quiz 2

When teaching a nutrition class to a student group with a large Hispanic population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

ANS: A Primary prevention involves activities such as health teaching to prevent a problem from occurring.

Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a hazardous vacant lot c. Referring a child with toxic lead levels to a neurologist d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

ANS: A Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages

A nurse who is explaining to a client why it is important to take medication states, The medication takes a couple of weeks to be effective, but then you should feel better. When the client is next seen, no medication has been purchased. Which of the following is the most likely explanation? a. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn't bother with the drug. b. The medication required a trip to the pharmacy, and the client just hadn't had time to obtain the drug yet. c. The medication was too expensive for the clients family. d. The client really hadn't understood why the medication was important

ANS: A Although any of the answers given is possible, if we look closely at what the nurse stated, there may have been a cultural disconnect based on time orientation. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes.

For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patients daily prayers. Which of the following is the nurse demonstrating through these actions? a. Accommodation b. Awareness c. Brokering d. Imposition

ANS: A Cultural accommodation involves including aspects of the patients religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is important-from the patients perspective, possibly more important than medical treatment.

A nurse is caring for a client of another culture. Which of the following actions would be most appropriate for the nurse to take? a. Alter personal nonverbal behaviors to reflect the cultural norms of the client. b. Keep all behaviors culturally neutral to avoid misinterpretation. c. Rely on friendly gestures to communicate caring for the client. d. Avoid any pretense of prejudice by treating the client in the same way as any other client.

ANS: A Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care.

At a local hospital, postpartum care policy requires that nurses observe the mother during infant care to assess the mothers ability to care for the new baby and to promote bonding. A new mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Which of the following actions would be taken by a culturally competent nurse? a. Allow family members to provide the newborns care and assess the mothers knowledge of child care through discussion. b. Reinforce the importance of bonding and that all good mothers gladly assume these responsibilities. c. Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care. d. State that she must abide by hospital policy because documentation of the mothers ability to give the infant care is required for discharge.

ANS: A Culturally competent nursing care focuses on the specific patient, reflects the patients individual beliefs and values, and is provided with sensitivity.

A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Equal rights c. Primary prevention d. Risk protection

ANS: A Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities. The Environmental Justice Act would be used in support of the nurses position

A nurse says, I'm not going to change the way I practice nursing based on where the client is from, because research shows that Western health care technology and research is best. Which of the following is being demonstrated by the nurses statement? a. Ethnocentrism b. Prejudice c. Racism d. Stereotyping

ANS: A Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that ones own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, The way we do it is the only right way to provide this care.

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? a. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement

ANS: A Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on the same criteria, but managed care integrates the financing and the delivery of health care. The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion.

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? a. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement

ANS: A In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of time.

Which of the following best describes most Americans attitude toward immigrants? a. Ambivalence because there are no clear solutions about how to address their needs b. Strongly negative because immigrants take jobs that native-born Americans could have instead c. Strongly positive because immigrants bring useful job skills and often join previous family members already in the United States d. Strong opposition to further immigration because of the increasing population in the United States

ANS: A Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions.

Which of the following best defines the word politics? a. A neutral term meaning influence b. The outcome of governmental policies c. A provision of power for making decisions d. The result of legislative action

ANS: A Politics is a neutral term meaning the art of influencing others to accept a specific course of action. Political action results in governmental policies and legislation.

A nurse is planning to conduct research on patient care outcomes. Which of the following agencies would the nurse use as a resource? a. Agency for Health Care Research and Quality b. Federal Agency for Patient Care Outcomes c. National Center for Nursing Research d. U.S. Agency for Patient Care Effectiveness

ANS: A The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care.

A public health nurse is counseling a client who is trying to determine if a health maintenance organization (HMO) or preferred provider organization (PPO) will provide the better health care coverage. Which of the following best describes one main difference between these two types of coverage? a. HMOs provide comprehensive care to members for a fixed fee. b. PPOs designate providers that members can choose. c. PPOs provide one model of care delivery. d. HMOs provide financial incentives to encourage members to select HMO providers.

ANS: A The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed, per member per month, fee. A PPO uses predetermined rates for services to be delivered to members. HMOs do not have one model of care delivery. PPOs provide financial incentives to encourage members to select PPO providers.

Which of the following demographic factors is expected to have the greatest influence on national health care spending? a. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

ANS: A The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the baby boom generation ages and retires, federal expenses for Social Security and health care will increase.

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center

ANS: A The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies.

A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors.

Which of the following activities is completed by the executive branch of the federal government? a. Administration of policy b. Interpretation of policy c. Proposal of policy d. Passage of policy

ANS: A The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws). The judicial branch interprets laws.

A client states to the nurse, I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I have seen no benefits from this legislation. Which of the following statements would be the best reply by the nurse? a. Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill. b. It will take years to see any effects from the act because of the delays in implementation of the changes. c. This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits. d. The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact.

ANS: A The goal of the Affordable Care Act in 2012 was to improve the health of the nation and access care. Several changes to health care have already been made because of this legislation, and more changes will continue in the future. However, it is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of this law.

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? a. Don't drop out of school. b. Sign up for childbirth classes. c. Sign up for the WIC program. d. Take your prenatal vitamins daily.

ANS: A The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child.

A Buddhist patient enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which of the following considerations was omitted by the nurse? a. The patient should not be served any food until a physicians order is obtained. b. The patients Buddhist faith probably requires a vegetarian diet. c. The patient may be too frightened about the tests to want to eat very much. d. The patient may have diabetes or be allergic to some foods

ANS: B Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don't eat meat.

. A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influenza. Which of the following phases of the nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation

ANS: C Giving immunizations is an intervention that will increase the number of people who will be vaccinated. Intervention includes coordinating medical, nursing, and public health actions to meet the clients needs.

Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The prevalence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

ANS: B Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink. Autism has increased 1000% since the mid-1980s. However, there is not a direct link to environmental toxins discussed in the text. The prevalence of asthma is at an all time high. Only about 5% of all cancers are strongly associated with heredity.

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care? a. Clinic operating hours b. Ability to pay for services c. Availability of local provider services d. Transportation availability

ANS: B Because there are not enough health care services available to provide desired services to everyone, the focus has been on reducing costs by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing (either directly or indirectly). The primary determinant, however, is the ability to pay for services. Without this ability, services are denied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out of pocket are unable to obtain services.

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Conduct health risk assessments of randomly selected individuals b. Perform a windshield survey c. Review facility permits and consumer confidence reports d. Survey community members

ANS: B Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides first-hand information about the community and areas of concern that must be investigated.

A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of law will the nurse refer? a. Common law b. Constitutional law c. Legislation and regulation d. Judicial law

ANS: B Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry. State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfare of their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe on individual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. The community's rights are deemed more important than the individuals rights when there is a threat to the health of the public.

A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurses community. b. Consider how the nurses own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures

ANS: B Cultural awareness requires self-examination and an in-depth exploration of ones own beliefs and values as they influence behavior.

A nurse states, The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs. What does this statement reflect in relation to culture? a. Awareness b. Blindness c. Knowledge d. Preservation

ANS: B Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs.

Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide exposure to oversight d. To monitor employee safety

ANS: B Ensuring compliance refers to the process of making certain that permitting requirements are met. Although this activity may be seen as a type of monitoring, the question asks for the purpose, which is to ensure compliance. Enforcement involves penalties such as fines or facility closure.

A nurse is about to despair. Earlier in the week, she carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose, although the patient denies taking more than the label indicated. Which of the following is the most likely explanation? a. The patient was taking more mediation in the hope of getting well faster. b. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. c. The patient truly did not understand and thought the dose being taken was correct. d. The patient had a unique response to the medication and should have a smaller dose ordered.

ANS: B For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients.

Which of the following groups pays the largest amount for health care in the United States today? a. Consumers b. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

ANS: B Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers.

A nurse is explaining the health care system in the United States to a group of physicians visiting from South America. How would the nurse best describe the current health care system? a. It is a logical, rational approach to meeting expressed needs while still trying to control costs. b. It is a system in the process of reform as problems have become increasingly apparent. c. It is divided primarily into two components: private health care and public health care. d. It is the best in the world with outstanding research and high-technology care available to all.

ANS: C Health care in the United States consists of a personal care system and a public health system, with overlap between the two.

Which of the following accurately describes a challenge that will be faced by health care providers in the twenty-first century? a. Lack of available space to provide care for clients in hospitals b. Emergence of new and old communicable and infectious diseases c. New guidelines for chronic disease management d. Increased use of technology leading to a decreased need for health care workers

ANS: B In the twenty-first century the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease the care provided for these diseases and wouldn't be seen as a challenge. The use of technology will continue to increase, but the need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.

How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their providers permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers).

. Which of the following statements best describes the law in relation to clinical practice by nursing students? a. Students are considered certified until licensure is obtained. b. Students are expected to meet the same standard of care as the professional nurse. c. Students are not legally liable for errors because they practice under the license of their instructor. d. Students have a scope of practice determined by the nurse practice act.

ANS: B Nursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Students are expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similar circumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act, they also cannot perform the tasks and responsibilities of the licensed practitioner within the scope of practice until they have received adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the students level of education.

A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse take to influence the bills implications? a. Exercise veto power by calling for petitions from health care agencies b. Contact the regulatory agency and participate in public hearings c. Call members of congress to request that they rescind the legislation that was passed d. Discuss the change in services with the administrators at the hospital

ANS: B Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying against a bill because it shapes the final implementation of the law.

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) b. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

ANS: B Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors.

Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford.

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? a. Applying for a grant to establish a day care center to serve dependent older adult clients living with working families b. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare

ANS: B Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a bill offering health care financial aid to families at risk addresses initiating interventions before an illness occurs.

A community health nurse is trying to increase enrollment in SCHIP. Which of the following interventions would be most effective? a. Explaining the program to children enrolled in public school systems b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments c. Having a newspaper campaign with information and applications printed in the newspaper d. Sending literature about the SCHIP program home with schoolchildren each year

ANS: B SCHIP builds on Medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid. Thus, the population that needs to be targeted for SCHIP is those being seen for medical care who do not have insurance.

A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. Ask the staff in employee health if there have been any other complaints. b. Call the local health department about any recent problems at the hospital. c. Check the material safety data sheet on any chemicals you have used recently. d. See the nurses health care provider for a complete work-up

ANS: C Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling.

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers complaints and general unhappiness d. Increased pressure to decrease overlap in services

ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies.

. A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his appliances with new energy-efficient ones.

ANS: C All citizens can engage in minimizing their impact on the environment by reducing, reusing, and recycling. Although it would be nice to replace all appliances for energy-efficient newer models, most people can't afford that furthermore, it is an environmental issue to discard the used models. Similarly, downsizing to a smaller living space could help the environment, because the nurse would use less energy, but again, not everyone can afford all the expenses involved in moving. On the other hand, all persons can reduce, reuse, and recycle the individual products they currently consume.

A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Which of the following interpreters would be the most appropriate in this situation? a. A Bosnian male who is certified as a medical interpreter b. A female from the clients community c. A female who does not know the client d. The clients 20-year-old daughter

ANS: C Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpreter for females. This client has specifically requested a female provider; therefore, one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client.

A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. Is anyone else in your family having these symptoms? b. Can you tell me about your house or apartment? c. What jobs have you held longest? d. Where do you live?

ANS: C An exposure history should identify current and past exposures, have a preliminary goal of reducing or eliminating current exposures, and have a long-term goal of reducing adverse health effects. The I PREPARE mnemonic consigns the important questions to categories that can be easily remembered. Asking about previous employment helps to answer the P of past work.

Which of the following agencies has the most influence on the health and welfare of U.S. citizens? a. Agency for Healthcare Research and Quality (AHRQ) b. Centers for Disease Control and Prevention (CDC) c. U.S. Department of Health and Human Services (USDHHS) d. World Health Organization (WHO)

ANS: C As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHOs policy-making body provides policy options and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid through the Centers for Medicare and Medicaid Services (CMS).

Mexican immigrants who take metamizole (Mexican aspirin) for pain may experience life-threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural repatterning? a. Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b. Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. d. Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.

ANS: C Cultural repatterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them.

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? a. Insurance resources b. Health care rationing c. Health economics d. Medical technology

ANS: C Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the health care industry. The other options are important components of health economics but by themselves do not provide the broad understanding called for in this question.

An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

ANS: C Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention.

Who is responsible for determining the scope of practice for registered nurses? a. American Nurses Association b. Federal legislators c. State legislators d. U.S. Department of Health and Human Services

ANS: C Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse practice act is governed by legislators in each state.

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department c. Medicaid d. Medicare

ANS: C Medicaid provides coverage for adults with low income and their children.

Which of the following services would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulance

ANS: C Medicare Part A covers hospital care, home care, and skilled nursing care.

. A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a. When the bill is first assigned to a committee b. When the bill is discussed and debated within the committee c. When the bill moves out of committee to be heard by the entire Senate d. When the bill passes the Senate and moves to the House of Representatives

ANS: C Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this senator, who will then be in a position to act on it. The nurse would not want to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.

Which of the following statements best describes why the federal government has become involved in health care? a. The states asked the federal level to become involved. b. Because of rising costs to the states, the federal budget needed to be used to pay for necessary services. c. The Constitution gives the federal government the power to promote the general welfare. d. This step was necessary to standardize care on a national level.

ANS: C One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution, that such federal governmental action was within the powers of Congress to promote the general welfare.

Which of the following best explains how the government inadvertently encourages low-income persons to use emergency departments as their primary care provider? a. A huge amount of paperwork is required when Medicaid clients go to a physician's office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. c. Legally, emergency departments must see clients even if clients can't pay. d. Physicians limited office hours make them unavailable during evenings and weekends.

ANS: C People on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians can choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of ability to pay. Emergency department copayments are modest and are frequently waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary care services.

Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for malpractice? a. Because the health care workers didn't turn my mother every 2 hours, she developed bedsores. b. I received permanent nerve damage because they would not remove a cast that was too tight. c. My daughter wasn't given a call light, and for a whole shift no one checked on her condition. d. They amputated the wrong leg during surgery.

ANS: C Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an injury, except for My daughter wasn't given a call light, and for a whole shift no one checked on her condition, in which case the care was substandard but no injury resulted.

A client is crying softly and saying, What did I do to deserve this punishment, Lord? Which of the following responses by the nurse would be the most appropriate? a. God doesn't punish people. You're sick just because of bad luck. b. I can call the hospital chaplain to help you talk about these feelings c. What can I do to be helpful to you right now? d. Would you like to confess your sins and repent so this illness will go away?

ANS: C Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the clients religious faith group, an open-ended response showing caring is the most appropriate statement.

How does the Department of Agriculture promote the health of U.S. citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food, so no foodborne illnesses can occur c. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists

ANS: C The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat.

Which of the following laws established programs for provision of health services for women and children and supported community-oriented nursing practice? a. Early Periodic Screening and Developmental Testing (EPSDT) Initiative b. Healthy People 2000 Initiative c. Sheppard-Towner Act d. State Child Health Improvement Act (SCHIP)

ANS: C The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children and made nurses available to provide these services in the community setting.

A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following branches of the government is the nurse working? a. Constitutional branch of government b. Executive branch of government c. Legislative branch of government d. Judicial branch of government

ANS: C The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies problems and proposes and then debates, passes, and modifies laws to address those problems.

A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia about 10 years ago. The nurses next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a. Covert intentional prejudice b. Covert unintentional prejudice c. Overt intentional prejudice d. Overt unintentional prejudice

ANS: C The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client.

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. Lets go through these medications and see which ones we can delete. b. You can get these medicines at this clinic for free. c. Lets see if we can get some help from Medicare to help you pay for these medications. d. These medications are important. Do your best to pay for them.

ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions.

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? a. A proportion of actual cost arbitrarily decided by the Medicare panel b. The federal budget constraints for the current fiscal year c. Hospital and health care provider feedback and political persuasion d. Prospective payment scale based on the medical diagnosis

ANS: D As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs).

. A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations of Healthy People 2020 d. Services mandated by the state government

ANS: D At the local level, health departments provide care that is mandated by state and federal regulations.

Which of the following individuals would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English b. A 25-year-old female with health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployed

ANS: D Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, child care needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income.

A family from Mexico comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English-Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, No hablo Espanol (I don't speak Spanish). d. Obtain an interpreter to translate.

ANS: D Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the clients language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received.

The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is hot and he believes that penicillin, a hot medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the clients prescription is changed to a different yet equally effective antibiotic? a. Cultural awareness b. Cultural brokering c. Cultural knowledge d. Cultural skill

ANS: D Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioners need to prescribe an effective antibiotic.

A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a clients history. He stopped doing this around Muslim clients after being told that Muslims were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a. Cultural accommodation b. Cultural imposition c. Cultural repatterning d. Cultural skill

ANS: D Cultural skill is the effective integration of cultural knowledge and awareness to meet client needs in this case, the clients need to not be offended by having the bottom of the nurses foot or shoe in view of the clients face. The nurse using cultural skill makes sure nonverbal communication techniques take into consideration the clients use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing ones values on others. Cultural repatterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.

. A nurse is trying to maximize the quality of life of her clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition d. Teaching a high school boy about sexually transmitted infections and proper condom application

ANS: D Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs.

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? a. Education of health care providers moved into universities. b. People finally had enough money to pay for medical care. c. The improved outcomes of hospital care were recognized. d. Advances were made in safe water, sewage disposal, and pasteurization of milk.

ANS: D Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes.

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment d. Neglecting to order certain tests or treatment to minimize cost to the provider

ANS: D In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the amount of money received to provide care to members of this group.

The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation

ANS: D In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. If you chose assessment, understand that this would have been done earlier in the process because assessment was needed to determine that a problem existed and that interventions were needed

Of the four main factors that affect health, which is the least important? a. Environment b. Human biology c. Lifestyle choices d. Health care system

ANS: D Of the four major factors that affect health personal behavior (or lifestyle), environmental factors (including physical, social, and economic environments), human biology, and the health care system medical services are said to have the least effect. Behavior (lifestyle) has been shown to have the greatest effect, but environment and biology account for 70% of all illnesses.

. A health care worker tells a nurse, It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them. Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping

ANS: D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food.

. What was the significance of the 1979 Surgeon Generals report? a. It planned the goals and priorities for the entire Veterans Administration medical system. b. It vastly increased funding for health promotion activities. c. It identified the use of tobacco as a cause of lung cancer. d. It created national goals for promoting health and preventing disease.

ANS: D The 1979 Surgeon Generals report began a focus on preventing disease and promoting health for all Americans. It was a national effort with all levels of government, as well as other interested parties, involved.

Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded. b. Nurses must be recognized and rewarded for health promotion efforts. c. Nursing research into patient care outcomes must be expanded and funded. d. Universal access to essential health services should be available for all citizens.

ANS: D The ANAs position is based on the belief that health care is a basic human right. Thus, a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents.

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

ANS: D The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. Others may contribute to safety but do not have the full oversight of OSHA.

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business man who works for a large corporation d. A 32-year-old man who works part-time at a small business

ANS: D The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it.

. A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the following factors should the nurse emphasize? a. Providing disease investigation training b. Providing research opportunities c. Providing leadership experiences d. Providing salaries commensurate with responsibilities

ANS: D Through the input of the Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP), the Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to support the public health nurse role are: competitive salaries commensurate with responsibilities, experience in health promotion and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health disparities.

. A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacologist d. Toxicologist

ANS: D Toxicology is the basic science that studies the health effects associated with chemical exposures. The other specialists would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes

The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and requires. Which of the following effects will this change have on nurses in this state? a. None, because they are just helpful guidelines for maximum safety b. None, because they just give specifics that may change over time c. Major, because prudent nurses would follow such regulations d. Major, because these rules and regulations have the effect of law and must be obeyed

ANS: D When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations. Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations.