Stanhope: Public Health Nursing, 9th Edition Chaptes: 1, 2, 17, 18, 16, 41, 12, 13, 14, 24

9. A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: a. HIV test results counseling. b. needle exchange. c. partner notification. d. instruction in standard precautions.

ANS: D Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected. Cognitive Level: Application Associated Chapter Objective: 1, 5 & 6 REF: p. 339

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

ANS: A Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 16

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

ANS: A CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. They can also serve as gatekeepers, using their own insider status to engage community members in the assessment process Cognitive Level: Analysis Associated Chapter Objective: 2 & 5 REF: p. 401

1. The minimum requirements for entry into home care practice should be: a. baccalaureate in nursing. b. baccalaureate in nursing and clinical nurse specialist (CNS) certification. c. master's in nursing. d. master's in nursing and CNS certification.

ANS: A Nurses come to home care from a variety of educational and practice backgrounds. Home care nurses should be educated to function at a high level of competency so that they can be relied on not only by their professional colleagues but also by the community. A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting, including home care. Cognitive Level: Comprehension Associated Chapter Objective: 3 REF: pp. 901-902

1. Morbidity data can most easily be located in which of the following sources? (Select all that apply.) a. Environmental surveys b. Hospital discharge reports c. Medical examiners' reports d. Specialized disease registries e. Vital statistics sources

ANS: A, B, D Mortality data can be found in data sources containing vital statistics, which typically include death certificates and coroner/medical examiner reports, and birth certificates. Morbidity data are typically found in reports of notifiable disease; laboratory reports; hospital discharge reports; billing data; outpatient health care data; specialized disease registries; injury surveillance systems; environmental surveys; and sentinel surveillance systems. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 533

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

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis. Cognitive Level: Analysis Associated Chapter Objective: 9, 10 & 11 REF: pp. 280-281

9. Although infectious disease epidemics are still the major cause of death worldwide, they have subsided in the United States because of improvements in nutrition and sanitation, the discovery of antibiotics, and the development of vaccines. Infectious diseases have not vanished, however, and remain a continuing cause of concern. Healthy People 2020 has a number of objectives aimed at reducing these illnesses because of the morbidity, mortality, and costs associated with infectious diseases. One such costly disease trend related to an increase in the performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs is the rise of: a. Escherichia coli 0157:H7. b. multisyndrome effect. c. health care-associated infections. d. severe acute respiratory syndrome.

ANS: C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Pennsylvania, the first state in the country to examine the costs of these infections, reported that health care-associated infections led to $2 billion in additional hospital charges and at least 1500 preventable deaths in 2004. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 314

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

ANS: C Health-promoting groups may form when people meet in community and health care settings and discover common challenges to their physical and mental well-being. People often make changes with the support of a group that they are unable to make independently. Health-promoting groups like Alcoholics Anonymous and Parents Without Partners improve members' health and deal with specific threats to health. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: pp. 368-369

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

ANS: A Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 15-16

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

ANS: B The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs. Cognitive Level: Synthesis Associated Chapter Objective: 6 REF: p. 18

8. Many behaviors place any individual—regardless of age, gender, ethnicity, or other characteristics—at greater risk for STDs. The nurse should include primary prevention interventions in all client encounters through the discussion of: a. partner notification. b. safer sex. c. standard precautions. d. STD testing.

ANS: B Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters. Cognitive Level: Application Associated Chapter Objective: 5 & 6 REF: p. 336

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

ANS: B The Association of Community Health Nurse Educators calls for increased graduate programs to educate PHN leaders, educators, and researchers. Natural disasters (such as floods, hurricanes, and tornados) and human-made disasters (including explosions, building collapses, and airplane crashes) require innovative and time-consuming responses. Preparation for future disasters and potential bioterrorism demands the presence of well-prepared nurses. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 6 REF: p. 39

7. In home health care, the use of performance improvement programs, evidence-based practice guidelines, and appropriate communication, documentation, and telehealth technologies are strategies to address the issue of: a. agency accreditation. b. professional performance standards. c. malpractice risk reduction. d. regulatory compliance.

ANS: C Home health and hospice nurses are at risk for malpractice claims related to the complexity of care, failure to adhere to standards of practice, and other errors. Nurses and their employers need to be proactive by taking responsibility for personal and agency actions. A focus on communication with clients, families, and the health care team; commitment to providing quality care; documentation refresher sessions; performance improvement programs; use of evidence-based practice guidelines; and appropriate use of information technology and telehealth are strategies that can help reduce risks. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 903

4. Hospice care would be an appropriate option to discuss with which of the following patients? a. Patient with stage II lung cancer who is undergoing chemotherapy b. Patient with early Alzheimer's disease whose caregiver needs respite care c. Patient with metastatic breast cancer who has discontinued chemotherapy and radiation treatment d. Patient with severe debilitating osteoporosis

ANS: C The criterion for entry into hospice care is that the disease process or condition has progressed to the point that further treatment cannot cure and death within 6 months would not be unexpected. This does not mean that the patient will die within the next 6 months, only that if death occurred, it would not have been unexpected. Hospice care services can be provided in the home and/or institutional setting. Multidisciplinary teams have the knowledge, skill, compassion, and experience to address the unique needs of the patient at the end of life as well as the needs of his or her family. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 887

3. The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies? a. Both focus on urban health risks and interventions to reduce the impact of those risks on the local population b. Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality c. Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease

ANS: D The Framingham Heart Study examined factors that influence the development of coronary heart disease (CHD). This study led to development of health risk appraisals, predictive risk models, and strategies to reduce CHD risk. The Alameda County study followed a large sample for 4 years to investigate the relationship of social and behavioral factors to mortality. Both studies are highly significant in detecting individual and environmental risk factors for disease and in prompting multilevel community-oriented intervention programs. Cognitive Level: Analysis Associated Chapter Objective: 1 & 3 REF: pp. 383-384

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

ANS: D Community health status (or outcome) involves biological, emotional, and social attributes. Biological attributes include morbidity and mortality. The social attributes of health status include crime rates and functional levels. The emotional attributes of health status include consumer satisfaction and mental health indices. The suicide rate is one of the measures used when compiling mental health indices. Educational levels are part of the structure dimension (social indices). The physical attributes of structure include measures of community health services and resources, such as use patterns and provider-to-client ratios. Cognitive Level: Application Associated Chapter Objective: 2 & 4 REF: p. 403

4. The first step in initiating a surveillance strategy is to confirm the: a. existence of the event. b. magnitude of the problem. c. source of the outbreak. d. tentative hypothesis.

ANS: A The first step in conducting an investigation is to confirm that an occurrence/outbreak actually exists and that a supposed event is not a false alarm. The investigator must find out the nature, location, and severity of the problem. Only the investigator can make this determination. The investigator can then verify the diagnosis and develop a case definition to determine the magnitude of the problem. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 539-540

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

ANS: B Objectives are specific, short-term criteria that need to be met as steps toward achieving a long-term goal. Objectives are written statements of an intended outcome or expected change in behavior and should define the minimum degree of knowledge or ability needed by the client. They must be stated clearly and defined in measurable terms. Objectives are different from goals, which are broad, long-term, expected outcomes. Cognitive Level: Analysis Associated Chapter Objective: 1 & 5 REF: p. 359

8. Collaboration among local, state, and federal agencies; health care providers, agencies, and organizations; and other community-based services that address issues of safety and welfare in a community is critical to the success of a quality surveillance program. The public health practice domain that best describes the ability to collaborate effectively is: a. communication. b. analytical assessment skills. c. community dimensions of practice. d. policy and program development.

ANS: C The Core Competencies for public health are divided into eight practice domains: analytical assessment skills, policy/program development, communication, cultural competency, community dimensions of practice, basic public health sciences, financial planning/management, and leadership. The practice domain for community dimensions of practice addresses the establishment and maintenance of links during an investigation; collaboration with partners; and development, implementation, and evaluation of an assessment to define a problem. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: pp. 532-533

8. The incentives and pressures for cost control and improved health outcomes have promoted the development of technologies that are simpler, more reliable, and: a. more acceptable to the patient. b. more expensive. c. more complex. d. efficient.

ANS: D The increased availability of telehealth coincides with trends described in this and other chapters in this book: an aging population, increased chronic illness and costs, and changes in health care reimbursement. Home health, palliative, and hospice providers face the challenge of managing increasingly complex clients in a highly constrained fiscal environment where patterns of care and reimbursement are based on client need and agency efficiency. Telehealth has emerged as a viable and acceptable way to supplement the delivery of health care economically. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 906

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

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

3. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children 15 years old and younger. What is the age-specific meningitis death rate for children age 15 years and younger for this region to date this year? a. 0.08/1000 b. 0.46/1000 c. 1/1000 d. 8/1000

ANS: A A rate is a measure of the frequency of a health event in a defined population in a specified period of time. A rate is a ratio but not a proportion, because the denominator is a function of both the population size and the dimension of time, whereas the numerator is the number of events. Rates relate to change: moving from one state of being to another, such as from illness to health or from life to death. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 1000 = 0.0833/1000. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 262

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

ANS: A Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Gatekeepers can confer credibility to the nurse. CHWs are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. Stakeholders refer to anyone with a personal or occupational interest or concern in a community's life. Professional service providers who are community members such as school teachers, public safety officers, and agricultural extension agents play a large part in the overall health of the community. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 5 REF: p. 401

3. The nurse epidemiologist in a local health district receives a report from a local pediatrician that a case of chickenpox has been diagnosed in a second grader at one of the local elementary schools. The nurse proceeds to contact the school to determine whether or not any other children are absent for illness or were recently seen by the school nurse. Other area pediatricians are also contacted to determine whether or not any other cases have been identified. The nurse works with the school to notify parents about what signs and symptoms they should look for and how to manage a child with such symptoms. This is an example of which type of surveillance? a. Active b. Passive c. Sentinel d. Special

ANS: A In an active system of surveillance, the PHN, as an employee of the health department, may begin a search for cases through contacts with the local health providers and health care agencies. The nurse names the disease or event and gathers data about existing cases to try to determine the magnitude of the problem. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 537

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

ANS: A In most definitions, the community includes three factors:people, place, and function. The people are the community members or residents. Place refers to both the geographic and time dimensions, and function refers to the aims and activities of the community. The parts of a community are interdependent, and their function is to meet a wide variety of collective needs. Therefore, the definition of community should also recognize the interaction among systems within the community. Cognitive Level: Analysis Associated Chapter Objective: 2 & 3 REF: p. 398

6. Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: a. antibody test results are typically negative. b. antibody production by the immune system increases. c. incubation period is prolonged. d. symptoms include myalgias, sore throats, and rash.

ANS: A Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 321

4. A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Appropriate intervention by the nurse would be to: a. arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. b. contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. c. provide STD prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. d. supply the client with nonsteroidal anti-inflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

ANS: A Nursing assessment should always include taking a comprehensive sexual history to determine an individual's potential risk for STDs. Each sexual partner is potentially exposed to all the STDs of all the persons with whom their partner has been sexually active. PID is a serious infection involving the fallopian tubes and is the most common complication of gonorrhea, but it may also result from chlamydial infections. Symptoms include fever, abnormal menses, and lower abdominal pain. Symptoms can vary among women. PID can cause ectopic pregnancy, and this should be ruled out in all cases. Stillbirth, premature labor, and infertility are also possible complications. Cognitive Level: Analysis Associated Chapter Objective: 2 & 3 REF: p. 328 & p. 334

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

ANS: A Pertussis (whooping cough) is caused by the bacterium Bordetella pertussis. It is highly contagious and is considered endemic in the United States. Endemic means that the disease is constantly present within a geographic area or population. Vaccination against pertussis, delivered in combination with diphtheria and tetanus vaccination, is a part of the routine childhood immunization schedule. The increase in adolescent and adult pertussis is alarming not because of the increased morbidity—cases are mild or inapparent in these groups—but because these individuals serve as a reservoir of infection for infants, especially those younger than 6 months of age, who are the most vulnerable to pertussis and the most likely to suffer complications resulting in hospitalization and death. Cognitive Level: Synthesis Associated Chapter Objective: 1, 8 REF: pp. 291-292

4. The World Health Organization (WHO) developed the Five Keys to Safer Food campaign in 2001 to address the problem of foodborne and waterborne diarrheal diseases worldwide. This campaign emphasizes which of the following practices? a. Keep clean, separate raw and cooked, cook thoroughly b. Never use raw, always cook, buy better c. Wash, cut, cook, and throw away d. Wash, cover, and always refrigerate

ANS: A Protecting the nation's food supply from contamination by virulent microbes is a multifaceted issue that is and will continue to be incredibly costly, controversial, and time-consuming to address. The specter of terrorist threats to the food supply adds an additional layer of complexity. However, much foodborne illness, regardless of the causal agent, can be easily prevented through simple changes in food preparation, handling, and storage. WHO estimates that 2.2 million people, most of them children, die annually from foodborne and waterborne diarrheal diseases in less-developed countries. In 2001, WHO initiated a new campaign entitled Five Keys to Safer Food, a simplified version of an earlier campaign that includes the following elements: keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, and use safe water and raw materials. Cognitive Level: Application Associated Chapter Objective: 3 & 9 REF: p. 307

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

ANS: A Some Depression-era federal programs, such as the Works Progress Administration, Relief Nursing Services, and Civil Works Administration (CWA), expanded the need for existing nursing services and created the need for new services in an effort to support employment of basic nurses while meeting the needs of the increasing ranks of impoverished individuals. More than 10,000 nurses were employed by the CWA and assigned to official health agencies. This facilitated rapid expansion of these programs and provided basic nurses with a taste of public health; but it also created a tremendous burden on existing public health staff to provide training and supervision. Basic nursing education focused heavily on the care of individuals, and students received very little training on working with groups and the community as a unit of service. A 1932 survey of public health agencies found that only 7% of nurses employed in public health were adequately prepared to practice in the community, which required considerable agency investment in orientation, training, and supervision. Cognitive Level: Evaluation Associated Chapter Objective: 1, 3, & 5 REF: p. 32

8. In the community-based participatory research (CBPR) approach, the use of lay community members to promote health within the community is an effective intervention because community members: a. are best at determining the health needs and plan interventions for their community. b. create a passive partnership. c. provide oversight for the health promotion activities. d. relieve local service providers of mundane tasks.

ANS: A The CBPR approach to community assessment allows understanding of sociocultural contexts, systems, and meaning through a collaborative research process. In CBPR, partnerships are active and community members are involved in assessing, planning, implementing, and evaluating change. Both professionals and community residents determine health needs and plan interventions. As residents increase their awareness, they are better able to determine what they want for themselves, their families, and their community and they are more likely to take leadership roles in program development, using health professionals as consultants. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: pp. 388-389

5. An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: a. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. host resistance.

ANS: A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of these factors may result in disease transmission. Many travelers are at risk for foodborne and waterborne diseases and should be careful to eat only thoroughly cooked foods prepared under reasonable hygienic conditions. Eating foods purchased from street vendors may not be wise. Fruits that can be peeled immediately before eating, such as bananas, are less likely to be a source of infection. Dairy products should be pasteurized and appropriately refrigerated. Only potable water (safe to drink) should be consumed, such as boiled water or bottled water. Other diarrheal diseases may not be related to viral or bacterial infective agents and may be the result of stress, fatigue, schedule changes, and consumption of unfamiliar foods. Cognitive Level: Application Associated Chapter Objective: 2 & 9 REF: p. 290

8. When a situation exists in which there is potential contact with blood or body fluids, health care workers must always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying reason for requiring these practices, known as universal precautions, is that: a. blood and body fluids of all clients need to be handled as if they were infected. b. effective infection control surveillance programs are in place. c. health care settings are reservoirs of infection. d. health care workers do not effectively use hand hygiene.

ANS: A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other blood-borne pathogens. Cognitive Level: Analysis Associated Chapter Objective: 10 REF: p. 314

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

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

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

ANS: A To facilitate skill learning, the nurse should teach and demonstrate the skill. The educator should allow learners to practice and immediately correct any errors in performing the skill. The basic sequence of instruction includes nine steps: gain attention, inform the learner of the objectives, stimulate recall of prior learning, present the material, provide learning guidance, elicit performance, provide feedback, assess performance, and enhance retention and transfer of knowledge. Cognitive Level: Analysis Associated Chapter Objective: 1 & 5 REF: p. 361

7. The local public health nurse (PHN) participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be: a. coalition building. b. evaluation of outcomes. c. health-risk assessment. d. wellness appraisal.

ANS: A The MAP-IT technique helps the community plan a path to achieve the change that its members want to see in the community. The Healthy People in Healthy Communities MAP-IT process recommends mobilization of individuals and organizations; assessment of the areas of greatest need, resources, and strengths; the planning of an approach; implementation of the plan; and tracking of progress over time. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 382

9. At the request of a local housing authority, a PHN conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The PHN , the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level? a. Aggregate client system level b. Environmental level c. Family client system level d. Individual client system level

ANS: A Within the integrative model of community health promotion, for the needs of this resident population to be met, it was paramount that the nurse understand the perceived problems of both the housing authority and the residents; the services desired by the residents; the resources available at the facility; and the strengths of the aggregate community to participate actively in the assessment, planning, implementation, and evaluation of a community nursing center. Application of a population-focused community model at the aggregate client system level laid the foundation for an active partnership and sustainable and effective intervention. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 387-388

9. The Omaha System was initially designed to address the concerns of nurses practicing in the community in the following areas: (Select all that apply.) a. Documentation b. Information management c. Nursing practice d. Telehealth e. Specialty certification

ANS: A, B, C The Omaha System was initially developed to operationalize the nursing process and provide a practical, easily understood, computer-compatible guide for daily use in community settings and is the only American Nurses Association (ANA)-recognized terminology developed inductively by and for nurses who practice in the community. As early as 1970, the nurses, other staff, and administrators of the Visiting Nurse Association (VNA) of Omaha, NE, began addressing nursing practice, documentation, and information management concerns. Cognitive Level: Synthesis Associated Chapter Objective: 4 REF: p. 894

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

ANS: A, B, C The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of PHNs. Cognitive Level: Synthesis Associated Chapter Objective: 1, 3, & 5 REF: p. 26

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

ANS: A, B, C, D The idea that health-related services are provided within a community is not new. At the turn of the century, most persons stayed at home during illnesses. As a result, the practice environment for all nurses (such as community health nurses, PBHs, and visiting nurses) was the home rather than the hospital. These roles continue to exist today. Early textbooks on public health nursing included lengthy descriptions of the home environment and tools for assessing the extent to which that environment promoted the health of the family members. By the 1950s, schools, prisons, industrial settings (occupational health), and neighborhood health centers were added to the list of sites for nursing practice. However, the practice became oriented toward direct-care services to individuals and families and began to lose the community/population focus. Today, direct-care services provided at the individual and family level are defined as community-based nursing practice if the target remains at the direct-care service level and the practice does not address overall community health issues (i.e., common community-related health problems). Presently, there is a resurgence in population-focused health care. Because of the findings from initiatives such as Healthy People 2010 and the World Health Organization's Healthy Communities and Cities, it is now understood that social change related to health behaviors and the use of health policy are more efficient and effective in improving health status overall. Cognitive Level: Synthesis Associated Chapter Objective: 1 & 2 REF: p. 398

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

ANS: A, B, C, D, E Cohesion is the attraction between individual group members and between each member and the group that allows them to identify themselves as a unit and work toward common goals, endure frustration for the sake of the group, and defend the group against outside criticism. This attraction increases when members feel accepted and liked by others, see similar qualities in one another, and share similar attitudes and values. Members of a highly cohesive group work toward their common goal, identify with the group, are willing to endure frustration to meet their goals, and recognize the needs of individual members. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 369

10. The ANA Standards of Home Health Nursing Practice is composed of two parts: Standards of Care, which follow the six steps of the nursing process, and Standards of Professional Performance, which include which of the following? (Select all that apply.) a. Quality of care b. Performance appraisal c. Collegiality d. Outcome identification e. Resource use

ANS: A, B, C, E The ANA scope and standards publications, including those for Home Health Nursing and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance. Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, critical thinking skills, education, collegiality, ethics, collaboration, research, and resource use. Cognitive Level: Synthesis Associated Chapter Objective: 3 REF: pp. 901-902

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

ANS: A, B, D The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care. Cognitive Level: Synthesis Associated Chapter Objective: 6 REF: p. 30

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

ANS: A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: pp. 293-295

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

ANS: A, B, E In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 5 REF: p. 28

10. A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection

ANS: A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them. Cognitive Level: Synthesis Associated Chapter Objective: 2, 3, 5, & 6 REF: p. 330

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

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 259

7. In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. This best exemplifies communicable disease control through: a. health education. b. multisystem approach. c. improved public health infrastructure. d. reduction of environmental hazards.

ANS: B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed. Cognitive Level: Analysis Associated Chapter Objective: 3, 4, & 6 REF: p. 297

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

ANS: B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 266

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

ANS: B Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness. Cognitive Level: Application Associated Chapter Objective: 1 & 4 REF: p. 27

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

ANS: B Groups of individuals with diverse interests can influence and change the larger social community. Alliances or coalitions unite diverse interest groups who share a common interest in perceived threats to community health, and nurses may work with groups both for community analysis and vehicles for change. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 372

7. A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: a. acute hepatitis B is self-limiting. b. hepatitis A outbreaks commonly occur in facilities where staff change diapers. c. hepatitis C is a "silent stalker." d. individuals with chronic liver disease are at greater risk for hepatitis A.

ANS: B Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic. Cognitive Level: Analysis Associated Chapter Objective: 2 & 4 REF: p. 330

2. A PHN uses the state health department's reportable disease system to complete a community assessment of a rural county with issues of access to primary care services. This can best be described as what type of surveillance system? a. Active b. Passive c. Sentinel d. Special

ANS: B In a passive system of surveillance, health care providers, agencies, or laboratories send case reports to local health departments. The case reports are summarized and forwarded to the state health department, national governmental agency, or organization responsible for monitoring the problem, or to an international organization like the World Health Organization. This system can then be used to derive disease-specific demographic, geographic, and seasonal trends for reported events. These data are useful to a PHN conducting a community assessment or mobilizing for action through planning and partnerships (MAPPS) on a defined community. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 536

5. During an investigation, once the problem has been identified and the initial magnitude delineated in a case definition, the next step is to: a. check the state reportable disease list and request help. b. initiate control measures appropriate to the event/outbreak. c. seek additional cases by interviewing health care agencies. d. develop a tentative hypothesis.

ANS: B Once an event/outbreak has been identified, confirmed, and initially defined, early and continuously changing control measures should be initiated to contain the event and minimize further impact on the public. Then, the investigation can proceed and the proper authorities can be notified or asked for assistance and further consultation. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 539-540

3. To promote quality improvement, the documented plan of care for an elderly home care patient should include which of the following? a. Listing of community resources available to meet the patient's needs b. Expected patient outcomes for each identified problem or diagnosis c. Formulated nursing diagnosis d. Objective physical assessment data

ANS: B Setting short- and long-term goals provides criteria for evaluation, and increases continuity of care and the potential for improved outcomes. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 898

2. A 6-year-old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful when temperature is not elevated. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

ANS: B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2-4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs). Cognitive Level: Application Associated Chapter Objective: 3 & 7 REF: p. 299

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

ANS: B The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs. Cognitive Level: Synthesis Associated Chapter Objective: 6 REF: p. 368

3. A nurse is assigned to teach clients STD prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use. Cognitive Level: Analysis Associated Chapter Objective: 5 & 6 REF: p. 330

1. Which of the following community health improvement projects uses subjective health perspective? a. Health-promotion project aimed at monitoring an adolescent's compliance with an asthma treatment regimen b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program c. Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin d. Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use

ANS: B The subjective life process approach involves taking a holistic view of the person's total lifestyle and not judging simply by compliance with a prescribed regimen. The focus is on improving health through lifestyle changes and other health-promoting interventions consistent with the focus of care in a multidimensional client system in the integrative community health promotion model. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 381

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

ANS: B The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important. Accurate identification is cost-effective and timely. Cognitive Level: Analysis Associated Chapter Objective: 8 & 11 REF: pp. 271-272

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

ANS: B There are six principles that guide the effective educator: send a clear message, select the learning environment, create the best learning experience, organize the learning experience, encourage participatory learning, and provide evaluation and feedback. People learn better when they are actively involved in the learning process. Participation increases motivation, flexibility, and the learning rate. Cognitive Level: Analysis Associated Chapter Objective: 2 & 5 REF: p. 375

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

ANS: B Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses (PHNs). More than 1,000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of PHNs with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease. Cognitive Level: Application Associated Chapter Objective: 1 & 7 REF: p. 33

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

ANS: B Evaluation of community health interventions can provide valuable information about an intervention's effectiveness and efficiency in obtaining the desired measurable outcome or its progress to date in reaching that desired outcome. Factors related to costs in money and time should also be addressed to determine if the intervention was worth carrying out. This is especially true given the fact that health care operates in a political environment in which competition for limited resources is a reality. The nurse must also recognize when selecting measurable outcomes in the planning phase that unintended outcomes may result from the intervention that may become evident upon evaluation. The success or failure of the intervention may carry unintended consequences. It may uncover new trends in the community. Finally, the evaluation process should identify whether the intervention was adequate and acceptable to the community. In this case, the change in the outcome measure was not sufficient to be acceptable, and the community's expectations were greater than the results delivered. The community decided to invest its limited resources elsewhere. The issue was not the power to design, judge, or institute change. The results of the intervention were not good enough in the community's eyes. Some of these challenges could have been addressed in the planning stages by exploring alternative approaches that would have ensured a better return on the dollar. This would have built community confidence in health interventions and fed success into the initiative. It may be harder to propose new initiatives when past initiatives produced such unintended consequences. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 5 REF: pp. 418-419

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

ANS: B The domains of learning are the cognitive, affective, and psychomotor domains. For health education to be effective, the community-oriented nurse must first assess the cognitive abilities of the learner, so that the nurse's expectations and plans are directed to the correct level. Teaching above or below the client's level of understanding may lead to frustration and discouragement. Cognitive Level: Synthesis Associated Chapter Objective: 1 & 5 REF: p. 358

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

ANS: B The unique pioneering spirit of the FNS influenced the development of public health programs to improve the health care of rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckenridge, the founder of the FNS, introduced the first nurse-midwives into the United States. Cognitive Level: Comprehension Associated Chapter Objective: 1 & 4 REF: p. 31

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

ANS: B, C, E Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community. Cognitive Level: Synthesis Associated Chapter Objective: 4 REF: p. 12

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

ANS: B, D, E Group norms set the standards for group members' behaviors, attitudes, and perceptions. All groups have norms and mechanisms to accomplish conformity. Group norms serve three functions: they ensure movement toward the group's purpose and tasks (task norms), they maintain the group through various supports to members (maintenance norms), and they influence members' perceptions and interpretations of reality (reality norms). Group norms combine to create group culture. Nurses working with groups should not dictate norms but support helpful rules, attitudes, and behaviors within the group. The role of the nurse becomes one of providing accurate information, confirming the possibility/attainability of the group's goals, and encouraging different/positive perspectives. Cognitive Level: Synthesis Associated Chapter Objective: 3 REF: p. 370

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

ANS: C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 16

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

ANS: C The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy. Cognitive Level: Synthesis Associated Chapter Objective: 2 REF: p. 10

7. The most common sources of surveillance data are databases maintained by the federal agencies, state health departments, and other organizations with an interest in understanding a specific disease or event. The National Program of Cancer Registries contains morbidity data for the types of cancer found in a state as well as: a. key centers for the specialized treatment of certain cancers. b. links to National Institutes of Health cancer research projects currently being conducted. c. locations of cancer risks and health problems within the state. d. major genetic determinants of cancer by age and sex.

ANS: C A good example of a process in place to collect morbidity data is the National Program of Cancer Registries. This program provides for monitoring the types of cancer found in a state and the locations of the cancer risks and health problems in the state. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 533

2. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. What is the prevalence proportion of meningitis in this region thus far in the current year? a. 4.1/100,000 b. 5/100,000 c. 46/100,000 d. 50/100,000

ANS: C A proportion is a type of ratio in which the denominator includes the numerator. The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 100,000 = 46.42/100,000. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 262

6. One of the unique advantages of using data reporting such as a spatial map to analyze and present data is that such a tool provides a graphical way of determining: a. characteristics of the population. b. potential hypothesis. c. priority prevention target areas. d. trends for the spread of the disease.

ANS: C A spatial map is a data-reporting tool that graphically presents the distribution of an event/outbreak in such a way that priority prevention target areas can easily be identified, because it shows graphically what is happening and where it is happening. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: pp. 540-541

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

ANS: C Community assessment is one of the three core functions of public health nursing and is the process of critically thinking about the community. It starts by defining the client in terms of person, place, and function. It is a logical, systematic approach for identifying community needs, clarifying community problems, and identifying community strengths and resources to address these problems. It involves collecting data to obtain usable information about the community and its health. Such data collection may include gathering existing data as well as generating new data. New data might be generated by performing secondary analysis of existing data, conducting surveys, and carrying out community reconnaissance. Both types of data are combined in a composite database that is then analyzed and synthesized to identify trends or themes. The analysis of data generates information about community health problems (needs for action) and community health strengths and abilities that can be drawn upon in tackling these problems. The nurse and the community, in partnership, identify the problems. This is the process of problem analysis, which seeks to clarify the nature of a given problem. The nurse identifies the origins and effects of the problem, the points at which interventions might occur, and the parties that have an interest in the problem or its solution. A community-of-interest focus group that contains both content and process experts, as well as the nurse, should review the information to identify problem correlates (factors that contribute to the problem) and explore the relationship between each factor and the given problem. Active community participation is critical for the data interpretation process, particularly problem identification. A community nursing diagnosis is the end product of assessment and clarifies who gets the care (community defined), states the community problem or risk, and lists the factors contributing to the problem (problem correlates); for example, "Risk of ___ among ____ related to _____." Cognitive Level: Synthesis Associated Chapter Objective: 3, 4 & 5 REF: p. 418

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

ANS: C Community health is characterized by status, structure, and process dimensions. Status or outcome involves biological, emotional, and social attributes. The biological (or physical) aspect of community health is often measured by traditional morbidity and mortality rates, life expectancy indices, and risk factor profiles. Data gathering is the process of obtaining existing, readily available data. These data describe the demography of the community, but also include the vital statistics, such as mortality and morbidity data. The state bureau of vital statistics would be the best source, especially for rural counties that may not have biostatisticians at the county level. Raw data submitted to the state by the local community would be consolidated at the state level. All states have such bureaus. Cognitive Level: Application Associated Chapter Objective: 2 & 4 REF: p. 401

1. Which of the following article titles include(s) an example of epidemiologic distribution and determinants? a. Can Operating Room Nurses Measurably Reduce Patient Anxiety? b. Characteristics of Patients Newly Diagnosed with Tuberculosis c. Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah d. Postpartum Nurses' Reaction to Rotating Shifts Compared with Assigned Stable Shift

ANS: C Epidemiology investigates the distribution (patterns) and the determinants (factors such as exposure, characteristics, and behaviors) of health events in a population. Distribution addresses "Who, what, where, when, and why?" and determinants address "How did the health event occur?" and "Why are some affected more than others?" Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 258

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

ANS: C Healthy People 2020 cites community partnership as key to meeting program goals. In community-oriented practice, the nurse and the community seek healthy change together. Community members who are equal proactive collaborators in prioritizing, designing, implementing, and evaluating community interventions are much more likely to support and assist in community programs. Programs developed using a community partnership approach (rather than the approach that "I'm the community health expert and I know best") are more effective in identifying and addressing health problems, and such programs are more likely to be sustained over the long term. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 399

5. The shift of home care away from its charitable and public health-oriented roots toward current models in use can be attributed to: a. consolidation of voluntary and official home health agencies. b. expansion of home care to include community health needs. c. integration of home care into benefit programs. d. passage of the Medicare prospective payment system.

ANS: C Home care began changing from its charitable and public health-oriented beginnings when it was added to benefit plans by payers, starting with the Metropolitan Life Insurance Company in the early 1900s; Medicare included it as a benefit for enrollees in 1965. Inclusion of home care benefits began to change the nature of the services provided. Services were focused on individuals with specific functional and health problems who could not be cared for elsewhere, and the care provided became more technical, opening the door for population-focused home care, transitional care, home-based primary care, traditional home health care, and hospice care. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: pp. 888-889

6. A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices? a. The family is responsible for the health behaviors of children. b. The individual is responsible for health behaviors. c. There is multilevel responsibility for health behaviors. d. The community has a sense of responsibility for health behaviors.

ANS: C In the ecological perspective, individuals ultimately make decisions to engage in healthy or risky behaviors, and lifestyle improvement efforts typically focus on the individual as the target of care. From a public health perspective, however, risky behaviors may have significant implications for the overall health status of the community and contribute to health-related economic losses of the community. Health behaviors have multiple determinants that are both internal and external to the individual, family, community, and society. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 380

1. A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2012 = 2/100,000; 2013 = 3/100,000; 2014 = 1/100,000 b. 2012 = 4/100,000; 2013 = 8/100,000; 2014 = 6/100,000 c. 2012 = 12/100,000; 2013 = 8/100,000; 2014 = 31/100,000 d. 2012 = 16/100,000; 2013 = 24/100,000; 2014 = 9/100,000

ANS: C In this community's report, the incidence of hepatitis A in 2014 was more than double the incidence in 2012. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 5 REF: pp. 291-292

6. An example of secondary prevention of infectious disease is: a. malaria chemoprophylaxis. b. Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS. c. quarantine. d. restaurant inspections.

ANS: C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 297

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

ANS: C Secondary prevention refers to interventions that promote health and prevent complications of an existing disease, injury, or disability. A prevention intervention at this level is aimed at individuals and groups who have been diagnosed with a disease and have discernible pathology (state of prepathogenesis). Cognitive Level: Analysis Associated Chapter Objective: 4 & 11 REF: p. 269

1. Disease surveillance, a critical role function for the public health nurse (PHN), can best be defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of specific health data relevant to public health. The nurse's knowledge and understanding of surveillance systems is critical to: a. detecting epidemics and pandemics. b. facilitating planning and policy changes. c. improving the quality and usefulness of the data collected. d. understanding the relationship between epidemiologic principles.

ANS: C Surveillance is a critical role for the nurses practicing in the community. A comprehensive understanding and knowledge of surveillance systems and how they work will help nurses improve the quality and the usefulness of the data collected for the purpose of making decisions about needed community services, community actions, and public health programming. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 531

4. A community-oriented nurse wants to design the most effective intervention to reduce CHD morbidity and mortality in a rural area. The program approach should incorporate the strategies of: a. aggregate primary prevention. b. individual-level primary, secondary, and tertiary prevention. c. multilevel intervention with a focus on primary, secondary, and tertiary prevention. d. promotion of optimal health for the individual, family, aggregate, and total community.

ANS: C The Framingham, Alameda, and other studies have shown that effective health promotion must incorporate strategies that deal with all levels in the community—individual, family, aggregate, and total community; that is, they must adopt a multilevel approach. These studies also demonstrate that a program to reduce CHD morbidity and mortality needs to incorporate primary, secondary, and tertiary prevention strategies. An integrated model of community-oriented nursing care reflects the four client systems and multiple foci of care approach. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: pp. 383-384

2. A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STDs. b. cures for each of the STDs identified. c. risk of skin-to-skin contact in transmitting the identified STDs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur. Cognitive Level: Synthesis Associated Chapter Objective: 4, 5, & 6 REF: pp. 325-328

6. Medicare regulations, professional organizations, and state licensing boards dictate the responsibilities and functions of health professionals in providing home care, and a variety of specialized services can be included in home care either through direct care service, staff education, or consultation. Because of this need for various knowledge, skills, and perspectives, successful functioning in the provision of services requires: a. certified advance practice home health nurses. b. integration of home health aide and homemaker roles. c. interprofessional teams. d. physician certification of the medical problem and plan of care.

ANS: C The responsibilities and functions of health professionals in home care are determined by Medicare regulations, professional organizations, and state licensing boards. Many specialized services can be provided in home care, such as enterostomal therapy, podiatric care, pharmaceutical therapy, nutritional counseling, intravenous therapy, respiratory therapy, and psychiatric or mental health services. Many of these services can be provided on a consulting basis, either through staff education or through direct provision of services. This requires the use of an interprofessional team model, so that the specialized knowledge, skills, and perspectives of each team member can be integrated and will be implemented and reinforced by those in all involved disciplines to achieve successful patient outcomes. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 886

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

ANS: C The shift in the U.S. Congress to categorical funding provides federal money for priority diseases or groups rather than a comprehensive community health program. Thus local health departments designed programs to fit the funding priorities, which led to duplication of services among official health agency programs and a silo approach to program planning. When funding is directed by national preferences (silo programming), the ability of public health departments to respond to local and emerging problems is seriously impaired, because funding is earmarked for those national preferences only. Cognitive Level: Analysis Associated Chapter Objective: 1 & 3 REF: p. 33

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

ANS: C In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide follow-up care to children absent from school. Cognitive Level: Analysis Associated Chapter Objective: 1, 5, & 7 REF: p. 30

5. In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client: a. access to care. b. adjustment of lifestyle. c. compliance with a prescribed regimen. d. response to treatment.

ANS: C In the disease-oriented perspective, health is objectively defined as the absence of disease, and humans are conceptualized as composed of organ systems and cells. Therefore, health care focuses on identifying what is not working in a given system and repairing it. In this paradigm, health behavior is viewed as how the client complies with the recommendations of the health professional. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 381

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

ANS: D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: pp. 17-18

9. Disease and event surveillance systems exist to help improve the health of the public through the systematic and ongoing collection, distribution, and use of health-related data. A PHN utilizes the data in available surveillance systems to make a presentation to a community planning committee that is interested in the problem of childhood obesity. This use of the data for facilitating community planning is a good example of helping the community to: a. avert a health care epidemic. b. evaluate prevention and control measures. c. identify cases for fact finding. d. manage endemic health problems.

ANS: D A nurse can contribute to surveillance systems and can best use the data collected through such systems to help manage endemic health problems and those that are emerging, such as evolving infectious diseases and bioterrorist (human-created) health problems. Cognitive Level: Application Associated Chapter Objective: 5 REF: pp. 531-532

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

ANS: D Community members who are recognized as community leaders, (whether professionals, pastors, government officials or interested citizens) possess credibility and skills that health professionals often lack. The community member-professional partnership approach specifically emphasizes active participation. Coalitions are formal partnerships in which individuals and organizations serve in defined capacities such as steering committees, advisory committees, and work groups. Coalitions are active partnerships, in which all participants share leadership and decision making to some degree. Cognitive Level: Application Associated Chapter Objective: 2 & 4 REF: p. 400

1. A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur. Cognitive Level: Application Associated Chapter Objective: 4 & 5 REF: p. 335

2. An effective community-oriented diabetes program should include: a. access to a certified diabetes educator to teach the client self-management strategies and proper techniques. b. care that incorporates the American Diabetes Association treatment guidelines. c. access to a primary care provider, medication and supplies, and nutritionist consult. d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.

ANS: D From the ecological perspective, community-oriented interventions are directed toward multiple levels of client care: the individual level (self-management) and the environmental level (maximizing environmental resources, including family support and affordable quality care, medication, and testing supplies). Cognitive Level: Analysis Associated Chapter Objective: 1, 3, & 4 REF: pp. 385-386

2. A home health nurse is charged with identifying opportunities for health promotion and illness primary prevention. The activity that bests demonstrate this focus is: a. collaborating with the chaplain to address the spiritual needs of a hospice patient. b. educating a school nurse on the care regime of a returning student newly diagnosed with asthma. c. referring a newly diagnosed diabetic patient to the nutritionist for dietary teaching. d. tracking the immunization status of patients.

ANS: D Immunizations prevent disease, a function of primary prevention. Patients requiring home health care may be more at risk of complications of diseases like influenza and pneumonia. Keeping immunizations current is a critical aspect of health promotion and illness primary prevention for these patients. Home health nursing involves the same primary prevention focus in the care of aggregates as does other community-oriented nursing. It also requires a focus on secondary and tertiary prevention in the care of individuals in collaboration with the family and other caregivers. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 887

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

ANS: D In descriptive epidemiology, the components of person, place, and time are used to describe increases or decreases in the frequency of diseases over time. Temporal or spatial patterns that influence long-term changes in morbidity or mortality rates are known as secular trends and may reflect changes in social behavior or practices. Some aspects to be considered are the effects of improved diagnostic capability and changes in survival (case fatality) rather than changes in incidence. The trends in breast cancer have led to a mortality curve that is flatter than the incidence curve. This leads to uncertainty in determining the actual increase in incidence rate, because improved diagnostic capability may explain some but not all of the increase observed. Another area of consideration is changes in case definition or coding of disease in the International Classification of Diseases, because both can produce an artificial change in mortality rates. Cognitive Level: Synthesis Associated Chapter Objective: 5 & 6 REF: p. 275

5. John Snow played a critical role in the development of modern disease surveillance when he: a. devised a more statistically valid method of analyzing epidemiologic data. b. discovered causal agents for anthrax, tuberculosis, and cholera. c. tracked the incidence of tuberculosis in the tenements of New York City. d. used geographic mapping to demonstrate the connection between water supply and cholera.

ANS: D John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river. Cognitive Level: Comprehension Associated Chapter Objective: 2 REF: pp. 259-260 (When snow melts it becomes water)

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

ANS: D The groups to which people belong influence health behavior. Through participation with others, meaning is confirmed, confounded, contradicted, or compromised. This is how social reality is created. Nurses frequently use groups to help individuals within a community. When conflict occurs in a group, the resulting tension can help move the group toward its goals. Group members are most effective and productive when conflict is acknowledged and individual concerns are expressed in a manner that respects other members of the group. Effective groups promote collaboration and support expression and resolution of conflict. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: pp. 373-374

10. After hearing about home radon exposure on the news, a man and his wife contact the public health department to inquire about whether or not he should have his home tested. Which stage of the transtheoretical model (TTM) are the man and his wife at in regards to the process of change? a. Preparation b. Contemplation c. Action d. Precontemplation

ANS: A Preparation is the stage where the person intends to do something. Precontemplation is when the person does not plan to change; this may be because the person does not know there is a problem or does not want to do anything about it. In the contemplation stage, the person begins thinking about making a change in the future and examines the pros and cons of doing so. Action occurs when the person actually buys a radon testing kit and uses it in his home. Cognitive Level: Analysis Associated Chapter Objective: 1 & 3 REF: pp. 384-385

5. The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: a. immunocompromised persons, substance abusers, and those with diabetes. b. individuals previously treated for TB. c. long-term cigarette smokers. d. persons with new-onset asthma or emphysema.

ANS: A Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 332

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

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