Public Health Nursing_Exam 1 Role of a community health nurse in the maintenance of a healthy teen

Public Health Nursing Exam 1 1. 1. In 1988, the Institute of Medicine (IOM) published a report on the futureof public health and itsmission that defined public health as:a. what public-private partnerships do to treat vulnerable populations.b. what the government does to ensure that vital programs are in place.c. what the U.S. Public Health Service does to prevent disease, promotehealth, and deliverservices.d. what society does collectively to ensure the conditions in which peoplecan be healthy.: In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently,the mission of public health is "to generate organized community effort to addressthe public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.2. 2. A registered nurse is seeking a position as a public health nurse. In reviewing the jobdescription, the nurse would expect to find a descriptionof a position that focused on functions suchas:a. monitoring pregnant teenagers for symptoms of complications of preg-nancy.b. offering free hypertension screening and treatment referral at local healthfairs to low-income,uninsured, community members.c. partnering with local seasonal farmworkers to design a program aimed atpreventing illness andinjury, and advocating for this population with local political and community leaders.d. preventing injury among a population of elderly residents in an assistedliving facility andtreating residents' chronic illnesses.: The scope of practice of public health nurses is population focused and communityoriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or2 / 72community,particularly vulnerable populations, and uses political processes as a major inter-vention strategy.3. 3. A public health nurse leader is encountering barriers when trying to shift the public healthagency's efforts to a population-focused practice.Thereasons peers are not supportive of the proposed shift to a population focusare most likely related to:a. agency colleagues' push for nurses to focus on population initiatives.b. costs associated with staff training and revision of documents.c. lack of support from the agency's funding sources.d. opinions that nursing should focus on the provision of direct client careand services.: Barriers to implementing population-focused care include lack of understanding ofthe public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; andlack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, serviceadministration, and policy formation.4. 4. The role and goals of the community health nursing practice can bestbe described as:a. community-based interventions aimed at promoting, preserving, and maintaining the health ofpopulations residing in institutional facilities suchas nursing homes.b. education of nurses and other staff working in community-based and community-orientedsettings to improve the overall effectiveness of theirprograms to meet client needs.c. population-level strategies aimed at promoting, preserving, and maintain-ing the health ofpopulations through the delivery of personal health care services to individuals,families,and groups inan effort to improve the healthof the community as a whole.d. activities targeted at improving the health status of clients served by community-based healthservice agencies such as hospice and home healthagencies.: Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups.The focus of community health nursing practice is the healthof individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to communityflow).This is different from public health nursing, which is the synthesis of nursingtheory and public health theory applied to promoting and3 / 72preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health careresources, has on the health of individuals, families, and groups (community togroups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients.Community-based nursing practice is setting specific,and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school(school nursing).The emphasis of community-based nursing practice is acute andchronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.5. 5. A community-oriented nurse has identified obesity as a problem in themiddle school. The nextstep in a population-focused practice is to make information available about the health of the middleschool students. This describes the core public health function of:a. assessment.b. assurance.c. policy development.d. research.: Assessment is a core function of public health and refers to systematically col- lecting data concerning the population, monitoring the population's health status,and making information available on the health of the community. In a communi-ty-oriented approach, a nurse would apply both nursing and public health theory.In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.6. 6. The state public health agency has received multiple complaints re- garding the availability ofelder transportation services to a specific countysenior center. The state agency assigns a publichealth nurse to work with the community to evaluate its program for elder transportation servicesto publicly sponsored eldercare programs.The public health core functionapplied is:a. assurance.b. policy development.c. primary prevention.d. public transportation.: 4 / 72The public health core function of assurance focuses on the responsibility of publichealth agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential communi-ty-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance alsoincludes assisting communities to implement and evaluate plans and practices.7. 7. A nurse planning a smoking cessation clinic for adolescents in the localmiddle schools and highschools is providing:a. community-oriented care.b. community-based care.c. secondary care.d. tertiary care.: Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardlessof whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air,and buildings.8. 8. A community-oriented nurse conducts home visits to new parents to assess the health status ofthe infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, andthe need for healthdepartment and social services referrals to support the needs of the new parentsand the infant.This can best be described as an example of:a. clinical community health practice.b. community-based practice.c. population-focused practice.d. public health nursing.: Community-oriented nurses who provide direct care services to individuals, fami-lies, or groups are engaging in a clinically oriented practice even when they applyconcepts of population-focused, communityoriented strategies along with their direct care clinical strategies.9. 9. Nurses should consider opportunities for population-focused practice that result from the rapidtransformation of health care delivery from a medical model to a health promotion/disease preventionmodel. An exampleof such opportunity is:a. operator of a nurse practitioner-run urgent care center in a major retail location.5 / 72b. director of clinical services spanning inpatient and community-based settings that provide awide range of services to the populations seen bythe system.c. clinical director of a home health agency.d. school nurse position in the local high school.: The new focus on populations, coupled with the integration of acute, chronic, andprimary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations servedby the system. Such a role might be director of client care services for the healthcare system, who has administrative responsibility for a large program area.Therewill be a demand for individuals who can design programs of preventive and clinicalservices to be offered to targeted subpopulations and for those who can implementsuch programs.10. 1. Public health nursing specialists are interested in which of the follow-ing topic(s)? (Select allthat apply.)a. Educational materials for individuals with HIV/AIDSb. Evaluation of an outreach program for at-risk pregnant teenagersc. Community subpopulations with high rates of type 2 diabetesd. New technologies to monitor diabetese. Prevalence of hypertension among various age, race, and gender groups-: , C, EPublic health specialists often define problems at the population or aggregate levelas opposed to the individual level. At the population level, public health specialistsare usually concerned with more than one subpopulation and frequently with the health of the entire community.11. A clinic treating a child for otitis media is an example of:A. Community-based careB. Public health careC. Tertiary health careD. Community-oriented care: Answer: A - In community-based nursing, the nurse focuses on "illnesscare" of individuals and families across the life span.Theaim is to manage acute and chronic healthconditions in the community, and the practice is family-centered illness care.Community-based nursing is not6 / 72a specialtyin nursing but, rather, a philosophy that guides care in all nursing specialties.12. A state agency has received multiple complaints regarding the availabil-ity of eldertransportation services to a specific county senior center. The state agency assigns a public healthnurse to work with the community to evaluate its program for elder transportation services topublicly sponsoredelder care programs.The public health core function applied is:A. AssuranceB. Primary preventionC. Policy developmentD. Public transportation: Answer:A -The public health core function of assurancefocuses on theresponsibility of public health agencies to be sure that activities are appropriately carried out to meet publichealth goals and plans. This role requires skill in assessment, investigative functions, collaboration,consultation, and cooperation.Assurance also includes assisting communities to implement andevaluate plansand projects.13. A nurse planning a smoking cessation clinic for adolescents in the localmiddle schools and highschools is providing:A. Community-oriented careB. Community-based careC. Secondary careD.Tertiary care: Answer: A - Community-oriented nurses emphasize health pro-tection, maintenance, and promotion and disease prevention, as well as self-re- liance among clients. Regardless of whether the client is a person, a family, ora group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factorssuch as safe food, water, air, and buildings.14. A public health department makes sure that the essential community-ori-ented health servicesare available in the community. Which of the following core public healthfunctions is beingimplemented? a.Policy development b.Assessment c.Assuranced.Scientific knowledge-based care: Assurance focuses on the responsibility of public health agencies to ensure certainactivities have7 / 72been appropriately carried out to meet public health goals and plans. Policydevelopment seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on boththe health status and the health-related aspects of a community or a specific population.Public health isbased on scientific knowledge, but is not a core function.DIF:Cognitive level: ApplyingREF:p. 14TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Mainte-nance15. Collecting data and monitoring the health status of the population de-fines which of the corepublic health functions? a.Assessmentb.Prevention c.Assuranced.Policy development: a.Assessment16. Public health nurses who develop and implement local public health policies throughpartnerships with agencies, organizations, and consumerswithin the community are using which corepublic health function? a.Assessmentb.Preve ntion c.Assur anced.Policy development: d.Policy development17. Providing for the availability of essential personal health services for people who wouldotherwise not receive health care defines which publichealth core function?a.Assessm ent b.Preventi on c.Assuran ced.Policy development: c. Assurance18. A public health nurse provides a clinic for HIV-positive citizens in thecommunity.This is anexample of: a.Primary prevention8 / 72b.Secondary prevention c.Tertiary preventiond.Policy making: c.Tertiary prevention19. In the past, community-oriented nurses have been called:a. District nurses9 / 72b. Almshouse nursesc. Soldier nursesd.Sisters: In the past, community-oriented nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, andhome health nurses.20. Nurses have worked in the community to improve the health care statusof individuals,families, populations, and vulnerable groups. Part of the appeal of this type of nursing is:1. Working with wealthy contributors who provide the funds2. Locating the source of disease and curing patients3.The autonomy of practice and independence in problem solving and deci-sion making4.Caring for soldiers on the battlefield: ANS: 3Community health nurses have a long history of autonomous practice, problem solving, and decision making.The other three answers relate to acute care nursingor gathering funding. Community health care nurses did engage in these activitiesin the nineteenth century, but overall, they have been best known for autonomy ofpractice.21. Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently facedwith include:1.Diphtheria, cholera, and typhoid fever 2.HIV, AIDS, and bioterrorism 3.Avian flu, tuberculosis, and radiation 4.Polluted water and air: ANS:2The newer threats to health that public health nurses are involved in are HIV, AIDS,and bioterrorism. Choice #1 lists threats of the past. Avian flu may be a threat, butradiation and tuberculosis are ongoing. Polluted water and air are generally not seen in the United States.22. Early colonial health efforts in the United States included:1.Establishment of schools of nursing2.Development of vaccines given to large numbers of people10 / 723.Collection of vital statistics, improved sanitation, and control of communiable diseases introduced through seaports 4.Development of public housing and almshouses: ANS:3The other choices are events that happened after the colonial period.23. Florence Nightingale's contributions to public health included:1.Caring for the sick, poor, and neglected in institutions and at home 2.Using a populationbased approach that led to improvements in environ-mental conditions3.Writing the Elizabethan Poor Law to guarantee medical care for all 4.Founding of the district nursing association to provide health care to needypeople: ANS:2During the Crimean War, Nightingale progressively improved the soldiers' health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality.24. During America's Industrial Revolution, the number of jobs for women rapidly increased. Nightingale's successes became known across the UnitedStates,and the first nursing schools opened.Which of the following occurredrelated to public health nursing?1.Community-oriented nursing began with organizations formed to meeturban health care needs.2.Nurses were instrumental in the construction of sewers and public watersystems. 3.Nurses trained in hospitals worked long hours caring for patients withcommunicable diseases in a humane way.4.Nurses closed down almshouses and orphanages.: ANS:1The visiting nurse became the key to health care in urban areas. Although nurseswere involved in interventions to improve sanitation and nutrition, they were not instrumental in their construction. Nurses worked in hospitals, but that was acutecare. Almshouses and orphanages were not closed down at this time.25. Lillian Wald was the first public health nurse in the United States.Whichof the following is her major contribution to public health nursing?1. Founding the American Nurses Association 2.Establishment of the New YorkTraining Hospital for Nurses3.Establishment of the Public Health Service4.Establishment of the Henry Street Settlement that later became theVisitingNurse Service of NewYork: ANS:411 / 72Lillian Wald established the Henry Street Settlement.26. LillianWald invented the term public health nursing.Which of the follow-ing classes might a person of her day attend?1.Taking and recording blood pressures accurately2.Safe and sanitary baby and child care3.Environmental pollutants and their effects on lung disease 4.Time management: balancing factory work and the home: ANS:2Lillian Wald provided health care that included educating the community on healthcare matters.27. In 1909,Yssabella Waters published her survey Visiting Nurses in theUnited States.This document highlighted the fact that:1.Nurses were trained by Boards of Education.2.Trained nurses adequately covered less densely populated areas. 3.Visiting nurses services were concentrated in the northeastern quadrantof the nation.4.Nurses were curing diseases such as tuberculosis and typhoid fever thatgreatly enhanced their credibility.: ANS: 3This report emphasized the fact that visiting nurse services were concentrated inthe northeast, which underscored the need for rural health.28. The American Red Cross, through its Rural Nursing Service, improved living conditions in villages and isolated farms.Which of the following is anexample of the resourcefulness of a nurse of this era?1.Using hot bricks, salt, or sandbags to substitute for hot water bottles2.Testing well water for pollutants3.Teaching school and developing curricula for rural nursing programs4.Providing post-surgical care: ANS:1In providing medical care, rural nurses were resourceful in finding alternativeswhen they did not have medical products that were available in urban areas.29. Occupational health nursing began as industrial nursing.What was thepurpose of this type of nursing?12 / 721.Inventing new machines to streamline production of medical goods2.Investigating industrial injuries to improve work conditions 3.Working at industrial sites treating work related-injuries 4.Providing care for factory workers and their families: ANS:4Early occupational health nursing did not provide care for work-related injuries, butinstead focused on the care of employees and their families in the home.30. Lina Rogers became the first school nurse.Early school nursing focusedon:1.Investigating causes of absenteeism such as malnourishment and lack ofshoes or clothing 2.Teaching school as well as being a nurse3.Starting the first school of public health4.Providing medical treatment to enable children to return to school: ANS:1 Early school nursing focused on investigating causes of absenteeism, not provid-ing medical treatment. That was the responsibility of physicians.31. The National Organization for Public Health Nursing was formed in 1912.Lillian Wald was its first president. The mission was to improve the educa- tional and services standards of the public health nurse and promote publicunderstanding.Which of the following is a contribution of this organization?1.Requiring that public health nurses have a baccalaureate degree in nursing2.Standardization of public health nursing education3.Development of nursing cooperatives 4.Opening of the Henry Street Settlement: ANS:2The National Organization for Public Health Nursing sought to standardize publichealth nursing. The Henry Street Settlement was already in existence. The bac- calaureate degree in nursing was not developed yet.32. In the late 1800s,local health departments were formed in urban areas forwhat purpose?1.To target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties 2.To facilitate interdisciplinary efforts and promote the "practical applicationof nursing"3.To provide immunizations to all citizens13 / 724.To provide public health education for nurses who had finished basic "training school" education: ANS:1Local health departments were formed to handle environmental issues in cities.33. The Frontier Nursing Service was established by Mary Breckinridge toemulate systems of care used in the Highlands of Scotland. Her biggest contribution was:1.Establishment of the Henry Street Settlement2.Development of health programs geared toward improving the health careof the rural and often inaccessible populations3.Blazing a nursing trail through the Rockies, providing nursing care tominers and their families4.Teaching birth control measures to large numbers of women in the South- : ANS:2Mary Breckenridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky.Lillian Wald established the Henry Street Settlement.34. Which of the following is true about African American nurses in publichealth?1.Segregation existed until the 1960s, which made certificate and graduateeducation more difficult to obtain.2.Cities were the major areas where they practiced3. They often belonged to the Frontier Nursing Service. 4.Theywere recruited heavily as military nurses.: ANS:1The otherstatements listed are false.35. A nursing student during World War II would likely join which group?1.The Public Health Service of NewYork City2.The Marine Nurse Corps 3.The Frontier Nursing Service 4.The Cadet Nurse Corps: ANS:4The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduatelevels.14 / 7236. Between 1900 and 1955, the leading causes of mortality were pneumonia,tuberculosis, and diarrhea/enteritis. By mid-century, nurses faced new chal-lenges as the leading causes of death became:1. Heart disease, cancer, and cerebrovascular disease2. Influenza3.Tropical diseases from increased travel abroad4. Diseases from overcrowded conditions in large cities: ANS: 1Chronic illness care, long-term illness and disability, and disease prevention be-came the new challenges for nurses.37. Ruth Freeman was a leading public health educator, administrator, con- sultant, author, and leader of the National Health Organization of the twenti- eth century. Which of the following characterize her philosophy of nursing?1. Nursing should move from acute care to community-based care.2. Nurse practitioners should control public health.3. Nursing is about caring for people, and is also intellectually challengingand offers manyprofessional opportunities.4. All nurses should seek graduate education to increase their credibility.: -ANS: 3Ruth Freeman felt that nursing was about caring for people and was also intel-lectually challenging and offered many professional opportunities. She did notspecifically espouse the other statements.38. The Elizabeth Poor Law of 1601 is similar to which of the following currentlaws?1. Welfare2. Food Stamps3. Medicaid4. Medicare: ANS: 3The Poor Law guaranteed medical care for poor, blind, and "lame" individuals,similar to15 / 72Medicaid.39. An intervention by the United States federal government to protect thehealth of its citizens was the establishment of the Marine Hospital Service,presently known as the Public Health Service. Its purpose was to:1. Set policy on quarantine legislation for immigrants2. Establish hospital-based programs to care for the sick at home3. Establish and promote environmental interventions such as adequatehousing andsanitation for urban cities4. Provide health care for merchant seamen to protect seacoast ports andcities fromepidemics: ANS: 4Providing health care to seamen was an early effort by the federal government to improve public health. Its purpose was to secure its maritime trade and seacoastcities.16 / 7240. Nurses who provided care to people in their homes and provided thatcare to several people at a time were called:1. Private duty nurses2. Visiting nurses3. Public health nurses4. Community staff nurses:ANS: 2Correct by definition41. Neighborhood centers that provided health care and social welfare pro-grams were called:1. Settlement houses2. Nursing care centers3. Nurse-managed clinics4. Public health services: ANS: 1Correct by definition. Nursing centers, nurse-managed clinics, and public healthservices are not necessarily in neighborhoods.42. An accomplishment for which the Frontier Nursing Service was noted is:1. Improvement of the care of sick and injured soldiers2. Establishment of a fee-for-service program for workers at Metropolitan LifeInsuranceCompany3. Reduction of infant and maternal mortality regardless of environmentalconditions4. Increasing funding for communicable disease treatment: ANS: 3The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reducedmortality.43. A major provision of the Social Security Act of 1935 was the establish-ment of:1. The Frontier Nursing Service to provide nursing service to rural commu-nities17 / 722. State and local community health services and training of personnel3. District nursing to provide home health care to sick people4. Community-based settlement houses: ANS: 2Title VI of the Social Security Act established state and local community healthservices and training of personnel.18 / 7244. Which of the following trends in health issues in the United States be-tween 1900 and 1955 is accurate?1.There was a rise in chronic disease such as heart disease and cancer. 2.There was a rise in communicable disease.3.The crude mortality rate increased dramatically.4.The life span after diagnosis remained the same.: ANS: 1Leading causes of death in 1955 were heart disease and cancer, while in 1900they were pneumonia and tuberculosis. All other answers are false.45. A 66-year-old woman is retired and no longer has health insurance through her place of employment.Which of the following programs wouldbe appropriate for her health insurance needs?1. Medicare2. Medicaid3. Social Security4. Economic Opportunity Act: ANS: 1The Social Security Act was amended to include health insurance benefits for theelderly, which is addressed through Medicare.46. Which of the following programs provided funds for neighborhood healthcenters, Head Start, and other community action programs?1. Medicare2. Medicaid3. Social Security4. Economic Opportunity Act: ANS: 4Funding for neighborhood health centers, Head Start, and other community actionprograms began in 1964 with the Economic Opportunity Act.47. The impact ofWorldWar I on public health nursing included which of thefollowing? Select19 / 72all that apply:1. Many communicable diseases were eradicated.2.The depletion of the ranks of public health nurses to the war.3.The feeling that the greatest patriotic duty was to stay at home.4. Inadequate funding was the major obstacle to extending nursing servicesin the community.: ANS: 2, 3, 4Both World Wars I and II depleted the public health nurse population as nurses20 / 72went off to war.The feeling of patriotism extended to the idea that patriotic dutycould also be served on the home front.48. Which statement about the Intervention Wheel is true?a. It provides a graphic illustration of population-based public health prac-tice.b. It describes in detail the components of public health nursing.c. It demonstrates the practice of community health nurses for policy andlawmakers.d. It is a framework used by all health departments in the United States.: ANS:AThe Intervention Wheel provides a graphic illustration that gives public healthnurses a means to describe the full scope and breadth of their practice.49. Since the Intervention Wheel was first published in 1998, it has:a. Guided national policyb. Been used as a tool in deciding licensure issues for State Boards ofNursingc. Been incorporated into the public health curricula of many nursing pro-gramsd. Gained wide acceptance internationally: Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduatecurricula.50. Public health interventions are implemented with:a. Legislators, policy makers, and community leadersb. Individuals and families, communities, and systemsc. Children, adolescents, and adultsd. Health departments, public health agencies, and visiting nurses associa-tions: It is important to know that public health nurses work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where public health nurses are intervening.51. Which statement is true about the origins of the Intervention Wheel?21 / 72a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, andWisconsindeveloped and refined the Intervention Wheel.b. It was conceived by a group of international nurses from Norway, Kaza-khstan, andJapan.c. It was a result of a qualitative analysis carried out by the State Boards ofNursing.d. It resulted from a grounded theory process carried out by public healthconsultants atthe Minnesota Department of Health.: Public health consultants with the Minnesota Department of Health carried outa grounded theory process in response to uncertainty about the contributions of public health nursing to population health-level improvement, resulting in theidentification of the Intervention Wheel components.52. When public health nurses conduct an assessment of a communityshealth, theya. Define one problem that will be the focus for a year.b. Assess a social network of interacting individuals usually in a definedterritory.c. Minimize the effects of health risks and hazards.d. Intervene at the population-level by changing laws and regulations.: ANS:BA community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimizationdo not take place during the assessment phase.53. A public health nurse utilizes the nursing process at all levels of practiceby:a. Including specific goals for community health nursesb. Developing an accurate nursing diagnosisc. Analyzing the needs of the community, system, and individuals and fami-liesd. Utilizing primary, secondary, and tertiary prevention: Public health nurses must customize the nursing process to consider the commu-nity, systems, and individual/family levels of practice.54. Public health nurses use a common set of interventions to:22 / 72a. Describe the proper order of implementation.b. Emphasize surveillance as the main focus of public health practice.c. Guide practice and generate agency protocols.d. Improve the health status of communities, systems, individuals, and fam-ilies.: Interventions are actions taken on behalf of communities, systems, individuals, andfamilies to improve or protect health status.55. A public health nurse uses Assumption 2, Public health nursing practicefocuses onpopulations, to guide practice. Which would be considered a population of interest?a. Healthy school childrenb. Homeless individualsc. A person recently diagnosed with diabetesd. Teenage parents: A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populationsthat are essentially healthy but could improve factors that promote or protect health;one such population is healthy school children. Homeless individuals and teenageparents would both be considered a population at risk.A person recently diagnosedwith diabetes is not a population.56. What is the purpose of the color-coded wedges on the InterventionWheel?a.The interventions are grouped together in related wedges.b. The wedges consist of referral information for each wedge.c.The element of health teaching is the predominant feature of each wedge.d. Coalition building must be implemented with each wedge.: Each wedge consists of related interventions.The other answers describe someof the individual wedges.57. A nurse who is involved in identifying individuals with unrecognized health riskfactors or asymptomatic disease is using which intervention?23 / 72a. Screeningb. Referral and follow-upc. Surveillanced. Health teaching: Screening involves identifying individuals with unrecognized health risk factors orasymptomatic disease.58. A nurse promotes alliances among organizations for a common purpose.Which publichealth intervention is being implemented?a. Health teachingb. Coalition buildingc. Surveillanced. Referral and follow-up: One example of coalition building is promoting alliances among organizations fora common purpose.59. A nursing student develops a teaching plan about hand washing to present to a group ofelementary school children at the local school.Whichpublic health intervention is beingimplemented?a. Collaborationb. Surveillancec. Health teachingd. Screening: Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/orcommunities.60. A public health nurse uses collaboration, coalition building, and commu-nity organizingwhen:a. Providing case management, referral, and follow-up services with individ-ualsb. Carrying out collective action at the systems or community levels ofpracticec. Conducting a community assessment24 / 72d. Implementing primary and secondary prevention strategies: Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice.These interven-tions can be used at all levels of prevention.61. The levels of practice encompassed by the Intervention Wheel are:a. Communities, individuals and families, and systemsb. Assessment, diagnosis, and evaluationc. Primary, secondary, and tertiaryd. Communities, populations, and aggregates: Communities, individuals and families, and systems are the three levels of publichealth nursing practice.25 / 7262. Public health nurses utilize registries to identify children with delayed or missingimmunizations.They subsequently follow up with families by phonecalls or home visits. This isan example of -level of practice.a. Systemsb. Communityc. Policyd. Individual/family: The individual/family-level of practice focuses on interventions that involve workingwith individuals, either singly, or in groups, and with families.63. A social marketing campaign urging community members to avoid dri-ving motorizedvehicles after consuming alcohol is implemented in a local community. This intervention isoccurring the -level of practice.a. Individual/familyb. Systemsc. Communityd. Government: Community-level interventions care carried out with the community as a whole.64. An occupational health nurse works with an employer to develop a work-place wellnessprogram for its employees. This intervention is occurring atthe -level ofpractice.a. Individual/familyb. Systemsc. Communityd. Government: Systems-level of practice consists of changing laws, policies, and practices thatinfluence population-based issues.26 / 7265. . When implementing interventions at the systems-level of practice, thepublic healthnurse would:a. Involve the entire community in solving the health problem.b. Identify health problems in the community.c. Change laws, policies, and practices that influence population-based is-sues.d. Provide outreach services to populations at risk.: Systems-level practice consists of changing laws, policies, and practices thatinfluence population-based issues.66. Which is an example of a public health nurse conducting a communityassessment?a. Visiting an elderly person at home to assess and evaluate safety and fallriskb. Developing diagnoses to identify nursing interventions at a health clinicc. Evaluating services at an immunization clinic where a translator providesservicesd. Compiling recent data from the county health department on child abusecases: Compiling recent data from the county health department on child abuse casesis an example of community assessment, assessing needs and data within a community.67. An example of a measurable outcome health status indicator at the individual-level ofpractice that would be used by a public health nurse is:a. A 50-year-old woman receives annual mammograms b. School absences in a community decline c.Teachers have increased awareness of health problemsd. Those in poverty utilize the free mammogram program: Outcome health status indicators are used to measure the impact of the interven-tions on population health. In this case, a 50-year-old woman receiving an annualmammogram will have an impact on the population health when considering thosewho are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual-level.68. Which nursing diagnosis would a public health nurse use when address-ing the problem27 / 72of obesity at the community-level of practice?a. Alteration in nutrition: More than body requirementsb. Need for increased knowledge of proper nutritionc. Families at risk for obesity because of inactivityd. Overweight child related to poor dietary habits: Nursing diagnoses must be modified to meet the needs of population-focused carein public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need offurther intervention.69. A public health nurse implements the public health intervention of healthteaching at thesystems-level of practice by:a. Participating in the Great American Smokeoutb. Working with a local employer to provide smoking cessation educationc. Providing one-on-one counseling to smokersd. Advocating for increased taxes on tobacco products: Working with a localemployer to provide smoking cessation education is theonly example of health teaching at the systems-level of practice. Participating inthe Great American Smokeout occurs at the community level and is not health teaching. Providing oneon-one counseling to smokers is health teaching at theindividual-level of practice. Advocating for increased taxes on tobacco productsoccurs at the systems-level of practice, but it is not health teaching.70. The cornerstones of public health nursing practice (select all that apply):a. Focus on the health of the entire populationb. Reflect community priorities and needsc. Promote health through strategies driven by epidemiological evidenced. Are grounded in an ethic of collaboration: Cornerstones of public health nursing practice focus on the health of the entirepopulation, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursingis grounded in an ethic of caring28 / 7271. Change for the community as client must often occur at several levelsbecause:a. Health problems caused by lifestyle are multidimensional.b. Most individuals can change their habits alone.c. Aggregates are responsible for social change.d. Geographic areas often have health risks that the nurse must identify.: -Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must oftentake place at several levels.72. A nurse cares for the community as the client when focusing on:a. Providing care for aggregates living in the communityb. The collective good of the populationc.The provision of care for families in the home setting d. Providing health education in the community: The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope thanonly education.73. A collection of individuals who have in common one or more personal orenvironmentalcharacteristics is the definition of a(n):a. Communityb. Groupc. Familyd. Aggregate: An aggregate is a collection of individuals who have one or more personal orenvironmental characteristics in common.74. What are the critical attributes in the definition of community?29 / 72a. Families, groups, and health organizationsb. Health needs, geographical boundaries, and target populationc. People, place, and functionsd. Populations and health resources: The people are community members or residents; place refers to geographic andtime dimensions; and function refers to the aims and activities of the community.75. A group of nursing students forms a student nursing association to provide supportwhile they are enrolled in a nursing program.This is knownas a community of:a. Placeb. Special interestc. Problem ecologyd. Function: A community of special interest brings members together with common concernsand interests.76. A public health nurse is collecting data about the biological aspects ofcommunityhealth.What data will the nurse collect?a. Race/ethnicityb. Traditional morbidity and mortality ratesc. Policy making and social changed. Homicide rates: Biological community health is often measured by traditional morbidity and mor-tality rates, which can be found in The Morbidity and Mortality Weekly Report.77. A community that has residents who are very involved in its activities and encourageactivities that promote the health of the community displayswhich condition of communitycompetence?a. Commitmentb. Participationc. Articulateness30 / 72d. Effective communication: Participation is an essential condition of community competence defined by active,communityoriented involvement.78. Which data source provides information about the function of the com-munity?a. Mapsb. Census datac. State departments, business and labor, local libraryd. Civic groups: Function relates to production, distribution, and consumption of goods and ser-vices.79. Which characteristic is an indicator of community health process?a. Participation and community actionb. Live birth ratec. Racial distributiond. Socioeconomic levels: Participation and community action are indicators of community health process.80. A community that demonstrates commitment would most likely supportthedevelopment of a:a. Community club to facilitate community involvementb. Childrens recreation programc. Curb-side recycling program and community-based education about recy-clingd. Cooperative agreement with a neighboring city to share needed services-: The commitment condition of community competence defined by Cottrell refers tothe affective and cognitive attachment to a community, that is worthy of substantial effort to sustain and enhance. Creating a recycling program as well as associated education enhances both the cognitive and affective domains of the community.31 / 7281. The main characteristics of partnership are:a. Awareness, flexibility, and distribution of powerb. Rights, responsibilities, and consensusc. Commitment, participation, and articulationd. Collaboration, advocacy, and utility: The main characteristics of partnership are being informed, flexibility, and negoti-ated distribution of power.82. When completing a community assessment, the nurse will:a. Identify community needs and clarify problems.b. Determine the weaknesses of a community.c. Perform the core functions of public health nursing.d. Assess individual needs within a community.: In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources.83. When a nurse focuses intervention strategies on the structural dimen-sion ofcommunity health, they are directed toward:a. Health servicesb. Primary preventionc. Health promotiond. Secondary prevention: Intervention strategies include service use patterns, treatment data from various health agencies, and provider/client ratios.84. Which characteristic is an indicator of community health structure?a. Infant mortality rateb. Effective communication32 / 72c. Crime rated. Emergency room utilization: The structure of the community is defined in terms of services and resources.33 / 7285. After identifying the boundaries of a community,what is the next step thenurse shouldtake in completing a community assessment?a. Gather relevant existing data and generating missing data.b. Plan interventions that benefit the entire community.c. Formulate nursing diagnoses.d. Evaluate the interventions that were used.: Community assessment includes gathering relevant existing data and generatingmissing data.86. What intervention would be the most appropriate for the nurse to usewhen trying todevelop community partnerships?a. Involve only the community residents.b. Use nurses as the source of information and leadership.c. Rely on the power of local officials.d. Include a variety of disciplines.: Community partnerships occur when community residents and health workerscome from a variety of disciplines.87. When writing a community-level diagnosis, Among refers to the:a. Specific problem or health risk faced by the communityb. Characteristics of the communityc. Community client experiencing the risk or problemd. Likelihood that the problem will be solved: Among identifies the specific community client with whom the nurse will be workingto address the identified problem.88. Which nursing diagnosis is written at the community-level?a. Risk of hypertension related to poor diet and sedentary lifestyle34 / 72b. Risk of obesity among school-age children related to lack of opportunitiesto engage inphysical activityc. Risk of ineffective health maintenance among individuals who do not haveaccess to aprimary care providerd. Ineffective coping related to multiple stressors as evidenced by clientcrying andstating she has no support system: There are three parts:risk of, among, and related to.The risk of identifies a specificproblem or health risk faced by the community. Among identifies the specific community client with whom the nurse will be working in relation to the identifiedproblem or risk. Related to describes characteristics of the community.89. A nurse surveys the school nurses in a community to determine their roles in the schoolsbecause this data is not available.The nurse is engagingin the process of data:a. Collectionb. Gatheringc. Generationd. Interpretation: Data generation is the process of developing data that do not already exist by interacting with community members or groups. This data includes information about a communitys knowledge and beliefs, values and sentiments, goals and perceived needs, norms, problem-solving processes, power, leadership, and influ-ence structures.90. A nurse schedules an appointment with a physician who has a practicein thecommunity to learn more about the communitys beliefs regarding childhoodimmunizations.This is known as:a. Informant interviewb. Participant observationc. Secondary analysisd. Windshield survey: An informant interview is a method of community data collection that involvesdirected conversation with selected community members.35 / 7291. When conducting informant interviews in a small community, the nursewould mostlikely contact:a.The state department of health for death records b. A local priest for congregation informationc. Surrounding communities for crime comparisond.The Centers for Disease Control and Prevention (CDC) for illnesses in thearea: Informant interviews are methods of directly collecting data.County health depart-ment nurses and church officials are often good key informants.92. A nurse collects data about seat belt usage by interviewing key infor- mants andobserving behaviors in the community.What type of data is beingcollected?a. Quantitativeb. Qualitativec. Focus-groupsd. Survey: Qualitative data is collected through interviews and observation.93. A nurse who reads the local community newspaper is using whichmethod togather data about the community?a. Informant interviewb. Surveyc. Participant observationd. Windshield survey: The nurse is deliberately sharing in the life of the community.94. Which method of data collection is being used as a nurse gathers infor-mation about thecondition of homes, size of lots, neighborhood hangouts, road conditions, and modes oftransportation?a. Participant observationb. Windshield survey36 / 72c. Surveyd. Informant interviews: Windshield surveys are the motorized equivalent of simple observation.95. A nurse who uses such data as minutes from a community meeting isusing:a. Secondary analysisb. Informant interviewsc. A surveyd. A windshield survey: The data is secondary because it is collected by someone else.96. A nurse plans on implementing a community-wide influenza immuniza- tion program.Which factor should the nurse consider when implementingthis program?a.The number of community members who have already received the immunizationb. The existence of formal groups in the communityc. Public policy that mandates influenza immunization for certain popula-tionsd. The communitys readiness to participate in the program: The factors that influence implementation in the community are the nurses chosenroles, the type of health problem selected as the focus for intervention, the com- munitys readiness to take part in problem solving, and characteristics of the socialchange process.97. To effectively complete the evaluation phase, the nurse must have:a. Demonstrated the ability to improve the health of the participantsb. Developed measureable objectives and goals before implementationc. Encouraged full participation by community membersd. Improved the health of the population through the program: Evaluation begins inthe planning phase, when goals and measurable objectives are established and goal-attainingactivities are identified. After implementing theintervention, only the meeting of objectives andeffects of the intervening activitieshave to be assessed.98. To analyze the problem of increased adolescent alcohol use in the com-munity, a nurse37 / 72brings together several groups of people to address the issue. These groups come together at the same time to work on identifyingpotential causes of the problem, but do not interact during the process. Which model is the nurse applying?a. Delphi techniqueb. Program planning modelc. Community-as-partner modeld. Community empowerment model: The program planning model is known as the nominal group process. It makes the most of the contributions by various groups with diverse interests, skills, and knowledge.These groups work in the presence of one another but do not interact.99. A nurse is trying to increase participation in a free colorectal screening program formiddle-aged adults who lack health insurance. Which implemen- tation mechanism would bemost effective?a. Small interacting groupsb. Health policyc. Lay advisorsd. Mass media: The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to alarge number of people.100. A nurse may define a community as a(n) (select all that apply):a. Social group determined by geographic boundariesb. Group of people who share common values and interestsc. Group of people defined by their interactionsd. Individual with a specific health concern: Community can be defined as many things, including a social group determinedby geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions.38 / 72101. Which data would be useful for a nurse to collect when assessing safetyin a community?Select all that apply.a. Number of billboards in the areab. Interviews with health care providers who are familiar with the communityc. Observation of community membersd. Nurses own observations: , C, DOther nurses, social workers, and health care providers, community members, andthe nurses own observations are reliable sources of information about the safety of an area102. 1. A home health case manager is charged with identifying opportunitiesfor healthpromotion and illness prevention. The fulfillment of this charge would best be demonstratedwhen the case manager:a. collaborates with a local chaplain to ensure that the spiritual needs ofcancer clientsare addressed.b. refers a new diabetic client to a nutrition counselor for dietary teaching.c. teaches a school nurse how to care for a client who will be returning toschool and willrequire new asthma treatments.d. tracks the immunization status of clients and facilitates access to immu-nization whenneeded.: Case management involves assessment—in this case, screening—and arrange-ment for delivery of services. Primary prevention includes case managementto identify at-risk clients and arrange for services to prevent disease. Throughnurse management activities, general community deficiencies in the quality or quantity of health services are often discovered. Case management activities withindividual clients and families will reveal the broader picture of health services in and health status of the community. Community assessment, policy development,and assurance activities that frame the core functions of public health actions areoften the logical next step in the nurse case manager's practice to intervene at the community level to make changes. Therefore, the core components of case management and the nursing process are complementary. The nursing process function of assessment is complementary to the case management process function of case finding and39 / 72includes such activities as applying screening tools according to program goals and objectives.103. 2. During a home visit, a case manager for a community health center notes markedpitting edema, shortness of breath, and increased fatigue in a52-year-old male client who livesalone.The client is admitted to the hospital,where he is diagnosed with congestive heart failure.The case manager works with the hospital's utilization manager to devise a discharge plan.Thecase manager's most logical next step would be to:a. assess the client; obtain information on the scope of services covered bythe benefit plan forthe client; if needed services are not covered, seek to identify and arrange for the resources toprovide these services.b. call the client, reintroduce himself or herself, and explain his or her role asa case managerfor homebound clients.c. discuss with the family their schedule of availability to offer care in theclient's home;ensure that the client has daily visits by family members.d. investigate the availability of local support and rehabilitation services forclients withcongestive heart failure; contact the client's family.: Case management has been described as a set of logical steps and process of interaction within a service network that ensures that a client receives needed services in a supportive, effective, efficient, and cost-effective manner. The Na- tional Case ManagementTask Force defines case management as a collaborativeprocess that assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual's needs, using communication andavailable resources to promote quality cost-effective outcomes.Case managementhas been defined in the public health nursing literature as the establishment of anappropriate plan of care based on assessment of the client/family and coordinationof the necessary resources and services for the client's benefit.Therefore, a criticalrole of the case manager is to help clients obtain the care they need to achieve a maximum level of health.The nurse needs to understand what the client's insurance covers (broker). If necessary services or equipment is not covered byinsurance, the nurse may act as an advocate (facilitator) and connect the clientwith other resources in the community (coordinator) if available.104. 3. A community health nurse is serving as a case manager for prema- ture infantsreceiving home health care. The case manager arranges for an in-home apnea monitor and40 / 72daily home visits by a registered nurse who specializes in high-risk pediatrics.The case manager is demonstrating whichof the following case manager roles?a. Consultant and coordinatorb. Mentor and liaisonc. Monitor and reporterd. Standardization monitor and negotiator: The case manager is responsible for fulfilling a variety of roles.The nurse is actingas a consultant when working with suppliers to arrange for the apnea monitor.Thenurse is acting as a coordinator when arranging for needed heath care services such as daily home visits by a specially trained pediatric registered nurse.105. 4. A community health nurse is the case manager for a homebound clientrecovering froma hip replacement. The nurse works with the client and his family to prioritize needs andservices, and to address these care needs. These activities represent which step in the nursingprocess?a. Assessment and planning/outcomeb. Diagnosis and planningc. Implementationd. Planning/outcome: The case management process function of problem prioritizing and planning to address care needs is complementary to the planning/outcome step of the nursingprocess.106. 5. A case manager employed by a health maintenance organization is charged withdiscontinuing home health services for a disabled homeboundelderly client in an effort toreduce costs. The case manager reviews the client's record and determines that home healthservices are still indicated for this client.The ethical dilemma faced by the case manager is:a. beneficence.b. justice.41 / 72c. nonmaleficence.d. veracity.: Beneficence—"doing good"—becomes an ethical dilemma when the insurer's goalof containing costs supersedes the case manager's duty to improve health and relieve suffering.This ethical tenet of nursing practice to act in the best interest ofthe client also involves fidelity to the nurse-client trust relationship.Duty to clients tosecure benefits on their behalf and to limit unnecessary expenditures can create dilemmas when the goals are not uniform. Advocacy on this client's behalf with accurate and updated information based on sound assessment, evidence-basedpractice, and liability risk management could produce a favorable outcome for allparties.The incorrect action would be to do nothing.107. 6. A community health nurse involved in care management would mostlikely:a. develop, conduct, and evaluate health teaching programs in primary care.b. manage the staff at a free clinic.c. monitor the health status, resources, and outcomes for an aggregate.d. provide immunizations to migrant workers.: Care management is a continuing process in which a case manager establishes systems and monitors the health status, resources, and outcomes for an aggre-gate—a targeted segment of the population or group.108. 7. In case management, it is unlikely that any single professional has the expertise,knowledge, or skills required to achieve success.The synergyproduced by all involved parties(client, providers, payers, family/significantothers, and community organizations) can resultin successful outcomes. These statements relate to the sequential process of:a. collaboration.b. communication.c. cooperation.d. negotiation.: 42 / 72Collaboration is achieved through a developmental process carried out in a se- quence, yet it is reciprocal among those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes.No single professionalhas the expertise required for all aspects. Synergy among all parties involved is required. Although communication is essential to collaboration, it is not sufficientto create or maintain collaboration.109. 8. Members of an extended family are in conflict over the treatment plan for thefamily's 90-year-old matriarch, who has developed indications of advanced dementia.Thecase manager is using conflict resolution strate-gies to allow the parties involved to developtrust, credibility, and distance from the issue at hand, as well as to retain personal dignity.The nurse is demonstrating a knowledge of the strategic process of:a. advocating.b. clarifying.c. cooperating.d. negotiating.: Techniques for conflict management involve a range of active communication skills. These skills are directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reachingthe goal of mutual benefit with limited loss. Negotiating is a strategic process usedto move conflicting parties toward an outcome and has several stages that allow the parties to develop trust, credibility, and distance from the issue, while retainingpersonal dignity.All of these factors are important when attempting to move partiestoward the creation of new solutions or options through relearning, brainstorming,reflective thinking, and problem-purpose-expansion techniques (systematic prob-lem solving approaches).110. 9. The insurer's risk manager has informed an independently contractedcase managerthat a liability risk related to experimental treatment and technology was identified in arecent recommendation made by the case manager. Which of the following is the bestexample of action by a case manager that might be associated with potential liability riskrelated to experimental treatment and technology?a. Inappropriately recommending that treatment be curtailed when treatmentwas actually43 / 72neededb. Failing to apply the contractual definition of "experimental" treatmentfound in theclient's insurance policyc. Substituting the case manager's clinical judgment for that of the insurer'smedical directord. Upcoding intensity of care or intervention requirements: 44 / 72For case managers, liability concerns exist when three conditions are met: (1)the provider had a duty to treat (i.e., provide reasonable care); (2) a breachof contract occurred through an act of omission; and (3) the act of omission caused injury or damage to the client. Five general areas of risk are liability for managing care, negligent referrals, use of experimental treatment or technology,breach of confidentiality/security, and fraud and abuse. With regard to the use of experimental treatment and technology, the case manager is obligated to apply thecontractual definition of "experimental" treatment found in the client's insurance policy (certificate of coverage), because this a legally binding document betweenthe insurer and the insured.111. 1. A nurse performing home hospice case management notes the in- creasing numberof hospice clients who lack caregivers in the home envi- ronment.The nurse identifies thepotential need for a hospice house facilityto meet the needs of these clients.The casemanagement process frequentlyreveals larger picture issues such as which of thefollowing?(Select all thatapply.)a. Community cost concernsb. Community conflict resolution skillsc. Community satisfactiond. Community weaknesses in quality of servicese. Community weaknesses in quantity of services: , ECase management activities with individual clients and families very often reveal the larger picture of health services and health status of a community. General community weaknesses in the quality and quantity of services often are discov- ered. The nurse can then intervene at the community level to initiate changes. In this case, the nurse identified a deficiency in the quality of hospice services to individuals who did not have a caregiver in the home environment and the parallelconcern of the lack of hospice-related facilities to meet the needs of these clientsto achieve a quality dying process.112. 1. Advantages of community health program planning include ensuringthat availableresources are used to meet the needs of the population and:45 / 72a. applying for grants.b. identifying clients and soliciting board members' support.c. identifying resources, activities, and needs.d. increasing the visibility of the program.: Community health program planning is population focused and puts the well-beingof the public above private interests.Systematic planning for meeting the needs ofpopulations in a community has benefits for clients, nurses, employing agencies,and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organiza-tion and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives,reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events,allows for quality decision making, and provides better control over the actual program results. Identifying clients, soliciting board support, applying for grants, and promoting the actual program are steps in the implementation phase of program management.113. 2. A community health nurse is conducting a community assessment aspart of a programplanning initiative and is seeking a tool that is low cost, allows clients to participate inidentification of need, and would stimulate community support for the program.The nursewould most likely use whichof the following?a. Community forumb. Focus groupc. Indicators approachd. Survey: There are several types of needs assessment tools, including community forums,focus groups, key informants, indicators approach, survey of existing agencies, and general surveys.Both community forums and focus groups are low-cost tools.The focus group provides clients with the opportunity to participate in identificationof needs and can help increase community support for a program.The focus groupmethod has several disadvantages, such as being time consuming to carry out andtending to focus on irrelevant or political "hot button" issues.Leading focus groupsrequires strong skills in group process to maintain the focus of the group.46 / 72114. 3. A community-oriented nurse is writing a grant application for fundingfor a nurse-runclinic serving clients with chronic illnesses.The grant appli-cation asks for informationregarding program benefits, effectiveness, and efficiency.The most effective tool to obtain thisinformation would be:a. cost studies.b. Mobilizing for Action through Planning and Partnerships (MAPP) model.c. Planning Approach to Community Health (PATCH) method.d. Tracer method.: Cost studies are essential to show the value of nursing in the marketplace now and in the future.All cost studies involve three major tasks:financial, research, andstatistical.The financial tasks include identifying total program costs.The statisticaltasks include identifying appropriate, quantifiable measures for analyzing data.The research tasks include setting up an appropriate study design to answer questions about benefit, efficiency, or effectiveness. Types of cost studies includecost-accounting, cost-benefit, cost-effectiveness, and cost-efficiency studies.115. 4. When planning a new community health center, a nurse will integrateknowledge ofthe nursing process and program management. The nurse's initial and most critical step forfunding purposes would be:a. finding the lay leaders in the community.b. identifying the target population's health problems and needs.c. outlining the major causes of mortality in the community.d. prioritizing the community's problems.: The program management process is parallel to the nursing process and consistsof a rational decision making system designed to help nurses know when to makea decision to develop a program (assessment and problem identification); where they want to be at the end of the program (goal setting); how to decide what to do to ensure a successful program (planning); how to develop a plan to go from where they are to where they want to be (implementation); how to know that they are getting there (formative evaluation); and what to measure to know that the program has successful outcomes (summative evaluation). Planning for effectiveand efficient programs must be47 / 72based on determination of the needs of populationswithin the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationalefor the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.116. 5. A nurse who is the program director for a new antismoking campaignis developing awritten program plan that will include the program's goals, priorities, objectives, budget, andtimelines. Before implementation of theprogram, the written program plan should also address which of the follow-ing?a. Cost-benefit analysisb. Perspectives on the programc. Plan for the evaluation processd. Process evaluation: When the planning process begins, the plan for evaluating the program should alsobegin. Everyone who will be involved in implementing a program should be giventhe opportunity to play a role in planning for program evaluation. Assessment of need is one component of evaluation. Once needs have been established and theprogram is designed, the nurse must continue plans for program evaluation, suchas ongoing process evaluation (formative evaluation) and summative evaluation.117. 6. The nurse engaging in a formative program evaluation would mostlikely:a. conduct medical record audits for quality assurance.b. make a home visit before a client is discharged from the program.c. participate in a new client evaluation.d. write a policy for risk management.: Process evaluation, also referred to as formative evaluation, occurs during programimplementation and makes it possible to make midterm corrections to ensurethe achievement of program goals. Process evaluation is an ongoing function of examining, documenting, and analyzing the progress of a program. This type of program monitoring can be used to justify continuing the program, because it willaddress the efficiency and effectiveness of the program in meeting its goals.Qualityassurance programs are examples of program evaluation in48 / 72health care delivery.118. 7. Local officials have requested a program evaluation of a comprehen-sive teen sexeducation program offered in the local schools in prepara- tion for annual budget-planningdiscussions.The public health nurse (PHN)determines that the teen pregnancy rate hasgradually declined over the years that the program has been in place. The nurse has alsoidentified the evaluation plan that was articulated during the program planning phase.Thebesttool for demonstrating the efficiency of this program is:a. cost-benefit analysis.b. cost-efficiency analysis.c. relevance assessment.d. school records audit.: 49 / 72The efficiency of a program can be evaluated through a formative or summative evaluation. The evaluator may be able to determine whether a given program provides better benefits at a lower cost than a similar program, or whether the benefits to the clients justify the costs of the program (efficiency). Public health programs are usually recognized as having a net positive impact, and appropriatesex education can reduce the incidence of teen pregnancy by altering teen sexual behaviors.To perform a cost-benefit study, the evaluator must decide which costsand which benefits are to be included, how the costs and benefits are to be valued, and what constraints are to be considered (e.g., legal, ethical, social, and/or economic). Health programs involving politically sensitive issues such as teen sex education can benefit from the articulation of measures to determine costs, benefits, and constraints in the program planning phase.119. 8. The community planning board is attempting to determine if the clients and healthcare providers affected by a recent mental health outreachinitiative are satisfied that theprogram interventions have accomplished the program objectives and that clients havebenefited from this program. The analysis model that is best designed to provide an estimateof costs toachieve an outcome is:a. cost-benefit analysis.b. cost-effectiveness analysis.c. cost-efficiency analysis.d. Multi-Attribute UtilityTechnique.: An evaluation of program effectiveness may help determine whether both providersand clients are satisfied with program activities, as well as whether the program met its stated objectives.A costeffectiveness analysis is a subset of a cost-benefitanalysis and is designed to provide an estimate of the costs to achieve a given outcome.Such an analysis can answer several questions:Did the program meet itsobjectives?Were the clients and providers satisfied with the effects of the interven-tions? Are things better as a result of the interventions? In cost-benefit analysis, both the cost and outcomes are quantitative. In cost-effectiveness analysis, the outcomes are both qualitative (satisfaction) and quantitative (cost).120. 9. The nurse program manager is determining the direct client care costsas well as thecost of indirect nursing activities for home visits for a home health agency. Analysis of thisinformation along with nursing workload information and client needs can best provide anagency evaluation measurefor:50 / 72a. program decision making.b. cost-effectiveness.c. cost-efficiency.d. perceived value.: Cost-efficiency analysis determines the actual cost of performing a number of program services, both direct and indirect, by addressing the productivity of the workforce in achieving specific objectives. The relationship between direct and indirect activities, workforce, caseloads, client needs, and actual costs determinesthe productivity of the program.121. 10. Which of the following are the major sources of information forprogramevaluation?(Select all that apply.)a. Community indicesb. Media reportsc. Program clientsd. Program providerse. Program records: , C, EBoth quantitative and qualitative methods may be used to conduct an evalu- ation. However, the strongest evaluation designs combine both qualitative andquantitative methods. Major sources of information for program evaluation arethe program clients (especially user satisfaction information), program records(especially clinical records), and community indices (epidemiologic data).122. The cognitive domain includes:a. Changes in attitudes and the development of valuesb. The performance of skillsc. Memory, recognition, understanding, reasoning, and problem solvingd. Memorization of one set of skills before moving on to the next: The cognitivedomain includes memory, recognition, understanding, reasoning,and problem solving.51 / 72123. What is the purpose of providing education across the three levels ofprevention?Education:a. Enables clients to attain optimal healthb. Identifies and treats health problems early to eliminate disabilityc. Enables populations to break into individualsd. Teaches people about Healthy People 2010: Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of adisability may not be possible.124. A nurse is teaching a client about how to complete a dressing change of a wound. Thenurse knows that what conditions must be met before learningwill occur?a. Must be able to memorize the instructions, relay this information to apartner, anddemonstrate the dressing changeb. Must master the dressing change at the time it is taught, repeat thedemonstration for the nurse, and teach another personc. Must be able to speak the language of the nurse, have time to practice thedressing change,and master the dressing change in a short timed. Must have the necessary ability, a sensory image of how to carry out thedressing change,and an opportunity to practice the dressing change: ANS:DBefore psychomotor learning occurs, the learner must have the necessary ability,a sensory image of how to carry out the skill, and an opportunity to practice the skill.125. A health educator trying to change a clients attitudes about smokingwould be usingwhich of the following domains?a. Cognitiveb. Affectivec. Psychomotord. Developmental: The affective domain is used to attempt to influence what individuals, families,communities,52 / 72and populations feel, think, and value.126. Which of the following domains would be used to teach a new diabetichow to give aninsulin injection?a. Developmentalb. Cognitivec. Affectived. Psychomotor: The psychomotor domain includes the performance of tasks that require somedegree of neuromuscular coordination and emphasizes motor skills.127. Which format would be most appropriate for teaching a group of nursingstudents whoare learning to give injections?a. Demonstrationb. Health fairc. Lectured. Nonnative language session: Demonstration also includes return demonstration. Giving injections can best belearned by seeing the behavior being done.128. Which statement about education is true?a. It emphasizes the provider of knowledge and skills.b. It emphasizes the recipient of knowledge and skills.c. It is a process of gaining knowledge and expertise.d. It results in behavioral change.: Education is the establishment and arrangement of events to facilitate learning.129. Which core competency of communication is used by nurses engagedin group work?a. Soliciting input from individuals and organizations53 / 72b. Using simple language when presenting informationc. Asking the group to develop the program of interestd. Presenting material to lay audiences only: Soliciting input from individuals and organizations is a communication competency.130. When implementing a community health education program, which ed-ucationalprinciple will the nurse use as a guide?a. Refer to trustworthy sourcesb. Use an active voicec. Create the best learning environmentd. Accentuate the positive: The environment must be conducive to learning for educational programs to beeffective.131. Nurses who use Healthy People 2020 as a guide for education:a. Focus on avoiding cigarette smoking and using alcohol in moderationb. Educate clients using primary and secondary levels of preventionc. Use Blooms taxonomy when planning educational objectivesd. Design health fairs aimed at individuals: Healthy People 2020 focuses on primary and secondary prevention. Understand-ing the three learning domains is crucial in providing effective health care.132. A nurse is implementing an educational program about the importanceof beingphysically active.Which step would the nurse complete first?a. Provide learning guidanceb. Present the stimulusc. Gain the learners attentiond. Ask learners to recall prior learning: Gaining the learners attention must happen first before learning can take place.133. A potential barrier that a nurse may experience when in the educatorrole is:54 / 72a. Working with clients with a low literacy levelb. Memorizing the information that is to be taughtc. Having a limited vocabularyd. Lacking knowledge about how to gain participation: Educators may lack knowledge about how to gain participation. Participation canbe fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather thanpresenting his own information.134. After evaluating learning needs, what is the next step the nurse shouldtake indeveloping an educational program?a. Consider any potential barriers to learning.b. Establish goals and objectives for the program.c. Select appropriate materials for the program.d. Assess the dynamics of the group.: Instructional objectives need to be evaluated before a teaching program is de-signed.135. Which behavior would the nurse anticipate when working with an indi-vidual withlow literacy?a. Asking for additional clarification of materialsb. Requesting to read the information later55 / 72c. Having a high level of motivationd. Being overly dependent on others: Individuals with a limited literacy may have a limited vocabulary and general knowl-edge and do not ask for clarification. They may focus on details and deal in literalor concrete concepts versus abstract concepts. They may select responses on a survey without necessarily understanding them and may be unable to understandmath. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home.136. A nurse prepares for a presentation to a group of adults using strategiesappropriate foradult learning.This concept is called:a. Authoritarianismb. Learning stylec. Pedagogyd. Andragogy: Andragogy is a term and model developed by Malcolm Knowles to describelearning strategies for adult learners.137. A nurse is teaching a postpartum mother how to breastfeed her infant.The nursenotes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby.The nurse outlines the expecta-tions of breastfeeding for the mother and the baby. Considering the eventsof instruction, what should the nurse do next?a. Ask the mother about her previous experience with breastfeeding.b. Demonstrate how to position the baby for breastfeeding.c. Show the mother a video about breastfeeding.d. Have the mother demonstrate breastfeeding.: Asking the mother about her previous experience with breastfeeding identifies hereducational needs. Using the TEACH mnemonic, the first thing the nurse should do is Tune in: listen before starting to teach; the clients needs should direct the content.138. A diabetic client reports to the nurse that she has been learning moreabout56 / 72controlling her blood sugars by reading information found on the Internet.Which statement by the nurse would be most appropriate?a. Looking at the date the content was posted on the website is important.b.The Internet is an unreliable source of information and should not be used.c.The best sources of information are found on pharmaceutical websites.d.Your physician will provide you better information than the Internet.: ANS:AOne of the ways to assess the reliability and validity of Internet sources is to lookat its currency, including the dates when the content was posted and updated.139. Which of the following is an example of a goal?a. Mr.Williams will look at his stoma without disgust each time his ostomybag comes off.b. Mr.Williams will be able to independently take care of his ostomy bagwithin threemonths.c. Mr.Williams will gather all ostomy supplies correctly each time his ostomybag needs to bechanged.d. Mr.Williams will successfully describe to the nurse how to care for hisostomy when heis asked.: Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time.The other choices describeobjectives.140. A correctly written objective would be:a. Each member of the Jones family will give an insulin injection to Billy withaccurate dosage100% of the time for 10 consecutive trials.b. Ms.Smith will perform a blood sugar test on herself with an accurate bloodsugar reading.c. The community will take their children to receive immunizations within 1month of theimmunization due date.d. Fifty percent of the eligible women seen in the clinic will return for theirscheduledmammogram appointment.: Objectives are specific, short-term criteria that need to be met as steps toward achieving the longterm goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurableterms.57 / 72141. Which group would be likely to demonstrate the most cohesion?a. A group with several leadersb. A group with diverse attitudes and valuesc. A group with a common goald. A group with efficient members: Cohesion is the attraction between individual members and between each memberand the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members.142. It is important for a nurse to recognize group norms because they:a. Allow for creativity and variety among group membersb. Influence members perception of communityc. Are helpful in evaluating the effectiveness of the groupd. Maintain the group through various supports to members: Group norms serve to maintain the group through various supports to members.143. A nurse demonstrates the leadership behavior of reflecting when:a. Providing feedback on how behavior appears to othersb. Introducing new topics to the groupc. Verifying information through questions and restatementd. Highlighting important points from the discussion: Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlightsthe important points.144. A leader controls members through rewards and often keeps membersin the darkabout the goals and rationale behind prescribed actions. What type of leadership does thisdescribe?a. Democratic58 / 72b. Patriarchalc. Socialistd. Communication structure: Patriarchal or paternal style is authoritative, winning respect and dependencethrough parentlike devotion.145. A group member who has taken on the role of the gatekeeper will:a. Seek and accept the authority or direction of others.b. Guide and direct the group activity.c. Control outsiders access to the group.d. Focus the movement toward the main work of the group.: Thegatekeeper controls outsiders access to the group.146. An established group requests a teaching and learning session onhypertension.What can the nurse expect with this type of group?a.The group membership will change from week to week.b. The members all have the same interests.c.They prefer lectures rather than demonstrations.d. The group already has operating methods that have been successful.: -Nurses working with established groups should know that this type of group hasmembership ties and an existing structure that has proven to be successful.147. Which intervention can be implemented by a nurse when working witha groupfocused on improving the health of the community?a. Make decisions for the group to move the process along.b. Invite wealthy individuals to participate in the group process.c. Maintain members through recognition and encouragement.d. Teach topics that are of national importance.: Maintaining members is an important intervention to facilitate group process.59 / 72148. A nurse is working with a group of clients with diabetes and is teachinga class aboutavoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basicphysiology of diabetes, which was taught the week before.This nurse is providing effectiveeducation by:a. Stimulating recall of prior learningb. Gaining attentionc. Presenting the materiald. Providing learning guidance: The educator should have the learners recall previous knowledge related to thetopic of interest.149. During a class on newborn care given at a local health department, a nursing studentasks the participants to practice with baby dolls.Which stepof promoting effective education isthe student using?a. Eliciting performanceb. Assessing performancec. Enhancing retention and transfer of knowledged. Gaining attention: The step of eliciting performance includes encouraging the learners to demon-strate what they have learned.150. The educational process of selecting appropriate educational methodsis similar towhich of the following steps of the nursing process?a. Assessmentb. Evaluationc. Implementationd. Planning: Assessment would be identifying educational needs, evaluation would be evaluat-ing educational process, and implementation would be implementing the educa- tional plan. Planning is similar to selecting appropriate educational methods.60 / 72151. When a nurse is evaluating the components of an educational program,the nurse iscompleting a(n):a. Education evaluationb. Educational productc. Process evaluationd. Ongoing evaluation: Process evaluation means looking at the components of an educational program.152. Evaluation of individual and group progress toward health goals is important.Whichcomponent should be included in the evaluative process?a.Type of teaching strategy usedb. Recognition of accomplishments in the groupc. Conflict that occurred in the groupd. The type of leadership in the group: Recognition of accomplishments in the group and of the group is built into theevaluative process.153. When conducting an effective educational program, a nurse would usewhich basicprinciple? Select all that apply.a. Use a clear, succinct style.b. Use an active voice.c. Refer to Internet sources.d. Use aids to highlight key points.: , B, DReliable sources must be used, and information found on the Internet is not alwaysreliable.154. The biomedical model defines health as the:a. Avoidance of illnessb. Absence of diseasec. Promotion of healthy behaviorsd. Protection from illness and disease states: 61 / 72The biomedical model defines health as the absence of disease.It does not explainwhy populations remain healthy or how health is enhanced.155. According to Leavell and Clark, primary prevention consists of:a. Health promotion and rehabilitationb. Health promotion and specific protectionc. Early diagnosis and prompt treatmentd. Health maintenance and early diagnosis: Leavell and Clark stated that primary prevention includes health promotion andspecific protection from disease.156. According to Laffrey, Loveland-Cherry, andWinkler, the health perspec-tive views:a. Health as the absence of diseaseb. Human lifestyle based on ones prescribed regimec. Humans as complex and interconnected with the environmentd. Community education as the role of the registered nurse: The health paradigm includes the view that humans are complex and interconnect-ed with the environment.157. Screening school-age children for hearing deficits is an example of:a. Primary preventionb. Secondary preventionc.Tertiary preventiond. Health promotion: Secondary prevention focuses on early detection and prompt treatment of disease,injury, or disability.158. Examples of modifiable behaviors include:a. Smoking, poor diet, and alcohol consumptionb. Cancer, emphysema, and cardiovascular diseasec. Walking, running, and aerobic exercise62 / 72d. Genetic abnormalities: 63 / 72The leading causes of death in 2000 were tobacco use, poor diet, physicalinactivity, and alcohol consumption.These are modifiable behaviors.159. A nurse utilizing a disease-oriented approach would:a. Promote a greater level of positive health.b. Teach about common disease processes.c. Provide acute care management of chronic disease.d. Direct care toward disease prevention.: Disease prevention, risk appraisal, and disease management are all elements ofthe disease-oriented approach.160. A client eats a nutritious, balanced diet on a daily basis to keep thecurrent stateof health.This is described as behavior.a. Illness preventionb. Health promotionc. Health maintenanced. Health protective: Health maintenance behavior is directed toward keeping a current state of health.161. A 5-feet, 6-inch, 25-year-old female who weighs 120 pounds walks 5 miles a daybecause she has a long family history of early death from heart attacks and is refrainingfrom a sedentary lifestyle.Which term bestdescribes this example?a. Health promotionb. Illness preventionc. Health maintenanced. Health protection: The woman is exercising to prevent an illness that runs in her family. Illnessprevention is a behavior directed toward reducing the threat of illness.162. A 5-feet, 6-inch, 25-year-old woman who weighs 120 pounds runs 5 miles a day because64 / 72it improves her mood and energy level.Which term bestdescribes this example?a. Health promotionb. Illness preventionc. Health maintenanced. Health protection: The woman is exercising to improve and promote her health. Health promotion isdirected toward achieving a greater level of health.163. A woman has attended a weight reduction program for a year and lost75 pounds. Shenow attends weekly meetings to keep the weight off.Whichterm best describes this example?a. Health promotionb. Illness preventionc. Health maintenanced. Health protection: The womans weight is being maintained through attending the weight reductionprogram. Health maintenance focuses on keeping a current state of health.164. The Guide to Clinical Preventive Services provides:a.The most recent recommendations for preventive interventionsb. Assistance in interpreting Healthy People 2020c. A basis for public health nursing practiced. Health risk appraisal instruments: The Guide to Clinical Preventive Services provides recommendations for pre- ventive interventions including screening tests, counseling, immunizations, andchemoprophylaxis.165. One advantage of health-risk appraisal instruments is that they:a. Are suitable for all age-groupsb. Accurately reflect an individuals ability to initiate changes in lifestyle65 / 72c. Provide support to nurses in counseling individuals about self-care be-haviorsd. Emphasize environmental factors: Health-risk appraisal instruments provide support to nurses in counseling andeducating individuals in self-care behaviors.166. Which statement best describes health risk appraisals?a. Data about health practices are collected from families.b. Primary prevention strategies are implemented by using the collecteddata.c. Identified risks can be easily modified.d. Individual health practices are compared with data from epidemiologicstudies.: ANS:DDuring a health risk appraisal, individuals supply information about their health practices, demographic characteristics, and personal and family medical history for comparison with data from epidemiologic studies.These comparisons are usedto predict individuals risk of morbidity and mortality and to suggest areas in whichdisease risks may be reduced. Health risks appraisals use secondary preventionby screening to prevent or detect disease in its earliest stages.167. When using the integrative model for community health promotion, thenurse wouldapply the dimension of client system by:a. Concentrating on individual health behaviorsb. Studying client-centered initiativesc. Providing multidimensional nursing care among various levels of clientsd. Focusing on health promotion, illness prevention, and illness care: ANS:CNursing care is targeted toward several levels of clients in the client system.168. When would a nurse useThe Guide to Clinical Preventive Services?a. Conducting group risk appraisal and risk reductionb. Providing recommendations for preventive interventionsc. Completing a community wellness inventory66 / 72d. Improving environmental living conditions and sanitation: These include screening tests, counseling, immunizations, and chemoprophylaxisregimens for more than 80 conditions.169. The Framingham Heart Study was successful in:a. Providing information on the effectiveness of risk-reduction interventionsb. Documenting the relationship between social variables and heart diseasec. Identifying factors contributing to the development of coronary heartdiseased. Demonstrating the effects of mass media in modifying high-risk behavior-: The Framingham Heart Study identified factors contributing to the development ofcoronary heart disease and high blood pressure.170. Which community-based risk-reduction intervention resulted in equallyfavorablehealth risk changes for both control and treatment groups?a. Framingham Heart Studyb. Stanford Heart Disease Prevention Programc. North Karelia Studyd. Minnesota Heart Health Program: The Minnesota Heart Health Program resulted in equally favorable health riskchanges for both control and treatment groups.171. A public health nurse collaborates with local community leaders to develop a localcampaign educating about the importance of wearing a seatbelt.What client system of theintegrative model does this describe?a. Communityb. Aggregatec. Familyd. Individual: Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of67 / 72care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote opti-mal health for the community and its people.172. When applying the integrative model for community health promotion,a nurseassesses a neighborhood for accessibility and adequacy of care to provide treatment formedical conditions. What client system does this describe?a. Individualb. Familyc. Aggregated. Community: The community focus includes the nurse assessing the community for accessibilityand adequacy of care to provide treatment for medical conditions.173. When using Anderson and McFarlanes model to complete a communityhealthassessment, a nurse would collect information about the tha. Resources available to promote health inb. Interactions among subsystems inc. Physical environment ofd. Demographics of: A community health assessment must include information about the subsystemsand interactions of the total community with the systems external to it.174. A nurse provides counseling to an obese client about the importance ofgood nutritionand regular exercise with the intention of helping the client avoid future chronic diseasesassociated with obesity. What client system and focus of care are being applied in thissituation?a. Family level health promotionb. Individual level illness preventionc. Aggregate level illness preventiond. Individual level health promotion: 68 / 72The simplest level of the client system is the individual.The focus of care is illnessprevention, directed at disease or disability prevention.175. A public health nurse collaborates with a physicians clinic to increasethe number ofinfants and toddlers who receive lead screening. Accordingto the integrative model, whatclient system and focus of care are being addressed?a. Aggregate level health promotionb. Aggregate level illness preventionc. Family level illness cared. Individual level health promotion: Each succeeding level of the client system is more complex. In this situation, thepublic health nurse is working with an aggregate of infants and toddlers.The focusof care being addressed is health promotion, focusing on positive measures suchas education for healthy living and promotion of favorable environmental conditionsas well as periodic examinations, including well-child developmental assessmentand health education.176. Which intervention is being performed on the individual level? Select allthat apply.a.Teaching well-balanced nutrition to a mother with a malnourished childb. Providing a parent age-specific information for immunizationsc. Assessing the community for other cases of malnutritiond. Assessing other families on the same street for similar problems: ,BTeaching well-balanced nutrition and age-specific information about immuniza- tions are the only interventions that focus on individuals.The other examples relateto families and the community.69 / 72177. Which statement about Florence Nightingale's ideas about ethics iscorrect?a. Nursing is a call to service, and the moral character of persons enteringnursing isimportant.b. Ethical principles are based on the values of the individual nurse.c. Society will dictate the ethical principles to which nurses must adhere.d. Ethics are very important in times of war,such as in the CrimeanWar,whenshe set up publichealth centers.: Florence Nightingale saw nursing as a call to service and viewed the moralcharacter of persons entering nursing as important.178. When nurses apply the knowledge and processes of ethics to the exam-ination of ethicalproblems in health care, they are using:a. Valuesb. Moralityc. Ethicsd. Bioethics: Bioethics applies the knowledge and processes of ethics to the examination ofethical problems in health care.179. A nurse in the 1960s would have referred to which code of ethics toguide ethicaldecision making?a. Nightingale Pledgeb. Code for Professional Nursesc. Code of Ethics for Nurses with Interpretive Statementsd. International Council of Nurses (ICN) Code of Ethics for Nurses: FlorenceNightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code ofEthics for Nurses with Interpretive Statements wasadopted in 2001, and the International Councilof Nurses (ICN) Code of Ethics forNurses was adopted in 2000.70 / 72180. An orderly process that considers ethical principles, client values, andprofessionalobligations is:a. Accountabilityb. Ethical decision makingc. Moral principlesd. Code for Nursing Practice: Ethical decision making is defined as an orderly process that considers ethicalprinciples, client values, and professional obligations.181. The growing multiculturalism of American society can contribute toethnicityconflicts when:a. Cultural standards are congruent with professional standards.b. Cultural traditions within an ethnic group align with those of the commu-nity.c. Ethnic groups overburden the health care system.d.The greater communitys values are jeopardized by specific ethnic values.- : Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in Americanculture.182. There are two medically indigent clients in the clinic who have come to get theirmonthly supply of free insulin. There is only enough for one client. Which action does thenurse take first?a. Identify all options.b. Make a decision.c. Gather additional information.d. Act and assess decisions made.: One must have all information before looking at options and making a decision.183. An example of an ethical dilemma is:71 / 72a. Whether or not to set up a community health center in a rural areab. Allocating resources in a natural disasterc. Deciding to withdraw care on a hospice patientd. Applying the principles of Florence Nightingale in Bangladesh: When resourcesare scarce, a dilemma may exist as to how to allocate them.184. The steps of the ethical decision making process are similar to the stepsof:a. Healthy People 2010 b. Deontology c.The nursing process d. Advocacy: The nursing process involves the same basic steps: assessment, diagnosis, plan-ning, implementation, and evaluation.185. Which ethical principle requires doing no harm?a. Respect for autonomyb. Non-maleficencec. Beneficenced. Distributive justice: Non-maleficence refers to doing no harm.186. Which statement fits the Liberal DemocraticTheory of John Rawls?a. Rejection of any idea that societies, states, or collectives of any form canbe the bearers ofrights or can owe duties.b. Inequalities result from birth, natural endowment, and historic circum-stances.c. Everyone has a right to private property.d. Government should be limited.: Rawls acknowledges that inequities are inevitable in society, but he tries to justifythem by72 / 72establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.187. According to Leininger and Watson, the moral ideal of nursing is:a. Caringb. Advocacyc. Responsibilityd. Accountability: This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice frommedical practice.188. Which statement about feminist ethics is correct?a. Feminists include only women in their worldview.b. Persons who ascribe to feminist ethics are passive and wish to pursuetheir idealsthrough the legislative process.c. Feminists believe that men should not be nurses.d. Womens thinking and moral experiences are important and should betaken into account.: Feminist theory ascribes to the idea that womens thinking and moral experiencesare important and should be considered.189. Examples of the benefits of distributive justice are:a. Basic needs, material and social goods, liberties, rights, and entitlementsb. Taxes, military service, location of incinerators or power plantsc. Entitlement to equal rights and equal treatmentd. The right to private property and personal assets: Justice requires that the distribution of benefits and burdens on a society be fair or equal. the third option refers to egalitarianism, and the last option refers to libertarianism.Taxes, military service, and location of incinerators or power plantsare not benefits associated with justice.73 / 72190. A nurse believes everyone is entitled to equal rights and equal treatmentin society whenapplying:a. Distributive or social justiceb. Egalitarianismc. Libertarian view of justiced. Communitarianism: Egalitarianism is defined as the view that everyone is entitled to equal rights andequal treatment in society.191. When using the principles of virtue ethics in decision making, a nursewould:a. Provide efficient and effective nursing care.b. Identify the meaningful facts in the situation.c. Seek ethical community support to enhance character development.d. Plan ways to restructure the social practices that oppress women.: ANS:CAccording to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. Onepart of the process is seeking ethical community support to enhance character development.192. A nurse applies the ethical principle of non-maleficence when:a. Administering medications using the five rightsb. Allowing clients to be active participants in their carec. Providing patient privacy when delivering cared. Referring a client to a physical therapist: Non-maleficence requires that one do no harm. It requires that health care profes- sionals act according to the standards of due care, always seeking to produce theleast amount of harm possible.193. A nurse providing care using the idea of servicing citizens, not cus-tomers isapplying the:a. Ethical tenets of policy development74 / 72b. Basic concepts of the feminist theoryc. Underlying premise of virtue ethicsd. Components of distributive justice: There are three tenets of both policy and ethics.The approach is based on thevoice of the community as the foundation on which policy is developed.194. Public health administrators in a community provide a health depart- ment to serve anindigent population of immigrants providing translators oncertain days of the week.This is anexample of:a. Policyb. Qualityc. Assuranced. Libertarian philosophy: Assurance refers to the role of public health in making sure that essential commu- nity-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them.195. Which core function supports the belief that all Americans should re-ceive basichealth care services?a. Assessmentb. Assurancec. Policy developmentd. Advocacy: Assurance purports that all persons should receive essential personal healthservices.196. Which statement is discussed in the Code of Ethics for Nurses withInterpretiveStatements?a.The profession of nursing is responsible for making political statementsand supporting nurse-friendly candidates for office.75 / 72b. The nurses primary focus is on acute bedside nursing, followed by com-munity healthcare to promote seamless care.c. The nurse owes duty primarily to the physician to strive to protect health,safety, and therights of the patient.d. The profession of nursing is responsible for articulating nursing values,for maintainingthe integrity of the profession, and for shaping social poli-cy.: Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concernsas well as be involved with shaping policies through political action.197. Why would a nurse refer to the Code of Ethics for Nurses or the PublicHealth Code ofEthics?a.To provide answers for ethical dilemmasb. To guide professional practice related to ethicsc.To increase moral leadership in ethicsd. To find a framework for ethical decision making: These codes provide general ethical principles and guide personnel in thinkingabout the underlying ethics of the profession.198. Which nursing action demonstrates advocacy?a. Offering a smoking cessation programb. Screening for hypertensionc. Lobbying for health care reformd. Conducting home visits: Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, efficient health care for all.199. The community leaders in a lesser-developed country decide not to tellthe citizens of asmall village about a chemical spill at a major industrial fa-cility that could produce harmfuleffects.Which principle are they violating?76 / 72a. Policyb. Advocacyc. Caringd. Virtue: Advocacy requires that the community be properly informed, and this was violated in the above scenario.200. The ethical tenets that underlie the core function of assessment are(select all thatapply):a. Competency: the persons assigned to develop community knowledge areprepared to collectdata on groups and populationsb. Moral character:the persons selected to develop,assess,and disseminatecommunityknowledge possess integrityc. Service to others over self: a necessary condition of what is good or rightpolicyd. Do no harm: disseminating appropriate information about groups andpopulations ismorally necessary and sufficient: , B, DService to others over self is an ethical tenet of policy development. Competency, moral character, and do no harm are the ethical tenets of assessment.201. How can a community health nurse apply the Ethical Principles forEffectiveAdvocacy? Select all that apply.a. Act in the health care providers best interest.b. Keep the client (group, community) properly informed.c. Maintain client confidentiality.d. Carry out instructions with diligence and competence.: Keep the client (group, community) properly informed, maintain client confidential-ity, and carry out instructions with diligence and competence are ethical principlesfor effective advocacy202. Why is it important for nurses to understand the premises of environ-mental health?77 / 72a. Nurses should be able to assess risks and advocate for policies thatsupport healthyenvironments.b. Toxicologists often consult nurses about environmental pollutants.c. Pollutant exposures such as lead are reported by nurses to the Environ-mentalProtection Agency.d. Many Americans live in areas that do not meet current national air qualitystandards.: Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments.203. Environmental health is important to nurses because chemical, biolog-ical, andradiological materials are:a. A major cause of global warmingb. Often found in the air, water, and products we usec. Frequently linked to the development of chronic illnessesd. Products that nurses work with on a daily basis: Chemical, biological, and radiological pollutants are often found in the air webreathe, the water we drink, and the products we use.204. How have nurses historically learned to identify a possible relationshipbetweenenvironmental chemical exposures and their potential harm?a. Extrapolation by toxicologistsb. Biomonitoringc. Completing chemistry coursesd. Observing signs and symptoms in clients: Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity.Thefirst two options are modern methods.205. The basic science applied to understanding the health effects associat-ed with chemicalexposures is:78 / 72a.Toxicology b. Pharmacology c. Chemistryd. Environmental epidemiology: Toxicology is the study of the health effects associated with chemical exposures.206. Epidemiology:a. Is a science that studies the poisonous effects of chemicalsb. Explains the association between learning disabilities and exposure tolead-based paintat the cellular levelc. Helps nurses understand the strength of the association between expo-sure and healtheffectsd. Is a method for tracking the prevalence of a disease: Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects.207. A public health nurse is working with a migrant farm worker who has experienced anexposure to a pesticide. When researching pesticides, the nurse looks at the family of thechemical.What similarities are found amongchemicals that have been placed in the samefamily?a. Route of entry into the bodyb. Actions and associated risksc. Effects that they have on the bodyd. Potency and toxicity: Chemicals are grouped so its possible to understand the actions and risks asso-ciated with each group.208. A public health nurse is organizing a multidisciplinary team to address the issue ofwater pollution in the community. The most likely members that would be invited to addressthis issue would be:79 / 72a. Physicians, water sanitation workers, and occupational therapistsb. Pharmacologists, radiologists, and epidemiologistsc. Nurse practitioners, pharmacologists, and environmentalistsd. Geologists, meteorologists, and chemists: Scientists who study how pollutants travel in air, water, and soil are geologists,meteorologists, and chemists.209. Which example contains the components necessary to form an epidemi-ologic triangle?a. Pesticides, water, foodb. Lead, mercury, soilc.Trichloroethylene, water, infantsd. Children under 12, elderly, temperature: The epidemiologic triangle consists of an agent (chemical), host (communityconsisting of several variants), and environment (air, water, soil,210. An example of a point source of air pollution is:a. A smoke stackb. The number of cars and trucksc. How much fossil fuel is consumed in a communityd. Ground ozone levels: Point sources of pollution are identifiable sources of air pollution, such as a smokestack.211. Which is considered a nonpoint source of pollution?a. Hazardous waste siteb. Animal waste from wildlifec. Chlorine poured down a welld. Stagnant water: Point source means a single place from which the pollutant is released into the environment,80 / 72whereas nonpoint source implies a more diffuse source of pollution.212. If a nurse wanted more information on indoor air quality, which websitewould be mosthelpful?a.The National Institutes of Health (NIH)b. The American Lung Associationc. Right to Knowd. The Occupational Safety and Health Administration (OSHA): Sources ofinformation about air quality include the Environmental ProtectionAgency (EPA) and theAmerican Lung Association.213. A nurse is completing an exposure history using the mnemonic I PRE- PARE. Whatdata would a nurse collect when asking questions about the firstP?a. Present workb. Potential exposuresc. Personal protective equipment used. Problems with health:Present work is the first P.214. A nurse fulfills the environmental health competency of assessment andreferral when:a. Advocating for public policy changesb. Understanding policy framework and major pieces of legislationc. Completing an environmental health historyd. Describing the scientific principles about environmental health: Assessment isalways an important element of the nursing process. The third option is an example of theassessment phase of the nursing process.215. The greatest single source of air pollution in the United States is from:81 / 72a. Waste incinerationb. Power plantsc. Motor vehiclesd. Molds: Waste incineration and power plants are major contributors after motor vehicles.Molds contribute to poor indoor air quality.216. Which environmental law sets basic structure for regulating pollutantsto UnitedStates waters?a. Safe Drinking Water Actb. Toxic Substance Control Actc. Clean Water Actd. Pollution Prevention Act: The Clean Water Act sets basic structure for regulating pollutants to United Stateswaters.217. Employees working with hazardous chemicals have the right to knowabout thechemicals they are working with through the creation of the:a. Material Safety Data Sheetb. Consumer Confidence Reportc. Hazard Communication Standardd. Environmental Protection Agency: This standard requires employers to maintain a list of all hazardous chemicals thatare used on site.218. A nurse is addressing the problem of air pollution in the community.Thefirst step in theprocess of controlling the pollution would be:a. Setting standardsb. Monitoringc. Permittingd. Compliance: Permitting is a process by which the government places limits on the amount ofpollution emitted82 / 72into the air or water.219. An acceptable level of emissions or a maximum contaminant levelallowed is an exampleof which environmental protection strategy?a. Controlling pollutionb. Waste minimizationc. Land use planningd. Environmental standard: An example of an environmental standard is an acceptable level of emissions or amaximum contaminant level allowed.220. An inspection of a facility after a permit is obtained for the purpose of observingwhether the plans submitted in the permit application are being implemented as approved isan example of which environmental protectionstrategy?a. Controlling pollutionb. Waste minimizationc. Land use planningd. Environmental monitoring: Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are beingimplemented as approved.221. Which question would a nurse ask during the first phase of a riskassessment?a. Has the chemical been released into the environment?b. How much and by which route of entry can the chemical enter the body?c. Is the chemical known to be associated with a negative health effect?d. What is the prediction for potential harm?: The first phase is determining if a chemical is known to be associated with negativehealth effects (in animals or humans).222. What action can a nurse take on an individual level to reduce pollutionin theenvironment?83 / 72a. Provide a tax incentive to factories that do not pollute.b. Make laws related to allowed levels of pollution in the area.c. Choose a less-polluting car.d. Move to an area with less pollution.: Citizens can reduce air pollution by doing their part, which can include choosingless-polluting cars.223. When would it be appropriate for a nurse to use a Geographic Informa-tion System(GIS)?84 / 72a. Recording client data collected at a foot clinicb. Determining neighborhoods that have an increased incidence of leadpoisoningc. Evaluating effectiveness of a farm safety programd. Scheduling health promotion programs in the community: The use of a Geographic Information System (GIS) allows the public health nurseto apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determiningconcentrated areas for incidence of disease and illness.224. Which approach(s) can a nurse use when assessing environmentalhealth risks?Select all that apply.a. Ask legislators to provide a list of environmental pollutants in the area.b. Develop a list of exposures associated with urban, rural, or suburbansettings.c. Assess the risk by medium such as air, water, soil, or food.d. Divide the environment into functional locations:home,school,workplace,and community.:, C, DThe 2nd, 3rd, and 4th options are ways a nurse can assess the environment.225. A public health nurse working with a family living in poverty recognizesthat they aremore likely to be exposed to environmental hazards because they have (select all that apply):a. Limited funds to pay for health careb. Poor nutritionc. Homes located closer to hazardous waste sitesd. Less education: Families living in poverty are more likely to experience environmental justice issuessuch as disproportionate environmental exposures. Sub-standard housing, livingcloser to hazardous waste sites, working in more hazardous jobs, poorer nutrition,and less access to quality health care all contribute to this issue. Although limitededucation is related to poverty, it is not discussed as causing an increase in environmental exposure.226. 1. The population group that is likely to be the MOST vulnerable is:85 / 72a. children with a family history of sickle cell disease and hypertension.b. homeless pregnant teens in a substance abuse program.c. nNative Americans at risk for diabetes.d. overweight children.: A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, theinteraction among many variables creates a more powerful combination of factorsthat predispose the person to illness.Vulnerable populations often experience mul- tiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poorand homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictivesubstances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiencyvirus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).227. 2. In an effort to decrease health disparities and improve life expectancy,the SocialSecurity Act was amended in 1998 to provide federal funding to:a. assure access to health care for elderly Americans.b. build hospitals to care for the medically indigent.c. insure children without health insurance.d. provide supplementary income for citizens with disabilities.: Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently unin- sured children. Legislation enacted subsequently provided for new outreach andcase-finding efforts to enroll eligible children in Medicaid.228. 3. Vulnerability is multidimensional,and one of the primary contributorstovulnerability is:a. gender.b. race and ethnicity.86 / 72c. resource limitations.d. urban or rural residency.: Resource limitations are strongly related to health. Lack of adequate social, edu- cational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status(e.g., income, education, and occupational status) and a range of health indicators(e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-levelcharacteristics such as income inequality also make a difference. Resource lim- itations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.229. 4. A nurse providing a tertiary prevention intervention to a populationof womenwho are HIV positive will most likely:a. educate about self-care and the women's rights as employees.b. establish a partnership with a community to initiate a community healthcenter.c. help identify new cases and ensure that clients receive proper treatment.d. teach how to lobby state legislators.: Helping clients understand their rights to protect from on-the-job discrimination ispart of the nurseadvocate role.Tertiary prevention includes educating women witha chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levelsof self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.230. 5. After performing an assessment of a client seeking treatment for hypertension atthe local free clinic, the nurse informs the client that the family's children may qualify forenrollment in the state children's health insurance program.The nurse provides theenrollment forms and reviewsthem with the client, emphasizing how to apply for thebenefits. This bestexemplifies which principle for intervening with vulnerable87 / 72populations?a. Carrying out primary preventionb. Setting family-centered, culturally sensitive goalsc.Trying to minimize the "hassle factor"d. Using the MAP-IT approach: Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensiveservices with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities.One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."231. 6. A community health nurse directly contacts a mammography clinic toarrange anappointment for a migrant worker with limited English languageskills. The nursecommunicates with the client through an interpreter to ensure that the appointment isscheduled to meet her needs and that the client understands the procedure to be performed.The role played by the nurse in this encounter with a member of a vulnerable population canbest be described as:a. advocacy.b. empowerment.c. partnership.d. social justice.: The nurse functions as an advocate when referring clients to other agencies andensuring that the clients' preferences are accommodated.232. 7. Health education is often used as a strategy in working with vulnera-ble populations.The benefits of health education can be greatly affected bythe individual's or group's:a. cycle of dependency.b. health literacy.c. level of income.88 / 72d. race and ethnicity.: A new concern for public and community health nurses is whether the populationswith whom they work have adequate health literacy to benefit from health educa-tion. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.233. 8. Congress passed the Balanced Budget Act of 1997 with provisions intended toensure the appropriateness of home health services for those who received them; however,the act may have increased health disparitiesfor vulnerable populations such as:a. frail older adults.b. low-income families with newborns.c. poor clients discharged from acute care.d. clients requiring intravenous antibiotics.: One objective of the balanced Budget Act of 1997 was to curb the rapid growth ofhome health spending and financial fraud in the home health industry following ashift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Respon-sibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups,such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.234. 9. An unemployed individual with acquired immune deficiency syn- drome (AIDS)develops recurrent opportunistic infections that require re-peated visits to the health clinicand the purchase of various medicationsto combat the infections and treat their associatedside effects. This best demonstrates how the stress caused by poor health status can berelatedto:a. barriers to access.b. cascade effects.c. cumulative risk.d. socially based inequity.: 89 / 72Poor health status creates stress.Vulnerable populations cope with multiple stres-sors, and this creates a cascade effect, with chronic stress likely to result. Chron-ic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lackof insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status.The outcomes of vulnerability reinforce the predisposing factors,which leads to more negative outcomes.This cycle of vulnerability must be brokenin order for vulnerable populations to change their health status.235. 1. Vulnerable population groups are those that, in comparison with thepopulation as awhole, have which of the following characteristics? (Selectall that apply.)a. Better access to health care services but poor health outcomesb. Greater likelihood of exposure to risk factorsc. Multiple risk factors but equal health outcomesd. Worse health outcomes: Vulnerable populations are defined as those at greater risk for poor health statusand health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they areat risk. A vulnerable population group is a subgroup of the population that is morelikely to develop health problems as a result of exposure to risk or to have worseoutcomes from these health problems than the rest of the population.