role of educator, and supporting all parties to work toward mutual goals is the role of facilitator.

A nurse is investigating the structure of the community. Which of the following indicators would the nurse most likely collect data about? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization

D The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation.

A nurse is working with a 17-year-old pregnant cocaine addict who is homeless. Which of the following best describes this client? a. At risk b. A special population c. A Healthy People 2020 target group d. A vulnerable individual

D Vulnerable individuals often have multiple risk factors. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs. Risk is an epidemiological term meaning that some people have a higher probability of illness than others.