Textbook Tests

The Elizabethan Poor Law of 1601 is similar to which current law? a. Food stamps b. Medicare c. Welfare d. Medicaid

d. Medicaid The Elizabethan Poor Law guaranteed medical care for poor, blind, and "lame" individuals, similar to Medicaid. Welfare and food stamps do not provide for medical care. Medicare provides medical care to primarily the elderly population.

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

a. Stay in skilled nursing facility Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers "medically necessary" services, such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services and physiotherapy.

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

a. Capitation In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of time. In the fee for service payment system, which is like the retrospective reimbursement, the practitioner determines the costs of providing a service, delivers the serivce to a client, submits a bill for the delivered serivce to a third-party payer, and is paid by the third-party payer. Rationing implies reduced access to care and potential decreases in the acceptable quality of services offered.

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

a. Advances were made in sewage disposal, and water and milk quality. Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes. The education of health care providers did move into universities during this time period; however, this is not the reason why there was an increased focus on infections and trauma. Health care was paid for primarily by individuals during this time period so there was not an increase in the amount of money available to pay for health care. The outcomes of hospital care improved because of the advances that were being made in technology, not because health care providers were focusing more on infections and trauma.

The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care would drastically reduce the family's resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious. c. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. d. Talk to the media to see whether a campaign to raise funds for the family can be created.

a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. According to Callahan, although the nurse may attempt moral persuasion to change the family's values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family's values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family's decision. Thus, the other answers are not an appropriate action for the nurse to take.

Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Assurance b. Assessment c. Policy development d. Scientific knowledge-based care

a. Assurance Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment, policy development. Scientific knowledge-based care is not a core function of public health. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.

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

a. Blindness Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural knowledge is information about organizational elements of diverse cultures and ethic groups; emphasis is on learning about the client's worldview from an emic (native) perspective. Cultural preservation means that the nurse supports and facilitates the use of scientifically supported cultural practices from a person's culture along with those from the biomedical health care system.

A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the client to in order to receive care? a. Community health center b. Emergency department c. Physician office d. Managed care

a. Community health center There is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide a broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and dentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people of all ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specific network of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergency departments and physician offices are not the best place for an individual without health insurance to receive care. Both are expensive and do not provide the necessary resources for the individual to possibly receive health insurance.

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

a. Cultural skill Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioner's need to prescribe an effective antibiotic. Cultural awareness is the self-examination and in-depth exploration of one's own biases, sterotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural knowledge is information about organizational elements of diverse cultures and ethic groups; emphasis is on learning about the client's worldview from an emic (native) perspective.

Which of the following is considered the most important goal in nursing today? a. Demonstrating caring as the basis of nursing practice b. Seeking evidence-based outcomes to demonstrate nursing's contribution to care c. Distinguishing nursing care from medical care d. Adapting to technological advances such as electronic medical records

a. Demonstrating caring as the basis of nursing practice Since the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing practice. Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationship between the patient and the care provider. The primary goal of nursing is not to adapt to technological advances, distinguish nursing from medical care, or seek evidence based outcomes; rather, the goal of nursing is to implement caring which has been the moral ideal of nursing for many years.

The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following approaches should the nurse use in personally deciding what is right? a. Do whatever the nurse would recommend to anyone in a similar situation. b. Do whatever will not get the nurse in trouble with employer. c. Do whatever is supported by an ethical expert, such as the hospital chaplain. d. Do whatever the nurse supervisor would feel comfortable reporting to administration.

a. Do whatever the nurse would recommend to anyone in a similar situation. One of the rules in deontological decision making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly. In the same way, principlism suggests the nurse examine the context and make the decision that can be morally justified within that context. In order to apply the deontological ethics decision process the nurse must first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine their own personal motives, and then determine wheter the proposed actions can be generalized. Doing whatever will not get the nurse in trouble, whatever is suppported by an ethical expert, or whatever the nurse supervisor feels comfortable with is not an appropriate way to make an ethical decision.

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

a. Essential care available to all community members, which encourages self-management Primary health care is generally defined as essential care made universally accessible to individuals, families, and the community. Health care is made available to them with their full participation and is provided at a cost that the community and country can afford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, not primary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitative services. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted all citizens of the world to live socially and economically productive lives.

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

a. Facilitation of inter-professional care The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. There is not evidence that an electronic health record improves client compliance with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies.

With which of the following ethical approaches are Gilligan and Noddings associated? a. Feminine ethic b. Principlism approach c. Distributive justice approach d. Virtue ethics

a. Feminine ethic Gilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality of responsibility in relationships that emphasize connection and caring as a moral imperative. Distributive justice (fair distribution of the benefits and burdens of society), principlism (relying on ethical principles for decision making), and virtue ethics (seeking to enable persons to flourish as human beings) were not developed by Gilligan and Noddings.

Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders? a. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company. b. Employing nurses directly was less expensive than paying taxes to the city for the same purpose. c. Having the company's nurses make home visits increased worker morale. d. Creating such a service was the morally correct thing to do.

a. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company. Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of children under the age of 3 years. The insurance company attributed this improvement and the associated reduced costs to the work of visiting nurses. There was limited funding in the early twentieth century to extending nursing services in the community; thus, home visiting was a very expensive service to provide. Although Metropolitan Life Insurance Company may have increased worker morale that was not the primary reason for continuation of the program.

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

a. Health care system The four major factors that affect health are lifestyle, environment, human biology, and the health care system. However, the health care system (medical services) has the least effect on health. Of the four major factors that affect health — personal behavior (or lifestyle), environmental factors (including physical, social, and economic environments), human biology, and the health care system — medical services are said to have the least effect. Behavior (lifestyle) has been shown to have the greatest effect, but environment and biology account for the greatest effect on the development of all illnesses.

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

a. Increased focus on emergency preparedness and response Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both important factors to consider, however, this is not the reason why increased collaboration has occurred. There has not been an increase in taxpayer complaints or unhappiness that has caused these changes to occur.

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

a. Legally, emergency departments must see clients even if clients can't pay. People on Medicaid frequently have no primary-care provider and may not be able to pay for their care. Although physicians can choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of ability to pay. Emergency department copayments are modest and are frequently waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary-care services. Limited physician office hours over the weekend does make it difficult for low-income persons to access care through a primary care provider; however, this is not influenced by a government decision. The government does not require Medicaid clients to use the emergency department when their primary care provider is unavailable, rather the policies of the emergency department to see all clients regardless of ability to pay may inadvertently encourage them to use this service. The paperwork at a physician's office that needs to be completed by a Medicaid client is not any different than any other client receiving care at the office.

Which of the following nurses is famous for creating public health nursing in the United States? a. Lillian Wald b. Frances Root c. Florence Nightingale d. Mrs. Solomon Loeb

a. Lillian Wald Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades. Mrs. Solomon Loeb was a wealthy layperson who assisted Mary Brewster in the establishment of the Henry Street Nurses Settlement. Francis Root was the first trained nurse in the United States who was salaried as a visiting nurse. Florence Nightingale had many accomplishments, but none of these occurred in the United States.

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

a. Low socioeconomic status Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors. The rate of uninsured remained higher among people with lower incomes and lower among those with higher incomes. Households of three with less than $20,000 annual income are at the highest risk for being uninsured. Socioeconomic status has the closest correlation to health status; thus, age, gender, minority race status, and high-risk lifestyle behaviors do not have the closest correlation.

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

a. Major, because these rules and regulations have the effect of law and must be obeyed When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations. Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They are laws that must be followed, not guidelines.

How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate? a. Migration and urbanization resulted in increased demand for care. b. Caregivers could easily find other employment, so they demanded to be paid. c. Incredible plagues consistently and constantly swept the European continent. d. Economic and political wars resulted in frequent death and injuries.

a. Migration and urbanization resulted in increased demand for care. Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care. The Industrial Revolution was a time of great advances in technology, transportation, and communication, not a time of economic and political unrest or a time where incredible plagues occurred in Europe. Caregivers during this time period were typically poorly educated and untrained, so there was not an issue related to wages or employment.

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

a. Obtain an interpreter to translate. Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client's language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for the client - attempting communication using a book, stating that he/she does not speak English, and arranging for a referral do not address the priority action of finding an interpreter.

A man entered the emergency department bleeding profusely and screaming, "I've got to see a doctor right now! I've got a right to see a doctor! I'm hurt. You have to take care of me!" Which of the following premises would ethically justify such a demand for immediate attention? a. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. b. The man has a property right to his own body, and the government is responsible to ensure that property rights are protected. c. All hospitals receive federal money and all capable employed adults pay taxes, so all adults have a right to what their tax money has purchased. d. Saving an individual's life improves society and upholds tradition.

a. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society—and that the government's role is to ensure this happens, at least on a basic level. Therefore, the man has a right to emergency care. Hospital funding and use of tax payer money does not demonstrate the use of an ethical principle. Saving an individual's life may or may not improve society. There is not an ethical principle that states that the man has a property right to his own body.

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as laboratory services and equipment. Which of the following best describes this part of Medicare? a. Part B b. Part D c. Part A d. Part C

a. Part B Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, equipment, and some supplies. Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part C plans are coordinated care plans that include health maintenance organizations, private fee-for-service plans, and medical savings accounts. Medicare Part D provides prescription drug coverage.

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

a. Prospective payment scale based on the medical diagnosis As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs). There is not a Medicare panel that determines the actual cost of services. Payments are determined in advance based on DRGs and are not determined by the budget of the federal government. Hospital and health care provider feedback do not influence the prospective reimbursement, rather, the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client.

A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely have completed? a. Providing health care for merchant seamen b. Identifying and improving environmental conditions c. Setting policy on quarantine legislation for immigrants d. Establishing hospital-based programs to care for the sick at home

a. Providing health care for merchant seamen Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities. Quarantine legislation was enacted by legislation during this time period, but the nurse would not have been responsible for setting these policies. Nursing care for clients in the home began in the first half of the 1800s through a variety of agencies including the Ladies' Benevolent Society of Charleston South Carolina. Identifying and improving environmental conditions was a focus of the public boards of health, not necessarily specifically a role of the nurse.

Which of the following is responsible for the dramatic increase in life expectancy during the 20th century? a. Sanitation and other population-based prevention programs b. Advances in surgical techniques and procedures c. Use of antibiotics to fight infections d. Technology increases in the field of medical laboratory research

a. Sanitation and other population-based prevention programs Improvements in control of infectious diseases through immunizations, sanitation, and other population-based prevention programs led to the increase in life expectancy from less than 50 years in 1900 to more than 78 years in 2013. Although people are excited when a new drug is discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant gains in the health of populations that have come largely from public health accomplishments.

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

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

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

a. The aging population The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the Baby Boom generation ages and retires, federal expenses for Social Security and health care will increase. The use of diagnosis-related groups to determine reimbursement started in 1983 and is not expected to have a great influence on national health care spending at this time. Insurance reform is not a demographic factor. Due to the Affordable Care Act, the number of people without health insurance is decreasing.

Which of the following best defines the word politics? a. The art of influencing others b. The outcome of governmental policies c. The result of legislative action d. A provision of power for making decisions

a. The art of influencing others Politics is the art of influencing others to accept a specific course of action. Political action results in governmental policies and legislation. The result of legislative action typically is done in the form of laws and policies. The provision of power for making decisions is typically assumed by the government.

The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The needs of the aggregate rather than a few individuals b. The most rational probable outcome c. The specific moral or ethical principle related to the situation d. The cheapest, most economical approach

a. The needs of the aggregate rather than a few individuals The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent components of a decision that the nurse might consider in determining the needs of the aggregate.

The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a. To work with the groups, not for the groups b. To make the groups feel good about their contribution c. To increase the group's self-esteem d. To maintain communication links with the groups

a. To work with the groups, not for the groups Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a "with the people"—not a "to the people" or "for the people"—approach to planning. The purpose of meeting with community groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them to act for themselves to solve the problems they are facing. The first task of working with the group should occur before addressing maintaining communication links.

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

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

Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Upholding ethical principles b. Doing what is best for the community c. Doing what is best for the family d. Obeying legal mandates

a. Upholding ethical principles In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandates or doing what is best for the community or family.

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

b. "Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill."

A new nurse states to a nursing colleague, "But why do I have to be involved in politics? I just want to be the very best clinical nurse I can." Which of the following would be the best response from the nursing colleague? a. "When you've completed your clinical orientation, then you'll have time to be involved in politics." b. "Political action is the way you try to fulfill your ethical responsibilities to clients." c. "You're absolutely right; if you are good clinically, you have fulfilled your obligation." d. "As long as you pay your membership fee to the American Nurses Association, you have participated in the profession's political endeavors."

b. "Political action is the way you try to fulfill your ethical responsibilities to clients." To be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action to ensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked access to quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as the mechanism to effect social justice and reform regarding homelessness, violence, and stigmatization. Nurses need to be involved in the political process in more ways than only being a dues paying member to the American Nurses Association. Clinical practice is not the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse. Nurses must make a conscious effort to be involved in political action.

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

b. A 30-year-old male who is unemployed Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, childcare needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income. Those who speak English and have health insurance should both find it easier to access health insurance than someone who is unemployed as communication problems and lack of insurance are barriers to receiving care. Medical diagnoses, such as having hypertension, do not present a barrier to accessing health care.

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

b. A female who does not know the client

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

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

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

b. Accommodation Cultural accommodation involves including aspects of the patient's religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is important—from the patient's perspective, possibly more important than medical treatment. Cultural awareness is the self-examination and in-depth exploration of one's own biases, sterotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural imposition ist he belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others.

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

b. Alter personal nonverbal behaviors to reflect the cultural norms of the client. Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care. Nurses should be knowledgeable of other cultures and communicate with the client based on cultural norms. Cuturally skillful nurses understand the unique difference among individuals within a given culture and work with those individuals to learn more about their culture and provide culturally sensitive care.

Which of the following actions best represents public health nursing? a. Caring for clients in their home following their outpatient surgeries b. Assessing the effectiveness of the high school health clinic c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic

b. Assessing the effectiveness of the high school health clinic A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. Caring for clients and their families focuses on individuals and families and not on the entire population. Public health focuses on care of populations.

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

b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. Cultural awareness requires self-examination and an in-depth exploration of one's own beliefs and values as they influence behavior. Cultural awareness is the first element in the model of cultural competence. Following the development of cultural awareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethic groups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The fourth construct essential to this model is cultural encounter which is the process that permits nurses to seek opportunities to engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a speciifc cultural group.

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

b. Constitutional law

Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It is a wife's responsibility to care for an ill husband." Which of the following ethical approaches is being used by this nurse? a. Principlism b. Deontological ethics c. Communitarianism d. Consequentialism

b. Deontological ethics The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions.

How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions? a. Systematically survey community residents regarding their perception. b. Examine the morbidity and mortality rate of the community. c. Ask community leaders for their opinion of the interventions. d. Reassess the community to determine whether obvious needs have been met.

b. Examine the morbidity and mortality rate of the community. The end products of appropriate advocacy are decreased morbidity and mortality. In other words, if advocacy has been effective, public health problems will be decreased. Efffectiveness can not be assessed accurately by asking community leaders for their opinions, reassessing the community, or surveying community members regarding their perception; data must be collected to determine results.

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

b. Explain the harmful effects of metamizole and recommend an alternative medication for pain. Cultural repatterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them. Completing a cultural assessment involves learning more about the client's culture but does not address the need to consider changing or modifying cultural practices. In order to complete cultural repatterning, the nurse has to take an action to resolve this potential problem.

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

b. Federal and state government Combined state and federal governments paid the most for health care in 2014. Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers. From 1960 to 2014, the percentage of third-party public insurance payments increased and the percent of out-of-pocket payments declined.

Which of the following best describes the cost of health care in the United States? a. Health care costs and indicators of health are the highest in the world. b. Health care costs are the highest in the world, but the indicators of health are not the best worldwide. c. Health care costs are kept low, and the indicators of health are among the best worldwide. d. Health care costs are low which has resulted in poor health outcomes.

b. Health care costs are the highest in the world, but the indicators of health are not the best worldwide. Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic product, the indicators of what constitutes good health do not document that Americans are really getting their money's worth. Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor in comparison to other countries who spend less money on health care.

Which of the following is the primary focus of public health nursing? a. Families and groups b. Health care of communities and populations c. Illness-oriented care d. Individuals within the family unit

b. Health care of communities and populations In public health nursing the primary focus is on the health care of communities and populations rather than on individuals, groups, and families. The goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population within it. Community-based nurses deal primarily with illness-oriented care of individuals and families acorss the life span. The aim is to amanage acute and chronic health conditions in the community, and the focus of practice is on individual or family-centered illness care.

Which of the following is the first and most crucial step in a generic ethical decision-making process? a. Consider the various ethical principles or theories. b. Identify the ethical issues and dilemmas. c. Make a decision and act on it. d. Assess the context or environment in which the decision must be made.

b. Identify the ethical issues and dilemmas. The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all relevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6) make the decision and take action, and (7) evaluate the decision and action.

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

b. Legislative branch of government

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

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

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

b. Persuading legislators to pass a bill offering health care financial aid to families at risk Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a bill offering health care financial aid to families at risk addresses initiating interventions before an illness occurs. Applying for a grant and referring clients with renal failure both demonstrate the use of tertiary prevention as the illness or condition has already developed. Screening cocaine addicts displays the use of secondary prevention as a screening technique is being used to identify the problem as soon as possible.

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

b. Primary prevention Primary prevention involves activities such as health teaching to prevent a problem from occurring. Secondary prevention occurs when a nurse completes screenings. Tertiary prevention occurs after a problem has occurred and aims to restore the client to the highest level of functioning as possible.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "But it doesn't have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn't that be fair?" Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Principlism c. Utilitarianism d. Deontology

b. Principlism The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

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

b. Providing salaries commensurate with responsibilities

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

b. Sheppard-Towner Act

A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which of the following accomplishments of today was started within this organization? a. Opening the Henry Street Settlement b. Standardizing public health nursing education c. Requiring that public health nurses have a baccalaureate degree in nursing d. Developing public health nursing competencies

b. Standardizing public health nursing education The National Organization for Public Health Nursing sought to improve the educational and services standards of public health nursing. The Henry Street Settlement was already in existence and was opened by Lillian Wald and Mary Brewster. The baccalaureate degree in nursing was not developed yet. Public health nursing competencies were developed by the Quad Council.

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

b. Stereotyping Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food. Cultural imposition is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others. Ethnocentrism is a type of cultural prejudice at the population level which involves the belief that one's own group determines the standards for behavior by which all other groups should be judged. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth.

Which of the following would confirm that the nurse's advocacy has been truly successful or effective? a. Audiences agree with the nurse who is serving as advocate. b. Systematic social changes are made to improve quality of life. c. Legislators discuss appropriate legislation to better allocate resources. d. People verbalize that the disenfranchised should be better treated.

b. Systematic social changes are made to improve quality of life. Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community live to reduce death and disability and improve quality of life in the community. Only when systematic social changes are made to improve quality of life can advocacy be considered truly effective. Systematic change encompasses the complete role of the nurse as an advocate. Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations may have different views than the nurse. Advocacy goes beyond only working with legislators to allocate resources. Serving those who are disenfranchised is only one part of the advocacy role.

Which of the following is a basic assumption of public health efforts? a. Health disparities among any groups are morally and legally wrong. b. The health of individuals cannot be separated from the health of the community. c. The government is responsible for lengthening the life span of Americans. d. Health care is the most important priority in government planning and funding.

b. The health of individuals cannot be separated from the health of the community. Public health practice focuses on the community as a whole, and the effect of the community's health status (resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices is the directive for lengthening life span not the role of the government.

Which of the following public health nurses most clearly fulfills the responsibilities of this role? a. The nurse who watched the city council meeting on local cable television b. The nurse who spent the day attending meetings of various health agencies c. The nurse who met with several groups to discuss community recreation issues d. The nurse who talked to several people about their particular health concerns

b. The nurse who spent the day attending meetings of various health agencies Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To demonstrate their courage and commitment b. To assess the needs of the homeless who live there c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed

b. To assess the needs of the homeless who live there In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance to this population that may or may not be helpful or welcomed.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "The whole family is being affected and will fall apart if they don't focus on their family's needs first before anything else." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Utilitarianism c. Deontology d. Principlism

b. Utilitarianism By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision making. Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

A physician refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the physician merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is the physician using (or misusing)? a. Deontological ethics b. Virtue ethics c. Consequentialism d. Communitarianism

b. Virtue ethics

From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should always be fair, and that everyone should make his or her own decisions? a. Some people think they deserve more than others. b. With this belief, the needs of society as a whole are ignored. c. Insufficient resources exist to give everyone a fair share. d. This belief leads to a propensity for some people to like to be taken care of.

b. With this belief, the needs of society as a whole are ignored. All principles of justice focus on the individual, which ignores the needs of society as a whole. The rights of an individual may conflict with the rights of the community as a whole. It is recognized that distribution should be based on what needs and deserves there is considerable disagreement that exists when considering what these terms mean in the context of fairness.

A nursing student during World War II would likely join which group? a.The US Public Health Service b.The Cadet Nurse Corps c.The Frontier Nursing Service d.The Marine Nurse Corps

b.The Cadet Nurse Corps The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels. The U.S. Public Health Serive began to use nurses during World War I to establish a public health nursing program for military outposts. The Marine Hospital Service was established well before World War II in 1798. The Frontier Nursing Service was established by Mary Breckinridge in 1925 and provided health care to the rural and often inaccessible populations in the Appalachian region of southeastern Kentucky.

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

c. "Don't drop out of school." The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child. The priority of the nurse should be to encourage the teenager to stay in school as this choice will provide for the best long-term outcome for the client. Signing up for childbirth classes, the WIC program, and taking prenatal vitamins all address short-term outcomes which are not as important as the future of the teenager raising this child.

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

c. "My daughter wasn't given a call light, and for a whole shift no one checked on her condition."

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

c. "What can I do to be helpful to you right now?" Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the client's religious faith group, an open-ended response showing caring is the most appropriate statement. The most therapeutic response from the nurse is an open-ended question. This allows the client to share information and not feel like his/her actions are being judged by the nurse. Also, this allows the nurse to not give advice or offer false information to the client.

A registered nurse was just employed as a public health nurse. Which question would be the most relevant for the nurse to ask? a. "Which patients should I see first as I begin my day?" b. "With which physicians will I be most closely collaborating?" c. "Which groups are at the greatest risk for problems?" d. "With which nursing assistants will I partner the most?"

c. "Which groups are at the greatest risk for problems?" Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals rather than a community-oriented perspective.

Which person is most likely to be uninsured? a. A 2-year-old whose mother is on welfare b. An 82-year-old woman with chronic medical problems c. A 24-year-old man who works part-time at a small business d. A 50-year-old business man who works for a large corporation

c. A 24-year-old man who works part-time at a small business Young adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it.

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

c. Allow family members to provide the newborn's care and assess the mother's knowledge of child care through discussion. Culturally competent nursing care focuses on the specific patient, reflects the patient's individual beliefs and values, and is provided with sensitivity. The nurse should accept the cultural norms and behviors of this client and her family. Thus, the nurse should provide culturally competent care and comply with the client's desire. This should take priority over any judgments the nurse could make about this client or hospital documentation related to infant care by the mother.

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

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

Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century? a. New guidelines for chronic disease management b. Lack of available space to provide care for clients in hospitals c. Emergence of new and old communicable and infectious diseases d. Increased use of technology leading to a decreased need for health care workers

c. Emergence of new and old communicable and infectious diseases In the 21st century the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease the care provided for these diseases and wouldn't be seen as a challenge. The use of technology will continue to increase, but the need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.

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

c. HMOs provide comprehensive care to members for a fixed fee. The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed, "per member per month," fee. The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed, "per member per month," fee.

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

c. Health economics Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the health care industry. Insurance resources, health care rationing, and medical technology are important components of health economics but by themselves do not provide the broad understanding called for in this question.

Which of the following would have been the focus of a school nurse in the early 20th century? a. Promoting nursing as an autonomous practice b. Providing medical treatment to enable children to return to school c. Investigating causes of absenteeism d. Teaching school as well as being a nurse

c. Investigating causes of absenteeism Early school nursing focused on investigating causes of absenteeism. Providing medical treatment was the responsibility of physicians. School nurses did not teach in the schools nor were they part of an autonomous practice during this time period.

A nurse didn't know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn't seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse's actions? a. Appropriate, because the supervisor is responsible for the nurse's choices b. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision d. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn't considered

c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. The supervisor is not responsible for the nurse's choices, the nurse must maintain responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have similar knowledge as the supervisor.

A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Ensure timely and effective medical intervention and treatment for community members. b. Increase the community's knowledge about hospice care. c. Promote healthy lifestyle behavior choices among the community members. d. Encourage employers to have wellness centers at each industrial site.

c. Promote healthy lifestyle behavior choices among the community members. Public health approaches could help prevent premature deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment. Increasing knowledge of hospice care, encouraging on-site wellness centers, and ensuring timely treatment of medical conditions do not address the focus of improving overall health through health promotion strategies. This is the major method that is suggested to decrease the incidence of premature death.

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

c. Services mandated by the state government At the local level, health departments provide care that is mandated by state and federal regulations. Data available from the most recent community assessment, suggestions from community members about need, and recommendations from Healthy People 2020 could all be used. However, funding for these types of programs may not be available. The services that are mandated by the state government will be funded and allow the clinic to be able to provide these services.

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

c. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn't bother with the drug. If we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time should be the immediate concern of the nurse. It is posssible that the client did not have the necessary resource or did not understand the importance of the medication, but the nurse should first investigate the potential cultural disconnect.

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

c. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients. It is unlikely that tne patient was taking too much medication, taking the incorrect dose, or having a unique reaction to the medication. Rather the nurse should first interview the patient about use of folk medicine which may interact with the prescribed medication regimen.

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

c. The patient's Buddhist faith probably requires a vegetarian diet. Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don't eat meat. The nurse should be aware of the cultural considerations that should be made for Buddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that these considerations can be made.

A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the nurse make about this population? a. They have difficulty accessing health care due to a shortage of primary-care providers. b. They most likely receive health insurance through Medicare. c. They have access to affordable health care insurance. d. They are unable to access health care due to the implementation of the Affordable Care Act.

c. They have access to affordable health care insurance. Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only 2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly different in Massachusetts than in other areas of the country. Low income populations are eligible for Medicaid services, not Medicare. The program in Massachusetts became a model for the Affordable Care Act.

Why did American citizens become interested in establishing government-sponsored boards of health? a. Such a system would allow for accurate records of births and deaths. b. The government could force the poverty-stricken to accept care. c. They were afraid of infectious diseases such as yellow fever. d. Such boards could tax and thereby ensure adequate funds to pay for care.

c. They were afraid of infectious diseases such as yellow fever. Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health. The threat of disease was the impotus for creation of the boards of establishing boards of health. The primary interest of the boards of health was to provide public health services for the entire population and not only those who were poverty-stricken. The primary purpose of the boards of health was not to collect accurate vital statistics or receive tax dollars rather its purpose was to ensure the health of the population.

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

c. When the bill moves out of committee to be heard by the entire Senate

Why were nurses so unprepared for public health nursing in the early 20th century? a.Public health nursing had not yet been created as a field. b.Nightingale's textbook did not include content on public health nursing. c.Nurses were educated in diploma schools, which focused on care of hospitalized clients. d.No one would teach the nurses how to engage in public health activities.

c.Nurses were educated in diploma schools, which focused on care of hospitalized clients. Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for home visiting. The specialty of public health nursing practice was developed in the early 1800s. There was not a lack of teachers for this activity, rather the focus of nursing care was in the acute care setting and not in the community. Nightingale did not have a published textbook.

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

d. "It is divided primarily into two components: private health care and public health care." Health care in the United States consists of a private or personal care system and a public health system, with overlap between the two. The United States health care system is one of the most expensive systems in the world that does not do a good job at controlling costs. Care is provided through an enormous range of facilies and providers, including hosptials, physicians' and dentists' offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clincis. Although there is great research and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health care disparities exist among multiple populations making this system not available to all.

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

d. "Let's see if we can get some help from Medicare to help you pay for these medications." This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figure it out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before looking into receiving the medications for free as there may be other barriers which limit the abilities to get these medications at a discounted cost.

Which of the following best defines aggregate? a. A collection of individuals and families b. Another name for demographic group c. A large group of persons d. A collection of people who share one or more characteristics

d. A collection of people who share one or more characteristics An aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of a community can be defined in terms of either geography (e.g., a county, a group of counties, or a state) or a special interest (e.g., children attending a particular school). These members make up a population. The term population may be used interchangeably with the term aggregate. A large group of persons, a collection of individuals and families, and another name for demograhpic group are not accurate definitions of the term aggregate.

Which of the following best describes community-based nursing? a. Providing care with a focus on the group's needs b. Giving care with a focus on the aggregate's needs c. A value system in which all clients receive optimal care d. A practice in which care is provided for individuals and families

d. A practice in which care is provided for individuals and families By definition, community-based nursing is a setting-specific practice in which care is provided for "sick" individuals and families where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and continuous care. These nurses may be generalists or specialists in maternal-infant, pediatric, adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems.

Which client would have been most likely to receive care from the Frontier Nursing Service? a. A child with a broken femur b. A homebound, elderly male c. An injured soldier d. A woman in labor

d. A woman in labor The Frontier Nursing Service nurses were trained in nursing, public health, and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality. Care for soldiers, elderly, and children was not the focus of the care provided by the Frontier Nursing Service.

A nurse is considering joining the American Public Health Association (APHA). What information about this organization should be considered when making this decision? a. APHA represents concerns of nursing specialty practices. b. APHA focuses on the public health concerns of the medical profession. c. APHA focuses on providing health promotion education to the public. d. APHA provides a national forum for nurses to discuss their public health concerns.

d. APHA provides a national forum for nurses to discuss their public health concerns. APHA was formed to facilitate interprofessional efforts and promote the "practical application of public hygiene." The Public Health Nursing Section within APHA provides nurses with a national forum to discuss their concerns and strategies within the larger context of the major public health organization. It also serves as a focus of leadership and policy development for community/public health nursing. The focus of public health concerns of the APHA is broader than only the medical profession. The APHA focuses on concerns of public health nurses, not all nursing specialty practice. The APHA focuses on practical application of public hygiene, which is broader than only health promotion education.

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

d. Administration of policy

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

d. Ambivalence because there are no clear solutions about how to address their needs Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions. Because Americans' have an attitude of ambivalence, there is not strong negative or positive attitudes towards immigrants. However, many times immigrants do enter the United States because the have useful job skills or family ties. They are more likley to be a low-income worker who works in low-wage, blue-collar jobs and industries.

How are ethics and public policies similar? a. Both are best achieved by persons in high political office who can effect change. b. Both use general principles in making decisions. c. Both are abstract principles that often differ in actual practice. d. Both strive for the public good.

d. Both strive for the public good. An important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. Ethics involves the application of specific principles when making decisions. There is nothing that supports that ethics and public policies are better achieved by those in high political office.

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

d. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary-care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers who agree to comply with the care approaches established through a case management approach, not through a point of service list of individual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve different populations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather a case management approach is used to control costs.

A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed? a. Developing vaccines to administer to large numbers of people b. Developing public housing and almshouses c. Establishing schools of nursing d. Collecting vital statistics and improving sanitation

d. Collecting vital statistics and improving sanitation Collecting vital statistics and improving sanitation are examples of activities from the early colonial America. Establishing schools of nursing, developing vaccines to administer to large numbers of people, and developing public housing and almshouses all happened after the colonial period.

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

d. Contact the regulatory agency and participate in public hearings.

How can ethics be applied to public health nursing practice? a. Although ethics is important, political and legal responsibilities are more important in practice. b. Knowing ethics allows nurse to recognize the source of most problems. c. Ethics and actual nursing practice are not related. d. Ethics is constantly involved in nurses' clinical decisions.

d. Ethics is constantly involved in nurses' clinical decisions. Ethical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation, conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of public health nursing as nurses attempt to meet the needs of the community. Ethical principles are applied in nursing practice on a regular basis and assist with problem solving. The use of ethics does not allow the nurse to recognize the source of most problems. The used of ethics is more important than political and legal responsibilities in practice.

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

d. Ethnocentrism Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one's own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, "The way we do it is the only right way to provide this care." Prejudice refers to having a deeply held reaction, often negative, about another group or person. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth. Sterotyping means attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences.

A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? a. Documented needs of the local community b. Comprehensive assessment and planning done in the community c. Nursing staff's expertise and skills d. Federal funding for priority diseases or groups

d. Federal funding for priority diseases or groups Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort is focused locally. A need in the community may be identified through community assessment, planning, and looking at needs in the community; however, without funding there will not be a way to create necessary programming. The expertise of the staff should not be the determining factor when deciding on programming in the community.

What was the outcome of the Shattuck Report? a. Environmental sanitation efforts became an immediate priority. b. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated. c. Local and state governments established boards of health after its publication. d. Guidelines for modern public health organizations were eventually developed.

d. Guidelines for modern public health organizations were eventually developed. It took 19 years for the first of Shattuck's recommendations to be implemented, but his report was the first effort to create a modern public health organization. This report called for broad changes to improve the public's health to take place; however, these changes did not happen immediately after publication. They took 19 years to be implemented in the first state of Massachusetts. The report included establishment of a state heatlh department and local health boards in every town, sanitary surveys, and food, drug, and communicable disease control, but none of these changes happened quickly.

Which of the following best describes community-oriented nursing? a. Providing care to manage acute or chronic conditions b. Giving direct care to ill individuals within their family setting c. Focusing on the provision of care to individuals and families d. Having the goal of health promotion and disease prevention

d. Having the goal of health promotion and disease prevention By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions. These definitions are not specific to community-oriented nursing.

When talking to a women's group at the senior citizens' center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a. Demonstrate that the nurse understood the women's concerns and needs. b. Express empathy, support, and concern. c. Ensure that the women did not expect the nurse to solve their problem. d. Help the women engage in political action.

d. Help the women engage in political action. Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyond merely understanidng the women's concern, and instead mobilizes them to take action. This action does not demonstrate the nurse showing empathy rather the nurse is empowering these women.

A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the wife's diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse's most important action? a. Educating the family concerning the usual treatment and the prognosis of breast cancer b. Emphasizing that the family must set up a surgical appointment for the wife immediately c. Assessing the family's current living situation, including insurance and other assets d. Interviewing the family concerning their perspective of the threat to the family's well-being

d. Interviewing the family concerning their perspective of the threat to the family's well-being The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family's cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures the family, rather than the individual, is the unit of primary concern. Setting up a surgical appointment immediately would not be an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has cancer. Assessing the family's current living situation would not be the first concern of the nurse; the first concern should focus on the family's well-being. After assessing the family's well-being, the next action of the nurse may be to educate the family about the treatment and prognosis of breast cancer.

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

d. It created national goals for promoting health and preventing disease.

A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing? a. Its flexibility and higher wages b. Its focus on acute care and immediately visible outcomes c. Its collaboration with other health care professionals d. Its autonomy and independence

d. Its autonomy and independence Public health nursing is known for its autonomy and independence. In many instances, there are limited other health care professionals and staff with whom to interact. In-patient acute care nurses focus on acute care with outcomes known fairly quickly. Acute care nurses collaborate frequently with other health care professionals. Depending on the position there may be more flexibility, but typically public health nurses do not receive higher wages.

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

d. Medicaid Medicaid provides coverage for adults with low income and their children. Medicaid provides coverage for adults with low income and their children.

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

d. Neglecting to order certain tests or treatment to minimize cost to the provider In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the amount of money received to provide care to members of this group. In a capitated arrangement, the provider would most likely not increase the number of interventions used or coerce clients to attend health promotion classes as both of these strategies would cost the provider more money, and the provider will be receiving a set amount of money to provide care for a given client for a set period of time. It is unlikely that the provider would encourage clients to seek care elsewhere, rather the provider would be consciencious about the number of tests and treatments that are ordered in order to try to contain costs.

Which of the following is generally considered to be nursing's first code of ethics? a. Code of Ethics for Nurses b. Principles of the Ethical Practice of Public Health c. Code for Professional Nurses d. Nightingale Pledge

d. Nightingale Pledge The Nightingale Pledge is generally considered to be nursing's first code of ethics. After the Nightingale Pledge, the Code for Professional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times, until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements.The Principles of the Ethical Practice of Public Health was approved in 2002.

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

d. Overt intentional prejudice The nurse may have assumed that the African American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client. Covert prejudice involves subtle or passive acts of prejudice. This can occur intentionally or unintentionally. In this case, the actions of the nurse were intentional which means it was an overt behavior. Overt prejudice includes any action that intends to give unequal treatment to an individual or group. Given the scenario, it appears that the action of the nurse was intentional, not unintentional.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It's not up to us; it's the family's decision. They know what is best for them." Which of the following ethical approaches is being used by this nurse? a. Utilitarianism b. Deontology c. Communitarianism d. Principlism

d. Principlism The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values and goals. Therefore, the nurse is using principlism—that is, basic principles are the basis of the nurse's actions. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

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

d. State legislators

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

d. Teaching a high school boy about sexually transmitted infections and proper condom application Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs. Assisting in a cast application, irrigating a client's eyes, and restoring a normal cardiac rhythm are all tertiary prevention methods as a condition has already occurred and the nurse if focusing on restoring health. In order to maximize quality while reducing health care costs, the nurse should focus on primary prevention strategies.

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

d. The Constitution gives the federal government the power to promote the general welfare.

A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts? a. To increase funding for public health nursing b. To promote the nursing profession c. To address the concerns of nurses d. To help improve health care access

d. To help improve health care access Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life. Health care reform has a larger scope than only the profession of nursing and public health nursing. It addresses the concerns of nurses as well as many other health care professions.

Which of the following actions would most likely be performed by a public health nurse? a. Using data from the main health care institutions in the community to determine needed health services b. Asking community leaders what interventions should be chosen c. Assessing the community and deciding on appropriate interventions d. Working with community groups to create policies to improve the environment

d. Working with community groups to create policies to improve the environment Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. The interventions of asking community leaders which interventions should be chosen, asessing the community and deciding on appropriate interventions, and using data from health care institutions do not demonstrate the engagement of the community when making decisions about what the community actually wants and needs.

African American females have a higher mortality rate from breast cancer than white females. This is an example of: a. a sentinel event. b. racism. c. projection. d. disparity.

d. disparity. Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention. Projection is an estimate or forecast of a future situation based on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that ones own race is superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the patient.

A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a.The Future of Public Health b.Patient Protection and Affordable Care Act c.Scope and Standards of Public Health Nursing Practice d.Healthy People 2020

d.Healthy People 2020 The Healthy People 2020 documents propose a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. The disarray resulting from reduced political support, financing, and effectiveness is described in the The Future of Public Health. The Scope and Standards of Public Health Nursing Practice describes the processes of assessment, analysis, and planning that are carried out by the public health nurse. The Patient Protection and Affordable Care Act improved access to health insurance for Americans.