Test Bank for Community and Public Health Nursing 10th Edition by Rector & Stanley

Chapter 1 The Journey Begins: Introduction 1.

After teaching a group of nursing students about the similarities and differences between public health and community health, which of the following statements by a nursing student would indicate knowledge of the similarities and differences between public health and community health?

A) “Community health nursing is defined as nursing care that is provided in a community setting, rather than an institutional setting.”

B) “Public health nursing is defined as nursing care that is provided in an institutional setting.”

C) “Public health nursing is focused on the health of individuals.”

D) “Community health nursing can shape the quality of community health services and improve the health of the general public.”

Ans: D Feedback: Operating within an environment of rapid change and increasingly complex challenges, this nursing specialty holds the potential to shape the quality of community health services and improve the health of the general public.

2.

Which of the following statements would best describe the difference between public health nursing and community health nursing?

A) Public health nursing is focused on the private aspects of health, and community health nursing is focused on the public aspects of health.

B) In our textbook, the term community health practice refers to a focus on specific, designated communities and is a part of the larger public health effort.

C) Public health nursing and community health nursing relate to the very same types of services and perspectives.

D) Both public health nursing and community health nursing are practiced exclusively within institutions.

Ans: B Feedback:

In this textbook, community health practice refers to a focus on specific, designated communities. It is a part of the larger public health effort and recognizes the fundamental concepts and principles of public health as its birthright and foundation for practice. Public health nursing is focused on the public aspects of health. Public health nursing and community health nursing have distinctive types of services and perspectives. Neither public health nursing nor community health nursing is practiced exclusively within institutions.

3.

Which of the following is most accurate about the concept of community?

A) A community is a collection of people who share some important features of their lives.

B) Community members live in the same geographic location.

C) Community members are biologically related.

D) A community is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

Ans: A Feedback: The broad definition of a community is a collection of people who share some important features of their lives. Community members may not live in the same geographic location as in a common-interest community or a community of solution. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

4.

A group of students are reviewing material for a test on populations, communities, and aggregates. Which of the following indicates that the students understand these concepts?

A) Members of a population share a sense of belonging.

B) Communities and populations are types of aggregates.

C) Individuals of a community are loosely connected.

D) Members of an aggregate share a strong bond.

Ans: B Feedback: An aggregate refers to a mass of grouping of distinct individuals who are considered as a whole and who are loosely associated with one another. Communities and populations are types of aggregates. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to the group. A community is a

collection of people who chose to interact with one another because of common interests, characteristics, or goals, which form the basis for a sense of unity or belonging.

5.

Which of the following would a community health nurse identify as a community of common interest?

A) The global community B) C) D) Ans:

Small rural town in a northern state National professional organization Counties addressing water pollution C Feedback: A common-interest community shares a common interest or goal that binds the members together. Membership in a national professional organization is one example. The global community and a small rural town in a northern state would be examples of a geographic community. Counties addressing a water pollution problem would be an example of a community of solution.

6.

The nurse is working with a community of solution. Which of the following would the nurse expect to find?

A) A health problem affecting the group B) Common goal binding members together C) Sharing of a similar goal D) Locational boundaries Ans: A Feedback: A community of solution involves a group of people coming together to solve a problem that affects them. A common-interest community involves a collection of people widely scattered geographically who have an interest or goal that binds the members together. A geographical community is one defined by its geographical or locational boundaries.

7.

Which one of the following statements made by a student would the nurse educator recognize as evidence that a student understands the health continuum?

A) The distinction between health and illness is well demarcated.

B) Illness refers to a state of being relatively unhealthy.

C) The term health is limited to reflect an individual's state.

D) Treatment of acute conditions reflects the current focus of health care.

Ans: B

Feedback: Although society typically depicts an absolute line of difference between being either well or ill, health is considered a relative term. Thus, illness is viewed as a state of being relatively unhealthy. Health is typically described as a continuum that involves a range of degrees from optimal health at one end to total disability or death at the other. The line of demarcation is not clear. Health applies to individuals, families, and communities.

Traditionally, most health care has focused on the treatment of acute and chronic conditions at the illness end of the continuum, but this emphasis is shifting to focus on the wellness end.

8.

When discussing the concept of the health continuum with a class, the nurse educator would be certain to include which statement in the description?

A) Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy.

B) A client's placement on the health continuum is static throughout time.

C) Health is best described as cyclic.

D) The health continuum can only be applied to individuals.

Ans: A Feedback: Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. The continuum can change. Because health involves a range of degrees from optimal health at one end to total disability or death at the other, it is often described as a continuum. The health continuum applies not only to individuals but also to families and communities.

9.

After discussing the leading health indicators with a class, which condition if stated by the class as one of these indicators suggests that the class has understood the information?

A) Cardiac disease B) Mental health C) Sedentary lifestyle D) Maternal health care Ans: B Feedback: Mental health is a leading health indicator. Other leading health indicators include physical activity, overweight and obesity, tobacco use, substance use, responsible sexual behavior, injury and violence, environmental quality, immunization, and access to health care.

10.

Which of the following statements about health promotion and disease prevention is the most accurate?

A) Health promotion and disease prevention include all efforts that seek to move people closer to optimal well-being or higher levels of wellness.

B) Disease prevention differs from health promotion in that disease prevention is targeted toward a specific disease or diseases.

C) Health promotion can be described in terms of primary, secondary, and tertiary prevention.

D) The goal of disease prevention is to raise levels of wellness for individuals, families, populations, and communities.

Ans: B Feedback: Health promotion includes all efforts that seek to move people closer to optimal wellbeing or higher levels of wellness. The goal of health promotion is to raise levels of wellness for individuals, families, populations, and communities. Disease prevention is targeted toward a specific disease or diseases and consists of primary, secondary, and tertiary prevention.

11.

A group of community health nursing students design a health education program for a group of pregnant teens that includes teaching nutrition during pregnancy, demonstrating helpful exercises, and discussing their concerns. This is an example of which of the following?

A) Health promotion B) Treatment of disorders C) Rehabilitation D) Evaluation Ans: A Feedback: The student nurses are engaging in health promotion activities. Health promotion incorporates all efforts that seek to move people closer to optimal well-being or to higher levels of wellness. Treatment of disorders would include direct care for issues involving the group, such as complications that might arise in this population.

Rehabilitation would involve activities to minimize disability or restore or preserve function.

Evaluation would involve an analysis of the effectiveness of these activities.

12. plan of primary prevention activities. Which of the following might the nurse include?

Select all that apply.

A) Teaching about safe-sex practices to high

school students B) Encouraging older adults to install safety devices in the bathroom C) Providing regular immunization programs for communicable diseases D) Participating in cholesterol screening programs at health fairs E) Providing skin testing for tuberculosis for children over 1 year of age F) Working with a group testing water samples for contamination Ans: A, B, C Feedback: Primary prevention activities are those taken to keep illness or injuries from occurring.

These include teaching about safe-sex practices, encouraging older adults to use safety devices in the bathroom, and providing regular immunization programs for communicable diseases.

Cholesterol screening programs, skin tests for tuberculosis, and working with a group testing water samples for contamination are examples of secondary prevention activities.

13.

A community health nurse is preparing a presentation for a group of nursing students about community health nursing. Which of the following descriptions about community health nursing would the nurse most likely include in the presentation?

A) Focusing on addressing continuous needs B) Working with the client as an equal partner C) Engaging in tertiary prevention as the priority D) Encouraging clients to reach out to the nurse Ans: B Feedback: The community health nurse works with the client as an equal partner, encouraging autonomy. At any time, the nurse deals with continuous and episodic needs simultaneously.

Primary prevention is the priority for community health nurses. The community health nurse engages in primary prevention as the priority, having the obligation to actively reach out to all who might benefit from a specific activity or service.

14.

A community health nurse is working with other members of a team that will be implementing a citywide immunization program. The nurse is coordinating the services and addressing the needs of the population groups to ensure which of the following?

A) Involvement of the community B) Client participation C) Continuity of service D) Plan for follow-up Ans: C Feedback:

Working in cooperation with other team members and coordinating services and addressing the needs of population groups are essential to interprofessional collaboration. In doing so, the community health nurse is preventing fragmentation and gaps thereby ensuring continuity of service. Involvement of the community and client participation are important but these help to ensure that the clients are viewed as equal partners of the health care team. A plan for follow-up may or may not be appropriate. In addition, it is the only aspect that may be addressed with the program.

15.

A community health nurse works to ensure the greatest good for the greatest number of people by applying which of the following?

A) Secondary prevention activities B) Autonomy C) Justice D) Utilitarianism Ans: D Feedback: The ethical theory of utilitarianism promotes the greatest good for the greatest number.

Primary prevention activities, not secondary prevention, are the priority. Autonomy refers to the freedom of choice. Justice involves treating people fairly.

16.

When working in the community, the community health nurse adopts the teaching plan to ensure that the population understands the basic information provided to address which of the following?

A) Self-care B) Health disparities C) Health literacy D) Episodic needs Ans: C Feedback: Consumers are often intimated by health professionals and are uninformed about health and health care affecting the quality of care.

Adopting a teaching plan to ensure that the population understands the basic information addresses health literacy, the ability to read, understand, and use health care information appropriately. Doing so helps to ensure that the teaching plan will be effective. Self-care refers to the process of taking responsibility for developing one's own health potential by actively participating in promoting one's own health. Health disparities reflect differences in all aspects of health care related to vulnerable populations. Episodic needs are one-time specific negative health events that arise and are not an expected part of life.

17.

Which of the following would be crucial for the community health nurse to address as the priority when dealing with policy makers about the development of community health programs?

A) Research-based best practices B) Population's make up C) Amount of services to be provided D) Scarcity of the available resources Ans: A Feedback: Decisions for programs or services are often made on the basis of cost-effectiveness or cost–benefit. Therefore, community health nurses must provide policy makers with information about best practices, grounded in research. Although population make up, amount of services to be provided, and scarcity of resources are factors that may need to be considered, the community health nurse must demonstrate evidence-based practice.

18.

After a class that described the differences between acute care nursing and community health nursing, which statement by the class about community health nurses indicates successful teaching?

A) Use a reactive approach.

B) Seek out potential health problems.

C) Concentrate on the illness end of the continuum.

D) Emphasize curative care.

Ans: B Feedback: Community health nurses, in contrast to acute care nurses, seek out potential health problems, identifying high-risk groups and instituting preventive programs; use a proactive approach; concentrate on the wellness end of the health continuum; and put less emphasis on curative care.

19.

Which of the following activities would be associated with a community health nurse?

Select all that apply.

A) Examining infants in a city well-baby clinic B) Caring for elderly stroke victims in their homes C) Providing emergency care in an acute care facility D) Carrying out epidemiologic research E) Participating in health policy analysis Ans: A, B, D, E Feedback: Community health nurses work in every conceivable kind of community agency, from a state public health department to a community-based advocacy group. Their duties rang from examining infants in a well- baby clinic or teaching elderly stroke victims in their homes to

carrying out epidemiologic research or engaging in health policy analysis and decision making.

Providing care in an acute care facility would not be an activity associated with a community health nurse.

20.

The term health can be described in many different ways. A community health nurse would view health as which of the following?

A) The absence of disease B) The potential to lead a productive life C) An environment free of toxins D) A holistic state of well-being Ans: D Feedback: Community health nurses view health as a holistic state of well-being, which includes soundness of mind, body, and spirit. Along with this foundational view is the emphasis on wellness, which includes the definition of health as well as the capacity to develop a person's potential to lead a fulfilling and productive life. Health is more than just the absence of disease or an environment free of toxins.

21.

While interviewing a client, which of the following statements would a nurse identify as reflecting an objective dimension of health?

A) “I'm feeling better since I started taking that medication.”

B) “Life is pretty good right now, except for an occasional upset stomach.”

C) “I'm able to wash myself in the mornings with just a bit of help.”

D) “Sometimes when I wake up, I don't even want to face the day.”

Ans: C Feedback: The objective dimension of health involves one's ability to function in daily activities.

The statement about being able to care for one's self is an example. The statements of feeling better with medication, life being pretty good, and not wanting to face the day are examples of the subjective dimension of health, which involves how people feel.

22.

When employing a population-oriented focus, the community health nurse would do which of the following?

A) Assess the groups' relationships looking for a common need.

B) Consider the members individually for

similarities.

C) Focus on the geographical area of the population.

D) Promote the groups' dependency for improving health.

Ans: A Feedback: A population-oriented focus requires the assessment of relationships, considering the groups or communities in relationship to the rest of the community to discover common needs or risks for a common health problem. The nurse does not consider the groups or communities separately but rather in context. The population may or may not be delineated by the geographical area. The community health nurse encourages individuals' participation to promote their autonomy rather than permitting dependency.

23.

A community health nurse is involved in a project to evaluate the health of a city. Which of the following findings would suggest that the city would most likely need additional programs?

A) Citizens are actively involved in the city's department of recreation and after-school programs.

B) The construction of affordable organized housing developments and communities is nearing completion.

C) Approximately one third of the people are recently unemployed due to closure of the automotive factory.

D) Several new recreational facilities for adults and children have been created at several locations.

Ans: C Feedback: A healthy city is one in which there is continual creation and improvement the physical and social environments with expansion of community resources so that people can mutually support one another. It is characterized by the meeting of basic needs for all of the city's people.

This would include food, water, shelter, income, safety, and work. Loss of employment of one third of the city's workforce would be a threat to the health of the city and necessitate intervention. Active involvement in the city's functioning, affordable housing, and recreational facilities are suggestive of a healthy city.

Chapter 2 Public Health Nursing in the Community 1.

A community health nurse is engaging in assurance activities. Which of the following would best explain these activities?

A) Gathering and analyzing information that will affect the health of the people to be served B) Providing leadership in facilitating community groups toward meeting their needs, often involving changes in and additions to existing laws C) Being involved in activities to make certain that necessary services are being provided to the community D) Accessing relevant data that enable identification of strengths, weaknesses, and needs within the community Ans: C Feedback: Assurance activities are those activities that make certain that services are provided and include focusing on the availability of necessary health services throughout the community, maintaining the ability of public health agencies and private providers to manage day-to-day operations as well as the capacity to respond to critical situations and emergencies. Assessment involves gathering and analyzing information that will affect the health of those to be served and accessing relevant data to enable the nurse to identify strengths, weaknesses, and needs. Policy development involves providing leadership in facilitating community groups.

2.

When fulfilling the function of assessment, which of the following would be most important for the community health nurse to do?

A) Secure the trust of the clients B) Gather appropriate information C) Interact with key community leaders D) Use a variety of assessment tools Ans: A Feedback: Although securing and maintaining the trust of others is pivotal to all nursing practice, it is even more critical when working in the community. Trust can afford a nurse access to client populations that are difficult to engage, to agencies, and to health care providers. As difficult as it may be for the nurse to gain the trust and respect of the community, if it is ever lost, these attributes can be difficult if not impossible to regain. Gathering information, interacting with key community leaders, and using a variety of assessment tools are important, but they can only occur after trust is established.

3.

The community health nurse is engaging in the core function of policy development.

With which of the activities would the nurse most likely be involved?

A) Monitoring health status to identify community health problems B) Empowering communities about important health issues C) Linking individuals to needed personal health services D) Ensuring a competent health care workforce is available Ans: B Feedback: With policy development, the community health nurse would be involved in informing, educating, and empowering people about health issues. Monitoring health status is associated with the assessment function.

Linking individuals to needed personal health services and ensuring a competent public health and personal health care workforce are associated with assurance.

4.

A community health nurse is collaborating with local community leaders to prepare a community disaster plan. Which function is the nurse fulfilling?

A) Research B) Assurance C) Policy development D) Assessment Ans: B Feedback: Community health nurses perform the assurance function at the community level when they collaborate with community leaders in the preparation of a community disaster plan.

Research is demonstrated by gaining new insights and innovative solutions to health problems.

Policy development would involve client information, education and empowerment, mobilization of community partnerships, and the development of plans and policies to support community health efforts. Assessment involves monitoring health status for community health problems and diagnosing and investigating health problems and hazards in the community.

5.

A community health nurse has collected data for several months on the birth weights of newborns to mothers who smoked throughout their pregnancy. This nurse is acting in which role?

A) Collaborator B) Manager C) Researcher D) Clinician

Ans:

C Feedback:

The nurse is assuming the role of a researcher, that is, engaging in systematic investigation that includes data collection. In the collaborator role, the nurse would work with numerous members of the health team, working jointly with others in a common endeavor. In the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations.

6.

A nurse in community health nursing setting works with police officers, social workers, health educators, and other nurses to promote the health of clients. The nurse is acting in which role?

A) Clinician B) Educator C) Researcher D) Collaborator Ans: D Feedback: The nurse is assuming the role of collaborator. In this role, the community health nurse works jointly with many individuals to benefit client care. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations. As an educator, the nurse is the health teacher and provides information to community clients. In the researcher role, the community health nurse engages in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.

7.

A community health nurse is interviewing for employment. The interviewer describes some of the typical activities that the nurse would be involved in, such as making home visits to families, holding immunization clinics for infants and children, and setting up flu-shot clinics for elders. The interviewer is describing which role?

A) Educator B) Advocate C) Clinician D) Manager Ans: C Feedback: The interviewer is describing direct care activities associated with the clinician role. As an educator, the nurse is the health teacher and provides information to community clients. In the advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals.

8.

A community health nurse is reviewing his or her schedule for the day. Included in his or her activities are planning client care, leading a staff conference, and supervising a new staff member. This nurse is fulfilling which role?

A) Advocate B) Manager C) Collaborator D) Researcher Ans: B Feedback: When functioning in the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals. Overseeing client care as a case manager, supervising ancillary staff, managing caseloads, running clinics, or conducting community health needs assessment projects are examples of activities associated with the manager role. In the advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the collaborator role, the nurse would work with numerous members of the health team, working jointly with others in a common endeavor. In the researcher role, the community health nurse engages in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.

9.

While providing care to a family at a local center, the community health nurse contacts the local department of social services to help the family attain assistance with health insurance coverage. The nurse also gives the family a list of pharmacies where they can get their prescriptions filled. The nurse is acting in which role?

A) Educator B) Leader C) Clinician D) Advocate Ans: D Feedback: The nurse is acting in the role of advocate, by pleading their cause and acting on their behalf. The nurse acts as an advocate by showing clients what services are available, the ones to which they are entitled, and how to obtain them. As an educator, the nurse is the health teacher and provides information to community clients. As a leader, the nurse directs, influences, or persuades others to effect change that will positively impact people's health and move them toward a goal. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations.

10.

Which of the following best exemplifies the attributes of a community health nurse in the researcher role?

A) Gaining the trust and respect of the staff members B) Interpreting abstract ideas so others can understand C) Implementing a staff development program for a technique D) Evaluating the correlation between variables in specific health conditions Ans: D Feedback: Attributes of a researcher include a spirit of inquiry, careful observation, analytic skills, such as evaluating the possible cause and effect of a situation, and tenacity. Gaining the trust and respect of staff, interpreting abstract ideas, and implementing a staff development program are examples of the management skills used in the role of manager.

11.

Which of the following statements about the role of educator within the framework of public health nursing functions is true?

A) The educator role has the potential for finding greater receptivity and providing higheryield results.

B) People are unable to recognize the value of health and are not well motivated to achieve higher levels of wellness.

C) It is only possible for a nurse to reach a limited number of persons.

D) The public's higher level of health consciousness hinders the educator's role.

Ans: A Feedback: The educator role has the potential for finding greater receptivity and providing higheryield results. People are recognizing the value of health and are increasingly motivated to achieve higher levels of wellness. With an emphasis on populations and aggregates, the educational efforts of community health nursing are appropriately targeted to reach many people.

One factor that enhances the educator role is the public's higher level of health consciousness.

12.

Which of the following statements about the importance of the role of collaborator is true?

A) Community health nurses frequently practice in isolation.

B) Successful community health practice depends on multidisciplinary collegiality and leadership.

C) Community health nurses must assert themselves as the most powerful person on the health care team to ensure each client receives services that are necessary.

D) It is best for community health nurses to focus on what they, as nurses, can do for their clients.

Ans: B Feedback: Community health nurses seldom practice in isolation. As collaborators, nurses work jointly with others in a common endeavor, cooperating as partners. Successful community health practice depends on multidisciplinary collegiality and leadership. The community health nurse's collaborator role requires skills in communicating, in interpreting the nurse's unique contribution to the team, and in acting assertively as an equal partner.

13.

Which of the following statements about the community health nurse's selection and practice of each role is true?

A) Within a given time, a community health nurse may practice multiple roles.

B) The knowledge that vulnerable populations need someone to guide them through the complexities of the health care system and the nurse can serve as an advocate for them C) The researcher role for community health nurses involves only the use of quantitative statistics.

D) The leadership role consists solely of managing staff.

Ans: B Feedback: Community health nurses wear many hats while conducting day-to-day practice. At any given time, however, one role is primary.

They need someone to guide them through the complexities of the system and assure the satisfaction of their needs. This is particularly true for minorities and disadvantaged groups.

Although research technically involves a complex set of activities conducted by persons with highly developed and specialized skills, research also means applying that technical study to real-practice situations. As leaders, community health nurses seek to initiate changes that positively affect people's health.

14.

A community health nurse is involved in education, screening, referral, and support for the individuals of a specific religious congregation. The nurse is practicing in which setting?

A) Occupational health nursing B) Faith community nursing C) School nursing D) Residential institution nursing Ans: B Feedback: In faith community nursing, the practice focal point is the faith community and the religious belief system provided by the philosophical framework. It may be called church-based health promotion, parish nursing, or primary care parish nursing practice. Occupational health nursing occurs in business and industry settings. School nursing, as the name implies, involves practicing in the school system, including from preschools to colleges and universities.

Residential institution nursing occurs in any facility where the clients reside such as a halfway house or continuing care center.

15.

Which of the following differentiates the home setting for community health nursing from other settings?

A) The nurse acts primarily as an educator.

B) The client is viewed within his or her environment.

C) Technologically advanced care is limited.

D) The home is being used less frequently today.

Ans: B Feedback: In the home, unlike most other health care settings, clients are on their own “turf,” such that the client is the host, comfortable and secure in familiar surroundings, and the nurse is a guest. Although education may be a major component of care in the home, all community health nursing roles are performed to varying degrees. In addition, technologically advanced care in the home is increasing in demand, with the home being the most frequently used setting for community health nursing.

16.

After teaching a group of students about the various settings for community health nursing, the instructor determines that this teaching was successful when the students identify which of the following as an example of ambulatory service setting?

A) Local preschool B) Halfway house C) Continuing care center D) Family planning clinic Ans: D

Feedback: Ambulatory service setting includes a variety of venues for community health nursing in which clients come for day or evening services that do not include overnight stays. One example is a family planning clinic. A local preschool would be an example of a school setting. A halfway house and continuing care center are examples of residential institutions.

17.

After teaching a group of students about the changing roles of the community health nurse in the occupational setting, the instructor determines that the students need additional teaching when they state which of the following?

A) Occupational health nurses are increasing their role as employee advocates.

B) Health education is a key function of the occupational health nurse.

C) There is a greater emphasis on the occupational health nurse's role as a clinician.

D) Collaboration with other health care providers fosters the offering of better services.

Ans: C Feedback: The clinician role was primary for many years, as nurses continued to care for sick or injured employees at work. However, recognition of the need to protect employees' safety and, later, to prevent their illness led to the inclusion of health education in the occupational health nurse role. Occupational health nurses also act as employee advocates, assuring appropriate job assignments for workers and adequate treatment for job- related illness or injury. They collaborate with other health care providers and company management to offer better services to their clients. They act as leaders and managers in developing new health services in the work setting, endorsing programs such as hypertension screening and weight control.

18.

A community health nurse is working as a lobbyist for health legislation for AIDS research at the state capital. This nurse is practicing in which setting?

A) Faith community B) Ambulatory service C) Residential institution D) Community at large Ans: D Feedback: The community at large is not confined to a specific philosophy, location, or building. It serves as the setting for practice of a nurse who serves on health care planning committees, lobbies for health legislation at the state capital, runs for a school board position, or assists with

flood relief in another state or country. Faith community nursing focuses on activities involving the faith community and religious belief system.

Ambulatory service settings include a variety of venues in which clients come for day or evening services that do not include overnight stays. Residential institutions include any facility where clients reside.

19.

Which of the following is included in the most accurate description of school nursing?

A) This is one community health setting where the role is static.

B) The primary role of school nurses is clinician.

C) The practice of school nurses is widening.

D) School nurses rarely act as advocates.

Ans: C Feedback: School nurses, whose primary role initially was that of clinician, are widening their practice to include more health education, interprofessional collaboration, and client advocacy.

20.

A community health nurse is assuming the role of a manager. Which function would be most important for the nurse to address first?

A) Planning B) Organizing C) Leading D) Controlling Ans: A Feedback: The management process incorporates a series of problem-solving activities or function: planning, organizing, leading, and controlling and evaluating. Although these activities occur simultaneously, they are sequential with planning being the first activity.

21.

A nursing student is interviewing a community health nurse about the various roles the nurse assumes and the skills and behaviors necessary to perform each role. Which of the following would the community health nurse identify as being essential to the role of an advocate? Select all that apply.

A) Assertiveness B) Ability to plan C) Ability to negotiate D) Risk taking E) Holistic view F) Questioning attitude Ans: A, C, D Feedback:

As an advocate, the community health nurse must be assertive, willing to take risks, be able to communicate and negotiate well, and be able to identify resources and obtain results. The ability to plan is associated with the manager role. A holistic view is critical to the community health nurse acting as a clinician. A questioning attitude is necessary for the role as a researcher.

22.

A community health nurse works in a busy community health nursing practice. Today, the nurse is devoting the day to the educator role. With which of the following activities would the nurse be involved? Select all that apply.

A) Planning seven home visits today B) Working on a new curriculum for high-risk teens C) Meeting with colleagues to discuss organizational changes in the office D) Ordering pamphlets over the Internet to be used in a parenting class E) Tabulating data from surveys distributed to elders during a flu-shot clinic F) Going to social services to speak up for a family in his or her caseload Ans: B, D Feedback: In the educator role, the nurse would work on a new curriculum for high-risk teens and order pamphlets for use in a parenting class. Planning seven home visits would be part of the clinician role. Meeting with colleagues to discuss organizational changes would be part of the manager role. Tabulating data from surveys would be part of the researcher role. Speaking up for a family in the nurse's caseload would be an example of the advocate role.

23.

A community health nurse is devoting the day to being a manager. Which activities would the nurse expect to perform? Which of the following activities are part of this role?

Select all that apply.

A) Orienting three new community health nurses in the agency B) Attending a strategy meeting for a new service the community will be offering C) Working with a team to direct a smoking cessation program in public areas D) Investigating an outbreak of Salmonella in the community E) Tabulating the findings of exploring immunization practices among teens F) Reviewing the staff evaluations to assist with planning future in-services Ans: A, B, F

Feedback: As a manager, a community health nurse would be involved in orienting new nurses in the agency, attending meetings for new services to be offered, and reviewing staff evaluations.

Working with a team to direct a smoking cessation program in public areas exemplifies the leadership role. Investigating an outbreak of Salmonella and tabulating the findings of immunization practices depict the researcher role.

24.

Of all the nursing roles assumed by community health nurses, which role must be assumed in every situation?

A) Researcher B) Manager C) Leader D) Clinician Ans: B Feedback: The type and number of roles that are practiced vary with each set of clients and each specific situation, but the nurse should be able to successfully function in each of these roles as the particular situation demands. The role of manager is one that the nurse must play in every situation, because it involves assessing clients' needs, planning and organizing to meet those needs, directing and leading clients to achieve results, and controlling and evaluating the progress to ensure that the goals and clients' needs are met.

25.

Which of the following are core values of professional behavior that are unique to public health nursing? Select all that apply.

A) Community/population as client B) Prevention C) Rehabilitation D) Partnership E) Healthy environment F) Ans:

Diversity A, B, D, E, F Feedback: Core values of professional behavior emphasize community/population as client, prevention, partnership, healthy environment, and diversity. Rehabilitation is not population centered.

Chapter 3 History and Evolution of Public Health Nursing 1.

A group of students are reviewing the various historical events associated with the evolution of community health nursing in preparation for a test. They identify the time from 1970 to the present as the era known as community health nursing based on the understanding that which of the following influences contributed most to this change?

A) The settings and the nurses delivering health care in the community B) Decisions made by the American Nurses Association C) Decisions made by physicians in a variety of community settings D) The demand to eliminate the word “public” from health services Ans: A Feedback: The numbers, increasing variety of settings, and many nurses coming to work in the community settings since the 1970s have contributed most significantly to the change. As a result, professional associations supported the broader term of community health nursing.

Physician decisions played no role in the change. The term public health nursing still remains.

2.

Before the mid-1800s, early home care nursing was best recognized by which of the following?

A) Technical advances with the Industrial Revolution making major changes B) Care provided by family members, friends, and religious groups in the home C) Accomplishments stemming from the work of Florence Nightingale D) Formal organization of visiting nursing to provide care to the sick poor Ans: B Feedback: Before the mid-1800s, early home care was characterized by care of the sick in the home by family members, friends, and religious groups. Technical advances came after 1850, as did the work of Florence Nightingale and the formal organization of visiting nurses to provide care to the sick poor.

3.

Community health nursing has a long history of contributing to the health of populations.

Which of the following forms of service would the nurse identify as being most recent?

A) Voluntary home nursing care for the sick poor via district nursing B) Care provided termed public health nursing C) Lay and religious groups providing care to the sick poor in their homes D) Focus on populations with community health nursing seen as a specialty field Ans: D

Feedback: The four stages of community health nursing followed from lay and religious groups providing care in the early years before 1850, the more specialized “health nurses” or district nursing after the mid-1800s, concern for the health of the general public from 1900s to 1970, and finally community health nursing as a specialty with a focus on populations since 1970.

4.

Which factor was the most significant feature associated with district nursing?

A) Caring for the sick B) Teaching hygiene and cleanliness C) Preventing illness D) Gathering statistical data Ans: B Feedback: Although district nurses primarily cared for the sick, they also taught cleanliness and wholesome living to their clients. This early emphasis on prevention and health became one of the distinguishing features of district nursing and later of public health nursing.

Preventing illness and gathering statistical data were key contributions of Florence Nightingale during the Crimean War of the early 1850s.

5.

In their early stages, district nursing was sponsored by which of the following?

A) Religious organizations B) Private philanthropy C) Contributions D) Public funding Ans: A Feedback: Early district nursing services were founded by religious organizations that served as their sponsors. Later sponsorship shifted to private philanthropy. Funding came from contributions and fees charged to clients on an ability-to-pay basis. Finally, visiting nursing began to be supported by public money.

6.

Which of the following would characterize the public health stage of community health nursing?

A) Voluntary health agencies emphasizing disease prevention B) Family considered as the primary unit of care C) Service provision to the sick poor population D) Primary health care as the key to health for all

Ans:

B Feedback: The public health nursing stage was characterized by service to the public, with the family targeted as a primary unit of care. Official health agencies, which placed a greater emphasis on disease prevention and health promotion, provided the chief institutional base.

Primary health care as the key to health for all characterizes the community health nursing stage.

7.

At which time did the focus of district nursing broadened to include the health and welfare of the general public?

A) Beginning of 20th century B) In the late 19th century C) Prior to the 1850s D) By the early 1970s Ans: A Feedback: The focus of district nursing broadened to include the health and welfare of the general public by the beginning of the 20th century or the early 1900s. In the late 19th century, district nurses were ill-prepared to cope with their clients' multiple health and social problems resulting from widespread immigration and filled tenement housing that led to inadequate sanitation, unsafe and unhealthy working condition, and barriers adding to poverty and disease. District nursing did not develop until after 1850. The early 1970s is associated with the emergence of community health nursing.

8.

A student is planning a presentation about the evolution of public health nursing. As part of the presentation, the student would identify which person as being the first one to use the term “public health nursing”?

A) Jessie Sleet B) Lillian Wald C) Lina Rogers D) Margaret Sanger Ans: B Feedback: Lillian Wald, a leading figure in the expansion of district nursing, was the first to use the term “public health nursing” to describe the specialty. Jessie Sleet was credited as being the first Black public health nurse. Lina Rogers was credited with being the first school nurse. Margaret Sanger was the nurse who opened the first birth control clinic in America that eventually resulted in the formation of the International Planned Parenthood Federation.

9.

Which of the following are important contributions made by Lillian Wald to the profession of public health nursing? Select all that apply.

A) Demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children B) Promoting the use of birth control C) Convincing the Metropolitan Life Company that nurse intervention could reduce death rates D) Providing rural “frontier nursing” to serve mountain families in Kentucky E) Founding the National Organization for Public Health Nursing (NOPHN) Ans: A, C, E Feedback: Lillian Wald contributed to the profession of public health nursing by demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children, convincing the Metropolitan Life Company that nurse intervention could reduce death rates, and Founding the National Organization for Public Health Nursing (NOPHN).

10.

After a class discussion about the contributions of Lillian Wald to the advancement of community health nursing, which of the following if stated by the class indicates that the discussion was effective?

A) Establishment of family-centered nursing and outreach services in New York City at the turn of the 20th century B) Use of clean and safe nursing care practices to soldiers during the Crimean War in the 1850s C) Assistance to high-risk populations experiencing tropical diseases in Central America and the Caribbean in the late 1800s D) Creation of home nursing services in London, marking the beginning of district nursing in the 1860s Ans: A Feedback: Lillian Wald worked with immigrant families in the Lower East Side of New York City, providing home visits, a neighborhood center, and general sanitation improvement for families

and health care services to children in schools. Florence Nightingale was responsible for providing clean and safe nursing care practices to soldiers during the Crimean War. Mary Seacole helped high-risk populations who experienced tropical diseases in Central America and the Caribbean. William Rathbone was responsible for establishing a visiting nurse service for the sick in London.

11.

A group of nursing students are studying for an examination on influential nursing leaders involved in the advancement of community health nursing. The students demonstrate that they are prepared for the examination when they identify which person as the first community health nurse in the United States?

A) Frances Root B) Mary Robinson C) Mary Seacole D) Reba Thelin Ans: A Feedback: In the United States, Frances Root was the first community health nurse who was hired by the Women's Branch of the New York Mission in 1877. Mary Robinson was the nurse who cared for William Rathbone's wife and was hired by Rathbone to visit the sick poor in their homes in England. Mary Seacole, the “Black Nightingale,” practiced Creole or Afro-Caribbean medicine in Jamaica and helped populations who experienced tropical diseases in Central America, Panama, and the Caribbean. Reba Thelin was a nurse hired by Johns Hopkins Hospital to visit the homes of tuberculosis clients in 1903.

12.

Which of the following nurses openly defied a law that she saw as unjust and eventually resulted in the formation of The International Planned Parenthood Federation?

A) Lillian Wald B) Florence Nightingale C) Margaret Sanger D) Mary Brewster Ans: C Feedback: Margaret Sanger openly defied a law that she saw as unjust (the Comstock Act that prohibited the provision of any information on contraception to women). This defiance eventually resulted in the formation of The International Planned Parenthood Federation. During the same period that Lillian Wald and her contemporaries were working to alleviate the suffering caused by disease and poverty, Margaret Sanger began a different battle.

Florence Nightingale wrote a series of papers on the need for “home missioners” and “health visitors” and endorsed the view that prevention was better than cure. Mary Brewster was a nurse and a friend of Lillian Wald who both together started the Henry Street Settlement.

13.

The community health nurse is preparing a presentation for a group of nursing students about the societal influences on the development of community health nursing. Which factors should the nurse include that have influenced the growth of community health nursing? Select all that apply.

A) Advances in the technology B) The recognition that one single agent could be considered a cause of illness C) Access to education being limited to the privileged few D) Continued increase in the number of women entering nursing because it is recognized as a choice career for women and not men E) Consumer demand for quality services coupled with community health nurses provision of holistic care Ans: A, E Feedback: Many factors have influenced the growth of community health nursing, including advances in technology, progress in causal thinking (relating disease or illness to its cause and recognition that many factors might contribute to a disease or health disorder), and the consumer movement with consumers demanding quality services. Education is now widely available and is considered a basic right and necessity for a vital society.

Changing demographics and the role of women have influenced community health nursing; however, the number of women entering nursing has decreased.

14.

Which of the following actions by the community health nurse exemplifies the societal influence of causality on the practice of community health nursing?

A) Using computer-based education programs for client education

B) Engaging in video conferencing to share research findings C) Identifying multiple factors associated with promoting wellness D) Developing a plan to address the rapid increase in older adult population Ans: C Feedback: Causal thinking relates disease or illness to its cause and includes areas such as epidemiology; interactions among an agent, host, and environment; and recognition of multiple factors contributing to a disease, health disorder, or wellness. Using computer- based education programs and engaging in video conferencing are examples reflecting the advancement of technology. Developing a plan to address the rapid increase in the older adult population involves application of the change in demographics affecting community health nursing.

15.

A community health nurse who is teaching a group of nursing students about the various societal influences on community health nursing is explaining the effects of the consumer movement. Which of the following student responses would lead the community health nurse to determine that the teaching was successful?

A) Individuals are considered passive members of the health care team.

B) Consumers are demanding more coordinated comprehensive care.

C) People are expecting community health nurses to develop new programs.

D) Consumers are identifying a greater need for care by a variety of care providers.

Ans: B Feedback: The consumer movement has led to changes in community health nursing. Consumers are demanding more humane, personalized health care, seeking more comprehensive coordinated care. They are viewed as active members of the health care team. The need to develop new programs is a response to the economic forces that have affected the practice of community health nursing.

Consumers desire more coordinated care, not care from a variety of care providers.

16.

Which of the following most accurately reflects the response of community health nursing to economic forces?

A) Decreased competition with other community health service providers B) Reduction in available programs and services C) Development of new services for generating revenue D) Switch to a more illness-oriented philosophy for service Ans: C Feedback: Economic forces have led community health nursing to respond by developing new revenue-generating services to augment depleted budgets. Other responses include directly competing with other community health service providers and developing new programs and service emphases. Although some public health agencies have been drawn into more illnessoriented services, community health nursing continues to be resourceful in finding ways to foster the community's optimal health.

17.

A prospective nursing student is interested in working in community health nursing after graduation. Which type of education would be most appropriate for this student to choose?

A) Diploma program B) Associate degree C) Baccalaureate degree D) Graduate degree Ans: C Feedback: Community health nursing is a challenging specialty in nursing. The demands of this type of nursing require additional courses in liberal arts and science, along with courses in community health nursing practice as a student. The minimum preparation for community health nurses in many states is a baccalaureate degree. The diploma and associate degree level prepares students for basic nursing practice. Students can build on this basic knowledge by entering a BSN completion program, which will prepare them to enter the specialty of community health nursing. In order to stay current and to build skills in this specialty, advanced courses or a graduate (masters) degree is needed.

18.

A community health nurse desires to attain a tenure-track position at a local university to teach community health nursing. Which of the following would this nurse need?

A) Certification B) Master's degree C) Doctoral degree D) Nurse practitioner license Ans: C Feedback: A doctoral degree would be the required education needed to obtain a tenure-track teaching position at a university. Certification provides additional education for specialization and may result in a promotion or higher salary accompanied by additional responsibilities and opportunities. A master's degree can lead to management positions, private community health ownership, agency teaching, or research positions. Nurse practitioners can run well-child clinics and direct a school-based clinic if a school nurse. Advanced practice can open doors into leadership positions in community health nursing.

Chapter 4 Evidence-Based Practice and Ethics in Community/Public Health 1.

A nursing instructor is preparing a teaching plan for a class comparing evidence-based practice and critical thinking. Which of the following would the instructor include?

A) Evidence-based practice and critical thinking are polar opposites.

B) Both involve problem clarification of central concepts.

C) Interpretation of accumulated evidence is unique to evidence-based practice.

D) Problem exploration is unique to evidencebased practice.

Ans: B Feedback: Evidence-based practice and critical thinking share commonalities including exploring a problem, addressing a purpose or goal, making assumptions, clarifying the problem around central concepts or indicators, accessing data, interpreting accumulated evidence, using reasoning, processing, defining, planning and documenting, acting on the problem, and evaluating, adjusting, generalizing, and applying to a broader problem set. In addition, critical thinking is an important component of evidence-based practice.

2.

According to the Institute of Medicine's landmark report, The Future of Nursing, nurses should: Select all that apply.

A) work independently from other health professionals to promote the profession of nursing.

B) work collaboratively with other health professionals to promote health care.

C) attempt to redesign health care.

D) improve practices through evidence-based means.

E) The Future of Nursing report does not express the importance of evidence-based nursing.

Ans: B, C, D Feedback: The Future of Nursing highlights the need for nursing to work with other health professionals in “redesigning health care” by “conducting research” and improving practices through evidence-based means.

3.

Which of the following statements about evidence-based practice has been identified by multiple reports over the past decade, such as To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003)?

A) We must continue to cling to “the way we've always done it.”

B) We have spent billions of dollars each year researching new treatments and have translated that knowledge into clinical practice.

C) We are not translating the knowledge that we are gaining into clinical practice.

D) We have continued to spend more than a trillion dollars a year providing care and do translate that capacity into improved clinical practice.

Ans: C Feedback: To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003). These reports draw attention to the fact that we spend

billions of dollars each year researching new treatments, and more than a trillion dollars are spent annually on health care, but “we repeatedly fail to translate that knowledge and capacity into clinical practice.”

4.

Which of the following statements about the steps of the EBP process is most accurate?

A) One of the last steps of the EPB process is to search for and collect the most relevant best evidence.

B) One of the earliest steps in the EBP process is to disseminate the outcomes of the EBP decision or change.

C) It is optional to integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.

D) The first step in the EBP process is to cultivate a spirit of inquiry.

Ans: D Feedback: The steps of the EBP process in order are cultivating a spirit of inquiry; asking the burning question in PICOT format; searching for and collecting the most relevant best evidence; critically appraising the evidence for its validity, reliability, and applicability and then synthesizing that evidence; integrating the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluating outcomes of the practice decision or change based on evidence; and disseminating the outcomes of the EBP decision or change.

5.

Which one of the following statements about cultivating a spirit of inquiry is most accurate?

A) It is not very important; research will be performed anyway.

B) In order for effective change to occur, current practices must be continually examined, questioned, and challenged.

C) It involves “asking the burning clinical question.”

D) The agency does not have an important role in cultivating a spirit of inquiry.

Ans: B Feedback:

In order for effective change to occur, current practices must be continually examined, questioned, and challenged. It is very important that the spirit of inquiry is cultivated. “Asking the burning clinical question” is part of the next step of asking the question. The agency does have a role in cultivating a spirit of inquiry. The organization must be open to a cultural shift from the status quo. The foundations of this spirit of inquiry are ongoing curiosity and a culture that supports it.

6.

A nurse is planning a research study to answer a clinical question. Which of the following would be most appropriate for qualitative research approach?

A) Evaluating the reported cases of post vaccination complications after varicella immunization B) Determining the use of complementary and alternative health care by middle-aged adults in rural areas C) Ascertaining the effect of using calming music on older adults with dementia in extended care facilities D) Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illness Ans: D Feedback: Qualitative research is used to study those areas that need a broader focus or that do not lend themselves to objective measurement. This type of research emphasizes subjectivity and the meaning of the experiences to individuals. Thus, qualitative research would be most appropriate for assessing the emotional responses and feelings of individuals who require isolation for a communicable illness. Quantitative research would be used to evaluate the reported cases of post vaccination complications, to determine the use of complementary and alternative health care, and to ascertain the effect of calming music.

7.

Which of the following research studies would most likely use a quantitative research approach?

A) The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized

B) The experience of parents whose children have had serious complications subsequent to immunization C) The experience of parents whose children were not properly immunized and developed a vaccine-preventable illness D) Reasons that parents who practice a particular religion do not have their children properly immunized Ans: A Feedback: Quantitative research is helpful in identifying a problem or a relationship between two or more variables, such as type of treatment. A more subjective or qualitative approach is needed to study those areas that need a broader focus or that do not lend themselves to objective measurement. Qualitative research emphasizing subjectivity asks “how” or “why.”

8.

Which of the following statements about the impact of research on community health nursing are true? Select all that apply.

A) It is important to conduct research to affect public policy.

B) Public policy will continue to have a negative effect on the community's health.

C) Research will affect the effectiveness of community health nursing practice.

D) Research will affect the status and influence of nursing as a profession.

E) The impact that research has on community health nursing is negligible.

Ans: A, C, D Feedback: Research has the potential to have a significant impact on community health nursing in three ways: by affecting public policy and the community's health, the effectiveness of community health nursing practice, and the status and influence of nursing as a profession.

Community health nurses have been involved in research addressing all three of these dimensions.

9.

Application of nursing research results to community health nursing practice is essential.

Which of the following must occur

first before results can be applied?

A) Be informed about research findings B) Demonstrate skill in examining research reports C) Assess abstracts of relevant research studies D) Check if the study was funded by a drug company Ans: A Feedback: Community health nurses have many opportunities to apply the results of other investigator's research, but a necessary prerequisite is that the nurse must be informed about research findings. Critically examining research reports and assessing abstracts are all part of evaluating relevant research studies.

However, the nurse needs to know what the research findings are before he or she can evaluate the research. Checking if the study was funded by a drug company might indicate that the results of the study could be questioned due to a conflict of interest.

10.

After teaching a class on values, which of the following, if stated by the class, indicates the need for additional teaching?

A) Some values are descriptive, while others are evaluative.

B) Keeping a promise is an example of a terminal value.

C) Values persist, remaining relatively stable over time.

D) Certain values have more importance than others.

Ans: B Feedback: Terminal values refer to end states of existence such as spiritual salvation, peace of mind, or world peace. Instrumental values refer to modes of conduct such as confidentiality, keeping promises, and honesty. Some values are descriptive or capable of being true or false, while other values are evaluative, involving judgments of good and bad. Values remain relatively stable over time and persist to provide continuity to personal and social existence. A hierarchical system of values occurs in which certain values have more weight or importance than others.

11.

Which of the following would the community health nurse do first when making an ethical decision?

A) Engage in critical thinking B) Choose a value C) Identify isolated values D) Clarify one's values Ans: D Feedback: Clarification of a person's values is the first step in the process of ethical decision making. Critical thinking is a strategy that can be used to help clarify values. Choosing a value is the first step in the process of valuing. Identifying isolated values are those which are organized into a hierarchical system where certain values have more weight or importance than others.

12.

After a class discussion on moral evaluations, which characteristic if identified by the class would lead the instructor to determine that the discussion has been effective?

A) There is specificity that applies to an individual person.

B) A special place is given to a person's own welfare.

C) Other values cannot override the moral evaluation.

D) They relate to a matter of individual taste.

Ans: C Feedback: Moral evaluations have distinctive characteristics: the evaluations are ultimate, having a preemptive quality, meaning that other values or human ends cannot, as a rule, override them; they possess universality or reflect a standpoint that applies to everyone, such that everyone in principle ought to be able to make and understand, even if some individuals, in fact, do not; moral evaluations avoid giving a special place to a person's own welfare, having a focus that keeps others in view, or at least considers one's own welfare on a par with that of others. Moral evaluations are prescriptive–proscriptive beliefs that have certain characteristics separating them from other evaluations including matters of taste.

13.

A group of students are reviewing for an examination on values. Identification of which of the following as an instrumental

value indicates the need for continued study?

A) Spiritual salvation B) Confidentiality C) Honesty D) Promise keeping Ans: A Feedback: Spiritual salvation is an example of a terminal value, which refers to end states of existence. An instrumental value refers to a mode of conduct, such as confidentiality, promise keeping, and honesty.

14.

A community health nurse obtains a client's informed consent for care demonstrating the understanding that this is derived from which value?

A) B) C) D) Ans:

Self-interest Well-being Equity Self-determination D Feedback: Informed consent derives from self- determination. Self-interest refers to a deterioration of self-determination in which the person focuses on fulfilling one's own desires without regard for the greater good. Well-being is a state of positive health, the intent of all therapeutic interventions. Equity refers to justice or fair and equal treatment.

15.

Which of the following statements about basic values that guide decision making in community health nursing is true?

A) Client empowerment means that the provider must use a paternalistic approach to health care.

B) Self-interest does not interfere with selfdetermination.

C) When matters of well-being are considered, the client's preferences and needs should not be considered.

D) Equity is not possible in times of limited resources.

Ans: D

Feedback: In times of limited technical, human, and financial resources, however, it may be impossible to fully respect the value of equity. Client empowerment is an approach that differs from the paternalistic approach to health care in which decisions are made for, rather than with, the client; instead, it enables patients and professionals to work in partnerships. When selfdetermination deteriorates into self-interest, it poses a major roadblock to equitable health care.

Well- intended interventions sometimes fall short if they are in conflict with clients' preferences and needs.

16.

Situations in which self-determination should be restricted include which of the following?

Select all that apply.

A) When some objectives of individuals are contrary to the public interest or the interests of others in society B) When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals C) When it interferes with self-interest D) Self-determination and personal autonomy must never be restricted.

E) When self-determination deteriorates into self-interest and poses a major roadblock to equitable care Ans: A, B Feedback: There are two situations in which self- determination should be restricted: when some objectives of individuals are contrary to the public interest or the interests of others in society (e.g., endangering others with a communicable disease) and when a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals.

When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care.

17.

A community health nurse is applying the value of equity in decision making with clients. Which of the following best describes this value?

A) Forming, revising, and pursuing personal life plans B) Promoting clients' health and a sense of well-

being C) Fulfilling one's desires over those of others D) Treating similar cases in the same fair fashion Ans: D Feedback: Equity is defined as the value directing like cases to be treated alike and that all individuals be treated fairly. Self- determination refers to a person's exercise of the capacity to shape and pursue personal plans for life. Well-being involves promoting clients' health and sense of well-being. Self- interest is the fulfillment of one's own desires without regard for the greater good.

18.

When working with clients, a community health nurse promotes the clients' self-concept and health promoting behaviors. The nurse is attempting to achieve which outcome?

A) A value system B) Prescriptive–proscriptive beliefs C) Individual autonomy D) Values clarification Ans: C Feedback: Promoting clients' self-concept and health- promoting behaviors are associated with the value of self-determination that promotes individual autonomy. Value system, prescriptive– proscriptive beliefs, and values clarification are not associated with self- determination. A value system is an organized set of beliefs that guide individual behavior. Prescriptive–proscriptive beliefs are viewed as desirable or undesirable beliefs. Values clarification is a process that helps identify the personal and professional values that guide actions.

19.

A community health nurse discovers that a bill in the legislature would eliminate a state law that currently funds child health promotion services for low-income children. Which action at the primary level of prevention would be most appropriate?

A) Advocate for amendment to the passed law to allow some funding for children to remain B) Once the bill has been passed, seek private resources to support funding of health promotion services for low-income children.

C) Gather a group of health professionals to volunteer to provide the health promotion services eliminated by the passed bill D) Advocate through active lobbying against the bill and gather community support Ans: D Feedback: Appropriate activities at the primary level of prevention would include actively lobbying against the bill, garnering community support in favor of the revised bill, and advocating for the clients. Advocating for amendments would be appropriate at the secondary level. Seeking private resources and gathering volunteers to provide the health services would be appropriate at the tertiary level.

20. the instructor determines that the class needs additional instruction when they identify which of the following as an ethical principle?

A) Respect B) Autonomy C) Morality D) Justice Ans: C Feedback: Morality is the behavior or judgment that conforms to a standard that is right and good.

When judgments involve moral values, conflicts are inevitable. There are seven fundamental ethical principles that guide decision making. These include respect, autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.

21.

A community health nurse is working to support programs to encourage preschool immunizations. The nurse is integrating which ethical principle in his or her practice?

A) Beneficence B) Autonomy C) Nonmaleficence D) Justice Ans: A Feedback: Beneficence means doing good or benefitting others, such as supporting programs to encourage preschool immunizations.

Autonomy means freedom of choice and exercise of people's rights, such as promoting individuals' and groups' rights to and involvement in decision making.

Nonmaleficence means avoiding or preventing harm to others as a consequence of a person's own choice and actions, such as encouraging physicians to prescribe drugs with the fewest side effects. Justice refers to treating people fairly, such as ensuring equal access to health care.

22.

A community health nurse working with a group of families who come to local community health care center tells them that she is going to be setting up child care so that the families can participate in the various classes being offered by the center. Three months have passed, and the nurse still has not instituted the child care program. The nurse has violated which ethical principle?

A) Veracity B) Fidelity C) Justice D) Respect Ans: B Feedback: Fidelity means keeping promises or commitments to foster trust and trustworthiness. By failing to set up the child care program, the nurse has violated this fidelity. Nurses who follow through on what they have said earn their clients' respect and trust. In contrast, when a commitment is not kept, community members may lose faith and interest in participation.

Veracity refers to telling the truth, giving clients accurate information in a timely manner.

Veracity involves treating clients as equals. Justice refers to treating people fairly, such as by ensuring equal access to health care and not limiting the amount or quality of services due to income level. Respect involves acknowledging clients as valued participants in shaping their own and the community's health outcomes.

23.

A public health nurse is faced with an ethical dilemma. Which question should the nurse consider first when deciding how to resolve the dilemma?

A) “What exactly is the ethical dilemma?”

B) “What are the alternative courses of action?”

C) “What are the consequences of each alternative courses of action?”

D) “How should this dilemma be solved?”

Ans: A Feedback: A framework is applied in public health ethics inquiry. Three core functions of this inquiry include (1) identifying and clarifying the ethical dilemma, (2) analyzing it in terms of alternative courses of action and their consequences, and (3) resolving the dilemma by deciding which course of action best incorporates and balances the guiding principles and values.

Chapter 5 Transcultural Nursing 1.

After discussing the meaning of cultural diversity and its significance for community health nursing, the nursing instructor recognizes that some points need to be clarified when a student makes which of the following comments?

A) “Dominant values are those held by the male head of the household in most American families.”

B) “The percentages of White European descent Americans are rising, while the percentages of other ethnicities are declining and this is projected to continue into the year 2050 at least.”

C) “Nurses maintain their original culture as they are socialized throughout the educational process.”

D) “America has become an amalgamation of people who have different values, ideals, and behaviors, rather than the melting pot that was once envisioned.”

Ans: A Feedback: The beliefs and sanctions of the dominant or majority culture are called dominant values.

The proportion of the population identified as White is projected to continue to fall below other ethnicities between 2010 and 2050.

Nurses will still have the same culture as they did before they were socialized in the nursing educational process, but they may be able to see things differently. America is not the ideal melting pot once described, but rather an amalgamation of people who have different values, ideals, and behaviors.

2.

The population that community health nurses serve in the United States is changing.

Because of population shifts, nurses must become sensitive to the cultural differences and language differences among new community members. Which minority group currently represents the largest group?

A) African Americans B) Hispanic Americans C) Asian Americans D) American Indians Ans: B

Feedback: Significant minorities include Hispanic Americans, numbering more than 35 million in 2000 and over 42 million in 2005 and currently representing over 14% of the population; African Americans, numbering over 37 million or approximately 12.8% of the population; Asian Americans, numbering more than 12 million or approximately 4.3% of the population; and American Indians and Alaska Natives, numbering 2.8 million or 1% of the population.

3.

While providing care to a community group, a community health nurse provides culturally sensitive care by avoiding which of the following?

A) B) C) D) Ans:

Ethnocentrism Ethnorelativism Enculturation Ethnicity A Feedback: Ethnocentrism is the belief or feeling that one's own culture is best causing the person to believe that his or her way of doing things is right and to judge others' methods as inferior, ignorant, or irrational. It blocks effective communication by creating biases and misconceptions.

Ethnorelativism is seeing all behavior in a cultural context. Enculturation refers to the process of each person learning his or her culture through socialization with the family or significant group.

Ethnicity refers to the group of qualities that mark a person's association with a particular ethnic group (collection of people who have common origins and a shared culture and identity).

4.

As a community health nurse, you overhear a colleague say, “I don't understand why the Yang's take their young teenage daughters to the Hmong New Year celebration and have them play these match-making games. The girls meet boys every day at school and they are too young to be looking for husbands.” Which of the following would be the most appropriate response?

A) “The Yang's are very different from us; maybe in time we can convince them that their practices are not right.”

B)

“Every culture has its differences; I think it is valuable that the Yang's are keeping their

cultural practices alive.”

C) “I know what you mean, I was thinking the same thing. You wouldn't catch me doing something similar with my teens.”

D) “I feel sorry for those girls; they must feel funny in those cultural costumes. Let's talk to the parents and tell them how teens in America feel about such things.”

Ans: B Feedback: Community health nurses need to develop cultural sensitivity, becoming aware of own biases and preconceived values and beliefs. This would be evidenced by the statement about every culture having differences. The celebration is a part of the family's culture, and the nurses should not attempt to convince them that it is not right nor should they attempt to impose their views, feelings, or beliefs on the family.

5.

What is the most serious negative effect of a nurse maintaining ethnocentric views but not recognizing or acknowledging this?

A) The nurse fails to understand the views of other cultures because of his or her ethnocentrism.

B) The nurse does not communicate effectively with members of other cultures because of his or her ethnocentrism.

C) The nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions.

D) Nurses are immune to the effects of ethnocentrism.

Ans: C Feedback: The most negative effect of nurses maintaining ethnocentric views but not recognizing or acknowledging this is that the nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. The nurse who is ethnocentric and doesn't realize it will fail to understand the views of other cultures, but this is not the most serious negative effect. If the nurse is ethnocentric, he or she may not communicate effectively because of his or her ethnocentrism, and this can lead to impaired relationships and interference with the effectiveness of nursing interventions. All nurses hold ethnocentric views, but it is

important for the nurse to be aware of them and acknowledge them to avoid having it damage relationships and interfere with the effectiveness of nursing interventions.

6.

When describing culture as shared, which of the following would be most accurate?

A) It is acquired, not inherited.

B) It is a product of aggregate behavior.

C) It is interrelated and interdependent.

D) It undergoes change.

Ans: B Feedback: When describing culture as shared, it means that it is a product of aggregate behavior, not an individual habit. The customs are phenomena shared by all members of the group. Culture is learned; that is, the patterns of cultural behavior are acquired, not inherited. Culture is integrated; that is, it is a functional, integrated whole where all parts are interrelated and interdependent.

Culture is dynamic; that is, it is changeable and not entirely static.

7. by all cultures. Which description of culture being tacit indicates that the teaching was successful?

A) Culture is mostly unexpressed.

B) Cultures do not remain static.

C) Culture is a functional and integrated whole.

D) Patterns of cultural behavior are acquired.

Ans: A Feedback: Culture is tacit, that is, mostly unexpressed and at the unconscious level. Culture is dynamic, undergoing change and never entirely static. It is integrated and learned.

8.

Which of the following statements is an accurate description of the characteristic shared by all cultures, culture is integrated?

A) A person's culture is an interrelated and interdependent web of ideas and practices.

B) In order to describe a person's culture, it is necessary to describe each trait independently.

C) Aspects of a person's culture are best described as unrelated to other aspects of the person's culture.

D) A person's culture is an assortment of various customs and traits.

Ans: A

Feedback: A person's culture is an integrated web of ideas and practices. To understand culture, single traits should not be described independently. As in any system, all parts of a culture are interrelated and interdependent.

9.

A community health nurse is working with several Native American groups in Arizona.

Which of the following would the nurse be most likely to assess? Select all that apply.

A) The value of competition B) Respect for advancing age and elders C) Focus of living in the future D) Frequent dialogue and discussion E) Each tribe or nation has its own distinct language, beliefs, customs, and rituals.

Ans: B, C, E Feedback: Although there are differences among Native American tribes, most have respect for advancing age and they live in the present and not the distant future (making primary prevention activities more difficult). Each tribe or nation has its own distinct language, beliefs, customs, and rituals. Competition and frequent dialogue and discussion are not values held by Native Americans.

10.

A community health nurse working a large metropolitan city has a large Asian American client base. Which of the following would the nurse be least likely to assess in this population?

A) Belief that illness results from a body imbalance B) Reliance on Western medical practices C) Use of traditional self-care practices D) A focus on patriarchal family structures Ans: B Feedback: Asian Americans believe illness results from an imbalance of yin and yang forces. They use traditional healers and also exercise traditional self-care practices before using Western medical practices.

11.

While visiting an Asian American family in their home, the community health nurse inspects the skin of the 3-year-old child and notices a bruise-like lesion on the child's abdomen.

The mother states that the child has been experiencing diarrhea for 2 days. Which of the following would the nurse do next?

A) Report the family to the local child abuse agency B) C) D) Ans:

Recognize this as a normal skin variation Question the family about the use of cupping Obtain a blood test for clotting function C Feedback: The nurse needs to gather additional information about the lesion. Practicing transcultural nursing would require the nurse to perform a cultural assessment and question the family about their use of dermabrasive techniques such as cupping that would leave a bruise-like lesion on the skin and be mistaken for physical abuse. The nurse would report the family to the local child abuse agency if further investigation provides additional information to support that decision.

The lesion is not a normal skin variation.

Obtaining a blood test for clotting function would be warranted only if further assessment reveals additional bruising or other signs of clotting problems.

12.

The community health nurse is working in the health department of a major city that has a large Hispanic/Latino population. Which of the following would the nurse need to integrate into the plan of care for this population?

A) View of the female as superior to the male B) Importance of an extended, cohesive family C) Males as the binding force of the family D) Adherence to strict time schedules Ans: B Feedback: Hispanic people value extended, cohesive families. Families have been patriarchal, with male members perceived as superior and female members seen as a family-bonding life force.

Many Latinos tend to be oriented to the present and are not as concerned as the mainstream culture about keeping time schedules or preparing for the future.

13.

A group of nursing students are studying for a test about various cultural communities.

The students demonstrate that they understand the material when they identify which cultural group as believing in predestination?

A) Hispanic/Latinos B) African Americans C) Muslims D) Native Americans Ans: C Feedback: Muslims believe in predestination, that life is determined beforehand, and they attribute the occurrence of disease to the will of Allah.

Hispanic/Latinos believe that illness may be a form of punishment for sins. Some African Americans believe that illness is evidence of disharmony possibly due to evil spirits, punishment of God, or a hex placed on a person. Native Americans believe that health reflects living in total harmony with nature.

14.

A community health nurse is developing health promotion programs for a local community that consists predominantly of African Americans. Which of the following areas would be a priority for health promotion with this group?

A) Cardiac health B) Respiratory care C) Mental health D) Skin care Ans: A Feedback: Leading causes of death for African Americans include heart disease, cancer, and stroke.

Heart disease is also a major health problem. Thus programs emphasizing cardiac health would be a priority. African Americans show a lower incidence in suicide and chronic obstructive pulmonary disease. They may experience skin problems such as keloids and melasma. However, all of these conditions would be of lesser importance than cardiac health.

15.

A community health nurse is providing care to a family in the community who are Muslim.

Which of the following would be most important for the nurse to integrate when

providing care for this family?

A) Rules are stricter for boys than for girls.

B) Modest dressing is key for both men and women.

C) Most Arabic women work outside the home.

D) Most adhere to the three tenets of Islam.

Ans: B Feedback: For Muslims, modesty in dress is a core value for both men and women, although it is expressed more evidently by women. Rules are stricter for girls than for boys and most Arabic women stay at home and are not in the workplace. All practicing Muslims adhere to the five tenets of Islam.

16.

A community health nurse is providing care to an Asian American family who believes that a member's current illness is due to an excess of yin. The nurse integrates knowledge of this belief, expecting the family to avoid which foods?

A) Rice B) Eggs C) Chicken D) Fruits Ans:

D Feedback: If the imbalance is an excess of yin, then “cold” foods, such as vegetables and fruits, are avoided, and “hot” foods, such as rice, chicken, eggs, and pork, are offered.

17.

What is the most important reason for the nurse to conduct a cultural assessment?

A) Because it is often assigned by nursing faculty B) Because usually there is some culturally based reason that causes clients to engage in or avoid certain actions C) To meet the nurse's professional learning needs D) Because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action Ans: D

Feedback: The most important reason for the nurse to conduct a cultural assessment is that because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action. There is usually some culturally based reason that causes clients to engage in or avoid certain actions but that is not the most important reason for the nurse to conduct a cultural assessment. The nurse does not necessarily collect a cultural assessment to meet his or her own needs primarily.

18.

When developing an in-service program for a group of community health nurses about culture, which of the following would the presenter expect to include?

A) All members of a cultural group are alike.

B) Intraethnic variations underscore a population's cultural diversity.

C) Ethnicity has a major impact on the effectiveness of health care.

D) Ethnocentric attitudes are key to working with different cultures.

Ans: B Feedback: Intraethnic variations, differences within microcultures, underscore the range of culturally diverse clients served by community health nurses. Subcultures and microcultures have their own distinctive characteristics even within fairly homogenous cultural groups.

Culture, not ethnicity, has a major impact on the effectiveness of health care. Ethnocentric attitudes are to be avoided. All members of a cultural group are not alike. In general, individuals who are members of a specific culture are more alike than unlike but still not totally alike.

19.

When applying the principles of transcultural nursing, which of the following must the nurse do first?

A) Cultivate cultural sensitivity B) Develop cultural awareness C) Learn the client's group culture D) Demonstrate respect for culture Ans: B Feedback: Applying the principles of transcultural nursing involves the following: (1) developing cultural self-awareness, (2) cultivating cultural sensitivity, (3) assessing the client group's

culture, (4) showing respect and patience while learning about other cultures, and (5) examining culturally derived health practices.

20.

A community health nurse implements a plan of care that combines aromatherapy and acupuncture with medication therapy and surgery. The nurse is applying which of the following?

A) Holistic health care B) C) D) Ans:

Folk medicine care Herbalistic health care Integrated health care D Feedback: Integrated health care is defined as the combination of complementary therapies such as aromatherapy and acupuncture with biomedical or Western health care such as medication therapy and surgery. Holistic health care vies the world as being in harmonious balance in which all facets of the individual's natures (physical, mental, emotional, and spiritual) must be in balance. Folk medicine involves treatment practices that have been handed down from generation to generation. Herbalism is the use of medicinal herbs.

21.

A community health nurse is providing care to several cultural groups in the community.

When providing transcultural nursing, which of the following would be the priority?

A) Examining one's own culture carefully and recognizing that alternative viewpoints are possible B) Recognizing that cultural values, beliefs, and practices influence people's health and lifestyles C) Obtaining health-related information about a cultural group concerning their values, beliefs, and practices D) Actively and attentively listening to demonstrate respect while learning about other cultures Ans: A Feedback:

The first step in providing transcultural nursing is to develop cultural self-awareness by examining one's own culture carefully and recognizing that alternative viewpoints are possible.

Next, the nurse would need to cultivate cultural sensitivity by recognizing that cultural values, beliefs, and practices influence people's health and lifestyle. Then the nurse would assess the client group's culture by obtaining health-related information and actively and attentively listening to demonstrate respect.

22.

A community health nurse is assessing a family during a home visit. The nurse is examining the mother who is pregnant with her second child. The nurse asks the mother to raise her arms above her head. The mother replies, “I can't do this because it will cause the umbilical cord to strangle the baby.” The nurse interprets this statement as reflective of which of the following?

A) Home remedy B) Herbalism C) Folk medicine D) Alternative therapy Ans: C Feedback: The mother's statement reflects folk medicine, a body of preserved treatment practices that has been handed down verbally from generation to generation. One example is not reaching above your head if you are pregnant, because doing so will cause the umbilical cord to strangle the baby. Home remedies are caregiving practices passed down between families, for example, ice on a cold sore, baking soda paste on a bee sting. Herbalism involves the use of medicinal herbs.

Alternative therapy or complementary therapy is designed to promote comfort, health, and wellbeing and includes, for example, aromatherapy, music therapy, acupuncture, and yoga.

23.

When working with different cultural groups in the area of health care practices, the nurse acts as an effective advocate for the client.

Which of the following must the nurse do first?

A) Prepare to teach clients about the limits and benefits of cultural health practices

B) Assess the client or family adequately to ascertain their belief system and choices C) Individualize caregiving for the client within his or her culture D) Be knowledgeable about health care practices and choices Ans: D Feedback: When working with different cultural groups in the area of health care practices, the community health nurse can be an effective advocate for the client. First, however, the nurse must be prepared to speak knowledgeably about health care practices and choices. The nurse also must be able to assess the client or family adequately so as to know what belief system motivates their choices. Finally, the nurse must be prepared to teach clients about the limits and benefits of cultural health care practices. The community health nurse should always individualize assessment and caregiving for the client within his or her culture and should not generalize about the client based on cultural group norms.

24.

When working with immigrant groups in community health care, which of the following would be least appropriate for the community health nurse to do?

A) Permit ample time for interviewing to allow time to evaluate beliefs B) Develop educational programs to correct misconceptions C) Assume that the client has a basic understanding of health issues D) Ensure an appropriate interpreter for communication if needed Ans: C Feedback: When working with immigrant groups in the community, do not make assumptions about a client's understanding of health care issues; permit more time for interviewing; allow time to evaluate beliefs and provide appropriate interventions; provide educational programs to correct any misconceptions about health issues; provide an appropriate interpreter to improve communication with immigrants who do not speak English well.

Chapter 6 Structure and Economics of Community/Public Health Services 1.

After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information?

A) “It influenced the speed with which healthfocused bills pass the legislature.”

B) “The report set up the organizational structure of the U.S. Public Health Service.”

C) “It emphasized sanitary progress forming the basis for current public health practice.”

D) “It de-emphasized the issues addressed in the Hebrew hygienic code.”

Ans: C Feedback: The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress addressing public health concepts and methods that form the basis of public health practice today. It had no effect on getting bills passed by the legislation nor was it involved in setting up the organizational structure of the U.S. Public Health Service.

The Hebrew hygienic code, probably the first written code, was the prototype for personal and community sanitation.

2.

Over the past century, many health-related changes have occurred affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply.

A) High levels of chronic disease B) Shortened life spans C) Increased teen pregnancies D) Abuse of multiple substances E) F) Ans:

Increased maternal mortality Multidrug-resistant diseases A, C, D, F Feedback: Issues today include high levels of chronic disease, increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today.

With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today did not exist.

3.

During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community's health care needs. Which of the following would the nurse include as a current societal event?

A) Large disparity in male/female wages B) Rural to urban migration C) Rampant child labor D) Widespread violence Ans: D Feedback: Today, society is faced with widespread violence and terrorism. Populated urban areas continue to loose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago child labor laws were just forming and child labor was rampant.

4.

When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the understanding that these agencies are A) B) C) D) Ans:

voluntary. tax supported. proprietary. privately funded.

B Feedback: Official health care agencies, later called public health agencies, are tax supported; thus, they must provide services determined by the federal, state, or local government.

Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for profit or nonprofit.

5.

After describing the Public Health Service to a group of students, which description would indicate the need for additional discussion?

A) It offers consultation through national advisory health councils and special advisory committees made up of lay experts.

B) The Secretary of Health and Human Services is ultimately responsible for it.

C) The Secretary of Health and Human Services is an elected position.

D) A major function is to administer grants and contracts with other government agencies.

Ans: C Feedback: The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.

6. provision of care to clients in a clinic setting at the local health department. This nurse is engaging in which core public health function?

A) Clinical B) Assessment C) Policy development D) Assurance Ans: D Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community, policy development would involve helping to establish policies that will address the problems assessed, and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical is not a core public health function.

7.

Which of the following statements about the core public health functions are true?

A) Public health nurses practice as partners with other public health professionals within these core functions.

B) Assessment involves the actual provision of services.

C) Policy development relates to assessment.

D) Assurance means that the public health agency must directly provide the needed services.

Ans: A Feedback:

Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that populationbased services are provided, whether by public health agencies or private sources.

8.

Which one of the following groups of actions fulfills the three core public health functions in their proper order?

A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school B) Identifying a source of pollution in the community, educating local residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for the pregnant adolescents D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer Ans: A Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment is data collection, the policy development would be based on the assessment, and assuring is the process of translating established policies into services. Counting the number of kindergarten students who are fully immunized would be assessment, encouraging the school officials to exclude children who are not fully immunized would be policy development, and offering immunization clinics at the school would be assurance. Identifying a source of pollution in the community would be assessment, educating local residents about

precautions that should be taken when the pollution exceeds minimum standards would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance, determining how many pregnant adolescents currently attend the school would be assessment, and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance.

Lobbying for a citywide ban on smoking in public would be policy development, providing smoking cessation services in the community would be assurance, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.

9.

A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health agencies? Select all that apply.

A) American Diabetes Association B) The U.S. Public Health Service C) D) E) F) Ans:

The National Institutes of Health Women, Infant, and Children Program (WIC) National Society for Autistic Children Planned Parenthood Federation of America A, E, F Feedback: The American Diabetes Association, National Society for Autistic Children, and Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and are nonprofit organizations. The U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies or receive federal funds to operate; thus they are not voluntary agencies.

10.

Which of the following most well describes a public health care agency?

A) The agency most often has a very specific focus.

B) The agency is responsible for promoting and protecting the health of all within their jurisdiction.

C) The agency only employs nurses and environmental health practitioners.

D) The agency is able to perform its work independently with complete autonomy.

Ans: B Feedback: Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish a broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and interorganizational collaboration.

11.

Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies?

A) Private sector health services are complementary and supplementary to government health agencies.

B) Public sector health care agencies usually meet the needs of people with special needs.

C) Private sector health agencies usually are constrained in developing innovations in health care.

D) Public health sector agencies generally satisfy the health care needs of a community.

Ans: B Feedback: Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private sector health care agencies usually meet the needs of people with special needs (rather than public sector health care agencies that focus on the entire population within their jurisdiction). Private sector health care agencies are less constrained than public sector health care agencies in developing innovations in health care. A part of the reason for the development of private sector health care agencies is the impatience or dissatisfaction with government (public health) programs.

12.

Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies?

A) Public sector health care agencies are more likely to pilot or subsidize demonstration projects.

B) Private sector health care agencies are more likely to promote health legislation.

C) Public sector health care agencies are more likely to generate new research and innovation.

D) Private sector health care agencies usually focus on needs that are met.

Ans:

B Feedback: Private sector health agencies are more likely to promote health legislation, whereas public sector health care agencies are more likely to be responsible for carrying out health legislation. Private sector health care agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private sector health care agencies strive to detect unmet needs rather than met needs.

13.

Which of the following statements about the international health organization is most accurate?

A) PAHO is completely separate from the WHO. B) UNICEF promotes child and maternal health and welfare globally.

C) WHO focuses primarily on developing countries.

D) WHO and UNICEF are agencies of the United Nations.

Ans: B Feedback: United Nations International Children's Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from WHO. WHO focuses on the promotion of health worldwide, not just developing countries. The United States Agency for International Development (USAID) focuses on developing countries.

WHO and UNICEF are both agencies of the United Nations.

14.

An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans?

A) B) C) D) Ans:

Social Security Act Hill-Burton Act Patient Protection and Affordable Care Act Omnibus Budget Reconciliation Act C Feedback: Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs, the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in health care planning, safety, and funding.

15.

A group of students are preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true? Select all that apply.

A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions.

B) The Shepard-Towner Act provided funds to states for hospital construction.

C) The Hill-Burton Act provided funds to states for administration of programs to support the health and welfare of mothers and infants.

D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance.

E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants.

F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.

Ans: A, D, E Feedback:

The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill- Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for administration of programs to support the health and welfare of mothers and infants.

The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the privacy of medical records.

16.

A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, “Why do I need to know this information? My focus is my clients.” Which response by the presenter would be most appropriate?

A) “You are required to know this information because your agency receives government funding.”

B) “You might be in management one day and have to deal with cost control and reimbursement.”

C) “Although it seems foreign to you, it's an important topic that you might have to deal with someday.”

D) “This knowledge is important to the success of your practice and for the agency's survival.”

Ans: D Feedback: At the local level (the community health nurse and the employing agency), health care economics is very important for survival.

Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable.

Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of health care economics.

17.

When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of the following would the nurse include?

A) Quantity of services available B) Consumer's willingness to buy services C) Aggregate perspective of economic stability D) Allocation of the available resources Ans: C Feedback: Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumptions, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer's willingness to buy services) and study how allocation and distribution affect consumer demand for goods and services.

18.

As part of a community wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse include in the plan? Select all that apply.

A) It is a state health insurance program for elderly and the disabled.

B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services.

C) Medicare Part D covers prescription drug costs.

D) Medicare Part A is supplementary and voluntary.

E) Medicare beneficiaries can make changes to their coverage at any time.

Ans: B, C Feedback: Medicare is a federal health insurance program and covers citizens and some legal aliens who are over 65 years old (not a State program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing service. Prescriptions are covered under Medicare Part D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to their coverage during open

enrollment periods.

19.

After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional teaching is necessary?

A) Medicaid has a monthly fee that recipients must pay.

B) Medicaid is administered individually by each state.

C) Medicaid focuses on preventative services.

D) It is possible to be on both Medicare and Medicaid.

Ans: A Feedback: Medicaid monies come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined on the basis of financial need and residency status. Finally, some low-income Medicare eligible people also receive Medicaid.

20. health nurse identify as a drawback to retrospective reimbursement?

A) Spending was limited to the most necessary tests and treatments.

B) Services for sickness were encouraged rather than wellness.

C) Consumers had to bear the increased accountability for cost containment.

D) Payments for services were based on rates calculated from predictions.

Ans: B Feedback: Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illness and providing for additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatment. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.

21.

Which of the following statements about trends and issues influencing health care economics and community health services delivery are true? Select all that apply.

A) The United States has the most cost effective health care system in the world.

B) One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays.

C) In the United States, the health-related quality of life is lower than for most other countries.

D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated.

E) In a survey published in 2009, most US physicians identified that their health care system worked well.

Ans: B, C, D Feedback: The United States has one of the least cost effective health care systems in the world. One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than for most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system worked well.

22.

Which of the following statements about Health Care Rationing is most accurate?

A) It will not occur in the United States because of our country's values.

B) A danger of rationing is compromising quality and effectiveness.

C) Rationing in health care has never been practiced.

D) Advances in knowledge and technological capabilities will eliminate the need for rationing in the future.

Ans: B Feedback: A danger of rationing is compromising quality and effectiveness. Rationing is already practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing

decisions.

23.

When describing managed competition as a potential solution to resolve the health care crisis, which of the following would be included? Managed competition would A) promote cost containment and universal access to health care.

B) eliminate burdensome government regulations.

C) reduce state and federal control over health care delivery.

D) discourage consumers from making responsible choices.

Ans: A Feedback: Managed competition ideally would promote cost containment and universal access to health care. Governmental regulations and control would still be present as would insurance companies. Managed care would encourage consumers to make responsible choices.

24.

Which statement regarding the potential impact of health care reform on community health nursing is most accurate?

A) Health care reform does not affect community health nursing.

B) Community health nurses know that outcomes research is unnecessary.

C) Public health nurses can lead the effort in making health care more accessible to all citizens.

D) Community health nurses will only be able to work in public health agencies.

Ans: C Feedback: Public health nurses can lead the effort in making health care more accessible to all citizens. Health care reform definitely affects community health nursing. Community health nurses recognize the importance of outcomes research to document the value of nursing interventions with at-risk populations.

Community health nursing has important ties to both private and public health agencies.

Chapter 7 Epidemiology in the Community 1.

An instructor is discussing the worldwide distribution of AIDS. Which term would the instructor use to describe this situation?

A) Epidemic B) Pandemic C) Endemic D) Pathogenicity Ans: B Feedback: Pandemic is the term used to describe an epidemic that is distributed worldwide. An epidemic refers to a disease occurrence that clearly exceeds the normal or expected frequency in a community or region. Endemic is used to describe the continuing presence of a disease or infectious agent in a given geographic area. Pathogenicity refers to an agent's capacity to cause disease in a host.

2.

After a class describing the contributions of Florence Nightingale to epidemiology, the instructor determines that the class needs additional instruction when they state which of the following is associated with Nightingale?

A) Establishment of the need for a clean environment B) A sophisticated coding system for medical conditions C) Proper wound cleansing and bandaging techniques D) Separation of infected individuals from those injured Ans: B Feedback: Nightingale's colleague, William Farr, is credited for developing a more sophisticated system for coding medical conditions.

Nightingale's contributions included establishing the need for a clean environment, properly cleaning wounds and bandaging them, and separating infected soldiers from those who were injured.

3.

When applying the epidemiologic triad model to a community's plan of care, which of the following would the community health nurse address?

A) B) C) D) Ans:

Incidence, prevalence, and case fatality Health, illness, and injury Host, agent, and environment Immunity, causation, and risk C Feedback: The purpose of this model is to demonstrate the relationship among host, agent, and environment. Each component has to be present to a certain degree in order for any disease, illness, or injury to exist or happen. If one component is missing, illness or injury will not occur.

Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are terms used in epidemiology but do not refer to the epidemiologic triad model.

4.

Which of the following would the community health nurse identify as a key component of the host?

A) Infectivity B) Antigenicity C) D) Ans:

Virulence Inherent resistance D Feedback: The host, a susceptible human or animal, can sometimes have an ability to resist pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are characteristics of the agent.

5.

Which of the following statements apply to the concept of causality? Select all that apply.

A) Causality is the relationship between cause and effect.

B) The chain of causation is the most recent theory of causality.

C) The web of causation theory is the most recent theory of causality.

D) The chain of causation clearly explains causation in noninfectious disease.

E) Epidemiology has changed its view of causality over time.

Ans: A, C, E

Feedback: Causality is the relationship between cause and effect. The web of causation theory is the most recent theory of causality. Epidemiology has changed its view of causality over time.

The chain of causation was the first theory of causality. The chain of causation could not sufficiently explain causation in noninfectious disease because the chain of causation is too linear.

6.

A community health nurse is explaining the chain of causation to a family that includes a child who has developed Lyme disease. The nurse correctly describes the opening in the child's skin caused by the actual tick bite as the A) reservoir.

B) mode of transmission.

C) D) Ans:

portal of entry. host.

C Feedback: The opening in the child's skin caused by the actual tick bite is the portal of entry in the chain of causation. The mode of transmission would be the tick biting the child. The reservoir would refer to the tick. The host would be the child who has been bitten by the tick.

7.

A community health nurse is integrating the epidemiology of wellness into practice.

Which of the following would the nurse include?

A) Lifestyle with its self-created risks B) Communicable disease control C) The natural history of disease D) Vital statistics and reportable diseases Ans: A Feedback: Today there is an increased focus on lifestyle behaviors and how they relate to a person's state of wellness or illness. It is a basic component of a wellness model.

Communicable disease control focuses on an illness state, not a wellness state, and is not part of a wellness model. The four states of the natural history of a disease or health condition is not part of the wellness model. Vital statistics and reportable diseases are not part of the wellness model.

8.

The nurse is examining the possibility that multiple factors are involved in the development of a disorder. The nurse is applying which of the following?

A) Chain of causation B) Web of causation C) Strength of association D) Temporality Ans:

B Feedback: The web of causation is being used to apply the concept of multiple causes to explain the existence of health and illness states. It was a refinement of the chain of causation, such that it looked at the combination of multiple factors as implicated in the development of poor outcomes. The chain of causation focuses on one factor in the development of a condition. The strength of association is an element of causation in noninfectious disease that refers to the ratio of disease rates in those with and without the causal factor.

Temporality, also involved with the causation of noninfectious disease, is an element in which the exposure to the suspected factor must precede the onset of the disease.

9.

The nurse is reviewing a research article that describes the use of the bacille CalmetteGuerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to leprosy. The individuals did not develop the leprosy. The nurse interprets this as most accurately demonstrating which type of immunity?

A) Herd immunity B) Passive immunity C) Cross-immunity D) Active immunity Ans: C Feedback: Cross-immunity refers to a situation in which a person's immunity to one agent provides immunity to a related agent as well. This immunity can be active or passive. Herd immunity describes the immunity level present in a population group. Passive immunity refers to shortterm resistance acquired naturally or artificially. Active immunity is long-term and can be acquired naturally or artificially.

10.

The nurse educator knows that a nursing student understands the basics of immunity when the student nurse states A) herd immunity only pertains to cows.

B) active immunity can be attained via the use of vaccines.

C) passive immunity can be attained via the use of vaccines.

D) cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a completely different infectious agent.

Ans: B Feedback: Active immunity can be attained via the use of vaccines. Passive immunity is immunity that is given to a person, either by maternally provided protection for newborn infants or from antibody products that provide temporary resistance. Herd immunity describes the immunity level that is present in a population group. Cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a related infectious agent.

11.

When assessing several populations, the nurse notes each population's relative risk. Using the relative risk ratios below, which population would require a major emphasis for risk reduction intervention?

A) 0.59 B) 1.13 C) 1.79 D) 2.45 Ans: D Feedback: A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group.

Therefore, interventions to reduce this population's risk would be most important.

12.

Which of the following statements about risk is true? Select all that apply.

A) Risk is the probability that a disease or unfavorable health condition will develop.

B) Risk means that the person who has the most negative influences will definitely develop the disease or unfavorable health condition.

C) Risk refers to positive and negative influences on a person's likelihood of developing a specific disease.

D) Risk can be measured using the relative risk ratio, which is based on the ratio of incidence in an exposed group to incidence rate in unexposed group.

E) Risk is unimportant when determining the most effective points for community health intervention.

Ans: A, C, D Feedback: Risk is the probability that a disease or unfavorable health condition will develop. Risk also refers to positive and negative influences on a person's likelihood of developing a specific disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an exposed group to incidence rate in unexposed group. Risk does not mean that the person who has the most negative influences will definitely develop the disease or unfavorable health condition, but it refers to the probability that the person will develop the disease or unfavorable health condition. The relative risk ratio assists in determining the most effective points for community health intervention in regard to particular health problems.

13.

While visiting a family's home, the community health nurse finds out that the two children in the home were exposed to chickenpox. Assessment of the children reveals no signs of fever or lesions. The nurse determines that the children may be in which stage of the disease?

A) Susceptibility B) Subclinical disease C) Clinical disease D) Resolution Ans: B Feedback: The children have been exposed but have not yet developed the signs of chickenpox.

Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is not present and individuals have not been exposed. During the clinical stage, signs and symptoms are beginning to develop.

During the resolution stage, the disease causes sufficient anatomic or functional changes to produce recognizable signs and symptoms.

14.

A) B) C) D) Ans:

communicable disease would quarantine be most effective?

Susceptibility stage Subclinical disease stage Clinical disease stage Resolution stage A Feedback: Quarantine is the isolation of persons who are susceptible to a communicable disease and have been exposed to that communicable disease until the incubation period of the subclinical disease stage has passed.

Quarantining persons during the susceptibility stage itself is not indicated as individuals have not been exposed. The proper action for persons who are in the clinical disease stage and beyond is isolation until the danger of spreading the communicable disease has passed.

15.

The nurse is reviewing actual census data for information for use in an epidemiologic study. Which of the following would the nurse be least likely to find?

A) Occupational status B) Housing quality C) Births recorded D) Educational level Ans: C Feedback: Vital statistic data provides information about the number of births recorded. Census data includes information about age, sex, race, ethnic background, type of occupation, income gradient, marital status, educational level, and other standards such as housing quality. If the nurse is reviewing actual census data, the nurse would be least likely to find births recorded, which is vital statistics.

16. on the use of nursing home services and the common diagnoses of those using these services. Which source of information would be most appropriate for the nurse to investigate?

A) National Center for Health Statistics B) Consumer Product Safety Commission C) Environmental Protection Agency D) Cancer disease registries

Ans:

A Feedback: The National Center for Health Statistics furnishes valuable health prevalence data from surveys of Americans. Among the information available is the National Nursing Home Survey, which provides information on those who are using these services and the diagnoses and other characteristics. The Consumer Product Safety Commission and Environmental Protection Agency would provide information about environmental issues. Cancer disease registries would provide information specific to the diagnosis of cancer.

17.

Which of the following is true about incidence and prevalence? Select all that apply.

A) Prevalence is the number of new cases of a disease or health condition.

B) Incidence is the number of new cases of a disease or health condition.

C) Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time.

D) Incidence refers to all of the people with a particular health condition existing in a given population at a given point in time.

E) When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

Ans: B, C, E Feedback: Incidence is the number of new cases of a disease or health condition. Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

18.

A community health nurse is preparing to carry out an experimental epidemiologic study.

Which of the following would be most important for the nurse to do?

A) Focus the study on evaluating the cause of a disease B) Ensure carefully controlled conditions during the study C) Expose both groups to the same factor or condition

D) Ensure that there are a substantial number of subjects Ans: B Feedback: Experimental studies are carried out under carefully controlled conditions. In human populations, experimental studies should focus on disease prevention or health promotion rather than testing the cause of disease. The investigator exposes an experimental group to some factor and simultaneously observes a control group similar in characteristics to the experimental group but without the exposure factor. An experimental study need not be elaborate to provide important data.

19.

A community health nurse is participating in a case–control observational study. Which of the following would most likely explain this type of study?

A) Description of patterns of occurrence of illness and injury in a population B) Investigation of development of health–illness conditions over a long period of time C) Studying of a cohort with evaluation of variables associated with the disease or injury D) Comparison of persons with and without a health–illness condition Ans: D Feedback: Comparing persons with and without a certain condition is known as a case–control study. A study that describes patterns of occurrence in a population is a descriptive study.

Following people over a long period of time is a longitudinal study. And cohorts are groups studied over time.

20.

After teaching a group of students about the various types of epidemiologic research studies that can be done, the instructor determines that the teaching was effective when the students describe a community trial as which of the following?

A) A type of experimental study conducted at the community level B) An inexpensive type of analytic research study C) A study that gathers volunteers for the

experimental group D) A way to locate health problems in a variety of communities Ans: A Feedback: A community trial is conducted as an experimental study design with large populations.

Some of the community receives a treatment, while the other part does not.

This is probably the most expensive type of experimental study. It involves a great number of subjects, the support of the governmental forces as well as the population involved, a large number of staff over a long period of time, and the cost of the intervention itself.

When a whole community is involved, individuals are not approached to be volunteers. What makes it a community study is that the entire community is part of the study. The health problem is identified prior to the implementation of the study. The introduction of an intervention in one community with no introduction in a similar community forms the study population, and the health problem being studied is then monitored between the two populations. The health problem has to be identified first in this type of study.

21.

When using descriptive epidemiology, which type of study would the community health nurse expect to include?

A) Prevalence study B) Case–control study C) Cohort study D) Count study Ans: D Feedback: Descriptive epidemiology includes investigations that seek to observe and describe patterns of health-related conditions that occur naturally in a population. The simplest measure of a description is a count. Prevalence, case–control, and cohort studies are types of studies involved with analytical research.

22.

A) B) C) D) E) F)

epidemiologic study from the first step to the last.

Collect the data.

Identify the problem.

Analyze the findings.

Disseminate the findings.

Review the literature.

Develop conclusions and applications.

G) Ans:

Design the study.

B, E, G, A, C, F, D Feedback: The proper order of the steps in the epidemiologic study from the first step to the last is to identify the problem, review the literature, design the study, collect the data, analyze the findings, develop conclusions and applications, and disseminate the findings.

23.

When implementing an epidemiologic research study, which of the following would the community health nurse complete as the final step?

A) Analyze the data B) Design the study C) Disseminate findings D) Review the literature Ans: C Feedback: The last step in the research process is to disseminate the findings. After identifying the problem and reviewing the literature, the researcher designs the study, collects the data, analyzes the findings, and develops conclusions and applications.

Chapter 8 Communicable Disease 1.

When reporting the identification of a communicable disease and need for investigation, which of the following must be notified first?

A) B) C) D) Ans:

Centers for Disease Control (CDC) State health department Local health department National Reported Disease list C Feedback: The local health department is the initial point of notification of a communicable disease investigation. Each local health department or agency will investigate the specific disease.

The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as the guidance for State reportable diseases.

2.

Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that apply.

A) Immunization of children and adults B) Disease investigation and case/contact finding C) Diagnosing cases of communicable diseases D) Prescribing treatment for communicable diseases E) Environmental interventions F) Community Education Ans: A, B, E, F Feedback: Appropriate interventions that may be implemented by community health nurses include immunizations of children and adults, environmental interventions, community education, screening programs, and disease investigation and case/contact finding.

3.

Which of the following statements accurately describes important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply.

A) Review the information received from the news media reporter for completeness B) Review disease information including the reservoir, incubation period, infectious period, symptoms, and treatment C) Take all appropriate treatments to the interview site D) Investigate only laboratory confirmed communicable diseases E) Eradicate the disease

Ans:

A, B Feedback:

Steps to take prior to contacting an individual regarding communicable disease include reviewing the information received from the reporters for completeness (this refers to the individual reporting the communicable disease to the public health agency and not the news media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition; review the disease information (including reservoir, incubation period, infectious period, symptoms, and treatment); and identifying the specific questionnaire for the reported disease or using a generic disease investigation form and reviewing the questionnaire. It is not appropriate for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding communicable disease is one of the first steps in the process of investigation.

4.

Which of the following entities would the community health nurse know are required to report known or suspected cases of reportable diseases in every state in the United States?

Select all that apply.

A) Physicians, dentists, and nurses B) Laboratory directors C) Any individual who knows of or suspects the existence of a reportable disease D) Medical examiners E) Administrators of schools and child care centers Ans: A, D, E Feedback: In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors; and any individual who knows of or suspects the existence of a reportable disease.

5.

A community health nurse is presenting a program about hepatitis prevention and risk reduction to a local community group. The nurse determines that the group has understood the program when they identify which method as the major mode of transmission for hepatitis B? A) Oral–fecal route

B) C) D) Ans:

Exposure to contaminated blood Airborne droplet nuclei Infected rodents, such as mice and rats B Feedback: Hepatitis B can occur in certain high-risk groups, including injected drug users, heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal–oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is transmitted via infected rodents.

6.

When reviewing the trends in communicable diseases for a county, the community health nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan for prevention and control integrating the understanding that this disease is most likely transmitted by which mode?

A) Vector B) Airborne C) D) Ans:

Vehicle-borne Direct A Feedback: In the United States, vector-borne illnesses have received renewed attention with accumulating information about Lyme's disease, transmitted to humans by a tick vector.

Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host such as through touching, biting, kissing, or sexual intercourse.

7.

After a community health nurse implements an educational program for a local community group about food safety, which statement indicates that the teaching was successful?

A) “Handwashing is unnecessary if we use gloves.”

B) “After cooking the meat, we'll put it on the same platter that we used for the raw meat.”

C) “Our cooked foods should be cooled quickly.”

D) “If we peel the carrots, we don't need to wash them before eating.”

Ans: B Feedback:

Cooked foods should be cooled quickly. Surfaces, hands, and utensils should be washed in warm soapy water (even when gloves are used as gloves do not prevent cross-contamination by themselves). Foods when cooked should not come in contact with dishes, utensils, or containers used when the foods were raw and uncooked. Foods that are to be eaten raw and uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are to be peeled that grow on the ground or come in contact with soil.

8.

A community health nurse is teaching a group of clients about infection control and mentions the role of vectors in transmitting diseases. Which of the following would be examples of some common vectors? Select all that apply.

A) Chemicals B) Mosquitoes C) Salmonella D) Fleas E) Roaches Ans: B, D, E Feedback: A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not vectors and Salmonella is an infectious agent.

9.

Which of the following statements about modes of transmission are true? Select all that apply.

A) Direct transmission requires contact with a contaminated inanimate material.

B) Indirect transmission is also known as vehicle-borne illness.

C) Food- and water-related illnesses are considered to be spread by indirect transmission.

D) Vector transmission requires contact with a nonhuman carrier such as an animal or insect.

E) Airborne transmission commonly occurs from coughing and sneezing.

Ans: B, C, D, E

Feedback: Direct transmission occurs by immediate transfer of infectious agents from a reservoir to a new susceptible host. Indirect transmission requires contact with a contaminated inanimate material and is also known as vehicle-borne illness. Food- and water-related illnesses are considered to be spread by indirect transmission. Vector transmission requires contact with a nonhuman carrier such as an animal or insect. Airborne transmission commonly occurs from coughing and sneezing.

10.

Community health nurses practice within the three levels of prevention. Which of the following would the community health nurse engage in at the primary level of prevention for communicable disease control? Select all that apply.

A) Providing TB skin test to children entering kindergarten B) Administering immunizations to senior citizens C) Teaching kindergarten students to wash their hands D) Encouraging parents to complete their children's immunizations E) Providing chest x-rays to people with positive TB skin tests F) Administering prompt treatment for the symptoms of gonorrhea Ans: B, C, D Feedback: Primary prevention interventions include administering immunizations, teaching about hand washing, and encouraging adherence to the recommended schedule for childhood immunizations. Providing TB skin testing and chest x-rays, and promptly treating symptoms of gonorrhea are examples of interventions at the secondary level of prevention.

11.

The nurse educator has just discussed education of aggregates using mass media with targeting health messages. Which of the following statements by the nursing student would demonstrate the student's ability to analyze and apply the information?

A) Television would be the most important venue of mass media to educate the aggregate as everyone has a television.

B) The target audience must be assessed for educational level, salience of the issue, involvement in the issue, and access to the media channel used.

C) Pamphlets should be assessed to make sure they are at a twelfth grade reading level.

D) It is unnecessary to consider culture when planning the health message.

Ans: B Feedback: To effectively deliver a health promotion and disease-prevention message, the message must reach the target (at-risk) population.

This requires correct identification of the characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and access of the target audience to the media channels used. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease- prevention message to ethnic and racial minority groups. Television may not be the most important venue of mass media to educate the aggregate. Pamphlets may not be the best way to educate the aggregate, and the reading level of any literature must be specific for the target audience.

Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease- prevention message to ethnic and racial minority groups.

12.

A community health nurse has identified the index case. The nurse is involved in which of the following?

A) Contact investigation B) Screening C) Isolation D) Quarantine Ans: A Feedback: The index case (diagnosed person) results from contact investigation and partner notification. Screening describes programs that deliver a testing procedure to detect disease in groups of asymptomatic apparently health individuals. Isolation refers to the separation of the infected person from others for a period of communicability to limit transmission; quarantine refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period. Contact investigation and notification is one of two approaches to secondary prevention of communicable diseases.

13.

The three main approaches to the tertiary prevention of communicable disease include which of the following?

A) Education, immunization, and screening B) Screening, immunization, and isolation and quarantine C) Case and contact investigation, notification, and treatment D) Care and treatment, isolation and quarantine, and safe handling and control of infectious wastes Ans: D Feedback: The three main approaches to the tertiary prevention of communicable disease include care and treatment, isolation and quarantine, and safe handling and control of infectious wastes.

The primary prevention techniques for communicable disease include education, immunization, and screening. The secondary prevention techniques for communicable disease include case and contact investigation, notification, and treatment.

14.

If an agency discards used needles and syringes in plastic milk jugs, which of the four key elements of an infectious waste management program that are applicable to community practice would the agency be violating?

A) Health professionals must be able to correctly distinguish biohazardous waste from biomedical waste.

B) The waste management program must have administrative support and authority to institute practice guidelines.

C) Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture.

D) An enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

Ans: C Feedback: Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture; they should have sufficient strength to prevent rupture or tearing under normal conditions; and they should be sealed to prevent leakage. Containers for sharps must also be puncture resistant. Other key elements of an infectious waste management

program that are applicable to community practice include that health professionals must be able to correctly distinguish biohazardous waste from biomedical waste; the waste management program must have administrative support and authority to institute practice guidelines; and an enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

15.

The community health nurse determines that the adult population in the community has an increased incidence of vaccine preventable disease. Which of the following are factors that may contribute to low vaccination levels among adults? Select all that apply.

A) Lack of comprehensive vaccine delivery systems to the public and private sectors for adults (similar to the Vaccines for Children program for children) B) Lack of statutory requirements for vaccination of adults C) Health care providers may lack current information about recommended adult immunizations and may miss opportunities to vaccinate adults during contacts in offices, outpatient clinics, and hospitals.

D) Adults fear injections for immunizations but do not worry about adverse effects after vaccination.

E) A multitude of comprehensive vaccination programs exist in settings where healthy adults congregate such as workplaces and other locations.

Ans: A, B, C Feedback: Low vaccination levels among adults are associated with several factors: limited comprehensive vaccine delivery systems that are available; lack of statutory requirements for vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts in offices, outpatient clinics, and hospitals. Additionally there is a lack of comprehensive vaccination programs in settings where healthy adults congregate; and clients and providers may fear adverse reactions after vaccination.

16.

A community health nurse would recommend pneumococcal vaccine for which group?

A) 1-year-old children

B) 30-year-old adults who have simple respiratory tract infections C) Adults over age 65 who have COPD D) Healthy adults in their 50s Ans: C Feedback: Primary prevention includes a pneumococcal vaccine, especially for the high-risk groups, ages 2 years old and up, including those with chronic diseases, immune-suppressing health conditions, or those who are asplenic.

Reimmunization is recommended only for high-risk children, or adults over 65 years old who had their first vaccination before age 65. The vaccine is not effective in children younger than 2 years of age and is not recommended for the healthy population between the ages of 2 and 65 years.

17.

Which of the following statements about immunization is most accurate?

A) Immunization is helpful in the spread of all communicable diseases.

B) Immunization cannot provide herd immunity.

C) Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease.

D) Immunization is the process of administering antibodies to a person.

Ans: C Feedback: Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. There are many communicable diseases that a vaccine is not known for. Immunization can help to promote herd immunity. Immunization does not involve the administration of antibodies to a person.

18.

A family member has developed tuberculosis (TB) and the remainder of the family members are undergoing tuberculosis skin testing to determine their status. The nurse assesses the indurations and determines that a family member with which size induration is positive for TB? A) 2 mm B) 3 mm C) 4 mm D) 5 mm

Ans:

D Feedback: An induration of 5 mm or more is considered positive for individuals in close contact with others who have TB. Indurations <5 mm are not considered positive.

19.

The community health nurse observes an increase in the development of multidrugresistant tuberculosis. The nurse understands that a major reason for this occurrence for individual clients would most likely be A) political and social response to declining rates of TB over the past decade.

B) a reduction in funding for surveillance and research.

C) noncompliance with the therapy for the full, recommended period.

D) a premature sense that TB has been defeated.

Ans: C Feedback: On an individual case basis, the most common means by which resistant organisms are acquired is by noncompliance with therapy for the full, recommended period.

Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include the political and social response to declining rates of TB over past decades, which has resulted in funding cuts for surveillance, treatment, and research, and a premature sense that TB was defeated.

20.

Which of the following statements about the prevention of sexually transmitted diseases is true? Select all that apply.

A) Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum.

B) Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated.

C) The proper use of condoms prevents transmission of all sexually transmitted infections.

D) Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea.

E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other sex partners if sexual contact is only practiced when the person does not have any visible sores.

Ans: A, B, D Feedback: Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum.

Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection transmission but does not eliminate the transmission of all sexually transmitted infections. It is possible for a person who has HSV-2 infection to transmit the infection to other sex partners if sexual contact is practiced even when the infected partner does not have a visible sore.

21.

Which one of the following statements is true about the consequences of biologic terrorism with anthrax and smallpox?

A) Anthrax is not usually spread by person to person contact and so is not a good agent of biological terrorism.

B) Smallpox is globally eradicated and therefore does not present a problem.

C) Most adults are immune to smallpox due to routine immunization.

D) As many as one in five persons who become ill with cutaneous anthrax die and inhalation anthrax can cause death in 3 to 5 days.

Ans: D Feedback: The case–fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and expected death within a matter of days.

Anthrax is not usually spread by person to person contact, but it has been demonstrated to be an agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist attacks. Many adults are not immune to smallpox as it has not been used for routine immunization for 40 years.

22.

Which of the following statements about confidentiality, privacy, and discrimination is the most accurate?

A) It is permissible for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities.

B) It is permissible for a community health nurse to tell the contacts of a person who is infected with a communicable disease which disease they have been exposed to and the name of the source.

C) It is permissible for any health care provider to report any cases of known or suspected communicable diseases to the news media.

D) Only the identity of the index case of a communicable disease needs to be protected.

Ans:

A Feedback: It is permissible and necessary for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. It is important that the contacts of a person who is infected with a communicable disease which disease they have been exposed to but is not acceptable for the community health nurse to reveal the identity of the source. It is permissible and often helpful for a community health nurse to involve the news media in informing the public of information about the specific disease including mode of transmission, prevention, and treatment options but not the identity(ies) of the cases. It is important to assure the individual being interviewed that the information will be maintained in a confidential manner, and the goal is care and treatment.

Chapter 9 Environmental Health & Safety 1.

A community health nurse is presenting an in- service for a group of other community health nurses about ecological perspective of environmental health. Which of the following would the nurse incorporate into the program when describing this concept?

A) The study of governmental and private sector regulations of the environment B) A technological view of strategies for preventing illness and injury C) Identification of not only the physical environment but also the social and cultural factors that exist for populations D) The role of the community health nurse in preventing injury, disease, and illness Ans: C Feedback: The ecological perspective identifies not only the physical environment but also the social and cultural factors that exist for populations. Nurses who display this type of approach provide a more comprehensive level of care. It is not a study of the governmental and private sector regulations, a technological view, or the nurse's role in preventing injury, disease, and illness.

2.

When applying the ecological perspective to environmental health, a community health nurse integrates which of the following concepts as most essential?

A) Primary prevention is limited in this area.

B) The need for foresight in designing innovations C) No one factor can be viewed in isolation.

D) Implications of scientific advances are fully understood.

Ans: C Feedback: With the ecological perspective, no one factor can be viewed in isolation. The preventive approach involves all three levels of prevention, of which primary prevention is the most important. This approach also requires foresight in designing innovations and involves implications associated with the unprecedented advances in science and technology.

3.

Which of the following concepts is used by public health professionals to illustrate that the determinants of health interact to affect health?

A) Precautionary principle B) Ecological perspective

C) D) Ans:

Sustainability Upstream focus B Feedback:

The ecological perspective is used by public health professionals to illustrate that the determinants of health interact to affect health. The precautionary principle states that in the absence of clear data that indicates the safety of an action, chemical or material that poses a threat to human health, it should not be used. Sustainability is “the ability to meet the needs of

the present without compromising the ability of future generations to meet their own needs.”

Upstream focus identifies the root causes of disease and manufacturers of illness.

4.

Which of the following statements about an upstream focus is the most accurate?

A) The upstream approach does not focus on socioeconomic factors and the environmental origins of disease and health problems.

B) The focus of an upstream approach is the institution and system level.

C) The upstream approach pertains to the purity of water supplies.

D) The focus of an upstream approach is healthy lifestyle issues.

Ans: B Feedback: The focus of an upstream approach is the institution and system level, and not just healthy lifestyle issues. The upstream approach does focus on socioeconomic factors and the environmental origins of disease and health problems. The upstream approach does not pertain to the purity of water supplies.

5.

When the public health nurse uses an upstream approach to improve heart health, the nurse would examine which one of the following factors?

A) Unhealthy diets B) Decreased physical activity C) D) Ans:

Smoking tobacco Lack of safe places to exercise D Feedback: The upstream approach focuses on the factors at the institutional and system level rather than looking at healthy lifestyle issues.

Healthy diets, increased physical activity, and smoking cessation are all healthy lifestyle issues.

The root causes of the decreased physical activity would include lack of safe places to exercise.

6.

A public health nurse who uses the upstream approach would likely focus on which one of the following contributors to unhealthy diets in the community?

A) Consumer preference for sweet, greasy, and salty foods B) Marketing strategies of fast food businesses C) Busy lifestyles within the community D) Individual acceptance of obesity Ans: B Feedback: A public health nurse who uses the upstream approach would likely focus on factors that are at the institutional and system level rather than looking solely at healthy lifestyle issues.

Consumer preference for sweet, greasy, and salty foods; busy lifestyles within the community and individual acceptance of obesity are lifestyle issues. The marketing strategies of fast food businesses are one root cause of unhealthy diets in the community.

7.

The nursing student is preparing a report for class relating to Healthy People 2020 and environmental health. Which of the following should be included in this report? Select all that apply.

A) The agency that prepared this initiative is the World Health Organization.

B) The overall goal is to “promote health for all through a healthy environment.”

C) The document provides instructions for persons in the community regarding how to protect their own health.

D) One of the six focus areas is global environmental health.

E) The document provides guidance for nurses to identify targets for health.

Ans: B, D, E Feedback: The overall goal of Healthy People 2020 is to “promote health for all through a healthy environment.” The document does provide guidance for nurses to identify targets for health (not instructions for individuals). The six areas that are focused on include outdoor air quality, surface and ground water quality, toxic substances and hazardous wastes, homes and communities, infrastructure and surveillance, and global environmental health. The agency that prepared this initiative is the U.S. Department of Health and Human

Services.

8.

Which one of the following statements about assessment (one of the core public health functions) and how it can be applied to environmental health is most accurate?

A) Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs.

B) Assessment is least valuable when related to where the person attends school.

C) It is not necessary for nurses to have a background in the environmental health sciences.

D) Assessment should be limited to the general population and should not include the increased vulnerability of certain groups.

Ans: A Feedback: Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs. With assessment, priority should be given to locations where people spend the majority of their time (home, work, school). Where persons attend school is too limiting as many people do not go to school and the priority should be given to home and work. The ability to perform critical assessments for environmental health requires background in the environmental health sciences. Public health nurses must also be aware of the increased vulnerability of certain groups.

9.

The core public health function of policy development related to environmental health includes which one of the following?

A) Policy development is best left to legislators.

B) To be an effective advocate for change, it is only necessary that the nurse speak out.

C) There are many ways for public health nurses to participate in policy development related to environmental health.

D) Public health nurses are public servants and therefore cannot advocate for public policy.

Ans: C Feedback:

There are many ways for a public health nurses to participate in policy development related to environmental health that start with the nurse being informed about the hazards in the community, existing legislation that protects people in the community, and governmental and nongovernmental groups in communities that can be partners in the efforts to protect health.

They may write letters to their legislators, inform community members, and write letters to the editors of local newspapers and periodicals. Nurses can also present testimony at public forums or hearings. Policy development is not best left to legislators. It is important for nurses to advocate for policy development to care for the environment. Public health nurses are public servants and that is why they must advocate for policy development that favors the environment.

10.

A community health nurse is enacting policy development by preparing a presentation for a group of state health officials about the issue of water pollution in the United States. Which of the following would the nurse include?

Select all that apply.

A) Globally, the availability of clean water is becoming a very serious threat to human survival.

B) Water pollutants consist solely of chemicals.

C) Recently, there has been an increase in the concern about pharmaceuticals contaminating water supplies.

D) All water that is to be consumed is regulated through the EPA. E) The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised.

Ans: A, C, E Feedback: Globally, the availability of clean water is becoming a very serious threat to human survival. Recently, there has been an increase in the concern about pharmaceuticals contaminating water supplies. The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised. Water pollutants consist of organic and inorganic chemicals, contamination with microbes, pharmaceuticals, pesticides and insecticides, and radionuclides. The EPA only regulates public water systems.

11.

A community health nurse is working with the local health departments to educate the citizens about the effects of radon exposure and its link to possible illness. Which of the following would the nurse identify as being a major health concern associated with radon?

A) Skin cancer B) Lung cancer C) Diarrhea D) Cardiovascular disease Ans: B Feedback: Radon is a leading cause of death from lung cancer. Skin cancer is associated with sun exposure. Diarrhea and cardiovascular disease are not associated with radon exposure.

12.

During a community program about food safety, a participant asks, “I know it is important to use safe food practices to avoid microbial contamination, but what other possible risks are there with our food supply?” Which response by the nurse would be most appropriate?

A) “Nothing is more of a problem than foodborne illness.”

B) “Risks occur only at food production and not handling or consumption.”

C) “Radiating food is something that really doesn't occur in the United States.”

D) “A recent concern has been raised about genetically modified foods being marketed.”

Ans: D Feedback: There are many possible risks to the food supply, some even having more serious effects than food-borne illness. Risks occur at all points from food production to food consumption.

Radiating food does occur in the United States. A recent concern has been raised about genetically modified foods being marketed. Genetically modified foods may interfere with the safety of food for human consumption and also questions about the ecological impact and sustainability have been raised.

13.

Which of the following groups of persons have increased vulnerability to environmental hazards to human health related to food?

Select all that apply.

A) Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins to the unborn fetus.

B) Persons who have altered immunity are more likely to be affected by food exposures.

C) Middle-aged males D) Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size.

E) Adult women who are nonchildbearing Ans: A, B, D Feedback: Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins to the unborn fetus. Persons who have altered immunity are more likely to be affected by food exposures. Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size. Middle-aged males and adult women who are nonchildbearing are not especially vulnerable to environmental hazards to human health.

14.

Which of the following are variables that occur in nature and could have a negative impact on humans? Select all that apply.

A) The effect of climate change upon weather extremes (droughts, floods, and storms) B) Changes in rainfall and water supply for soil C) Ecology of microbial growth D) Risks for waterborne and food-borne pathogens in drinking water, seafood, and fresh produce because of climate variability E) There is adequate food supply and always will be.

Ans: A, B, C, D Feedback: The variables related to the food supply that occur in nature and could have a negative impact on humans include the effect of climate change upon weather extremes (droughts, floods, and storms); changes in rainfall and water supply for soil; ecology of microbial growth; risks for water-borne and food-borne pathogens in drinking water, seafood, and fresh produce because of climate variability. There are currently food shortages in parts of the world, and this is likely to continue and may worsen.

15.

An instructor is reviewing the evolution of environmental health and the development of various agencies designed to protect health. As part of the review, the instructor includes the Environmental Protection Agency (EPA), describing its primary goal as which of the following?

A) Identify and address world health issues B) Protect occupational safety and health C) Monitor food and drug production and availability D) Set standards and monitor and enforce environmental protection Ans: D Feedback: The EPA was established for the purpose of standard setting, monitoring, and enforcement of environmental protection. The World Health Organization (WHO) identifies and addresses world health issues. The Occupational Safety and Health Administration (OSHA) protects occupational safety and health. The Food and Drug Administration (FDA) is responsible for monitoring food and drug production and availability.

Chapter 10 Communication, Collaboration, and Technology 1.

When educating clients, which of the following parts of the communication process would be most important for the nurse to ensure?

A) Limit setting B) Feedback loop C) Goal direction D) Nonverbal expression Ans: B Feedback: A major component of the communication process is the feedback loop, which allows both the sender and the receiver to check on the success of the transference of meaning and to renegotiate the message to allow for clarity and better understanding. Limit setting may or may not be appropriate. Although therapeutic communication is goal directed and involves nonverbal expressions, these are not parts of the communication and they are not as important as making sure the message has been understood correctly.

2.

A community health nurse sends an e-mail stating a request to the local health department. This is an example of which part of communication?

A) Sender B) Message C) Decoding D) Channel Ans: D Feedback: A channel is the medium through which the sender conveys the message. It may be written, spoken, or nonverbal. Sending an e- mail is an example. The sender is the person conveying the message. The message is the expression of the purpose of the communication.

Decoding is the translation of the message into an understandable form by the receiver.

3.

Which of the following steps of the communication process does the community health nurse who is serving as the sender have the most control of? Select all that apply.

A) The receiver B) The decoding C) The message D) The channel E) The feedback loop F) Ans:

The encoding C, D, F Feedback: The community health nurse who is serving as the sender in the communication process has the most control over the sender, the message, the channel (the medium through which the sender conveys the message), and the encoding (the sender decides which specific signals or

codes such as language, words, gestures, and body language to use). The community health nurse does not have much control over the receiver, the decoding (the receiver's interpretation of the message), or the feedback loop (a way for the sender and receiver to check on the success of the transference of meaning and to renegotiate the message to allow for clarity and better understanding), all of which are controlled by the receiver.

4.

Which of the following would a community health nurse identify as most important to sending skills involved with communication?

A) Active listening B) Paraphrasing C) Nonverbal messages D) Rapport Ans: C Feedback: Sending skills involve the ability to transmit the messages effectively. Two main channels to send messages are nonverbal and verbal messages. Active listening and paraphrasing are involved with receiving skills. Rapport is an interpersonal skill.

5.

When communicating with a group of clients, which of the following would the nurse identify as a barrier to the communication process?

A) The nurse's sharing of complete and accurate information with the clients B) The clients' use of medical terminology in the discussion C) The clients' offering of feedback to allow the nurse to learn what the client understands D) The clients' interpretation of the message through their own perceptions Ans: D Feedback: Selective perception is the interpretation of a message through their own perceptions, and projects this onto the communication process as they decode a message. Sharing complete and accurate information, client's use of medical terminology, and the clients' offering of feedback to allow the nurse to learn what the client understands are important skills of effective communication.

6.

A community health nurse is dealing with a family in crisis. The nurse remains calm and firmly reassuring when communicating with them. This nurse is avoiding which barrier to communication?

A) B) C) D) Ans:

Filtering information Emotional influence Language barrier Selective perception B Feedback:

The nurse is avoiding emotional influence, that is, how a person feels at the time a message is sent or received, which can influence its meaning. Senders can distort messages and receivers can interpret messages incorrectly when emotions cloud their perception. Emotions can interfere with rational and objective reasoning, thus blocking communication. Filtering information means manipulating information by the sender to influence the receiver's response.

Language barriers involve the different interpretations of words by people. Selective perception involves the receivers interpreting a message through their own perceptions, which are influenced by their own experiences, interests, values, motivations, and expectations.

7.

Which of the following statements about filtering messages is most accurate?

A) Filtering is always intentional.

B) Filtering is never intentional.

C) Only clients use filtering.

D) Filtering leads to miscommunication and misinterpretation.

Ans: D Feedback: Filtering leads to miscommunication and misinterpretation. Filtering can be intentional or unintentional and may be used by clients or nurses.

8.

During an interview with several clients, the community health nurse assumes responsibility for and strives to understand the feelings and thoughts of the client. The nurse is demonstrating which of the following?

A) Reflection B) Respect C) Empathy D) Active listening Ans:

D Feedback: Active listening is the skill of assuming responsibility for and striving to understand the feelings and thoughts in a sender's message. The nurse actively works to discover what the clients mean. Reflection involves restating what clients or others have said to clarify the received meaning. Respect involves conveying an attitude that clients and others have importance, dignity, and worth.

Empathy is the ability to communicate understanding and to vicariously experience the feelings and thoughts of others.

9.

Which action by a community health nurse demonstrates respect to the client?

A) Feeling the same emotion that the client has B) Addressing the client as “Mr.” or “Mrs.” C) Being open and genuine with the client D) Having self-awareness Ans: B Feedback: Showing respect means conveying the attitude that clients and others have importance, dignity, and worth, such as by the manner in which the nurse addresses people—for instance, by using the courtesy titles of “Mr.” or “Mrs.” until it is determined how the client wants to be addressed. Putting one's self in the client's shoes demonstrates empathy; this is not the same as feeling the same emotion that the client has. Being open and genuine establishes rapport. Having self-awareness is a part of empathy that allows an individual to accurately demonstrate this understanding to the client.

10.

Which one of the following statement about health literacy and health outcomes is most accurate for clients who have low literacy?

A) It is important to make the message as basic and simple as possible because the client likely has low intelligence.

B) It is best to use written materials for clients who have low literacy.

C) It is very important for clients who have low literacy to have ample opportunity to provide feedback.

D) Health literacy is not a very important factor in mortality and morbidity.

Ans: C Feedback: It is very important for clients who have low literacy to have ample opportunity to provide feedback that will demonstrate understanding. Communication with low-literacy, highrisk groups should be simplified and easy-to-read materials. At the same time, there is the danger of making the communication so simple that the reader feels insulted. It has been well documented that most health information pamphlets, brochures, and other materials cannot be read or comprehended by adults who have low literacy. Those who have the lowest literacy levels have the highest mortality and morbidity.

11.

Which of the following are key issues related to health literacy? Select all that apply.

A) Health literacy is characterized as critical to health promotion and disease prevention.

B) Limited health literacy only affects those who have low educational levels.

C) Poor health literacy skills can contribute to increased health care costs.

D) Health literacy involves the ability to read, understand, and act on health information.

E) Health literacy goes beyond the basic definitions of literacy.

Ans: A, C, D, E Feedback: Health literacy is characterized as critical to health promotion and disease prevention.

Limited health literacy affects people of all races, incomes, ages, and educational levels. Poor health literacy skills have been associated with poorer health status and increased health care costs because people with a low-literacy level are less knowledgeable about their health conditions and are less likely to seek preventative care. Health literacy involves the ability to read, understand, and act on health information.

Health literacy goes beyond the basic definitions of literacy and includes cultural literacy, computer literacy, scientific, media, and technological literacy.

12.

While working with a community group, a community health nurse observes the group sharing ideas and opinions and being creative. The nurse determines that the group is in which stage?

A) Forming B) Storming C) Norming D) Performing Ans: C Feedback: During the norming stage, trust and openness are more apparent, and there is a sharing of ideas and opinions and creativity. The forming stage is characterized by members becoming oriented to each other. The storming stage involves conflict and competition with the group getting down to sharing more sensitive issues. The performing stage is characterized by the ability to work as

a total group, in subgroups, or independently.

13.

Which of the following descriptions of the five stages in group development are accurate? Select all that apply.

A) All groups eventually reach the performing stage.

B) The storming stage is detrimental to group development.

C) Loss of group affiliation often occurs with adjourning.

D) The group begins to focus more on maintenance rather than just tasks during the norming stage.

E) Conflict is inherent in the forming stage.

Ans: C, D Feedback: During the adjourning stage, the group must disengage, and this may cause feelings of loss. The group begins to focus more on maintenance rather than just tasks during the norming stage. Not all groups do reach the performing stage. The storming stage is necessary to allow group members to identify roles, expectations, and get a feel of how the group will work together. Conflict is to be avoided at the forming stage but must occur at the storming stage.

14.

A community health nurse is part of a group dealing with health issues. During one of the meetings, the nurse states, “Let's all take about 5 minutes to share ideas so that everybody will have a chance to be heard.” The nurse is demonstrating which of the following?

A) Encouraging B) Gatekeeping C) Blocking D) Mediating Ans: B Feedback: The nurse is demonstrating the maintenance role behavior of gatekeeping, by trying to make it possible for another member to make a contribution to the group such as by saying, “We

haven't heard from Jim yet” or suggesting limited talking time for everyone so that all will have a chance to be heard.

Encouraging is demonstrated by being friendly, warm, and responsive to others, praising others and their ideas, and agreeing with and accepting the contributions of others. Blocking is demonstrated by going off on a tangent, citing personal experiences unrelated to the problem, arguing too much on a point, or rejecting ideas without consideration.

Mediating involves attempts to harmonize, conciliate differences in point of view, or suggest compromises.

15.

A community health nurse working as part of group uses the group as a sounding board, often expressing personal, nongroup-related feelings. This nurse is demonstrating which of the following nonfunctional behaviors?

A) Self-confession B) Aggression C) Competition D) Sympathy seeking Ans: A Feedback: Self-confession involves using the group as a sounding board, expressing personal, nongroup-oriented feelings or points of view. Aggression involves working for status by criticizing or blaming others, showing hostility toward the group or some individual and deflating egos or status of others.

Competition involves vying with others to produce the best idea, talk the most, play the most roles, and gain favor with the leader.

Sympathy seeking involves trying to induce other group members to be sympathetic to one's problems or misfortunes, for example, deploring one's own situation, or disparaging one's own ideas to gain support.

16.

When the community health nurse encourages the group members of a collaborative partnership of interdisciplinary teams to effectively share ideas and frustrations on an equal, reciprocal basis, the community health nurse is focusing on which of the five characteristics of collaboration in community health?

A) Maximized use of resources B) Clear responsibilities C) Shared goals

D) Ans:

Mutual participation B Feedback:

When the community health nurse encourages the group members of a collaborative partnership of an interdisciplinary team to effectively share ideas and frustrations on an equal, reciprocal basis, the community health nurse is focusing on the mutual participation characteristic. The characteristic of maximized use of resources involves designing the collaborative partnership of those who are most knowledgeable and in the best positions to influence a favorable outcome. The characteristic of clear responsibilities involves each member in the partnership plays a specific role with related tasks. The characteristic of shared goals involves each member of the team entering the collaborative relationship with broad needs or purposed to be met and specific objectives to accomplish.

17.

A collaborative community health group working with the teenage population to improve health draws on the expertise of school nurses and others working with adolescents to develop a plan. The group is demonstrating which characteristic of collaboration?

A) Shared goals B) Mutual participation C) Maximized use of resources D) Clear responsibilities Ans: C Feedback: Maximizing the use of community resources involves drawing on the expertise of those who are most knowledgeable and in the best positions to influence a favorable outcome. In this case, it would be school nurses and others working with adolescents. Shared goals are demonstrated by recognition of the specific reasons for entering into the relationship, that is, the improved health of adolescents. Mutual participation involves the reciprocal exchange among team members, with all team members contributing and receiving mutual benefit.

Clear responsibilities involve each member playing a specific role with related tasks.

18.

Several community health agencies are collaborating on health promotion strategies. The community health nurse observes that the team is working on assessment, planning, implementation, and evaluation. The nurse correctly concludes that

A) the team is made up solely of nurses.

B) the team is in the beginning phase.

C) the team is determining the goals they will work toward.

D) the team is working together to accomplish desired goals.

Ans: D Feedback: The three phases common to the collaboration process are the beginning phase when the team relationship is being established and are identifying the project needs and determine the goals toward which they will work. The second phase occurs when team members start working together to accomplish desired goals. The work of the second phase may include assessment, planning, implementation, and evaluation that will recur cyclically until the goals are satisfactorily accomplished. The third phase occurs when the need for team members to work together has ended.

19.

The student nurse correctly identifies the four characteristics of contracting as: Select all that apply.

A) format.

B) partnership and mutuality.

C) negotiation.

D) commitment.

E) legal fees.

Ans: A, B, C, D Feedback: The four features of contracting in community health nursing are partnership and mutuality, commitment, format, and negotiation. Legal fees are not involved as contracting in community health nursing is not legally binding.

20.

When the nurse and client enter a contract in community health nursing and the nurse and client share participation and agreement between them, which characteristic of contracting is being enacted?

A) Partnership and mutuality B) Commitment C) Format D) Negotiation Ans: A

Feedback: The four features of contracting in community health nursing are partnership and mutuality (the nurse and the client share participation and agreement), commitment (the involved parties make a decision that binds them to fulfilling the purposed of the contract), format (outlining of specific terms of the relationship), and negotiation (the parties propose to accept certain responsibilities that are agreed upon by both parties).

21. contracting would be effective to use with client groups based on the understanding that this method is beneficial for which of the following?

A) Encouraging client participation in the decision-making process B) Contributing to a trusting nurse–client relationship C) Decreasing client stress during home visits D) Reducing client visit time by over 50% Ans: A Feedback: The nurse and the client contribute to the formulation of the contract, thus fostering client participation in decisions regarding the direction and activities within the contract.

Contracting also involves commitment, format, and negotiation. Contributing to trust, decreasing client stress, and reducing visit time are not considered benefits associated with contracting.

22.

A community health nurse is contracting with a client receiving services in the home. The nurse and client are negotiating the activities for which each will be responsible. This correlates with which phase of the nursing process?

A) Assessment B) Nursing diagnosis C) Planning D) Evaluation Ans: C Feedback: Dividing responsibilities via negotiation would be part of the planning/intervention phase of the nursing process. The assessment phase would involve exploration of needs.

The nursing diagnosis phase would correlate with goal establishment. Evaluation would involve formative and summative assessments of progress toward goals and renegotiation or termination.

23.

After teaching a group of students about the process of contracting, which statement by the group indicates successful teaching?

A) The process is dynamic as it moves through various phases.

B) Contracting involves a unidirectional client– nurse relationship.

C) The process must move backward before it can move forward.

D) Once the contract is developed, it remains relatively stable.

Ans: A Feedback: Contracting is a dynamic process that moves through phases. It forms a reciprocal relationship between clients, nurse, and other persons. The process moves forward, focused on meeting clients' needs, and enables the collaborating group to facilitate ultimate achievement of clients' goals.

Chapter 11 Health Promotion Through Education 1.

After teaching a class about the stages of change, the instructor determines that the class understands the information when they identify the following as the proper sequence of stages?

A) Unfreeze, plan, and integrate B) Plan, organize, and coordinate C) Plan, relearn, and integrate D) Unfreeze, change, and refreeze Ans: D Feedback: According to Lewin, change occurs in the following stages: unfreezing the old behavior, implementing the change, and then refreezing the new change in place to integrate it into the system. Planning, relearning, integrating, and coordinating are not stages of change.

2.

When implementing a program for teaching parenting to a group of teenagers, the community health nurse determines that the group is in the changing/moving stage of change when the group demonstrates which of the following?

A) Motivation for change B) Integration of the change C) Lack of resistance to the change D) Beginning adoption of the change Ans: D Feedback:

During the changing or moving stage, people experience a series of attitude transformations, ranging from early questioning to full acceptance and commitment to accomplishing the change.

They examine, accept, and try the innovation and the nurse helps them see the value of the change, encourages them to try it, and assists them in adopting it. Motivation for the change is part of the unfreezing stage. Showing a lack of resistance to the change and integration of the change characterize the refreezing stage.

3.

A client who needs to lose weight as part of an overall plan to become healthier has contracted with a nurse for behavior change. The client is working on increasing fruits and vegetables in his or her diet and currently consumes less than one fruit or vegetable per day. The nurse knows that the client is in the unfreezing stage of change when the client stated: A) “I have been reading a lot about the healing powers of many fruits and vegetables. I never ate many fruits and vegetables as a child so I am not sure how to prepare them. Can you refer me to some sources of information?”

B) “I have started to try one serving of fruits and one serving of vegetables at each meal. I am starting to discover some of my favorites.”

C) “I still hate fruits and vegetables and I don't think I will be successful at integrating them into my diet.”

D) “Today I ate a total of 10 servings of fruits and vegetables. I really do like them and I feel great!”

Ans: A Feedback: In the first stage, a disequilibrium develops and the system is more vulnerable to change.

People in this stage have a sense of dissatisfaction and have a void that they would like to fill.

When the client stated, “I have been reading a lot about the healing powers of many fruits and vegetables…,” he or she was expressing disequilibrium. When the client stated, “I have started to try one serving of fruit and one serving at vegetables at each meal…,” he or she was indicating that he or she is changing. When the client stated, “I still hate fruits and vegetables…,” he or she was expressing opposition to change which is not a part of the change process. When the client stated, “Today I ate a total of 10 servings of fruits and vegetables…,” the client was expressing that the change has become established as an accepted and permanent part of the system.

4.

A community health nurse is applying the normative–reductive strategy of change when working with clients. In doing so, the nurse engages them into changing their behavior in addition to providing education, based on which assumption?

A) Information alone is not enough, and behaviors change through persuasion.

B) Compliance by the client system will occur through the use of power to effect change.

C) People are rational and will adopt a new practice because it is in their best interest.

D) The clients can assume a high degree of responsibility for their own help.

Ans: A Feedback: Normative–reductive strategies not only give information but also directly influence people to change attitudes and behaviors through persuasion. Use of power or coercion is associated with the power–coercive change strategy. The Empiric–rational change strategy is based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest. The empiric–rational strategy is best used with clients who can assume a relatively high degree of responsibility for their own health.

5.

The community health nurse is presenting sexuality education to a group of sixth grade students. The community health nurse tells the students that they must never have unprotected sexual intercourse or they will die from a sexually transmitted infection and displays pictures of people dying from AIDS. The nurse is using which change strategy?

A) Normative–reeducative B) Rational–empiric C) Power–coercive D) Planned change Ans: C Feedback: The community nurse in this scenario is using power–coercive change strategies that are based on fear. Normative–reeducative change strategies present new information and directly

influence people's attitudes and behaviors through persuasion. Empiric– rational change strategies are based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest.

6.

As part of a community-wide program addressing the needs of seniors in the county, the nurse engages the seniors as well as their families in the program. The nurse is demonstrating which principle for effecting positive change?

A) Participation B) Proper timing C) Resistance to change D) Interdependence Ans: A Feedback: The principle of participation requires involvement of the persons who will be affected by the change. The principle of proper timing requires that it be the right time to introduce the change. The principle of resistance to change involves responding to the instinctive nature of the desire to preserve the status quo because change poses a threat to stability and security. The principle of interdependence requires the view that every system has many subsystems intricately related such that a change in one part of the system may affect other parts.

7. unsuccessful attempts before quitting 1 year ago today. The nurse decides to share this information with the group and tells them that all the attempts he or she had made before stopping smoking were necessary steps for his or her eventual success. Which principle of change was the nurse enacting?

A) Principle of flexibility B) Principle of self-understanding C) Principle of interdependence D) Principle of proper timing Ans: B Feedback: The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it. The principle of flexibility is the ability of the change agent to adapt to unexpected events and make the most of them. The principle of interdependence is that a change in one part of a system affects other parts and a change in one system may affect other systems. The principle of proper timing relates to the knowledge that even the right change may not occur if the timing is not right.

8.

The community health nurse is talking to a group of clients about the health importance of consuming a low-fat diet. The clients are members of a particular cultural group that grows their own food and consumes a lot of animal protein. The clients state that their forefathers ate a diet that was high in animal protein and they had lived into their 90s. The community health nurse expects this argument and points out that their ancestors did not have the luxury of modern machines and they had to engage in a lot more activity than the current generation. This is an example of which principle of effecting change?

A) Principle of participation B) C) D) Ans:

Principle of proper timing Principle of self-understanding Principle of resistance to change D Feedback: The nurse was aware that all systems instinctively resist change and was prepared to discuss aspects of the clients' cultural background that related to their current state of health. This is the principle of resistance to change. The principle of participation means that persons affected by the proposed change should participate as much as possible in every step of the planned change process. The principle of proper timing requires that it be the right time to introduce the change. The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it.

9.

Which of the following are examples of a community health nurse providing health promotion teaching? Select all that apply.

A) The community health nurse teaches a class of kindergartners how to properly wash their hands.

B) The community health nurse is a guest on a radio talk show to provide information how to avoid an infection that is endemic.

C) The community health nurse encourages an individual whose blood pressure screening was elevated to have his or her blood pressure rechecked in 1 week.

D) The community health nurse teaches a group of preschoolers about different fruits and vegetables that they might like to try.

E) The community health nurse teaches a mother and baby exercise group.

F) The community health nurse leads a group of stroke survivors in soft exercise.

Ans: A, D, E Feedback: Health promotion is behavior that is motivated by the desire to increase well-being and actualize human potential. This is different from disease prevention/health protection, which is behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. The activities of teaching a class of kindergartners how to properly wash their hands, teaching a group of preschoolers about different fruits and vegetables that they might like to try, and teaching a mother and baby exercise group are focused on wellbeing and not a particular illness. The activities of being a guest on a talk show to provide information how to avoid an infection that is endemic, encouraging an individual whose blood pressure screening was abnormal to have their blood pressure rechecked in 1 week, and leading a group of stroke survivors in soft exercise are focused on avoiding specific illnesses and not on improved general health.

10.

Which of the following statements most accurately describes the nurse's role as an educator related to the social determinants of health?

A) The nurse must focus on individual behavior and encourage people to take responsibility for their own behavior.

B) The nurse must examine one or two factors that contribute to our state of health.

C) The nurse must look at the root causes of disease and health inequities.

D) The nurse must lecture people about what is right and wrong behavior.

Ans: C Feedback: Community health nurses must look at the social determinant of health as the root causes of disease and health inequities. This requires that nurses look beyond the individual behavior and have a broader scope of what underlies illness.

11.

A community health nurse has been teaching nutrition to a group of seniors in a local senior center. After attending the nurse's class on nutrition, the nurse determines the group's cognitive level of learning. Which of the following indicates knowing?

A) Comparing the nutrient value in foods B) Eating well-balanced meals C) Planning recipes that are low in fat D) Naming three foods high in iron Ans: D Feedback: Naming three foods reflect the knowledge level of the cognitive domain of learning.

Comparing nutrient values reflects analysis; eating well-balanced meals reflects application; and planning recipes reflects synthesis.

12.

A teaching plan for a group of new mothers has the following objective: “The mothers will describe the principles that relate to safety while diapering their newborn.” The nurse is attempting to achieve learning at which level of the cognitive domain?

A) Knowledge B) Comprehension C) Application D) Analysis Ans: C Feedback: At the application level, the learner not only understands the material but can apply it to new situations, transferring understanding into practice. This is reflected by words such as practice, demonstrate, use, illustrate, and employ. Knowledge level learning would be reflected by words such as define, repeat, list, name, or recall. Comprehension level learning would be reflected by words such as restate, describe, explain, identify, and discuss.

Analysis level learning would be reflected by words such as distinguish, debate, question, compare, examine, or calculate.

13.

Which of the following interventions by the nurse is most likely to have a positive influence on the client's adoption of a new healthy behavior?

A) Providing feedback about what the client is doing incorrectly B) Providing feedback about what the client is doing correctly C) Not providing feedback D) Not providing role modeling of the desired change Ans: B Feedback: The nurse who recognizes clients' participation in a group praises them for completing assignments or commends them for sticking to diet plans will have more success than the nurse who only criticizes failures.

14.

To ensure learning in the psychomotor domain, which of the following would be most important for the nurse to ensure about the learner?

A) Has a sensory image of how to do the skill B) Has the ability to perform the necessary skill C) Is willing to listen to the information about the skill D) Can continue to practice the skill independently Ans: B Feedback: For psychomotor learning to occur, the nurse must ensure that the learner is physically, intellectually, and emotionally capable of performing the skill. Otherwise, the other two conditions, having a sensory image and practicing the skill, would not occur. A willingness to listen is an important aspect for all learning, especially learning in the affective domain.

15.

A community health nurse develops a written teaching plan for a community education program about nutrition and salt-reduction.

Which objective would reflect synthesis learning in the cognitive domain?

A) The client will create an enjoyable meal using low-sodium foods.

B) The client will compare the salt content in a

variety of packaged foods.

C) The client will practice eating meals that contain low-sodium foods.

D) The client will list foods that are low in sodium.

Ans: A Feedback: Synthesis, the fifth level of cognitive learning, is the ability not only to break down and understand the elements of a situation but also to form elements into a new whole. Synthesis combines all of the earlier levels of cognitive learning to culminate in the production of a unique plan or solution. The objective with the verb create demonstrates this level. Being able to compare foods of varying salt content reflects analysis. Practicing eating meals demonstrates application. Listing foods demonstrates knowledge.

16. good attendance and group participation in her Saturday class on newborn care for young mothers. The participants receive free transportation and a $10 food voucher for attending. When they participate, prizes are distributed. This nurse is using behavioral theory to encourage clients, focusing the teaching on which of the following concepts?

A) Meeting a hierarchy of needs B) The learner's self-confidence and personal mastery C) A person's natural tendency to learn D) Changes in response to a stimulus Ans: D Feedback: Behavioral theory is grounded in stimulus– response behaviors, and changes occur in response to stimuli. The nurse is also using conditioning through reinforcement as described by Skinner. Meeting a hierarchy of needs is based upon Maslow, a humanistic theorist. Selfconfidence and personal mastery reflect social learning theory. A person's natural tendency to learn is based upon humanistic theories.

17.

A 32-year-old wife and mother of two children was a bank manager before entering the nursing program. She is finishing a Baccalaureate nursing program in a few months. She learns best when she can plan and carry out her own learning activities, uses past experiences to help with current learning, and applies learning immediately. Which learning theory best fits this woman's learning style?

A) B) C) D) Ans:

Knowles' adult learning theory Bandura's social learning theory The Gestalt–Field family of theories Maslow's Hierarchy of Needs theory A Feedback:

The woman's behaviors support the tenets of Knowles' adult learning theory. She is a self- directed learner, experienced, ready to learn, and is problem centered rather than theoretically oriented. Bandura's social learning theory attempts to explain behavior and facilitate learning. With social learning theory, learners are benefitted by role models, building selfconfidence, persuasion, and personal mastery. The Gestalt–Field family of cognitive theories assumes that people are neither good nor bad; they simply interact with their environment and their learning is related to perception. Maslow's hierarchy of needs requires lower level basic needs to be met before working toward self-actualization.

18.

A community health nurse is preparing a teaching program for a group of elementary school-aged children about substance abuse awareness. The nurse would implement strategies that address which cognitive phase of development?

A) Preconceptual B) Intuitive thought C) Concrete operations D) Formal operations Ans: C Feedback: Elementary school-aged children would most likely be in the concrete operations stage of cognitive development where the child can solve concrete problems and recognize others' viewpoints. The preconceptual stage would apply to children between the ages of 2 to 4 years when language development is rapid and everything is related to “me.” The intuitive thought stage would apply to children between the ages of 4 to 7 years when egocentric thinking diminishes and words are used to express thoughts. Formal operations stage would apply to adolescents when the child uses rational thinking and can develop ideas from general principles and apply them to future situations.

19.

When choosing an appropriate model for health education, community health nurses often select the PRECEDE–PROCEED model for which reason?

A) It emphasizes the desired outcome of the teaching.

B) The steps are similar to those of the nursing process.

C) The nurse's perception of the problem is the key to this model.

D) Evaluation of outcomes is the final step.

Ans: B Feedback: The steps of the PRECEDE–PROCEED model are similar to the nursing process, and thus this model has become a useful tool for nurses teaching in the community. It does emphasize outcomes with evaluation of the outcomes as the final step. But these are not reasons for nurses selecting this model. The client's or community's perception of the problem is key to this model.

20.

Which of the following statements accurately describe Pender's Health Promotion Model? Select all that apply.

A) It has been revised to reflect a number of major theoretical changes.

B) It is not effective.

C) It is unrelated to interpersonal influence of others.

D) It allows the community health nurse to predict health promotion behaviors which enhances the ability to work with clients.

E) Individual characteristics and experiences are seen to interact with behavior-specific cognitions and affect to influence specific behavioral outcomes.

Ans: A, D, E Feedback: Pender's Health Promotion Model has been revised from the earlier framework that was published in 1980 and has been revised to reflect a number of major theoretical changes. It is viewed as an effective model. It focused on predicting behaviors that influence health promotion and includes the variable of interpersonal influence of others.

21.

Which of the following statements about teaching at three levels of prevention is most accurate?

A) Ideally, the community health nurse would focus at the tertiary level of prevention.

B) The outcome of focusing on the tertiary level of prevention is to help diminish years of morbidity and limit subsequent infirmity.

C) It is ideal to focus on the primary level of prevention.

D) Community health nurses do not spend a significant share of time teaching at the secondary level.

Ans: C Feedback: Ideally, the community health nurse focuses on the primary level. Because the primary level of prevention is not possible in all cases, a significant share of the nurse's time is spent teaching at the secondary or tertiary level.

22.

Which of the following is the best example of a community health nurse focusing on the secondary level of prevention?

A) Teaching clients how to navigate the health care system to receive prompt treatment B) Teaching clients about the importance of immunization C) Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem D) Teaching a class on sensible nutrition for adolescents Ans: A Feedback: The secondary level of prevention would be exemplified by the community health nurse when teaching clients how to navigate the health care system to receive prompt treatment.

Teaching clients about the importance of immunization is focused on the primary level of prevention. Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem is focused on the tertiary level of prevention. Teaching a class on sensible nutrition for adolescents is focused on the primary level of prevention.

23. must

When developing an educational program for the community, which of the following

the community health nurse do first?

A) Assess the clients' readiness to learn B) Ensure a conducive environment for learning C) Assess the client's perception of the problem D) Determine the appropriate subject matter Ans: A Feedback: Before any teaching can begin, it is essential to assess the clients' readiness to learn. Once this is determined, the nurse can determine the clients' perceptions of the problem and identify the appropriate subject matter.

Ensuring a conducive environment occurs when the teaching begins.

24.

A community health nurse is providing informal teaching to groups of parents about typical childhood developmental milestones. Which of the following would the nurse mostly likely be using?

A) Lecture B) Demonstration C) Anticipatory guidance D) Visual images Ans: C Feedback: Informal teaching such as anticipatory guidance and counseling requires the teacher to be prepared, but there is no defined plan of presentation. Lecture and demonstration are formal methods of teaching. Visual images also are often used with formal teaching.

25.

Which question would the community health nurse use as a guide to determine a client's participation in a teaching program?

A) “What does the client know about the current problem?”

B) “How does the client view the current situation?”

C) “Does the client need special seating?”

D) “What does the client want to learn?”

Ans: D Feedback:

To determine client participation, one of the first questions that need to be answered is, “What does the client want to learn?” This directly influences the client's participation in the educational process. Asking the question about what the client knows about the problem determines the client's readiness to learn. Asking about the client's view of the problem helps identify the client's perceptions. Asking about special seating helps to ensure that the educational environment is conducive to the client's needs.

26.

Which of the following is the best example of a positive learning environment for a group of developmentally disabled adults?

A) A local diner, seated near the door to the kitchen during lunchtime B) A brightly lit conference room with comfortable chairs C) A kindergarten classroom with small chairs that are low to the ground D) A park on a beautiful, sunny day Ans: B Feedback: A brightly lit conference room with comfortable chairs would be the best example of a positive learning environment among the choices listed. A local diner, seated near the door to the kitchen during lunchtime would not be a good choice as it is likely very noisy. A kindergarten classroom with small chairs that are low to the ground would not be a good choice as the adults could not comfortably sit in the chairs. A park on a beautiful, sunny day would not be a good choice as there would be too many distractions making it difficult for the clients to focus.

27. non-English speaking country about the need for immunizations, the nurse should include which in his or her plans?

A) Using a lot of pictures B) Guessing about the native language and attempting to speak it C) Using an interpreter D) Talking clearly and slowly, being sure to enunciate each word Ans: C Feedback: Planning to use an interpreter when presenting information to a group of new immigrants from a non-English speaking country is the best option among those listed. Pictures will not effectively convey the meanings that the clients need. Guessing about the native language and attempting to speak it will not be effective either, as the nurse should never assume anything and unless the language is native to the nurse, the nurse will not be any more effective at

communicating with the clients. Talking clearly and slowly, being sure to enunciate each word, might be appropriate for a group of immigrants from a non-English speaking country who have been in this country for a while and have been learning the language.

28.

Which of the following are factors to consider related to the social determinants of health?

Select all that apply.

A) Being marginalized B) Access to safe housing C) Safe workplaces D) Being related to a politician E) Access to social and economic opportunities Ans: B, C, E Feedback: Factors that influence an individual's ability to maintain good health include social factors, such as access to social and economic opportunities and equitable social interactions, and physical factors, such as access to safe housing and safe workplaces.

Being related to a politician may or may not have a positive impact on the social determinants of health.

29.

Which of the following endings to this sentence most accurately describes the reason a community health nurse must consider the social determinants of health? The community health nurse must consider the social determinants of health A) because the social determinants of health affect a wide range of health, functioning, and quality-of-life outcomes and risks.

B) because in our country all people are treated equally.

C) because it is the right thing to do.

D) because the community health nurse believes in social justice.

Ans: A Feedback: The social determinants of health affect a wide range of health, functioning, and qualityof-life outcomes and risks. There is a growing inequity in the distribution of disease, illness, and wellness across our society and not all people are treated equally. It is not enough to do this because it is the right thing to do. If the community health nurse believes in social justice, this is one

thing but really implementing social justice in considering outcomes and risks is more accurate.

Chapter 12 Planning, Implementing, and Evaluating Community/Public Health Programs 1. appropriate source of information for the nurse to investigate when attempting to determine the importance of an issue for a community-based intervention?

A) Special interest groups B) Client's concern C) State health department D) Local community priorities Ans: B Feedback: A client's concern may be the initial spark that leads the nurse to identify a need, but this would be most restrictive source of information and thus would be limited in scope. Therefore, when determining the feasibility of a community-based intervention, several methods can be used to determine the importance of the issue including federal agencies, special interest groups, state health departments, and local community priorities. These sources would provide information about whether or not a problem has affected a sufficient percent of the population to warrant intervention.

2.

A community health nurse is attempting to identify a target group for a program using geographic information system (GIS). Which type of information would the nurse be able to obtain?

A) Family status B) Past interventions used C) Previous health problems D) Areas needing more study Ans: A Feedback: GIS information includes information about race, age, and family status. Information about past interventions used or previous health problems can be obtained from talking with other nurses and health professionals.

Areas needing more study can be obtained from the Guide to Community Preventive Services: Systematic Reviews and evidence- based recommendations, a federally sponsored initiative that provides recommendations about population-based interventions.

3.

A community health nurse has just moved to your community. Which might be good ways for this community health nurse to identify group and community health problems?

Select all that apply.

A) Interview health professionals in the agency and other agencies to determine the needs B) Read about it in a national magazine C) Refer to the geographic information system (GIS) data for the community D) It is not necessary for the community health nurse to do so. It is best for the community health nurse to just pitch in and work to solve the problems of the community.

Ans: A, C Feedback: Interviewing health professionals in the area about the problems, what should be done, and what has been tried in the past and their input on why past interventions failed. Referring to the geographic information system (GIS) data for the community can look at groups of people by race, age, and family status.

Reading about it in a national magazine is too broad of an approach as factors that affect the nation may or may not reflect what is happening in your community. It is critical for the community health nurse to identify group and community health problems in order to effectively influence the health of the community.

4.

Which of the following change strategies would be most effective in maximizing the cooperation of the target population? Select all that apply.

A) Use only one strategy that the nurse is most familiar with B) Knowing that as a nurse, the nurse knows more about the health topic than their audience C) Employ multiple strategies to promote health, prevent disease, and ensure a safe environment for populations D) Learning about the target population's beliefs regarding the health topic E) Focusing on health promotion and not disease prevention Ans: C, D Feedback:

Standard 5B of the Public Health Nursing: Scope and Standards of Practice calls on the public health nurse to “employ multiple strategies to promote health, prevent disease, and ensure a safe environment for populations.” It is not enough for the nurse to use only one strategy that the nurse is most familiar with. Interventions that fail to engage the target population by learning about the target population's beliefs will be unsuccessful because clients hold just as strongly to their belief systems as the nurse does. It is important for the nurse to focus on health promotion and disease prevention and ensure a safe environment for populations.

5.

A community health nurse has identified the target population and is determining an appropriate intervention. Which of the following would be most important for the nurse to do next?

A) Develop an intervention based on the nurse's previous experiences B) Review the literature for research on previously attempted interventions C) Access the National Center for Health Statistics Web site for data D) Learn about the target population's beliefs and ideas Ans: D Feedback: Nurses may think that they know more about a topic, and therefore, their solutions are better than the target population's solutions. However, if nurses don't learn about the target population's beliefs and only consider their own, they will not be able to work out a solution with the target population that is acceptable and appropriate for them. Thus, the interventions will most likely be unsuccessful. Although reviewing the literature for research would be helpful on identifying possible strategies, the nurse needs input from the target population.

Accessing the NCHS Web site would provide information about whether a problem has affected a sufficient percent of the population to warrant intervention. It would not be helpful in determining an appropriate intervention.

6.

In an effort to ensure success of a proposed community intervention program, the community health nurse would include which of the following?

A) Formal leaders B) Advisory group C) Target population

D) Ans:

Local knowledge B Feedback:

A key factor for ensuring the success of any intervention is to appoint an advisory group that includes representatives from the target and service communities. Formal leaders are important in obtaining information about the possible target population. The target population is important in making sure that the planned intervention is appropriate.

However, it does not ensure that the intervention will be successful. Local knowledge provides information about possible environmental and social factors influencing the problem. However, it also does not help to ensure the success of the planned intervention.

7.

Which of the following interventions targeting health problems is most likely to be effective?

A) Teaching about prenatal care to a group of men in a men's homeless shelter B) Teaching about prenatal care in a home for unwed mothers C) Teaching about prenatal care to a group of cub scouts D) Teaching about prenatal care to a group of senior citizens Ans: B Feedback: It is crucial to analyze the extent to which individuals and families are affected by the problem. It would be a waste of resources to provide teaching about prenatal care to any of the listed groups except the home for unwed mothers.

8.

In order to evaluate a health program, which of the following should the community health nurse focus on when planning the program?

A) Measurement of goal attainment B) Creation of objectives that are specific, measurable, attainable, relevant, and timely.

C) D) Ans:

Patient satisfaction Measurement of consistency with standards B Feedback:

When planning a health program, the community health nurse should focus on the creation of objectives that are specific, measurable, attainable, relevant, and timely (acronym SMART). The other options describe what must be measured in the evaluation of the health program.

9.

A review of factors influencing a population's behavior related to childhood obesity reveals several reinforcing factors. Which of the following would the community health nurse identify?

A) Children's belief that they like to be similar to other children of the same age B) Children's view of themselves as becoming independent from adults C) Offering of incentives to students' modeling positive food choices D) Proposed monitoring of children's behavioral changes by the local PTA Ans: C Feedback: Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. It also includes authority figures such as teachers or managers, as well as agency and community decision makers, as these individuals also influence the target population. In this case, it would be the offering of incentives to student's modeling positive food choices. The children's belief in being similar to others and view as becoming independent are examples of predisposing factors. Proposed monitoring would be an example of enabling factors.

10.

Which of these behaviors is most likely changeable?

A) Smoking cessation among a group of people who have smoked for 20 or more years B) Smoking cessation at a work place where smoking is common and deeply imbedded C) Smoking cessation in a school for students who have only recently started smoking D) Smoking cessation in a public environment where cigarettes are openly sold and persons are allowed to smoke Ans: C Feedback: The behaviors that are easiest to change include those that are still in the developmental stage and have only recently been established (as would students who have only recently started smoking and not among a group of people who have each smoked for 20 or more years or at a

work place where smoking is common); are not deeply imbedded in cultural patterns or lifestyle (not in a workplace where smoking is deeply imbedded nor in a public environment where cigarettes are openly sold and persons are allowed to smoke).

11.

The community health nurse is identifying factors that would influence behavior change.

Which of the following would the nurse identify as enabling factors?

A) Attitudes of the target population B) Knowledge of the family of the target population C) Availability of resources D) Values of the authority figures Ans: C Feedback: Enabling factors include the availability of resources, the accessibility of resources, laws, and government support for the health behaviors or for the health program, as well as skills.

Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices.

Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. It also includes authority figures such as teachers or managers, as well as agency and community decision makers, as these individuals also influence the target population. These factors must be addressed as they can interfere with successful behavioral change and create barriers to behavioral change.

12.

When the community health nurse is examining barriers to successful behavioral change, the nurse identifies that there are no laws in the community that prohibit smoking in public areas, which leads to increased smoking and increased risks to health related to secondhand smoke. The nurse believes that a possible solution is to advocate for a citywide bans on smoking in public locations. Which type of factor is affecting the behavior in the community?

A) Enabling factors B) Predisposing factors C) Reinforcing factors D) Unrelated factors

Ans:

A Feedback:

Enabling factors include the availability of resources, the accessibility of resources, laws, and government support for the health behaviors or for the health program, as well as skills.

Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices.

Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. These factors must be addressed as they can interfere with successful behavioral change and create barriers to behavioral change.

13.

Several quality management models are helpful in measuring and improving the quality of care. They are designed differently but are developed to enhance care giving.

Which of the following uniquely places the client within the model?

A) Quality Health Outcomes model B) Donabedian model C) Omaha System model D) QSEN project Ans: A Feedback: The Quality Health Outcomes model includes the client in the model and proposes a twodimensional relationship among components. The Donabedian model consists of three components: environment structure, processes, and outcomes. The Omaha System model addresses process indicators, client outcome measures, and satisfaction with care. The QSEN project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, safety and informatics.

14.

A community health nurse is assisting with the evaluation of outcomes of a program. The client's response to care is being measured quantitatively. The nurse identifies this as which of the following?

A) Benchmarking B) Quality indicators C) Process D) Structure Ans: B

Feedback: Quality indicators are quantitative measures of a client's response to care. Benchmarking uses continuous, collaborative, and systematic processes for measuring and examining internal programs' strengths and weaknesses and includes studying another's processes in order to improve one's own. Process refers to activities and behaviors used to improve or maintain the client's status. Structure refers to the care environment, such as client mix, philosophy, facility, and staff.

15.

When participating in quality improvement activities, a community health nurse would be least likely to engage in which of the following?

A) Daily prioritizing of care needs for a caseload of clients B) Completing necessary documentation efficiently C) Seeking supervision for a difficult client case D) Reviewing organizational personnel Ans: D Feedback: Nursing administration would be responsible for developing a formalized quality management program that would include a review organizational structure, personnel, and environment. Quality improvement activities for community health nurses include daily prioritizing of care needs for a caseload of clients, seeking supervision or skills development for a difficult case, and systematizing charting so that needed documentation is efficiently completed.

16.

A community health nurse is engaged in the process aspect of quality management when the nurse does which of the following?

A) Contribute to the revision of standards B) Ensure an adequate amount of resources C) Determine additional sources of funding D) Review services provided for client needs Ans: A Feedback: As part of the process aspect of quality management, staff is encouraged to contribute to evaluation of the standards and revise them as needed. Adequate resources and funding are components of the structure aspect.

Reviewing services provided is a component of the outcome aspect.

17.

After teaching a group of students about the various models used in program evaluation, the instructor determines that the students have understood the teaching when they state which of the following as the model most basic?

A) Quality Health Outcomes model B) Donabedian model C) Quality and Safety Education for Nurses D) Omaha System model Ans: B Feedback: The Donabedian model is recognized as a simplistic and basic method of measuring quality that has been used widely over the past 35 years. The Quality Health Outcomes model takes the Donabedian model a step further by including the client in the model. The QSEN project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, safety and informatics. The Omaha System model focuses on process indicators, client outcome measures, and satisfaction with care.

18.

A community health nurse who is part of a committee that is deciding on which model to use for program evaluation reviews the Omaha System model. The nurse needs additional review of this model after identifying which of the following as an aspect for rating outcomes?

A) Client knowledge B) Client behavior C) Client status D) Client ownership of problem Ans: D Feedback: Ownership of the problem is component of the community, the group that shares a physical environment and ownership of a health-related problem. Knowledge, behavior, and status are how outcomes are rated in this model.

19.

A community health nurse is participating in an agency program evaluation using the Quality Practice Settings Attributes model. The nurse is assisting with evaluation of the professional system. Which of the following would the nurse need to address?

A) B) C) D) Ans:

Communication with clients Staffing ratios Safety of practice Continuing education D Feedback: Using the Quality Practice Settings Attributes model, evaluation of the professional system would address hiring, orientation, training, and continuing education. Communication with clients, families, and professionals are areas evaluated in the communication system.

Staffing ratios are addressed in the care delivery process. Collaboration is addressed with the leadership element.

20.

One community health agency has developed a clinical pathway that has proved useful with clients with heart failure. After review, another community health agency providing care to similar clients decides to implement that pathway. This reflects which of the following?

A) Structure B) Process C) Outcomes D) Benchmarking Ans: D Feedback: Benchmarking uses continuous, collaborative, and systematic processes for measuring and examining internal programs' strengths and weaknesses and includes studying another's processes in order to improve one's own. The example reflects external benchmarking which occurs between similar agencies providing like services. Structure is reflected in the agency's organization, facility, personnel, and philosophy. Process reflects the standards, attitudes, and activities.

Outcomes reflect the expected results, goals, efficiency, and satisfaction.

21.

A group of students are reviewing material in preparation for test on program evaluation models. The students demonstrate understanding of the material when they identify which model as dynamic with interventions always acting through the system and client?

A) Donabedian model B) QSEN project C) Quality Health Outcomes model D) Quality Practice Setting Attributes model Ans: C Feedback: The Quality Health Outcomes model includes the client in the model and proposes a twodimensional relationship among components. Interventions always act through the system and the client, creating a dynamic model. The Donabedian model is recognized as a simplistic and basic method of measuring quality. Structure, process, and outcome can be depicted in a boxshaped model. The QSEN (Quality and Safety Education in Nursing) project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, safety and informatics. The Quality Practice Setting Attributes model is used as a tool to assist in ensuring the quality of nursing practice and the nursing profession by promoting continuing competence.

22.

When devising a social marketing strategy for a community health issue, which of the following concepts is being integrated when the selection of one option inherently requires giving up on another option?

A) Self-interest B) Competition C) D) Ans:

Consumer orientation Exchange B Feedback: The concept of competition is being integrated by selecting one option that inherently involves the giving up of another option. Self-interest is demonstrated when people act in their own interests. Consumer orientation is reflected in the problem-solving process directed at the target. Exchange is demonstrated when an individual gives something to get something.

23.

A community health nurse is seeking seed money to set up a health promotion program for pregnant adolescents. The nurse would seek which type of grant?

A) Planning B) Start-up C) Management D) Facility Ans: B Feedback: The type of grant would be a start-up grant, for example, seed money. Other types of grants include planning grants (i.e., initial project development), management or technical assistance grants (e.g., for fund raising or marketing), and facilities or equipment grants (e.g., money for a building, computer, or van).

24.

When composing a letter of inquiry, which of the following would a community health nurse include?

A) Names and academic credentials of all the personnel who will be involved in implementing the program B) An extensive literature review of the evidence that supports the planned interventions C) Other funding sources for the project or program (prospective and committed) D) Lengthy description of the organization Ans: C Feedback: The letter of inquiry is normally only two to three pages in length and includes a concise overview of the project. For example, it would likely include an overview of the organization and its purpose, the reason for the funding request, clearly stated need or problem to be addressed, overview of the proposed project or program, and other funding sources for your project or program (prospective and committed). The letter is brief, yet clearly lays out your plan. Names and academic credentials of all the personnel who will be involved in implementing the program, an extensive literature review of the evidence that supports the planned interventions, and a lengthy description of the organization would make the letter of inquiry unnecessarily long when it should be concise.

25.

As the community health nurse engages in the process of seeking grant funding, the nurse ensures that the appropriate steps are followed. Place the following in their proper sequence.

A) Contact funders B) Acquire proposal guidelines C) Define the project D) Identify the proper funding source E) Be aware of submission deadline Ans: C, D, A, B, E Feedback: When seeking grant funding, define the project, identify the right funding sources, contact the funders (think of the funder as a resource), acquire proposal guidelines, and know the submission deadline.

Chapter 13 Policy Making and Advocacy 1.

When developing a teaching plan for a class that describes health policy, which of the following would the instructor include as an example of a regulatory health policy?

A) Licensure of health professionals B) Federal subsidies for nursing education C) Benefits for needy groups D) Allocating resources among groups Ans: A Feedback: Regulatory health policy regulates or licenses services or people providing services in the community. Distributive health policy subsidizes nursing education, benefits the needy, and allocates resources among and between groups.

2.

Which of the following is an example of a distributive health policy?

A) Reporting of communicable disease B) Federal funds for nursing education C) Medicare D) Arms control agreement Ans: B Feedback: Distributive health policy promotes nongovernmental activities that are thought to be beneficial to society as a whole. An example of a distributive policy is the Nurse Training Act, Title VIII of the Public Health Service Act, which was established in 1965 and provided federal subsidies for nursing education in an effort to address the need for a more nurses. Reporting of communicable diseases and arms control agreement are examples of regulatory health policy at the national and international levels respectively.

Medicare is an example of a redistributive health policy.

3.

Which of the following effects of a health system in disarray have the most direct influence for a public health nurse at this present time?

A) The United States is often touted as having the best health care system in the world.

B) Fewer jobs for nurses C) Crisis in public health related to underfunding and underappreciation of the core functions of public health leading to substantial reduction in public health programs D) Changes in the Medicare payment system Ans: C Feedback: Currently, there is serious underfunding and underappreciation of the core functions of public health, which has led to massive layoffs of staff and substantial reduction in public health programs. The United States is often touted as having the best health care system in the world.

However, this may be in question related to the expense of our current health problems and the lack of benefit to the health of all Americans. There is currently a serious nursing shortage that is projected to only get worse in the coming decades. There are changes in the Medicare payment system and this does affect health care in general but most public health programs do not receive Medicare support.

4.

Community health nurses are attending an in- service program about health policy.

Which of the following would the nurses expect to be included in the description?

A) Reflection of a community's values B) Creation for several influential people C) Development by those outside of the community D) Indication of needs of the community's poor Ans: A Feedback: Health policy should reflect a community's values and should not only be created for certain groups such as the influential or the poor. It needs to come from the people within the community and be for all of them.

5.

A group of community health nurses are discussing health care policy in the United States. Which of the following reflects the consensus view?

A) Market forces should solve the problem.

B) The government should assume responsibility.

C) Health care policy needs to change.

D) Health care policy is flawed but adequate.

Ans: C Feedback: Most people agree that health care policy in the United States must change, but there is little agreement among policy makers and citizens about how this should occur. Some believe market forces should be allowed to work this problem out; others believe the government should assume responsibility. Health care policy is not viewed as being adequate.

6.

When describing public health nursing to a group of community health nurses, which of the following would be identified as its foundation?

A) Social marketing B) Social justice C) Social disparities D) Advocacy Ans: B Feedback: The concept of social justice is seen as the very foundation of public health nursing.

Social marketing is the means to influence behavior of target populations for program development. Addressing social disparities or inequalities are one component of public health nursing. Advocacy involves pleading the case of another and pursuing influencing outcomes.

7.

Which of the following statements about special interest groups and policy making are true? Select all that apply.

A) Others will be persuaded by facts alone.

B) Power is wielded by special interest groups, business, and industry.

C) Nurses need to provide input to policy circles through advocacy.

D) Nurses need to provide leadership at decisionmaking tables.

E) There are power struggles behind all legislation and health care regulation.

Ans: B, C, D, E Feedback: Nurses need to provide input to policy circles through advocacy and leadership at decision- making tables. It is naïve to believe that others will be persuaded by facts alone.

Power is wielded by special interest groups, business, and industry. There are power struggles behind all legislation and health care regulation.

8.

The community health nurse is reviewing how managed care today has changed from its initial proposal. Which of the following would the nurse identify as an important change?

A) Current emphasis on cost containment B) Focus on choosing a practitioner C) Expansion in types of care provided D) Increase in nonprofit agencies Ans:

A Feedback: Managed care has evolved and the emphasis has shifted from prevention to cost containment. Reductions in reimbursement particularly for disadvantaged patients (e.g., those covered under Medicaid and Medicare), reductions in the choice of practitioners, and limitations on the types of care available transformed this system as originally envisioned. Most managed care today is for profit, setting up a dichotomy between the insured and the owners/investors.

9.

Which of the following statements about professional organizations and public policy is the most accurate?

A) Professional organizations increase polarization and cause a group to be more united and strong.

B) Professional organizations encourage selfishness and self-interest.

C) Professional organizations focus solely on “protecting their turf.”

D) A united voice on public policy is more powerful than individuals pleading with legislators.

Ans:

D Feedback: A united voice on public policy is more powerful than individuals pleading with legislators. The other statements about professional organizations are not true. They do not increase polarization and if they did, it would not cause the group to be more united and strong.

Professional organizations do not increase selfishness and self-interest, and professional nursing organizations do not focus solely on “protecting their turf.”

10.

Which of the following statements reflect progress in public policy that can be attributed to professional nursing organizations? Select all that apply.

A) Professional nursing organizations have elevated nursing professionalism.

B) Professional nursing organizations have given voice to the inequalities that affect our society.

C) Professional nursing organizations have developed the paradigms that influence and affect public health.

D) Nursing is regarded as a major player in Washington when discussing health care policy.

E) Professional nursing organizations have a long and consistent relationship with public policy.

Ans: A, B, C Feedback: Professional nursing organizations have elevated nursing professionalism, have given voice to the inequalities that affect our society, and have developed the paradigms that influence and affect public health.

Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be fully realized.

11.

Which is the best way for any nurse to advocate for change and exert power?

A) Pursuing an advanced degree B) Running for state congressional seat C) Actively participating in a professional nursing organization D) Becoming a member of a local not-for-profit agency board of directors

Ans:

C Feedback:

A major way in which nurses have been successful with advocacy is through membership in their professional organization. Influencing policy may be achieved by obtaining advanced education, which would be helpful in pursuing higher level positions, and political office whether at the local or state level. Influencing policy is not the same as advocating.

12.

After a class on nursing and political activism, which statement by the nursing student would indicate that the teaching was successful?

A) “Nurses have just now become increasingly active in the political arena.”

B) “Nurses are the smallest group of providers with the largest voice.”

C) “Nurses are considered major political players in Washington.”

D) “The ANA provides nurses with a collective political voice.”

Ans: D Feedback: A professional nursing association such as the ANA builds a collective voice for nurses.

Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be realized. Nursing also is not thought of as a major player in Washington when discussing health care policy.

13.

Which of the following statements about power and empowerment are true accurate? Select all that apply.

A) Power is the ability to act or produce an effect and possess control, authority, or influence over others.

B) Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community.

C) If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives.

D) All of the power belongs to the legislators.

E) Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.

Ans: A, B, C, E Feedback: Power is the ability to act or produce an effect and possess control, authority, or influence over others. Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives.

Professionals hold the power and authority by virtue of their place in the bureaucracy.

Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.

14.

A community health nurse integrates understanding of power and empowerment when working with clients by demonstrating which of the following?

A) Partnership with clients B) Hierarchical relationship C) Authority over clients D) Client autonomy Ans:

A Feedback: The various definitions of empowerment and the expansion of the definition of health, which now includes the social, political, and economic determinants of health, have changed our thinking on how best to interact with the communities we serve. This also suggests a change in the relationship between professionals and communities; a change from the customary hierarchical patient/ provider relationship to one of a partnership.

15.

How can nursing fulfill the potential to transform nursing and take the power to influence policy development? Select all that apply.

A) Practicing to the full extent of their education and training B) Achieving higher levels of education and training through an improved education system that promotes seamless academic progression C) Act as full partners, with physicians and other health professionals, in redesigning health care in the United States D) Improve data collection and an improved information infrastructure to ultimately influence effective workplace planning and policy making E) Most nurses are already involved in the regulatory framework development.

Ans: A, B, C, D Feedback: The four key messages from The Future of Nursing: Leading Change, Advancing Health include the following: 1.

Nurses should practice to the full extent of their education and training.

2.

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

3.

Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.

4.

Effective workforce planning and policy making require better data collection and an improved information infrastructure.

It is not yet true that most nurses are already involved in the regulatory framework development.

16.

Organize the following stages in the policy process in the order they should be considered.

A) Policy Adoption B) Policy Evaluation C) Policy Formulation D) Policy Implementation Ans: C, A, D, B Feedback:

The order of the stages in the policy process is formulation, adoption, implementation, and evaluation.

17.

Which stage in the policy process is exemplified by the activities of identifying the health problem and/or using a goal-oriented approach?

A) Policy adoption B) Policy evaluation C) Policy formulation D) Policy implementation Ans: C Feedback: Policy formulation involves identifying goals, problems, and potential solutions. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy implementation follows adoption and occurs when the policy is put to use. Policy evaluation compares policy outcomes or effects with the intended or desired effects.

18.

When involved in the policy process, the community health nurse must keep in mind that which of the following should be the strongest influence?

A) Social conditions B) Political conditions C) Public need D) Health planning Ans: C Feedback: The social and political conditions that affect policy formulation are limitless, but public need and public demand should be the strongest influences. Health planning may be an approach to policy formulation.

19.

A community health nurse identifies a problem of increased infant mortality with adolescent pregnancies. The nurse decides to address this problem with a health policy. The nurse is engaging in which stage of the policy

process?

A) Formulation B) Adoption C) Implementation D) Evaluation Ans: A Feedback: Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Implementation follows adoption and occurs when the policy is put to use. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.

20.

A community health nurse is involved in assessing the community's capacity to define strategies to enhance compliance with a policy. The nurse is working in which stage of the policy process?

A) Formulation B) Adoption C) Implementation D) Evaluation Ans: C Feedback: Implementation of health policy occurs when an individual, group, or community puts the policy into use. It involves overt behavior changes as the policy is put into nursing practice. As an implementer, the community health nurse assesses the capacity of the community to formulate and define strategies that will enhance the community's compliance with the policy. Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.

21.

When engaging in the policy process, which of the following would the community health nurse do last?

A) Define the problem B) C)

Gather information Look for alternatives

D) Ans:

Choose the approach D Feedback: Policy analysis involves the following sequential steps: define the problem, information gathering, looking for alternatives to the approach, and choose the most appropriate approach.

22.

When analyzing health policy, which question would be most important for the community health nurse to ask?

A) “How much does it cost?”

B) “What is the result?”

C) “Why is it in place?”

D) “Who benefits from it?”

Ans: D Feedback: When analyzing policy, nurses need to answer two general questions: Who benefits from this policy? and who loses from this policy?

Whether the policy should be advocated by the community as a whole depends on the degree to which the policy benefits the community without being detrimental to individuals or the country.

Cost, results, and reasons why are not key elements to address in policy analysis.

23.

Which of the following statements about advocacy and lobbying and the influence of both on policy are true? Select all that apply.

A) Advocacy can be defined as pleading the case of another or championing a cause.

B) Lobbying is the act of influencing legislators.

C) Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. D) Policy and politics are not related to each other.

E) Ans:

Public policy is a rational process.

A, B, C Feedback: Advocacy can be defined as pleading the case of another or championing a cause.

Lobbying is the act of influencing legislators. Nurses can gain access to legislators individually

or through the services of a professional lobbyist or PAC. Policy and politics go hand in hand; neither exists without the other. Public policy is not a rational process.

24.

Which of the following would be important for a politically involved nurse to do? Select all that apply.

A) Communicate ideas effectively B) Get to know local representatives C) Avoid involvement with community boards D) Be firm and unyielding in approach E) Stay current about health care issues Ans: A, B, E Feedback: The politically involved nurse should aim to accomplish three primary goals: (1) generate support for one's views by communicating ideas effectively and getting to know and influence representatives at local, state, and national levels; (2) create professional legitimacy by keeping abreast of current issues in health care and nursing and becoming involved in professional nursing organizations, community boards or committees, or political office at the local, state or national level; and (3) resolve conflict and effectively negotiate and compromise.

Chapter 14 Family as Client 1.

Which of the following would be most appropriate for the community health nurse to do first when planning an initial home visit to a family?

A) Obtain the basic supplies that will be needed B) Gather appropriate educational materials C) Contact the family via telephone D) Review the referral information Ans: D Feedback: The first step is to obtain the referral and review it to gather information about the possible needs of the family and the reason for the visit. Once this is done, then the nurse would obtain the basic supplies and education materials that might be needed and contact the family to arrange the visit.

2.

When planning for a home visit, which of the following would be most helpful to ensure a successful home visit?

A) B) C) D) Ans:

Documentation in a timely manner Summarizing the main visit points Providing incidental teaching Scheduling an appropriate visit time D Feedback: As part of planning the community health nurse would contact the family to set up an appropriate time for the visit. Documenting in a timely manner ensures successful evaluation.

Providing incidental teaching and summarizing the main visit points help to ensure successful implementation.

3.

A community health nurse arrives at a family's home. Which of the following would behaviors by the nurse would be nontherapeutic?

A) Maintaining eye contact with the family members B) Paging through paperwork for information C) Sitting on the furniture near the family members D) Placing car keys in the nurse's carryall bag Ans: B Feedback: Community health nurses, like all nurses, need to be aware of their own body language.

Fidgeting with car keys during the entire visit, noisily chewing gum, giving minimal eye contact, continuously looking at or paging through paperwork, appearing rushed, and refusing to sit on any of the furniture are behaviors that tell the family a great deal about the nurse, including how he or she feels about being in their home. These actions are nontherapeutic. Sitting on the furniture near family members demonstrates interest in the family. Placing car keys in the carryall bags prevents inadvertent distractions.

4.

A community health nurse is about to make the first home visit to a family based on a referral from the hospital where the high-risk infant was born to an adolescent mother about 6 days ago. The nurse plans to assess the family and home environment and provide anticipatory

guidance. On arrival, the mother sleepily answers the door after the nurse rings the bell and knocks several times. The mother lets the nurse in but is not happy to see the nurse. She gets the infant and places him in the nurse's arms, then sits across the room and turns on the TV. Which response by the nurse would be most appropriate?

A) “You must be very tired caring for a newborn baby.”

B) “I wasn't planning to hold the baby. You should hold him, you are the mother.”

C) “I need to talk to you, so please turn off the TV.” D) “How do you feel being a mother at 17?”

Ans: A Feedback: It is always best to acknowledge a client's feelings, and from the scenario, observations and referral information, being fatigued 6 days after having a baby is very possible. The option about holding the baby is not the best way to respond to the mother or the first comment to make, but holding the baby gives the nurse an opportunity to role model infant interaction and caring and assess his or her cleanliness and clothing appropriateness.

However, the nurse may want to say that he or she would like to wash his or her hands before holding the baby. This gives the nurse an additional opportunity to teach and assess another room when washing hands. Asking to turn off the TV might be appropriate after a few moments of introductory conversation. It would be best to ask the mother to turn the TV down because of difficulty hearing her.

The nurse will win the mother's favor with this approach better than by asking her to turn off the TV. Asking how she feels being a mother at 17 might be information to gather, but asking it directly as a first comment sounds like a put-down. There are better ways to obtain this information a bit later in the visit.

5.

While making a family health visit, an older relative who is visiting has been drinking and becomes verbally abusive and increasingly loud. Which action by the community health nurse would be best?

A) Continue the visit with caution B) Suggest the relative go in another room and take a nap C) Ask the sober family members to take the visitor home D) Terminate the visit, making plans for another visit Ans: D Feedback:

Terminating the visit is the best choice. It appears the problem is escalating, and the nurse's safety should always come first.

Continuing the visit puts the nurse and possibly the other family members at risk. Making a suggestion to go into another room and take a nap may agitate the relative and make a deteriorating situation worse. Making a suggestion for a family member to take the visitor home may agitate the relative and make a deteriorating situation worse.

Additionally, this is the client's home and the suggestion should be the client's.

6.

Which of the following things does a nurse who is traveling by automobile to make a home visit need? Select all that apply.

A) A full gas tank and well-operating vehicle B) A map that includes the geographic location where the home visit will be made C) A cellular telephone D) A bus schedule E) Exact change Ans: A, B, C Feedback: A nurse who is traveling by automobile to make a home visit needs the following: a full gas tank and well-operating vehicle, a map that includes the geographic location where the home visit will be made, and a cellular telephone. If the nurse is not using public transportation, the nurse does not need exact change for each bus trip or a bus schedule.

7.

Which of the following are specific safety measures the nurse should apply when making a home visit? Select all that apply.

A) Plan to reschedule the visit if you find a large group of people assembled between you and the client's door.

B) Immediately leave the home when family members begin to physically fight with one another.

C) Enter the residence before you determine that the family you are intending to visit does live there and is home.

D)

Travel only in pairs for all home visits.

E) If someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction.

F) Leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit and your cellular phone number at your base of operation.

Ans: A, B, E, F Feedback: It is most important to leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit, and your cellular phone number at your base of operation.

Specific safety measures the nurse should apply when making a home visit include planning to reschedule the visit if you find a large group of people assembled between you and the client's door; immediately leaving the home when family members begin to physically fight with one another; and if someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction. It is not appropriate for the nurse to enter the residence before determining that the family that is to be visited does live there and is home. It is not necessary to travel only in pairs for all home visits.

8.

Which one of the following has a negative influence on family health and individual health?

A) The level at which a family functions significantly affects the individual's level of health.

B) A healthy family fosters individual growth and sustains members during times of crisis.

C) Family patterns dictate whether members participate in their own health care.

D) Individuals can obstruct the family's health and families can obstruct individual family members' health.

Ans: D Feedback: A negative influence on family health and individual health is that individuals can obstruct the family's health and families can obstruct individual family members' health. The level at which a family functions significantly affects the individual's level of health; that a healthy family fosters individual growth and sustains members during times of crisis; and the influence of families that dictate whether members participate in their own health care are all positive influences.

9.

When assessing a family, which of the following would lead the nurse to question the health of a family?

A) Role relationships are inflexible.

B) Coping is actively attempted.

C) Family members communicate regularly.

D) The family lacks regular links with the broader community.

Ans: D Feedback: In a healthy family, role relationships are structured effectively so that they can change with changing family needs. Active coping, regular family communication, and regular links with the broader community reflect a healthy family.

10. community health nurse to take his or her shopping to purchase some of the food items he or she needs for his or her diet. Which response by the nurse would be most appropriate?

A) “I can't, I'm going in a totally different direction.”

B) “You need to find some other way to get to the store.”

C) “I'll help you find a way to get to the store.”

D) “Use the foods you have in the house and shop next week.”

Ans: C Feedback: The nurse needs to empower the client and helping the client find a way to get to the store promotes the skill of planning so that the client can begin to manage her own needs effectively.

Telling the client that the nurse is going in a different direction, telling him or her to find some other way to get to the store, and telling him or her to use the foods in the house are neither therapeutic nor do they promote empowerment.

11.

A community health nurse, visits an 81-year- old newly diagnosed insulin-dependent diabetic who lives alone. The nurse has visited the family three previous times and is visiting early in the morning to observe his client's insulin administration technique. The nurse finds the client depressed over his or her situation one morning. The nurse suggests that together they list positive points about his or her situation and discuss his or her feelings.

This is an example of which of the following?

A) Strengthening B) Data collection C) Goal-directed questioning D) Measuring family functioning Ans: A Feedback: The nurse is demonstrating a communication technique called strengthening which is used to assist the family in becoming independent of the nurse's services. Data collection, goaldirected questioning, and measurement of family function are methods used for assessment.

12.

Which one of the following is a principle that guides and enhances family nursing practice?

A) The nurse should expect that the family will be normal and will not change.

B) The nurse should start where the family is at the present time and not the ideal level of functioning.

C) The nurse should focus on each family member individually.

D) The nurse should evaluate the family based on consistency with traditional family patterns.

Ans: B Feedback: When working with families, community health nurses begin at the present, not the ideal level of functioning. This is accomplished after the nurse views the family collectively, not individually. The nurse should expect that what is normal for one family is not necessarily normal for another and that families are constantly changing. The nurse should recognize the validity of family structure variations.

13.

A community health nurse is attempting to empower a family to become independent.

Which of the following would be most appropriate?

A) Focus attention on the problem areas B) Do for the family what they cannot C) Emphasize the family's strengths D) Reinforce positive traits Ans: C

Feedback: To help empower families, the community health nurse needs to emphasize the family's strengths. It is the nurse's job to recognize the strengths in families and to help families recognize them as well. Focusing on problem areas portrays a negative view and can undermine the nurse's efforts. Doing for the family what they cannot fosters dependency. Reinforcing positive traits may be appropriate if those positive traits are strengths. Not all positive traits are strengths.

14.

A community health nurse is applying an interactional framework to assess a family's health. Which of the following would the nurse do?

A) View them in terms of the family's internal relationships B) Look at them from a life-cycle perspective C) Evaluate the members' changing roles and tasks D) Assess them as a social system relating to other social systems Ans: A Feedback: An interactional framework describes the family as a unit of interacting personalities and emphasizes communication, roles, conflict, coping patterns, and decision-making processes. A developmental framework studies the family from a life-cycle perspective by examining the members' changing roles and tasks in each progressive stage. A structural–functional framework describes the family as a social system relating to other social systems in the environment.

15.

A community health nurse constructs an ecomap for a family based on the understanding that this tool is useful for which reason?

A) Family relationships over three or more generations are depicted.

B) The ecological system of a family's neighborhood is charted.

C) It was originally devised to depict the complexity of the client's story.

D) Directions for gathering data about neighborhoods are provided.

Ans: C

Feedback: An eco-map depicts the complexity of the client's story. Lines are drawn to indicate connections to other systems with arrows signifying the direction of energy or flow of resources, and the absence of lines indicates a lack of connections. The family's neighborhood is one component, but not the central focus of the eco-map. A genogram displays family information about complex family patterns such as family relationships over three or more generations, arrows signify the direction of energy or flow of resources, and absence of lines indicates a lack of connections.

16.

A community health nurse is collecting data about the family's demographics. Which of the following would the nurse include? Select all that apply.

A) Dietary patterns B) Housing C) Climate D) Socioeconomic status E) Education of members F) Ethnicity Ans: D, E, F Feedback: Family demographics refer to such descriptive variables as a family's composition, its socioeconomic status, and the ages, education, occupation, ethnicity, and religious affiliations of members. Dietary patterns, housing, and climate are variables assessed with the physical environment.

17.

When a community health nurse is conducting a family assessment on an assigned family, which of the following would be most appropriate?

A) Use quantitative data only to maintain and preserve objectivity B) Interview one family member to avoid confusion and repeated information C) Use a checklist format, completing the tool in the family's presence D) Make several visits and accumulate data from all family members Ans: D Feedback:

Completing a family assessment takes time. It is better to keep notes from several visits with the family and observe the family as a group during some family activity. The nurse should not use obtrusive questionnaire techniques or take notes in the family's presence.

Quantitative data will give a one-sided view of family data. It is best to interview all family members over time. The nurse should collect both quantitative and qualitative data, which will provide a rich family assessment.

18.

During a home visit and assessment of an infant and new mother, the nurse determines that the infant looks healthy. The mother asks several questions and listens attentively. One question she asks is whether the nurse is going to visit her again. Which response would be most appropriate?

A) “Your baby looks healthy. You should not have any further questions.”

B) “The agency limits the number of visits I can make; I will let you know.”

C) “I plan to visit again. What would you like to accomplish at the next visit.”

D) “I can come weekly for the next 16 weeks, and then a staff nurse will visit.”

Ans: C Feedback: The response about what the client wants to accomplish together represents a mutual approach, giving power to the client and hints at accomplishing things together on subsequent visits. Noting that the infant looks good and that the mother should not have further questions is closed-ended and nurse- focused and does not promote open communication between the client and the nurse. The option about limiting visits is inaccurate; the nurse has more control over the number of visits than this response implies, unless the visit is part of a special and very limited program. Even then it would not be phrased this way. The final option about 16 weekly visits followed by a staff nurse sounds overwhelming and unrealistic. Very few clients receive this much service from public health agencies.

19.

A community health nurse determines that it is time for teaching a family about health promotion activities when they say which of the following?

A) “Is there a place we can go for the medicine?”

B) “It's time we do something about eating

right.”

C) “When are you coming back to visit?”

D) “Our grandchildren visit every summer.”

Ans: B Feedback: Teaching health promotion activities should begin only after family members express an interest and recognize a need, such as the statement about eating right. Asking about where to get medicine and when the nurse is coming back do not reflect an interest or need. The statement about grandchildren reflects information about the family structure and demographics.

20.

Which of the following would a community health nurse use when conducting an outcome evaluation?

A) Organization B) Family progress C) Timing D) Performance Ans: B Feedback: Outcome evaluation involves determining the change in the family's health status or progress. Organization and timing are components of the structure–process evaluation.

Performance is part of selfevaluation.

21.

The nurse educator knows that the nursing student has grasped the concept of selfevaluation when the nursing student makes which one of the following statements?

A) It is important for the family to evaluate itself.

B) It is important for the nurse's growth and effectiveness as a community health nurse.

C) Evaluations by others are not helpful.

D) Individuals can always see their own strengths or flaws.

Ans: B Feedback: Self-evaluation is important for the nurse's growth and effectiveness as a community health nurse. Self-evaluation is referring to the nurse's growth and not the family's.

Sometimes, we cannot see our own strengths or flaws, and evaluations by others are

helpful.

Chapter 15 Community as Client 1.

Which of the following statements about competent communities are accurate? Select all that apply.

A) A competent community is able to collaborate effectively identifying community needs and problems.

B) A competent community is able to achieve a working consensus on goals and priorities.

C) A competent community is able to agree on ways and means to implement the agreed- upon goals.

D) A competent community has no problems.

E) A competent community is able to collaborate effectively to take the required actions.

Ans: A, B, C, E Feedback: A competent community is able to collaborate effectively identifying community needs and problems. A competent community is able to achieve a working consensus on goals and priorities. A competent community is able to agree on ways and means to implement the agreedupon goals. A competent community is able to collaborate effectively to take the required actions. All communities have problems.

2.

Which of the following are overarching goals for the health of the nation presented in Healthy People 2020? Select all that apply.

A) To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death B) To achieve health equity, eliminate disparities, and improve the health of all groups C) To create social and physical environments that promote good health for all D) To promote quality of life, healthy development, and healthy behaviors across all life stages E) Healthy People 2020 does not address the health of the nation but does address the health of individuals.

Ans: A, B, C, D Feedback: The four overarching goals for the health of the nation are the following:

To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death To achieve health equity, eliminate disparities, and improve the health of all groups To create social and physical environments that promote good health for all To promote quality of life, healthy development, and healthy behaviors across all life stages

3.

When the nursing student identifies the three dimensions of the health of a community, the nurse educator is aware that the student has grasped which of the following concepts?

A) Status/people, structure, and process B) Assessment, policy development, and assurance C) Primary, secondary, and tertiary D) Function, structure, and process Ans: A Feedback: The three dimensions of the health of the community are status/people, structure, and process. Assessment, policy development, and assurance are the three core public health functions. Primary, secondary, and tertiary are the levels of prevention. Function, structure, and process are the descriptions of Human Anatomy and Physiology.

4.

A community health nurse is working as part of a health planning team to determine the needs of pregnant teenagers in the community. Which of the following population variables would be important to assess? Select all that apply.

A) Rate of growth or decline among those in need B) Health needs and practices of subculture groups C) Geographic placement of proposed health services D) Functions of community organizations E) Social class of the community F) Level of agreement on community goals Ans: A, B, E Feedback:

Population variables include size, density, composition, rate of growth or decline, cultural characteristics, social class structure, and mobility. Pregnant teens are a subculture of teenagers.

Cultural differences are population variables along with the numbers, social class, and mobility.

Health needs vary among subculture and ethnic populations.

Geographic placement reflects location. Functions of community organizations and social class reflect the social system.

5.

A community health nurse avoids focusing care on illness and health problems, considering clients as which of the following?

A) Aggregate B) C) D) Ans:

Agent Community Total system D Feedback: It was proposed by Mundinger and Jauron that the use of nursing diagnoses in the community could be formulated by substituting the terms, client, family, group, or aggregate for the word patient. Community health nurses look for evidence of all kinds of needs that relate to or influence a client's levels of wellness. Needs cover the whole span of the health–illness continuum and the total person, family, group, aggregate, population, or community—the total system. Not all clients are communities. They may be individuals or families. Not all clients are in the category of groups, aggregates, or populations. A client can be an individual or a family.

When using the epidemiological triad, there are three components: host, agent, and environment.

A client would be considered the host. An agent is a factor that causes or contributes to a health problem or condition.

6.

When the nursing student identifies the concept of community as client as which of the following the instructor knows that the student has grasped this concept?

A) The community is comprised of individual clients.

B) The community is comprised of families.

C) The community is a group or population of people as the focus of nursing service.

D) The community cannot be a client. Persons who are hospitalized are patients.

Ans: C Feedback: The concept of community as client refers to a group or population of people as the focus

of nursing service.

7.

Which of the following statements about the structural dimension of the community as client are accurate? Select all that apply.

A) Structure of a community refers to its services and resources.

B) Community associations, groups, and organizations provide a means for accessing needed services.

C) Adequacy and appropriateness of health services can be determined by examining patterns of use, number and types of health and social services, and quality measures.

D) Demographic data, such as socioeconomic and racial distribution, age, gender, and educational level, are important indicators of community structure.

E) Structure is the most common measure of the health of a community.

Ans: A, B, C, D Feedback: Structure of a community refers to its services and resources. Community associations, groups, and organizations provide a means for accessing needed services. Adequacy and appropriateness of health services can be determined by examining patterns of use, number and types of health and social services, and quality measures. Demographic data, such as socioeconomic and racial distribution, age, gender, and educational level, are important indicators of community structure. Status/people is the most common measure of the health of a community.

8.

The community health nurse is determining the health of a community by examining status. Which of the following would the nurse examine?

A) Leading causes of death and illness B) Adequacy of health services C) Socioeconomic distributions D) Strengths of the community Ans:

A Feedback: Status typically comprises morbidity and mortality data identifying the physical, emotional, and social determinants of health. Physical and social indices include vital statistics,

leading causes of death and illness, suicide rates, and rates of drug and alcohol addiction. Social determinants can be identified by crime rates and functional ability level, or by high school dropout rates or average income levels. Adequacy of health services and socioeconomic distributions reflect structure. Strengths of the community involve process.

9.

The community health nurse is assessing the health of a community by reviewing the dimension of process. Which of the following is true of this dimension?

A) Process of a community refers to its services and resources.

B) Process reflects the community's ability to function effectively.

C) It usually consists of morbidity and mortality data.

D) It refers to the physical, emotional and social determinants of health.

Ans: B Feedback: Process reflects the community's ability to function effectively. Structure of a community refers to its services and resources. Status/ people dimension usually refers to the morbidity and mortality data and the physical, emotional, and social determinants of health.

10.

As part of an orientation for a group of newly hired nurses for a community agency, a community health nurse emphasizes which of the following as crucial?

A) Cyclic nature B) C) D) Ans:

Client focus Interaction Flexibility C Feedback: Although the nursing process is cyclical, deliberative, flexible (adaptable), client focused, and need oriented, interaction is an essential first consideration for community health nursing.

All steps of the nursing process depend on interaction.

11.

When building a coalition, which of the following would the community health nurse do first?

A) Conduct a community assessment B) Identify key players C) Identify potential members D) Define goals and objectives Ans: D Feedback: Steps to coalition building include defining goals and objectives, conducting a community assessment, identifying key players or leaders, and identifying potential coalition members.

12.

When assessing a community's needs, which of the following would the nurse most likely complete first?

A) Familiarization assessment B) Problem-oriented assessment C) Community subsystem assessment D) Comprehensive assessment Ans: A Feedback: A familiarization assessment is a common starting place in evaluation of a community. It involves studying data already available on a community and then gathering a certain amount of firsthand data in order to gain a working knowledge of the community. A problem-oriented assessment begins with a single problem and assesses the community in terms of that problem. It is commonly used when familiarization is not sufficient and a comprehensive assessment is too expensive. A community subsystem assessment focuses on one dimension of community life. It is a useful way for a team to conduct a more thorough community assessment. A comprehensive assessment seeks to discover all relevant community health information.

13.

When completing a community assets assessment, the community health nurse would gather information about which of the following?

A) Key informants B) Strengths of the community C) Specific problem of the community D) Overall life of the community Ans: B

Feedback: An assets assessment focuses on the strengths and capacities of a community rather than its problems. Key informants are important sources of information with a comprehensive assessment. Information about a specific health problem is gathered during a problem- oriented assessment. Information about an overall view of the community and its life is gathered with a familiarization or windshield survey.

14.

Nursing students in a community health nursing course identified toxic waste disposal to be a major problem in their community.

The most cost-effective type of community assessment to determine the extent of the problem and the resources available to handle it would be a A) familiarization assessment.

B) community subsystem assessment.

C) problem-oriented assessment.

D) comprehensive community assessment.

Ans: C Feedback: The problem-oriented assessment is commonly used when familiarization is not sufficient and a comprehensive assessment is too expensive and not needed and a subsystem assessment is too narrow to determine the extent of the problem.

15.

A community health nurse involved in assessing community health needs is planning to get a group of approximately 10 similar individuals together to obtain information about opinions on first pregnancies. The nurse is using which assessment method?

A) Survey B) Community forum C) Focus group D) Descriptive epidemiology Ans: C Feedback: The nurse is using a focus group, similar to the community forum or town hall meeting in that it is designed to obtain grassroots opinion. Focus groups usually have only a small group of participants, usually 5 to 15 people and the members chosen for the group are homogeneous with respect to specific demographic variables. A survey involves a series of questions, often to

provide a broad range of data. Community forum is a qualitative method to obtain community opinions; the members typically represent all segments of the community involved with the issue. Descriptive epidemiologic studies examine the amount and distribution of a disease or health condition in a population by person, place, and time.

16.

A community health nurse obtains data about the community from primary sources, including which of the following?

A) World Health Organization B) Community members C) State health department D) Other community health nurses Ans: B Feedback: Primary sources of information include community members, including formal leaders, informal leaders, and community members, and can frequently offer the most accurate insights and comprehensive information. Information gathered by talking to people provides primary data, because the data are obtained directly from the community. The World Health Organization is an international source of information. State health department is a state source of data.

Other community health nurses as well as health team members, client records, community health (vital) statistics, census bureau data, reference books, and research reports are secondary sources of information.

17.

When developing community diagnoses, which of the following would the community health nurse do?

A) Focus primarily on deficits of the community B) Use broad statements to guide a range of interventions C) Employ a revised nursing diagnosis format D) Substitute the terms client, family, group, or aggregate for the word patient Ans: D Feedback: Community diagnoses should include statements about the strengths of the community and possible sources for community solutions, as well as the community's weaknesses or problem areas. In addition, they should portray a community focus, include the community response, and identify any related factors that have potential for change through community health nursing. These may also include wellness diagnoses, which indicate maintenance or potential change responses (due to growth and development), when no deficit is present.

Diagnoses statements should be narrow enough to guide interventions and use the standard nursing diagnosis format.

18.

During which stage of the health planning process would the community health nurse create a plan?

A) Assessment B) Analysis and design C) Implementation D) Evaluation Ans: B Feedback: During the health planning process, a community health nurse creates a plan during the analysis and design stage, which correlates to the planning phase of the nursing process.

Assessment involves data collection, interpretation, and goal setting.

Implementation involves how to operationalize the plan and a design for monitoring progress.

Evaluation involves examining the costs and benefits, judging the potential outcomes, modifying the plan, presenting the plan to the sponsoring group or agency, and obtaining acceptance.

19.

A community health nurse is engaged in evaluation of a health plan using a formative evaluation. The nurse would focus on which of the following?

A) Process during the actual intervention B) Outcomes of the interventions C) Development of performance standards D) Impact on the clients' health Ans: A Feedback: The focus of formative evaluation is on process during the actual interventions. It uses performance standards that are developed to determine what is working and not working.

Summative evaluation focuses on the outcome of the interventions and examines the programs' impact on clients' health.

20.

When applying community development theory, which of the following would most likely be considered the agent of change?

A) Clients B) Nurse C) Families

D) Ans:

Community leaders B Feedback:

When applying community development theory, the agent of change is most often the community health nurse who is considered a partner rather than an authority figure responsible for the community's health.

Clients, families, and community leaders would be the care recipients.

Chapter 16 Global Health Nursing 1.

When describing the global framework, which of the following would the community health nurse be least likely to include?

A) Population B) Provider C) Procedure D) Physician Ans: D Feedback: The global framework is bounded by a context and includes three parts, the three “Ps.” These are the population, the provider, and the procedure. Physician would be included as a provider.

2.

When applying the Universal Imperatives of Care, which of the following would be the priority?

A) Mortality B) Daily functioning C) Decision making D) Cost Ans: A Feedback: The Universal Imperatives of Care include mortality, morbidity, daily functioning, decision making, and cost. This paradigm underscores the notion of first things first. That is, one must be alive and well before interventions focus on functioning or decision making.

3.

A nursing student is considering a career in international community health nursing.

Which of the following statements are accurate regarding the context of international community health nursing? Select all that apply.

A) Global community health care is complex and is affected by multiple factors relating to geography, history, politics, culture, religion, and economy.

B) The types of services that can be provided include a range from providing clinical services to policy making at an international level.

C) People's conception of health, wellness, and illness are static from culture to culture.

D) By looking through a computer window, the student is able to see almost anyplace, connect to about any person, and access information about almost any concept.

E) The ways in which people view nurses and other health care providers are affected by their attitudes toward women, their culture, and belief systems.

Ans: A, B, D, E Feedback: The following statements are true: Global community health care is complex and is affected by multiple factors relating to geography, history, politics, culture, religion, and economy; The types of services that can be provided include a range from providing clinical services to policy making at an international level; By looking through a computer window, the student is able to see almost anyplace, connect to about any person, and access information about almost any concept; The ways in which people view nurses and other health care providers are affected by their attitudes toward women, their culture, and belief systems. The statement that people's conceptions of health are static from culture to culture is false.

Indeed, people's conceptions of health, wellness, and illness vary from culture to culture.

4.

A community health nurse is preparing a presentation for a community group about tuberculosis (TB) and its current epidemic status. Which of the following would the nurse include in the presentation about this disease?

A) TB kills about 1.7 million people each year.

B) All persons who are infected by the causative organism become ill and can spread the causative organism to others throughout the remainder of their lifetime.

C) Three fourths of the world's population is thought to be currently infected by the causative organism.

D) The highest number of deaths is in Eastern Europe.

Ans: A Feedback: TB kills approximately 1.7 million people each year. Only 5 to 10 of those infected become ill or can spread the causative organism to others within their lifetime. One third of the world's population is thought to be currently infected by the causative organism (tubercle bacillus). The highest number of

deaths occur in Africa.

5.

A community health nurse has identified noise as an environmental hazard. Using the Blumenthal classification, the nurse would identify this as which of the following class?

A) Infectious agents B) Asphyxiates C) Poison D) Physical agents Ans: D Feedback: The Blumenthal classification lists classes of environmental hazards. They include infectious agents (e.g., bacteria and viruses), respiratory fibrotic agents (e.g., coal dust), asphyxiates (e.g., carbon monoxide), poison (e.g., pesticides), physical agents (e.g., noise), psychological agents (stressful synergisms such as crowding combined with noise), mutagens (e.g., dioxin), teratogens (e.g., cadmium), and carcinogens (e.g., cigarette smoke).

6.

Which one of the following factors has resulted in the Era of Chronic Long-Term Health Conditions?

A) Decreased usage of tobacco by young populations B) Despite programs of control, many infectious diseases persist with many people surviving to experience chronic, long-term conditions secondary to the infectious disease.

C) Shorter life expectancies due to chronic diseases D) Death from infectious diseases results in a decrease in degenerative diseases.

Ans: B Feedback: Despite the programs of control, many infectious diseases persist. However, populations now survive and also experience chronic, long-term conditions. These conditions affect mortality and morbidity, daily functioning, decision making, and cost. Thus, the longevity that has resulted from meeting the challenges of the Era of Infectious Diseases compounds the more recent emergence of chronic diseases in the many countries. The emergence of multidrug resistant diseases, continued persistence of infectious disease, and urbanization with deforestation have resulted in new and emerging infectious diseases and conditions.

7.

When reviewing statistics about illnesses worldwide, which of the following would the nurse identify as the most common and a leading cause of mortality?

A) Tuberculosis B) Smallpox C) Acute respiratory tract infection D) Infectious diarrheal disease Ans: C Feedback: The most common illness in the world and a leading cause of mortality is acute respiratory tract infection (ARI). Three million deaths annually are attributed to ARI among children younger than 5 years of age, usually from pneumonia. Tuberculosis is considered epidemic today. Smallpox has been eradicated. Infectious diarrheal disease has been reduced due to oral rehydration therapy and improvements in water and sanitation.

8. help achieve a reduction in the number of measles deaths worldwide?

A) Integrated Management of Childhood Illness (MCI) B) Global Alliance for Vaccine and Immunization C) Oral rehydration therapy D) Geographical information systems Ans: A Feedback: The MCI is the intervention considered to have the greatest impact in reducing measles.

It provides wide immunization coverage, rapid referral of serious cases, prompt recognition of secondary conditions, and improved nutrition and vitamin A supplementation. The Global Alliance for Vaccine and Immunization is an interagency initiative that seeks to protect every child against vaccine-preventable diseases. This initiative addresses all of these types of diseases.

Oral rehydration therapy has been used to reduce mortality associated with diarrheal diseases.

Geographical information systems is not a program but a means to monitor diseases.

9.

Which one of the following statements about poliomyelitis is the most accurate?

A) Polio is not endemic in any countries at present.

B) Polio has been eliminated worldwide.

C) Rotary International has contributed no funds but many hours of manpower to eradicate polio.

D) Polio has been eliminated from the Western hemisphere.

Ans: D Feedback:

Polio has been eliminated from the Western Hemisphere. It is now almost eliminated worldwide. Polio is endemic in Afghanistan, India, Pakistan, and Nigeria. Rotary International has contributed over $900 million dollars to help eradicate this disease.

10.

A community health nurse is reading a journal article about global health and communicable diseases. The article states that elimination is the goal. The nurse interprets this to mean which of the following?

A) There are no further cases of the disease anywhere.

B) No further preventive efforts are necessary.

C) The disease is no longer a public health threat.

D) The disease has been interrupted in a geographic area.

Ans: D Feedback: The term elimination is used when a disease has been interrupted in a defined geographic area. In 1991, WHO defined elimination as a reduction of prevalence to less than one case per 1 million population in a given area.

Eradication means interruption of person-to- person transmission and limitation of the reservoir of infection so that no further preventive efforts are required; it indicates a status whereby no further cases of a disease occur anywhere. The term control indicates that a specific disease has ceased to be a public health threat.

11.

A community health nurse instructs a local community group on how to prepare homemade oral rehydration solution. Which of the following ingredients would the nurse include?

A) Sea water B) Table salt C) Baking soda D) Ans:

Crushed bananas B Feedback: Oral rehydration solution consists of 1 L of safe water to which is added half small teaspoon of salt, and four large spoons of sugar. In addition, bananas or green coconut water are encouraged to compensate for the loss of potassium.

12.

Communicable disease is a global health concern with a primary goal of eradicating communicable diseases worldwide.

Achievement of this goal would involve A) interrupting disease in a limited, defined geographic area.

B) reducing the incidence and/or prevalence of communicable diseases.

C) establishing primary health care services for all people on the globe.

D) interrupting transmission and reservoir of infection to prevent further cases.

Ans: D Feedback: Eradication is an ambitious and expensive goal and has occurred with smallpox in 1977 and is under way with other diseases such as poliomyelitis, guinea worm, leprosy, and measles so that many diseases can be eradicated early in the 21st century. One major means of eradicating communicable diseases is to interrupt the transmission and reservoir, thereby preventing the development of new cases. Interrupting disease in a limited area may be a starting point, but more widespread involvement is needed. Reducing the incidence or prevalence would provide indications about the effects of attempting to eradicate the disease. Establishing primary health care services is the goal of Alma-Ata “health for all.”

13.

immunization is true?

A) The World Health Organization estimates that a billion more lives could be saved each year with immunizations.

B) Vaccines are one of the most cost-effective interventions found in public health.

C) Half of the world's children are being reached with essential vaccines.

D) In the United States, toddlers are thoroughly vaccinated.

Ans: B Feedback: Vaccines are one of the most cost-effective interventions found in public health. The World Health Organization estimates that 3 million more lives could be saved each year with immunizations. Three fourths of the world's children are being reached with essential vaccines.

In the United States, only 10% of toddlers are protected against measles, mumps, and rubella via vaccinations.

14.

A community health nurse is working with an international agency in Australia. The nurse would most likely encounter which type of health care system?

A) Entrepreneurial B) Welfare-oriented C) Comprehensive D) Socialist Ans: B Feedback: Australia subscribes to a welfare-oriented health care system in which statutory programs drive these systems to support the cost of health care for all, or almost all, of the population through their “national health insurance.” An Entrepreneurial Health Care System, found in the United States, is one in which the country's health care system is based, in part, on its political economy. A Comprehensive Health Care System is a step away from the welfare-oriented type in that substantial modifications exist in delivery and financing that result in universal entitlements. These systems are found in Scandinavian countries, Great Britain, and New Zealand.

Socialist Health Care Systems came about through social revolutions that abolished free- market economies and replaced them with socialism where the health care system is also socialized.

They are found in countries such as Russia, Eastern Europe, Albania, Bulgaria, Czechoslovakia, East Germany, Hungary, Poland, Romania, Yugoslavia, and China.

15.

Which of the following are factors that influence populations' perceptions of health and health status and their receptivity to community health nursing programs? Select all that apply.

A) Their perceptions of healthy food B) Their attitudes toward women C) Their culture D) Their belief systems E) Their geographic location Ans: B, C, D Feedback: The factors that influence populations' perceptions of health and health status and their receptivity to community health nursing programs include their attitudes toward women, their culture, and their belief systems. Their perceptions of healthy food or their geographic location would not have a direct bearing on their perception of health and health status or receptivity to community health nursing programs.

16.

A community health nurse is preparing to work in a country in which women are viewed as weak and ineffectual. Which of the following would the nurse need to do first?

A) Determine his or her own position and beliefs about this view B) Develop a basic plan to change the view of women C) Become aware of possible areas that might impact care D) Avoid situations involving the care of women Ans: A Feedback: Community health nurses first, need to determine their own position on this issue and come to terms with it, realizing that it may impact their care. Once aware, the nurses can then prepare appropriately for situations in which their care may be affected. It would be inappropriate and probably impossible to attempt to change the view or avoid situations involving the care of women.

17.

Which of the following statements about the personal and professional perceptions that nurses bring to providing community health nursing interventions within an international context is most accurate?

A) Community health nurses are not susceptible to preconceived perceptions and biases.

B) It is not necessary for community health nurses to face their own beliefs.

C) Community health nurses are universally opposed to female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.

D) It is critical for community health nurses to face their own beliefs when confronting female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.

Ans: D Feedback: It is critical for community health nurses to face their own beliefs when confronting female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment. Community health nurses are as susceptible as any other group of people to preconceived perceptions and biases.

Community health nurses may not be universally opposed to female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.

18.

Community health nurses need to be knowledgeable about the World Health Organization because its mission reflects which of the following?

A) Collaboration in health development to free the world from poverty B) Service as an independent agency providing economic and humanitarian assistance overseas C) Representation of the global interests and concerns of the nursing profession D) Global health promotion by supporting development efforts of governments, organizations, and universities throughout the world Ans: D Feedback: WHO's mission reflects global health promotion by supporting development efforts of governments, organizations, and universities throughout the world.

Collaboration to free the world from poverty reflects the mission of the World Bank.

Service as an independent agency for economic and humanitarian assistance describes the mission of the United States Agency for International Development (USAID). Representation of global interests and concerns of nurses describes the mission of the International Council of Nurses (ICN).

19.

An instructor in community health nursing teaches a group of students about the role of the World Health Organization and global health, reviewing the importance of the Declaration of Alma-Ata. The instructor determines that the students have grasped the importance when they describe it as which of the following?

A) The beginning of the Carter Center's work in disease prevention and agriculture B) A formal document written by 134 nations in 1978 to achieve “health for all” C) Participatory development activities, working in partnership with voluntary organizations D) Alliance building and communicating best practices for global health development

Ans:

B Feedback:

The declaration represents the work of 134 nations during a WHO/UNICEF conference in 1978 to achieve primary health care for all. The Carter Center was founded in 1986 and is not related to the work at Alma-Ata. Participatory development activities describe the work of the United States Agency for International Development (USAID). Alliance building and communicating best practices describe the Global Health Council, which is a leading private, voluntary, American nongovernmental organization.

20.

Which of the following statements about the International Council of Nurses (ICN) are accurate? Select all that apply.

A) ICN represents the global interests and concerns of the nursing profession.

B) The mission of ICN is to maintain the role of nursing in health care through its global voice.

C) ICN has, as members, nursing organizations from 130 countries representing 13 million nurses.

D) ICN is a governmental organization.

E) ICN employs Regional Nursing Advisors.

Ans: A, B, C Feedback: The following statements about ICN are accurate: ICN represents the global interests and concerns of the nursing profession; the mission of ICN is to maintain the role of nursing in health care through its global voice; and ICN has, as members, nursing organizations from 130 countries representing 13 million nurses. ICN is a nongovernmental organization. Regional Nursing Advisors are employed at the international level of the World Health Organization.

21.

After teaching a class of community health nursing students about the World Health Organization, the instructor determines that the teaching was successful when the class identifies which of the following as the highest governing body?

A) World Health Assembly B) WHO Collaborating Centers C) The European Union D) U.S. Agency for International Development Ans: A

Feedback: The World Health Assembly is the highest governing body within WHO. WHO Collaborating Centers are networks of centers focusing on specific areas of expertise and carry out the work of the member countries in these areas. The European Union is an organization that provides funding for many projects including health. The U.S. Agency for International Development is an independent bilateral agency of the executive branch that works to enhance long-term and equitable economic growth.

22.

A group of students are reviewing for an examination on nongovernmental organizations that provide global interventions. The students demonstrate the need for additional study when they identify which of the following as an example?

A) Global Health Council B) CARE C) Carter Center D) World Bank Ans: D Feedback: The World Bank is an agency that focuses on economic development. It partners with countries, WHO, and other organizations. It is not a nongovernmental organization.

Examples of nongovernmental organizations include Global Health Council, The Center for International Health and Cooperation, CARE, and the Carter Center.

23.

Which organization would be most appropriate for the community health nurse to contact for assistance when dealing with countries shattered by war and ethnic violence?

A) Center for International Humanitarian Cooperation B) CARE C) Global Health Council D) International Council of Nurses Ans: A Feedback: The Center for International Humanitarian Cooperation (CIHC), founded in 1992, promotes healing and peace in countries shattered by war, regional conflicts, and ethnic violence.

CARE intervenes by responding to famines and disasters worldwide with emergency food, supplies, and rehabilitative efforts. The GHC advocates for needed policies and resources, builds networks and alliances among those working to improve health, and shares innovative ideas, knowledge, and best practices in health.

The ICN represents the global interests and concerns of the nursing profession.

24.

Which of the following statements about the World Health Organization is accurate?

A) The World Health Organization does not provide technical support for interventions or provide assistance developing nursing knowledge and skills.

B) The World Health Organization can help a member state determine the drugs that are essential and will assist in developing health policy, project plans, and programs.

C) The World Health Organization provides medicines and other tangible resources to its member states.

D) The World Health Organization focuses on professional issues to support the development of particular health-related practitioners, such as nurses.

Ans: B Feedback: The World Health Organization can help a member state determine the drugs that are essential and will assist in developing health policy, project plans, and programs. The World Health Organization does focus on providing technical support related to the interventions and provides assistance developing nursing knowledge and skills. The World Health Organization does not provide medicines and other tangible resources to its member states but does help member states determine the drugs that are essential and assist in developing health policy, project plans, and programs.

25.

Which of the following statements regarding WHO Collaborating Centers is most accurate?

A) One or two Regional Nursing Advisors carry out the work of a region that might be the home to thousands of nursing personnel.

B) The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas.

C) It is referred to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles.

D) It focuses on professional issues to support the development of particular health-related practitioners.

Ans:

B Feedback: The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas.

Regional Nursing Advisors work in collaboration with WHO Collaborating Centers to accomplish the work within each region. Primary Health Care is referred to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles.

Chapter 17 Disasters and Their Impact 1.

A community health nurse is working with people who experienced a tornado and have been forced to leave their homes to escape the effects of a disaster. The nurse would identify these people as which of the following?

A) Indirect victims B) Refugees C) Displaced persons D) Casualties Ans: C Feedback: Displaced persons are those who have been forced to leave their homes to escape the effects of a disaster. Indirect victims are the relatives and friends of direct victims.

Refugees are direct victims who are forced to leave their homeland, usually due to war, religious persecution, or political turmoil. A casualty is a human being who is injured or killed by or as a direct result of an accident.

2.

A community health nurse working as a part of a disaster response team is told that the disaster is classified as a multiple-casualty incident. The nurse would interpret this to mean which of the following?

A) There is more than 1 but less than 10 casualties.

B) The number of casualties is between 2 and 100.

C) Casualties number over 100.

D) Ans:

There are too many casualties to count.

B Feedback: If casualties number more than two people but fewer than 100, the disaster is characterized as a multiple-casualty incident. A mass- casualty incident involves100 or more casualties.

3.

A community health nurse is part of a disaster response team that is first to respond to an earthquake. The team evaluates the level of destruction and devastation, identifying this as which of the following?

A) Intensity B) Scope C) Casualty D) Range of effect Ans: A Feedback: The intensity of a disaster is the level of destruction and devastation it causes. The scope of a disaster is the range of its effect, either geographically or in terms of the number of victims.

Casualty refers to the human being(s) injured or killed by or as a direct result of an accident.

4.

Which of the following examples of disasters are natural disasters? Select all that apply.

A) The Earthquake and tsunami in Japan in 2011 B) The 2008 shootings at Virginia Tech C) The terrorist attacks on the United States on September 11, 2001 D) Wildfires that affected California in October 2007 E) The oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife Ans: A, D Feedback: Examples of natural disasters include the earthquake and tsunami in Japan in 2011 and wildfires that affected California in October 2007. The following disasters are man-made: the 2008 shootings at Virginia Tech; the terrorist attacks on the United States on September 11, 2001; and the oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife.

5.

After teaching a class about the factors that contribute to disasters, the instructor determines that the teaching was successful when the students identify which of the following as the agent?

A) Population's age B) Radiation C) Level of preparedness D) Flood-prone location Ans: B Feedback: The agent is the natural or technologic element that causes the disaster. For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs. The population's age is an example of host factor. The level of preparedness and flood-prone location are examples of environmental factors.

6.

Which of the following federal agencies would a community health nurse expect to be contacted to assist with a disaster in the United States?

A) American Red Cross B) Federal Emergency Management Agency (FEMA) C) WHO's Emergency Relief Operations D) Pan American Health Organization Ans: B Feedback: The Federal Emergency Management Agency (FEMA) is the federal agency responsible for assessing and responding to disaster events in the United States. The American Red Cross is authorized to provide disaster assistance free of charge across the country through its more than 1 million volunteers. It is not supported by the federal government. The World Health Organization's Emergency Relief Operations provide disaster assistance internationally, and the Pan American Health Organization works to coordinate relief efforts in Latin America and the Caribbean.

7.

The nurse is using the epidemiological triad to explain the factors contributing the disaster.

Which one of the following statements about the environment factors that contribute to disasters is most accurate?

A) The environment is the natural or technologic element that causes the disaster.

B) The environment is the human being who experiences the disaster.

C) Factors that could potentially contribute to or mitigate a disaster are environmental.

D) Examples of environmental factors that cause a disaster are high winds of a hurricane and the lava of an erupting volcano.

Ans: C Feedback: Factors that could potentially contribute to or mitigate a disaster are environmental. The agent factor is the natural or technologic element that causes the disaster, for example the high winds of a hurricane and the lava of an erupting volcano. The host is the human being who experiences the disaster.

8.

A community health nurse is working with a community that is involved with identifying risk factors for program development in case of a disaster. This community is in which phase of disaster management?

A) Prevention B) Preparedness C) Response D) Recovery Ans: A Feedback: During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

9.

A community health nurse is working with a community that is involved with improving community and individual reaction and responses, so that the effects of a disaster are minimized.

This community is in which phase of disaster management?

A) B)

Prevention Preparedness

C) D) Ans:

Response Recovery B Feedback: Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

10.

When would the nurse expect the response phase of a disaster to occur?

A) When no disaster is expected or anticipated B) Immediately after the onset of the disastrous event C) Long-term phase occurring after the disastrous event D) Prior to the disastrous event Ans: B Feedback: The response phase of disaster occurs immediately after the onset of the disastrous event.

During the prevention phase no disaster is expected or anticipated. Long-term phase occurring after the disastrous event is the recovery phase. Prior to the disastrous event is the preparedness phase.

11.

Which of the following statements about disaster planning is most accurate?

A) Disaster planning is essential for a community, business, or hospital.

B) A disaster plan must be lengthy and detailed.

C) A disaster plan should be created by the person responsible for the emergency management of the community.

D) It is assumed that all professionals have addressed their personal preparation.

Ans: A

Feedback: Disaster planning is essential for a community, business, or hospital. A disaster plan need not be lengthy. A disaster plan should be created by all involved, including community leaders, health and safety professionals, and lay people. All nurses should address their own personal preparedness to respond in a disaster, but this may not be assumed.

12.

Which of the following are necessary components of a nurse's personal preparedness? Select all that apply.

A) Workplace and community disaster plans have been reviewed by the nurse.

B) An individual disaster plan for the nurse's own family has been developed.

C) The nurse participated in disaster drills at the workplace and had a family disaster drill to practice what actions to take in the event of a disaster.

D) It is not necessary for the nurse to bring copies of their nursing license and driver's license.

E) In the case of an actual disaster, the nurse will be able to use equipment made available to them.

Ans: A, B, C Feedback: To be personally prepared, a nurse should have read and understood workplace and community disaster plans, should have developed a disaster plan for his or her own family, and should have participated in disaster drills. Nurses preparing to work in disaster areas should bring copies of their nursing license and driver's license and bring basic equipment.

13.

As part of secondary prevention, the community health nurse engages in crisis intervention to achieve which of the following?

A) Reestablish equilibrium to the lives of those involved B) Prevent the crisis altogether C) Involve as many people as possible in the resolution

D) Triage clients during the recovery phase of the crisis Ans: A Feedback: The stated goal of crisis intervention is to reestablish equilibrium. Prevention is the best approach, but some crises, such as natural disasters, cannot be prevented. They can, however, be prepared for to decrease the negative effects of the crisis as much as possible. It is important to have an adequate number of people needed to come to resolution. However, too many people involved in resolution may cause additional confusion, chaos, and unnecessary delays.

Triage decisions need to be made during the response phase of the disaster or crisis and not deferred until the recovery phase. Triage is an ongoing process throughout the response phase.

14.

A community health nurse is engaged in primary prevention activities related to disasters.

Which of the following would be examples of appropriate activities? Select all that apply.

A) Providing anticipatory guidance B) Practicing an escape plan C) Providing emergency assistance D) Planning disaster drills E) Providing immediate response F) Reducing the degree of disability Ans: A, B, D Feedback: Anticipatory guidance, practicing escape plans, and planning disaster drills all constitute primary prevention activities. Providing emergency assistance and immediate response reflect secondary prevention activities. Reducing the degree of disability or damage resulting from the disaster reflects tertiary level prevention activities.

15.

When describing primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax to a local community group, which of the following would the nurse include?

A) Investigating outbreaks to determine source B) Administering vaccines C) Screening suspected cases D) Treating persons who have been infected Ans: B Feedback:

Primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax would include administering vaccines. Investigating outbreaks to determine the source, screening suspected cases, and treating persons who have been infected would be secondary prevention activities.

16.

A community health nurse is assisting the local community in preparing a disaster plan.

Which of the following would the nurse expect to be addressed? Select all that apply.

A) Chain of command B) Routes for transportation C) Triage D) Basic equipment E) Copies of licenses Ans: A, B, C Feedback: A disaster plan should address the chain of command, routes and modes of transportation, and triage methods. Basic equipment and licenses are items that a nurse should bring along when preparing to work in a disaster area.

17.

A community health nurse is responding to a disaster. Which of the following would most likely be the least appropriate area for the nurse to be located?

A) The disaster site B) Triage C) Victim treatment area D) Local hospitals Ans: A Feedback: Usually, the immediate disaster site is not the best place for the disaster nurse, who can be far more effective in triage and treatment of victims. One of the lessons of the World Trade Center bombing was that the greatest need for medical professionals was at the local hospitals, not at the disaster site.

18.

When performing triage during a disaster, which color would indicate that the victim is in urgent need of care?

A) B) C) D) Ans:

Red Yellow Green Black A Feedback: During triage, red indicates that the victim has injuries or medical problems that will likely lead to death if no treated immediately.

Yellow indicates that the person has injuries that require medical attention but time to treatment is not yet critical. Green indicates that the victim has minor injuries or are presenting with minimal signs of illness.

Black indicates that the victim is dead or has suffered mortal wounds.

19.

A community health nurse responding to a disaster is involved with caring for the bodies of the casualties who have died. Which of the following would be an appropriate method for documentation?

A) Making a note on the triage tag B) Using a toe tag for identification C) Placing the name on a casualty list D) Recording the name on the victim's body Ans: B Feedback: Toe tags make documentation visible and accessible and are the most appropriate means for documentation. Making a note on the triage tag, placing the name on a casualty list and recording the name on the victim's body are inappropriate.

20.

Which time after the disaster would be the ideal time for this to occur?

A) Within 18 hours B) 1 to 3 days C) 4 to 6 days D) 7 to 10 days Ans:

B Feedback: The ideal time for CISD is between 24 and 72 hours after the disaster event.

21.

When providing secondary prevention activities for individuals experiencing psychological consequences of a disaster, which of the following would the nurse do as a generic approach?

A) Providing situational support for stress relief B) Conveying warmth and concern for the client C) Teaching about expected emotional reactions D) Reunifying family members who were separated Ans: C Feedback: The generic approach is designed to reach high-risk individuals and large groups who have experienced the same disaster, teaching them about the expected emotional reactions to the type of disaster they have experienced and promoting adaptive responses.

Environmental manipulation results in the change of a person's physical or interpersonal situation, providing situational support to relieve stress. An example of environmental manipulation is when a community health nurse coordinates the reunification of family members separated by the disaster. General support is defined as the caring, warmth, and concern the community health nurse conveys to the client as she or he delivers services.

22.

A community health nurse suspects that a client who was a victim of a disaster 3 months ago is experiencing post-traumatic stress disorder. Which of the following would the nurse expect to find? Select all that apply.

A) Diminished startle response B) Hypervigilance C) Feelings of detachment D) E) Ans:

Flashbacks Full range of affect B, C, D Feedback: Signs and symptoms of post-traumatic stress disorder include increased startle response, hypervigilance, feelings of detachment, flashbacks, and restricted affect.

23.

A group of ten people from the commune in the hills come into town dressed in robes and have their faces covered. They have weapons hidden in their clothing and begin entering the three banks in town to rob them. These actions can be classified as which of the following?

A) Natural disaster B) Terrorism C) Casualty D) Adventitious crisis Ans: B Feedback: The actions resemble terrorism, the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population or any segment thereof in furtherance of political or social objectives. The actions are not a natural disaster. Casualty refers to the person who is injured or killed by or as a direct result of an accident. An adventitious crisis is an event that is out of the ordinary in magnitude and personal experience.

24.

After teaching a group of students about agents associated with chemical warfare, the instructor determines that additional teaching is needed when the students identify which as an example?

A) Explosives B) Nerve agents C) Anthrax D) Ans:

Jet fuel C Feedback: Anthrax is considered a bioweapon. Explosives, nerve agents, and jet fuel are considered agents of chemical warfare.

25.

Which of the following would be most appropriate for community health nurses to encourage when helping communities cope with the anxiety associated with terrorism?

A) Maintaining high levels of alertness and fear B) Spending time with children and young people

C) D) Ans:

Spending more time indoors Keeping a fear journal B Feedback: Most young people carry a charge of positive energy that is infectious. Maintaining high levels of alertness and fear are not healthy.

Instead individuals should be a little afraid because a certain level of fear is healthy if the person learns to use it as positive energy.

Spending more time outdoors is helpful remedy. Individuals should keep a courage journal; fear immobilizes and courage takes action.

26.

A community health nurse is preparing a presentation for a community group about possible agents of terrorism. Which of the following would the nurse include as an example of a bioweapon? Select all that apply.

A) Mustard gas B) Sarin C) VX gas D) Nerve agents E) Bombs Ans: A, B, C Feedback: Bioweapons include mustard gas, sarin, VX gas, and anthrax. Nerve agents and bombs are examples of chemical warfare agents.

Chapter 18 Violence & Abuse 1.

A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which of the following as developmental crises? Select all that apply.

A) A windstorm that damaged 20 homes in a community B) Grandpa Jones dying at age 82 years C) A couple getting engaged D) The Smiths getting a divorce E) The Jones experiencing a home invasion F) Seven people dying in an automobile crash Ans: B, C, D

Feedback: Developmental crises are periods of disruption that occur at transition points during normal growth and development. Developmental crises, as a rule, do not occur suddenly. They are more evolutionary than revolutionary. Even the advancing, age, illness, or death of a grandparent or parent is a developmental expectation. However, the actual event may occur suddenly.

Experiencing damage from a windstorm, a home invasion, or an automobile crash are situational crises.

2.

A community health nurse is preparing a presentation for a community center group about crisis. Which of the following concepts about situational crises should be included in the presentation? Select all that apply.

A) A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community.

B) Situational crises can be predicted, expected, and planned.

C) Situational crises are never positive.

D) Situational crises often occur without warning.

E) Situational crises occur to people because of where they are in time and space.

Ans: A, D, E Feedback: A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur to people because of where they are in time and space.

Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.

3.

Which one of the following statements about primary prevention for family violence is most accurate?

A) The cycle of violence within the family cannot be interrupted.

B) Persons who have been victims of family violence will repeat the behavior with others.

C) Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring.

D) It is not possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

Ans: C Feedback: Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. The cycle of violence within the family can be interrupted, and persons who have been victims of family violence can learn to use more appropriate coping strategies. It is possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

4.

The nursing student reads the textbook in preparation for a class meeting about primary, secondary, and tertiary prevention related to families in crisis. The student determines which one of the following statements as most accurate regarding the levels of prevention?

A) Often people in crisis are temporarily helpless and unable to cope on their own but are receptive to outside influence.

B) Secondary prevention interventions include taking action to prevent the unwanted event from occurring.

C) Tertiary prevention focuses on moving past the crisis and returning to the precrisis state.

D) Primary prevention is the least effective level of intervention in terms of promoting client's health and containing costs.

Ans: A Feedback: Often people in crisis are temporarily helpless and unable to cope on their own, but understand the need for outside help and are receptive to other people's suggestions.

Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted event from occurring. Tertiary prevention focuses on moving past the crisis, although returning to the precrisis state may not be possible. Primary prevention is the most effective level of intervention in terms of promoting client's health and containing costs.

5.

After teaching a class about family and domestic violence directed toward children as a community health problem, which of the following if stated by the class indicates to the instructor that the teaching was effective?

A) Family violence is new and occurs as a result of our fast-paced technological society.

B) Family violence has occurred in most countries for centuries as children have been thought of as the property of their parents.

C) Family violence occurs mostly in the urbanized areas of the United States mostly in the urbanized areas where exposure to crime is more prevalent.

D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

Ans: B Feedback: The history of family and domestic violence is long. For centuries, children were thought of as the property of their parents, and any treatment doled out by the parents was their prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned and begun to do something about family violence. Family violence is brought to the attention of officials more frequently today than in yesteryear, especially in urban areas where more people live, but it occurs throughout the world—in urban, rural, and remote areas with no signs of decreasing.

Family violence in the United States occurs mostly in the urbanized areas where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

6.

After teaching a group of students about abuse and families, the instructor determines that the students have an understanding of this issue when they state which of the following?

A) Less than 10% of women worldwide reported being physically abused by an intimate partner at some point in their lives.

B) A woman's risk of intimate partner violence decreases during pregnancy, but increases once the baby is born.

C) Intimate partner violence is a leading cause of morbidity and mortality in women worldwide.

D) Intimate partner violence is a private matter and not a public health issue Ans: C Feedback: Intimate partner violence is a leading cause of morbidity and mortality in women worldwide and is a public health issue. It is estimated that between 10% and 52% of women

report being physically abused by an intimate partner at some point in their lives worldwide. A woman's risk of intimate partner violence increases during pregnancy with 44% to 48% of all women being abused at least once during the pregnancy.

7.

In preparation for an examination on the history of family violence, a group of students reviews the various laws enacted for protection. The students demonstrate understanding when they identify which of the following as one of the earliest laws enacted?

A) Child Abuse Prevention and Treatment Act B) Family Violence Prevention and Services Act C) Keeping Children and Families Safe Act D) Child Abuse Prevention and Treatment and Adoption Reform Act Ans: D Feedback: In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as the Keeping Children and Families Safe Act.

8.

A community health nurse suspects Munchausen syndrome by proxy when a child A) experiences “seizures” only when a parent is present, not if a third party is present.

B) has stunted growth and shortened limbs that have been noticeable since birth.

C) has a noticeable limp when wearing shoes but not in bare feet.

D) has periods of “acting out” and misbehaving, especially when there is company.

Ans: A Feedback: Experiencing seizures only when a parent is present would be a “red flag” for this syndrome if it were occurring in a child.

Stunted growth, limp, or acting out are not associated with Munchausen syndrome by proxy.

9.

Which of the following would lead a community health nurse to suspect possible child neglect? Select all that apply.

A) 15-year-old Lucy misses school once a week to watch her baby sister while mom works.

B) 6-year-old Sam plays in the yard with a sweater on when it is 60 degrees outside.

C) Twins, Bobby and Billy arrive at school in dirty and smelly clothing most school days.

D) 11-year-old Samantha comes to school without lunch or lunch money each day.

E) 9-year-old Tommy misses school two or three times a month due to asthma attacks.

F) 14-year-old Jennifer watches her neighbor's 2year-old every Saturday.

Ans: A, C, D Feedback: Educational neglect involves Lucy missing school to watch her baby sister and general neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how hard and long he is playing—he may be comfortable. Although Tommy is missing a number of days of school, he has a legitimate excuse. Fourteen is an appropriate and legal age to babysit.

10.

Which of the following would the community health nurse identify as an act of sexual exploitation of a child?

A) Child pornography B) Child molestation C) Fondling of child's genitals D) Vaginal penetration with an object Ans: A Feedback: Sexual exploitation of children includes conduct or activities related to pornography that depict minors in sexually explicit situations and promotion of prostitution by minors. Sexual assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration of the genital or anal opening by a foreign object, and child molestation.

11.

A community health nurse assesses a child during a home visit. Which of the following would lead the nurse to suspect that the child is a victim of sexual abuse?

A) Bruising of the arms and back B) Evidence of numerous dental caries C) Complaints of pain on urination D) Burns on the hands and feet Ans: C Feedback: A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising on the arms and back and burns on the hands and feet would suggest physical abuse.

Numerous dental caries may suggest neglect.

12.

A group of families are attending a local community group for a class on Internet safety and children. Which of the following statements by the group indicates effective teaching?

A) “It's not so much the time they spend but the sites they use.”

B) “We'll move the computer to the family room so we can easily observe the child's internet use.”

C) “We'll set the Internet browser feature to medium.”

D) “The firewall program that we have from 2 years ago should still be good.”

Ans: B Feedback: To promote Internet safety with children, the computer should be placed in a high traffic area in the home so that others can easily observe what is going on. Parents need to monitor the time as well as the sites that the child uses. The Internet security browser should be set to high.

With the advances in technology, a firewall program that is 2 years old may not be adequate to protect the child. However, it would be better than no firewall program at all.

13.

While visiting a family in their home, a community health nurse hears a parent screaming who says, “Everything you do is wrong. Can't you do anything right ever?”

The nurse suspects which of the following?

A) Neglect B) Emotional abuse C) Sexual abuse D) Physical abuse Ans: B Feedback: Emotional abuse involves psychological mistreatment or neglect and may involve verbal abuse such as statements like, “Everything you do is wrong. Can't you do anything right?”

Neglect occurs when physical, emotional, medical, educational resources necessary for healthy growth and development are withheld or unavailable. Sexual abuse involves acts of sexual assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain, physical injury, or death.

14.

When describing the cycle of violence to a group of students, the instructor includes which of the following as occurring as the cycle continues?

A) Frequency of the cycle slows B) Tension-building occurs less often C) Loving reconciliation lasts longer D) Acute battering occurs more often Ans: D Feedback: As the cycle of violence continues, the frequency of the cycle increases, with the tensionbuilding phase and the acute battering incident occurring more often, and elimination of the loving reconciliation phase. Without intervention, this shorter, more violent cycle becomes increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner, incarceration, or death of a partner.

15.

Which of the following would a community health nurse expect to assess in a perpetrator of intimate partner violence?

A) Occasional marijuana use B) High academic achievement C) Belief in male dominance D) Desire for complacency Ans: C Feedback:

Characteristics of perpetrators of intimate partner violence include a belief in strict gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement, and desire for power and control in relationships.

16.

When discussing elder abuse with a senior citizen group, which of the following would the community health include?

A) Older men experienced abuse at a higher rate than elderly women.

B) Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation.

C) The majority of cases of elder abuse are perpetrated by persons unknown to the victim.

D) Elders with dementia are less likely to be abused since they have less social interactions.

Ans: B Feedback: Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation.

Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder abuse may be either known or unknown to the elder. Some elders are especially vulnerable to elder abuse.

17.

A community health nurse is designated as a “mandated reporter.” Which of the following best describes this designation?

A) The nurse must witness abuse and neglect before being mandated to report.

B) The nurse commands that battered women report the abuse.

C) The supervising community health nurse is responsible for reporting only known cases of elder abuse.

D) The nurse must report any case of known or suspected abuse and neglect in children or elders.

Ans: D Feedback: The abuse or neglect simply needs to be suspected in order for the nurse to report. In most states the nurse can receive a jail sentence and a fine for not reporting suspected abuse.

Reporters may never witness the actual abusive event, but they can often see the resulting damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects according to the community's laws.

18.

A community health nurse is providing a community education program about suicide.

Which of the following would the nurse include as a common method used by women?

A) Hanging B) Firearms C) Vehicle crash D) Ans:

Overdose D Feedback: Women usually choose less violent methods, such as overdosing on medications. Men choose more violent forms of suicide, such as hanging, use of firearms, or vehicle crashes.

19.

Which of the following would be least appropriate for a community health nurse to include in a plan of care at the secondary prevention level for families who may need to respond in a case of crisis in the future?

A) Teaching social problem-solving skills B) Helping women develop assertiveness skills C) Providing parenting classes D) Helping to reestablish as sense of safety Ans: D Feedback: Helping to reestablish a sense of safety would be appropriate at the secondary level of prevention. Teaching social problem-solving skills, helping women develop assertiveness skills, and providing parenting classes are appropriate primary prevention level activities.

20.

When assessing a family in crisis, which of the following would the community health nurse need to do first?

A) B) C) D) Ans:

Assess the nature of the crisis Determine client's perception Define available supports Assess coping abilities A Feedback:

Initially, the nurse must assess the nature of the crisis and the client's response to it. Next, the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is available for support to the individual or family. Finally the nurse assesses the clients' coping abilities.

21.

A community health nurse is developing a plan of care for families in crisis. Which of the following would be most appropriate for the nurse to include?

A) Encourage clients to suppress feelings to minimize pain B) Avoid correcting distorted facts to reduce stress C) Allow clients to blame others for the crisis D) Help clients confront crisis Ans: D Feedback: In a crisis, the community health nurse encourages clients to accept help by acknowledging the problem. The nurse should encourage clients to express their feelings openly, assist them in finding facts (distortions create additional tension that may lead to maladaptive responses), and avoid blaming others to promote responsibility for problem solving.

Chapter 19 Maternal-Child Health 1.

Critical population health indicators that affect childbearing women, infant, toddler, and preschool populations globally and in the United States include which of the following?

Select all that apply.

A) Maternal mortality rate B) Infant mortality rate C) HIV/AIDS D) Crude mortality rate E) Ans:

Fetal alcohol syndrome A, B, C, E Feedback:

Critical population health indicators that affect childbearing women, infant, toddler, and preschool populations globally and in the United States include maternal mortality rate, infant mortality rate, HIV/AIDS, and fetal alcohol syndrome. Crude mortality rate does not apply specifically to childbearing women, infant, toddler, and preschool populations.

2.

Which one of the following statements about low-birth-weight and very-low-birth-weight babies is most accurate?

A) Low-birth-weight is more common in Whites and Hispanics than African Americans.

B) Birth weight is one of the most important predictors of infant mortality.

C) The incidence of low-birth-weight in the United States is decreasing in relation to the increase in multiple births.

D) Recent trends in very-low-birth-weight babies show that they continue to have morbidity with significant increases in survival.

Ans: B Feedback: Birth weight is one of the most important predictors of infant mortality. Low birth weight is more common in African Americans than in Whites and Hispanics. The overall incidence of low-birth-weight is increasing slightly, which can be explained by increased multiple births.

Recent trends in very-low- birth-weight babies show that they continue to have morbidity with no significant increases in survival.

3.

A community health nurse is developing a program that would encourage mothers to use breast-feeding exclusively for their babies' nutrition for the first 6 months. The nurse bases this program on the understanding about which of the following?

A) Exclusive breast-feeding promotes better growth and development.

B) Its lower cost provides more money for other needed items.

C) Infant mortality would significantly decrease.

D) It would aid in decreasing maternal mortality rates.

Ans: C Feedback:

Approximately 1.3 million infants would survive annually if mothers were able to exclusively breast-feed their infants for 6 months. The lack of breast-feeding is related to decreased survival and increased morbidity from infections, lower intelligence test scores, increased cardiac risk factors, and inadequate nutrition. The superiority of breast milk and lower costs would not be factors for developing a community health program for breast-feeding.

Exclusive breast-feeding is not associated with decreasing maternal mortality rates.

4.

A community health nurse is integrating the Healthy People 2010 goals into suggested programs for a local community. Which of the following goals would the nurse identify as having been met?

A) Reduction in low-birth-weight infants B) Reduction in total preterm births C) Increase in the number of infants put to sleep on their backs D) Increased proportion of mothers breastfeeding at 6 months Ans: C Feedback: After years of working toward improving maternal–child health, the United States has made limited progress. One objective, however, has been met: 70% of infants are now being put to sleep on their backs (up from 35% baseline), largely due to public health educational efforts and reminders.

Objectives for LBW, VLBW, and preterm births all moved away from their Healthy People 2010 targets. Breast-feeding is beneficial to both mother and infant, and in 2005, almost 73% of infants were breast-fed for some period of time. However, the goal has not been met.

5.

Which Healthy People 2020 goal that has been established has been met?

A) The number of infants being put to sleep on their backs and the rate for sudden infant death syndrome B) Improving the proportion of infants who are breast-fed C) Reduce the rate of fetal and infant deaths D) Reduce the occurrence of fetal alcohol syndrome Ans: A

Feedback: After years of working toward improving maternal–child health, the United States has made limited progress. One objective, however, has been met; 70% of infants are now being put to sleep on their backs, up from a 35% baseline. The rate for sudden infant death syndrome (SIDS) had dropped by over 50% since 1994. The proportion of infants who are breast-fed and reducing the rate of fetal and infant deaths and occurrence of fetal alcohol syndrome have not been met.

6.

A community health nurse is providing a class for pregnant women about the dangers of alcohol consumption during pregnancy.

Which of the following would the nurse include as an effect on the newborn? Select all that apply.

A) Intellectual impairment B) Low-birth-weight C) Leukemia D) Respiratory distress E) Altered growth and development F) Childhood cancers Ans: A, B, E Feedback: The health of infants can be dramatically affected by maternal consumption of alcohol.

The pregnancy itself can be threatened.

However, the most devastating consequence of alcohol consumption during pregnancy is fetal alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS), both of which compromise the intellectual functioning, birth weight, and altered growth and development of the infant or child. Respiratory distress, leukemia, and other childhood cancers are not associated with maternal alcohol consumption.

7.

A community health nurse is working with a group of pregnant women in the community to reduce lifestyle risk factors associated with low-birth-weight newborns and infant mortality.

Which of the following would the nurse address?

A) Multiparity B) College level education C) Environmental toxins D) Single gestation pregnancy Ans: C Feedback:

Environmental toxins are lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Other risk factors include primiparity, low educational level, and multiple gestation among others.

8.

A community health nurse visits a local women's health center to provide teaching about the effects of smoking during pregnancy. After teaching the class, the nurse determines that the women have understood the teaching when they identify which of the following as a possible maternal or infant effect?

A) Low-birth-weight newborns B) Newborn feeding problems C) Genetic malformations D) Developmental delays Ans: A Feedback: One of the strongest predictors of both LBW and preterm birth is maternal smoking.

Other studies have shown that there is a greater incidence of stillbirths, spontaneous abortions, and perinatal mortality in pregnancies in which women smoke.

Smoking during pregnancy is not associated with genetic malformations, developmental delays, or feeding problems.

9.

A local community health center is providing classes to childbearing families about the effects of alcohol use during pregnancy.

During one of the classes, a community health nurse describes fetal alcohol spectrum disorder (FASD). Which of the following would the nurse include as a common finding in the newborn?

A) Large for gestational age B) Facial abnormalities C) Hypoactive behavior D) Enhanced intellectual development Ans:

B Feedback: A newborn with FASD typically exhibits facial abnormalities, is small for gestational age, demonstrates hyperactivity and intellectual impairment.

10.

While providing preconception counseling to a group of women, the community health nurse emphasizes the need for adequate weight gain during pregnancy based on the understanding of which of the following?

A) Maternal nutritional habits do not affect later life.

B) Inadequate weight gain increases the woman's risk for cesarean birth.

C) Prolonged labor can occur with too little or too much weight gain.

D) Adequate weight gain is positively correlated with normal birth weight.

Ans: D Feedback: Research has demonstrated a positive correlation between weight gain during pregnancy and normal birth weight in babies. Inadequate weight gain is related to LBW, premature births, and perinatal mortality.

Gaining large amounts of weight can also cause problems at birth, including increased numbers of cesarean deliveries, large-for- gestational-age babies, along with the mother's retention of excessive weight.

Maternal nutritional habits set gene switches that affect later life.

11.

After teaching a group of pregnant women about the need for proper oral health during pregnancy, which of the following statements by the group indicates the need for additional teaching?

A) “We should continue seeing the dentist like we always do.”

B) “Chewing sugar-free gum is okay even with the pregnancy.”

C) “If we need dental work, we can postpone it until after the birth.”

D) “Flossing and brushing are just as important now as before.”

Ans: C Feedback:

Postponing dental work is inappropriate. Dental health procedures have generally been found to be effective and safe for pregnant women, especially during the second trimester.

Statements about the importance of regular dental health checkups and proper dental hygiene, along with referrals for dental treatment when needed, indicate effective teaching. Sugar-free gums that contain xylitol and chlorhexidine may be helpful in reducing the maternal–child transmission of cariescausing bacteria.

12.

What are the roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents? Select all that apply.

A) Clinician B) Educator C) Counselor D) Provider of referrals E) Friend Ans: A, B, C, D Feedback: Roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents include clinician, educator, counselor, and provider of referrals. It is not appropriate for the nurse to enact the role of friend with pregnant adolescent clients or any other client.

13. follow up. Which of the following would be appropriate to include when teaching the woman about controlling her blood pressure at this time?

A) Ensuring rest periods with legs elevated B) Limiting her daily intake of fluid C) Restricting intake of fresh fruits D) Encouraging additional weight gain Ans: A Feedback: Various methods are employed to attempt to prevent and control hypertension during pregnancy, namely, a diet rich in fresh fruits and vegetables, adequate fluid intake, weight gain limitations, rest, and regular exercise.

These remain the most common preventive suggestions that community health nurses, in collaboration with the clients' primary health care providers, can give to their pregnant clients. A calm environment, along with periods of rest with the pregnant woman either elevating her feet or reclining in a left side-lying position, is also recommended.

14.

During a home postpartum visit, a community health nurse suspects that the woman is experiencing depression. Which of the following responses would be most appropriate?

A) “You should try drinking more caffeine to help you be less tired.”

B) “Don't worry. Good mothers don't hurt their babies.”

C) “Try napping when the baby is napping.”

D) “You should be able to achieve perfection with housekeeping tasks while you are still on maternity leave.”

Ans: C Feedback: Getting adequate sleep is important, because sleep deprivation exacerbates psychiatric symptoms. Napping when the baby naps, resting when possible throughout the day, and going to bed early (albeit with the knowledge that sleep may be interrupted two or more times to feed the infant) will provide more hours of rest and sleep. Caffeine can lead to sleep disturbance, and alcohol is a depressant that has been implicated in depression. The elimination of both is a simple yet helpful suggestion. The statement about telling the woman not worry discounts her feelings. In addition, it also may increase her anxiety because she may be worried about hurting the baby. The statement about ability to achieve perfection with housekeeping tasks while on maternity leave is counterproductive as it has been recently identified perfectionism increases the risk for postpartum depression.

15.

After teaching a group of students about various community nutritional programs, the instructor determines that the teaching has been successful when the students identify which of the following as a result of the WIC program?

A) Increased expenditures for health care B) Decreased rates of large for gestational age babies C) Reduced rates of infant iron deficiency anemia D) Drop in breast-feeding rates Ans: C Feedback: In addition to supporting women and young children with nutritious foods and achieving the initial goals of decreasing the rates of preterm and LBW babies, increasing the length of

pregnancy, and reducing the incidence of infant and child iron deficiency anemia, WIC also increases breast-feeding rates and improves pregnant women's nutritional status.

16.

A group of nursing students are studying for a test on child health statistics. The students demonstrate that they are prepared for the test when they identify which of the following as a major cause of death in the 1- to 4-year-old population.

A) Pneumonia B) Poverty C) Unintentional injuries and homicide D) Heart disease Ans: C Feedback: Unintentional injuries and homicide cause most of the deaths for the 1- to 4-year-old population: motor vehicle crashes, falls, drowning, fires, and burns. Pneumonia is not a major cause of death among children.

Poverty contributes to morbidity and mortality but is not a cause of death in and of itself. Heart disease is the fourth leading cause of death among young children.

17.

A community health nurse is developing a plan to address the nutritional needs of infants, toddlers, and preschoolers. Which of the following would the nurse need to incorporate as a major issue associated with nutritional problems?

A) Life in the culture of poverty B) Overfeeding of an infant C) Cultural food preferences D) Rapid growth spurts Ans:

B Feedback: Overfeeding an infant can lead to childhood obesity and becomes a risk factor for heart disease, hypertension, and diabetes. Many parents overfeed infants and toddlers and allow preschool-aged children to make inappropriate food choices, which can lead to a lifetime of nutritional problems. Poverty may limit food choices and selection of inappropriate foods; however, poverty itself does not cause nutritional problems. Although there are major differences in food preferences and eating practices among different cultural groups, they do not account for

nutritional problems. Growth spurts in young children often are marked by changes in appetite, but it is the quality of the food that can cause the nutritional problems rather than the changes in quantity.

18.

A community health nurse implements a teaching program for new parents about ways to reduce infant mortality. Which suggestion would the nurse include as most important?

A) “Never leave the infant alone on a dressing table or couch.”

B) “Check the temperature of the bath water before bathing.”

C) “Stay within an arm's length when the baby is in the tub.”

D) “Put the infant to sleep on his or her back.”

Ans: D Feedback: Suffocation is the leading cause of death in infants. Therefore, the suggestion to put the baby to sleep on the back is a major preventive measure and the most important. Never leaving the infant alone would reduce the risk for falls, a leading case of nonfatal injuries for infants.

Checking bath water temperature is appropriate to prevent burns. Staying within an arm's length while bathing is a suggestion to prevent drowning.

19.

A community health nurse is involved in a screening program for lead exposure. The nurse would target this program primarily to which age group?

A) Birth to -year-olds B) - to 3-year-olds C) 3- to 5-year-olds D) 5- to 7-year-olds Ans: B Feedback: The critical age of lead exposure (or peak level) is thought to be between 18 and 36 months. Levels generally begin to decline after age 3.

20.

Which of the following issues motivated the increased doses of certain vaccines and reformulated vaccines at the start of the 21st century? Select all that apply.

A) Increased virulence of the vaccinepreventable disease causative organisms B) Pertussis immunity was found to wane with age so the vaccine was reformulated to cocoon infants by immunizing the adults around them to prevent exposure of infants.

C) Varicella vaccine given in two doses has been found to increase immunity.

D) Measles outbreaks were identified in populations where parents had refused MMR vaccination for their children and received personal belief exemptions.

Ans:

B, C, D Feedback: The following issues motivated the increased doses of certain vaccines and reformulated vaccines at the start of the 21st century.

Pertussis immunity was found to wane with age so the vaccine was reformulated to cocoon infants by immunizing the adults around them to prevent exposure of infants; varicella vaccine given in two doses has been found to increase immunity and measles outbreaks were identified in populations where parents had refused MMR vaccination for their children and received personal belief exemptions. There is no evidence that the vaccine preventable disease causative organisms have increased virulence.

21.

A community health nurse is making a family home visit. The family consists of the mother, father, 1-year-old, and 4-year-old. The mother states that the 4-year-old who is in preschool had a cold last week and now the 1-year-old has it. She asks the nurse if she can use the over-the-counter cold medication that she gave to the 4-year-old for the 1-year-old.

Which response would be most appropriate?

A) “It shouldn't be a problem if you use that same medication for the 1-year-old.”

B) “I don't know if the medicine will work, but you can try it and see.”

C) “That type of medicine should not be used in children under age 2.”

D) “You should use a smaller dose but watch if it makes him irritable.”

Ans:

C Feedback:

Community health nurses need to emphasize that over-the-counter cough and cold medications should not be used for children under age 2. The Food and Drug Administration (FDA) deemed them unsafe and ineffective and most manufacturers took them off the market in fall of 2007 in response to emergency room visits and deaths linked to their toxic effects.

Therefore, the nurse would tell the mother not to use the medicine since the child is only a 1-year-old.

22.

A community health nurse is working with a group of parents who have infants and toddlers. Which of the following would the nurse include in a teaching plan for this group about reducing dental caries?

A) Serving sugary foods at mealtimes and not snacks B) Providing juice in a sippy cup between meals C) Allowing the older infant to fall asleep with a bottle D) Permitting snacking throughout the day Ans: A Feedback: It is recommended that sugary foods be eaten at mealtimes and not as snacks, and that regular snack times be established. Between- meal drinks should consist of water or milk. Juice should be given only with meals.

Allowing infants to fall asleep with a bottle can lead to baby bottle tooth decay or nursing caries.

23.

Which of the following would be appropriate as secondary prevention level activities focusing on child abuse and neglect?

A) Prenatal parent preparation classes B) Public service announcements for positive parenting C) Education to improve family functioning skills D) Respite care for families with special needs children Ans: D Feedback:

Providing respite care for families with special needs children is an example of a secondary prevention action. Prenatal parent preparation classes, public service announcements, and education to improve family functioning skills are examples of primary prevention level activities.

24.

As one aspect of ensuring adequate brain development in a child, a community health nurse would encourage the intake of which during the first 2 years of life?

A) Vitamins B) Fats C) Protein D) Carbohydrates Ans: B Feedback: During the first 2 years, when rapid myelination is taking place, 50% of total calories should come from fat, but after age 2, the choice of 1% or 2% milk—should be the norm. A well-balanced diet including an adequate intake of vitamins, protein, and carbohydrates is needed for overall growth and development.

Chapter 20 School-Age Children and Adolescents 1.

When providing safety education for parents of school-age children, the community health nurse would focus interventions on which of the following as the priority?

A) Motor vehicle safety B) Water safety C) Fire safety D) Poisoning prevention Ans:

A Feedback: For the 1- to 9-year-old age group, motor vehicle/traffic injury, drowning, and fire/burn injuries were the top three causes of injury death. For the 10- to 19-year-old age group, motor vehicle/traffic injuries, drowning, and poisoning are the three leading causes of injury death.

Thus the priority would be to focus interventions on motor vehicle safety. Although water and fire safety and poisoning prevention would be important, motor vehicle safety would be most important.

2.

A community health nurse is presenting a program to a local elementary parent–teacher association on the topic of pediculosis. The nurse determines that the group needs additional teaching when they identify which of the following as a likely mode of transmission?

A) Coming into contact with an animal B) Combing hair with another's comb C) Using a towel of an infected child D) Sleeping in a friend's bed who had lice Ans: A Feedback: Head lice are most often transmitted by direct contact (head-to-head) or may be passed from infected to uninfected children through shared items such as combs and brushes, hats, scarves, sheets, and towels (called fomites).

Contrary to some popular myths, lice do not fly or jump, and they cannot be contracted from animals—they live only on humans.

3.

A community health nurse who is participating in a nutritional screening program with school-age children measures their body mass index (BMI). The majority of children fall within the 45th to 65th percentile for their age. The nurse would classify these children as which of the following?

A) Underweight B) Healthy weight C) At risk for overweight D) Overweight Ans: B Feedback: A BMI between the 5th and 95th percentile for age is considered healthy weight.

Underweight refers to a BMI below the 5th percentile. At risk for overweight refers to children with a BMI between the 85th and 94th percentile. Overweight refers to children with a BMI equal to or greater than the 95th percentile.

4.

Which of the following measures would be most appropriate for a community health nurse to include when developing programs to address childhood obesity?

A) Encouraging television watching for about 3 hours per day B) Suggesting that families eat less meals together at home

C) Urging participation in physical activity for 30 minutes per day D) Limiting the intake of unsaturated oils in cooking Ans: C Feedback: Research has demonstrated an association between poor eating habits and physical inactivity. Low levels of physical activity and more than 2 hours of watching television per day were found to be predictors of overweight status in a large longitudinal study of children.

Therefore, interventions should focus on increasing levels of physical activity and encouraging limited television for school- age children, encouraging families to eat more meals together at home, advocating for increased physical education in the school setting, and for more safe recreational opportunities in all neighborhoods. In addition, healthy eating habits such as using unsaturated oils in cooking need to be stressed.

5.

Which of the following programs would be least effective to institute for a community of school-age children who are experiencing dental caries?

A) Ensuring that the drinking water is fluoridated B) Having the school to institute a fluoride rinse program C) Encouraging the parents to get their children's teeth sealed D) Advising parents to encourage the children to brush once daily Ans: D Feedback: Regular brushing and flossing is important for dental hygiene. However, once daily is not enough. Fluoridated drinking water, school- based fluoride rinse or gel, and dental sealant programs are cost-effective, proven methods of reducing dental caries in school-age children.

6.

Which of the following would a community health nurse expect to assess in the adolescent population with an eating disorder?

A) B) C)

High levels of peer support Clear sense of self Feelings of being in control

D) Ans:

Distorted body image D Feedback: Adolescents with eating disorders typically have a disturbed body image, low levels of peer support, distorted self-concept and low self-esteem. In addition, they have issues with control, such that they used eating as a means for control.

7.

A community health nurse is teaching a group of parents about attention deficit hyperactivity disorder. Which statement by the parents would indicate the need for additional teaching?

A) “We probably will need to give him medication to help him in school.”

B) “We need to keep him away from foods that have additives in them.”

C) “This condition is most likely due to problems with genes and nerve receptors.”

D) “We'll be alert to the possibility of more injuries and accidents.”

Ans: B Feedback: While a number of parents feel that sugar and food coloring or additives may worsen ADHD symptoms in their children, research shows no behavioral or learning differences in double- blind studies with sugar and sugar substitutes. Medications are commonly used, with the primary goal of improving academics. New research is focusing on inherited tendencies for problems with dopamine receptors and transporter genes, supporting a neurologic basis for the condition. Children with ADHD are more prone to accidents and injuries.

8. local community agencies to provide services for children and adolescents with disabilities. Based on the nurse's knowledge of the most common disabilities affecting this group, the nurse would advocate for which of the following to address the largest group?

A) Special education services B) Speech therapy services C) Mental health services D) Mental retardation services Ans: A Feedback: In descending order, the most common disabilities found in school-age children and adolescents are learning disorders; speech or language impairment; mental retardation; serious

emotional disturbances and other disabilities, such as autism; deaf-blindness; orthopedic problems; traumatic brain injury; and other health impairments, such as asthma, diabetes, and epilepsy. Thus advocating for special education services would address the most common disability, learning disorders.

9.

Which of the following statements about children's health status and academic achievement are most accurate?

A) All health problems that can affect learning and achievement in school-age children are preventable.

B) Physical and emotional health can affect academic achievement in children and adolescents.

C) Only behavioral health problems can affect learning and achievement in school-age children.

D) Poverty is one health problem that does not affect learning and achievement in school-age children.

Ans: B Feedback: Physical and emotional health can affect academic achievement in children and adolescents. Not all health problems that can affect learning and achievement in school-age children are preventable. Behavioral health problems can affect learning and achievement in school-age children, but other types of health problems can also affect learning and achievement in school-age children. Poverty is a health problem that also affects learning and achievement in school-age children.

10.

A community health nurse is providing immunizations to school-age children at a local health department. At which age would the nurse expect to administer the first dose of human papilloma virus (HPV) vaccine?

A) 9 B) 11 C) 13 D) 15 Ans: B Feedback: The current recommendation is to administer the first dose of HPV vaccine at age 11.

However, the earliest age that the vaccine can be given is age 9. The HPV vaccine is administered to females at age 13 to 18 if they have not been previously vaccinated.

11.

A community health nurse is speaking to a group of parents of incoming college freshmen students who will be living in the dormitories. The focus of the program is on the college health program, health issues, and immunizations. Which immunization would the nurse most strongly encourage the students to receive if they have not received it previously?

A) Varicella virus vaccine B) Human papilloma virus vaccine C) Meningococcal vaccine D) Ans:

Influenza vaccine C Feedback: The meningococcal vaccine is a catch-up vaccine that is recommended for all previously unvaccinated college freshmen living in dormitories. Adolescents who have not had chickenpox and have not received prior vaccination should receive the varicella vaccines. The HPV vaccine is given to females only. The influenza vaccine should be given only those who are considered high risk.

12.

When preparing a program to address violence among school-age children and adolescents, the community health nurse integrates knowledge of which of the following?

A) Teen females commit homicide more frequently than teen males.

B) Homicide is the second highest cause of death for all adolescents.

C) Adolescents account for less than one half of all firearm injuries treated.

D) Serious youth violence is unrelated to drugs and guns.

Ans: B Feedback:

Homicide is the second leading cause of death for adolescents (ages 10 to 24) and is more common in males than females. Adolescents between the ages of 15 and 19 years account for almost 85% of all firearm injuries treated in emergency departments or hospitals.

Serious youth violence is part of a constellation of risk-taking behaviors that also includes precocious sex, drugs, and guns.

13.

When working with community groups to develop appropriate programs for adolescent health promotion, the nurse integrates knowledge of the Healthy People 2020 objectives, keeping in mind that many of the objectives address which of the following?

A) Self-esteem improvement B) Risk-taking behaviors C) Control of disease D) Behavioral issues Ans: B Feedback: Healthy People 2020 objectives are geared to improve the health of all Americans.

Twenty- one specific objectives have been ranked as critical for this population. The objectives focus on issues involving mortality and morbidity in this age group that stems primarily from risk-taking behaviors. Many of the objectives relate to reduction in alcohol- related unintentional injuries, declines in violent behaviors, suicide and mental health issues, as well as more responsible reproductive health behaviors.

14.

When working with school districts, which of the following would the community health nurse encourage as the most effective school- based approach to solve the problem of teenage suicide?

A) Suicide prevention programs with direct interventions B) Teachers assessing suicide risk among students C) Promotion of stronger parental control of teens D) Punitive treatment of teens by the school administration Ans: A Feedback:

Programs and interventions by counselors and school nurses that are focused on determining adolescent suicide intentions are the most effective approaches. Teachers do not feel comfortable or prepared to assess suicide risk, and this alone will not prevent teen suicide.

Peer pressure is strong, and parent concerns are not as important to the teen. Teens are seeking independence, and stronger parental control is not an effective method of reducing teen suicide.

This approach is inappropriate for any school-age child or teen behavior.

15.

A community health nurse is working with local schools to help address teen pregnancy.

The nurse would focus interventions on which of the following?

A) Better use of contraceptives B) Decreased sexual activity C) Improved parenting skills D) Proper nutritional habits Ans: B Feedback: Although contraceptives, parenting skills, and nutrition may be areas of focus for teen pregnancy, research has shown that the downward trend for teen pregnancy rates has been attributed largely to better contraceptive use rather than less sexual activity. Therefore, interventions should focus on the area of decreasing sexual activity.

16.

Which of the following would the community health nurse most commonly need to address when planning programs for children with chronic illness?

A) Asthma control B) Autism education C) Diabetes regimens D) Seizure control Ans: A Feedback: Although autism education, diabetic regimens, and seizure control are common issues related to chronic disease in children, asthma is the most common chronic disease.

Thus asthma control would be a priority.

17.

A community health nurse is working with a group of school nurses to develop interventions for a 10-year-old girl exhibiting signs and symptoms of school refusal. Which of the following would be most appropriate?

A) Limiting parent involvement in the school B) Exposing the child rapidly to the classroom C) Keeping the child at home for a while D) Providing relaxation training Ans: D Feedback: The most effective interventions for school refusal include early return to school with parental involvement in school, systematic desensitization (gradual exposure to the classroom), relaxation training, and counseling.

18.

A community health nurse is working with the local health department on screening for sexually transmitted infections. Which of the following would the nurse identify as the most common?

A) Syphilis B) Gonorrhea C) Chlamydia D) Herpes simplex virus Ans: C Feedback: Chlamydia is the most common STI in adolescents and should be a major focus of the screening. Syphilis, gonorrhea, and herpes simplex virus also are common among adolescents but less than Chlamydia.

19.

When preparing a program about substance abuse prevention for adolescents, the community health nurse would focus on which substance as the most frequently used?

A) Marijuana B) Alcohol C) Ecstasy D) Ketamine Ans: B Feedback: Alcohol is the most frequently used substance for adolescents in the United States.

Marijuana is the most commonly used drug among 14- to 17-year-olds. Ecstasy and ketamine are other drugs used by adolescents and young adults.

20.

A community health nurse is engaged in a community-wide program for promoting nutrition in adolescents. Which of the following would lead the nurse to target the program to adolescent girls?

A) Girls eat larger quantities of food than boys.

B) They are more physically active than boys.

C) They have a tendency to diet inappropriately.

D) They are more conscious about food nutrients.

Ans: C Feedback: Girls are more at risk for problems with nutrition for several reasons: They tend to diet inappropriately, to have more finicky eating habits, and to be less physically active than teenage boys. Boys typically eat large quantities of food, which increases the likelihood of obtaining adequate nutrients, and they also tend to be more physically active than girls.

21.

A community health nurse is implementing a family planning program near a local inner city's schools. The nurse is engaging which type of health service?

A) B) C) D) Ans:

Preventive program Health protection Health promotion Injury prevention A Feedback: A family planning program is an example of a preventive program that provides birth control information and counseling. Health protection programs focus on safety including injury prevention. Health promotion programs focus on areas such as nutrition and weight control, and drug abuse education.

Chapter 21 Adult Health 1.

A community health nurse is working with other professionals to develop preventive programs to address the leading cause of death in men and women. Which of the following would be appropriate?

A) Risk reduction for heart disease B) Cancer screening C) Safety education D) Flu vaccine immunization

Ans:

A Feedback: The leading cause of death for men and women is heart disease. Therefore, risk reduction for heart disease would be most appropriate. Cancer screening, safety education, and flu vaccine immunization would be appropriate for cancer, the second leading cause of death; unintentional injuries, the third leading cause of death in men; and influenza and pneumonia, the eighth leading cause of death in men and women respectively.

2. of the following would the community health nurse identify as a key aspect for this community's ability to follow through with the teaching?

A) Life expectancy B) Health disparity C) Health literacy D) Financial ability Ans: C Feedback: Health literacy is a critical aspect of managing health problems and a key to being able to read and understand health information so that individuals can follow through and make appropriate health decisions. Low health literacy also contributes to health disparities, a difference in health status due to sex, race, or ethnicity. Life expectancy is the average number of years an individual member is projected to live. It is a standard measurement unrelated to the ability to follow through with teaching. Financial ability may impact a person's ability to obtain needed services, but it is not a key aspect.

3.

When assessing a population for health disparities, which of the following would the nurse least likely evaluate?

A) Race B) Education C) Age D) Sexual orientation Ans: C Feedback: A health disparity is defined as a difference in health status that occurs by sex, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

Age would not be used to assess health disparity.

4.

Which one of the following statements about life expectancy is most accurate?

A) The life expectancy for White women is 4 years greater than for Black women.

B) The life expectancy for Black men is 6 years greater than for White men.

C) In the United States, life expectancy continues to decline.

D) There is a gap in life expectancy between women and men of more than 6 years.

Ans: A Feedback: The life expectancy for White women is 4 years greater than for Black women. The life expectancy for White men is 6 years greater than for Black men. In the United States, life expectancy continues to increase consistently over time. The gap in life expectancy between women and men was 5.0 years in 2007.

5.

A community health nurse is working with a grant funded project to address stroke prevention nationwide. After reviewing statistics related to stroke, which would the nurse identify as having the greatest need for this type of program?

A) North central B) Southeast C) Southwest D) Pacific northwest Ans: B Feedback: The nurse would identify the southeast as the area of greatest need because here. Known as the stroke belt, stroke death rates for both Blacks and Whites are higher than in any other part of the country.

6.

The nurse educator is aware that the nursing student has a grasp of the major health problems of adults when the nursing student makes which one of the following statements?

A) “Morbidity and mortality among adults does not vary much by age, gender, and race/ ethnicity.”

B) “The six leading causes of death in adults include suicide, Alzheimer's disease, and homicide.”

C) “Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults.”

D) “Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are not among the six leading causes of death in adults.”

Ans: C Feedback:

The following statement is true: “Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults.” Morbidity and mortality among adults varies substantially by age, gender, and race/ ethnicity. Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are among the six leading causes of death in adults. Causes of death in adults that are not among the six leading causes of death include suicide, Alzheimer's disease, and homicide.

7.

The following is a list of the top five causes of unintentional injuries accounting for the majority of adults deaths due to injury. Order these in their proper sequence from first to fifth.

A) Fire arms B) Suffocation C) Motor vehicle crashes D) Poisoning E) Falls Ans: C, A, D, E, B Feedback: The top five causes of unintentional injuries include motor vehicle crashes, fire arms, poisoning, falls, and suffocation. Together, these causes account for approximately 80% of all injury deaths.

8.

A community health nurse is preparing a presentation about drug use and abuse for a group of adults. Which of the following would the nurse include as the one of the fastest growing forms of drug abuse?

A) Cocaine B) Alcohol C) Prescription drugs D) Heroin Ans: C Feedback: Illegal use of prescription drugs is one of the fastest growing forms of drug abuse, and it is becoming a major public health concern. The primary illicit drugs used in the United States, such as cocaine and heroin, have and continue to be a public health problem. Alcohol abuse also is a public health problem and is considered the third leading lifestyle-related cause of death for people living in the United

States.

9.

After teaching a group of students about the major types of cancer affecting men and women, the instructor determines that the teaching was successful when the students identify which of the following as the number one cause of cancer deaths among adults?

A) Colon B) Pancreatic C) Esophageal D) Lung Ans: D Feedback: Lung and bronchus cancers are the number one cause of cancer deaths among adults.

Colon and rectal cancers are the third most common cancers in adults. Pancreatic and esophageal cancers are less common causes of cancer death.

10.

A patient comes to the community health clinic with complaints of changes in urination.

Which of the following would lead the community health nurse to suspect that the patient has benign prostatic hypertrophy (BPH)?

A) Nighttime frequency B) Dysuria C) Hematuria D) Flank pain Ans: A Feedback: The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as hesitant, interrupted, or weak urinary stream; urgency or leaking of urine; and more frequent urination, especially at night. Dysuria may indicate a urinary tract infection.

Hematuria could suggest a variety of problems, such as infection calculi, or cancer. Flank pain may indicate conditions such as pyelonephritis or renal calculi.

11.

When developing community health programs target to adult men, which of the following would the nurse need to integrate into the plan?

A) Improved quality of education programs available for men B) Increased access of health services by men as compared to women C) Limited male-gender specific research D) Increased awareness of men's health issues Ans: C Feedback: The current state of men's health involves a lack of quality health education programs for men, health care services that are only accessed half as much by men when compared to women, and a lack of male gender-specific research. In addition, awareness of men's health issues is lacking. Currently, there is no Office on Men's Health in the U.S. Department of Health and Human Services; legislation to establish such an office has been introduced; however, the bill did not progress out of the congressional subcommittee on health and has not been reintroduced.

12.

A community health nurse is reviewing research related to women's health. Which of the following would the nurse use to obtain information about postmenopausal women's health?

A) The Women's Health Study B) The Women's Health Initiative C) The Nurses' Health Study I D) The Nurses' Health Study II Ans: B Feedback: The nurse would use The Women's Health Initiative. This study was a major 15-year research program addressing the most common causes of death, disability, and poor quality of life in postmenopausal women— CVD, cancer, and osteoporosis. The Women's Health Study evaluated the effects of vitamin E and low-dose aspirin therapy in primary prevention of CVD and cancer in apparently healthy women. The Nurses' Health Study I investigated the potential long-term consequences of the use of oral contraceptives. The Nurses' Health Study II studied oral contraceptives, diet, and lifestyle risk factors in a population younger than the original Nurses' Health Study cohort.

13.

While working in a community health clinic, a community health nurse interviews a 24year-old client. Which of the following would lead the nurse to suspect that the client is binge eating?

A) Significant weight loss from dieting last year B) Participation in excessive exercise C) Exaggerated concern about body shape D) Severe emaciation Ans: A Feedback: Binge eating is an eating disorder that is characterized by repeated episodes of uncontrolled eating. It usually starts following significant weight loss from dieting.

Typically, individuals with this disorder eat quickly, eat until they are uncomfortably full, eat when they are not hungry, eat large amounts of food alone, have difficulty expressing their feelings, have difficulty controlling impulses and stress, and feel depressed about overeating.

Participation in excessive exercise and an exaggerated concern about body shape is usually associated with bulimia. Severe emaciation is associated with anorexia.

14.

Which of the following statements by a women's group indicates that they have understood the teaching about heart disease and women?

A) “More women die of breast cancer than heart disease.”

B) “Women experience similar symptoms as men.”

C) “Hormone replacement therapy protects the heart.”

D) “Heart disease is the number one killer of women.”

Ans: D Feedback: Heart disease is the number one killer of women. One in 2.6 female deaths is from cardiovascular disease, compared to 1 in 30 from breast cancer. Women have atypical symptoms or less acute chest pain than men, often leading them to delay care. Hormone therapy does not reduce coronary events.

15.

Which one of the following statements about coronary heart disease and stroke are most accurate?

A) Cardiovascular disease kills more women

than men.

B) Stroke kills more men than women.

C) White persons are more likely to have their first stroke earlier than Black persons.

D) Risk factors for cardiovascular disease are not known.

Ans: A Feedback: Cardiovascular disease kills more women than men. Stroke kills more women than men.

Black persons are more likely to have their first stroke earlier than White persons. Risk factors for cardiovascular disease are known. Some are controllable such as lifestyle, and some are uncontrollable such as heredity.

16.

A community health nurse working in a local women's health clinic is planning a teaching session for a group of women about menopause. Which of the following would the nurse include in the session?

A) Menopause involves very noticeable and characteristic symptoms.

B) The symptoms are usually temporary lasting for a month or two.

C) It can occur as early as age 30 but more commonly ages 45 to 55 years.

D) Going 6 months without a period signals menopause.

Ans: C Feedback: Menopause is a time that marks the permanent cessation of menstrual activity. It usually occurs between the ages of 45 and 55 years. However, it can occur as early as age 30. Symptoms of menopause vary among women and last from months to years. They range from hardly noticeable in some women to very severe in others. Natural menopause is when a woman has not had a period in 12 months (no other apparent causes).

17.

During a home visit to a family, a community health nurse encourages the mother, aged 42, and grandmother, aged 67, to have a clinical breast exam at which frequency?

A) Monthly B) Yearly

C) D) Ans:

Every 2 years Every 3 years B Feedback: Clinical breast exams, performed by a health care provider should be done every year for each of these women. They should also perform breast self-exam every month. The mother at her current age should have a physical examination every 2 years. Both the mother and grandmother should have a pelvic exam and Pap smear done every 3 years after three consecutive negative Pap smears.

18.

As part of a health screening program, a community health nurse determines that a client is infected with the human papilloma virus (HPV). The community health nurse encourages the client to do which of the following?

A) Get a mammogram immediately B) Have her blood glucose level checked C) Undergo testing for a breast cancer gene D) Have a pelvic examination and Pap smear Ans:

D Feedback: Infection with certain types of human papilloma virus is associated with an increase risk for developing cervical cancer. Pap smears have improved early detection and prevention of cervical cancer dramatically.

HPV infection is not associated with breast cancer, so there is no need for a mammography or testing for a breast cancer gene. HPV is not associated with diabetes so blood glucose testing is not indicated.

19.

A nurse is instructing the adult male members of a family on how to perform testicular self examination. Which of the following would the nurse include?

A) Performing the examination every 3 months B) Completing the exam right after a hot shower C) Examining both testicles at the same time D) Reporting a slight difference in size of one testicle Ans: B Feedback:

A testicular self-examination should be performed monthly right after a hot shower or bath. One testicle is examined at a time. One testicle, usually the right one, is normally slightly larger than the other.

20.

Which one of the following statements best describes the role of the community health nurse in promoting the health of adult men 35 to 65 years of age?

A) Anticipatory guidance to men approaching each stage and help them with ways to manage life more effectively.

B) Men of this age do not need to enhance their self-care skills.

C) A positive attitude toward aging is not helpful to men at this time in their lives.

D) Men of this age should exercise sporadically.

Ans:

C Feedback: The community health nurse can provide anticipatory guidance to men approaching this stage and help them with ways to manage life more successfully. Successful navigating this stage of life can be fulfilling but may require a man to enhance his self-care skills. This includes having a positive attitude toward aging, one that examines the benefits of maturity, finds a balance between work and home, and maintains a healthy lifestyle by eating balanced meals and obtaining regular exercise.

21.

When developing a plan of care for a group of male patients experiencing erectile dysfunction, which of the following would the nurse expect to institute first?

A) Lifestyle changes B) Adjustments to current medications C) Psychotherapy D) Behavior modification Ans: A Feedback: Treatment for ED usually proceeds from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Smoking cessation, weight loss, and increased physical activity may help some men regain sexual function. Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure

work in different ways. If a particular drug is causing problems with erection, a different class of blood pressure medicine might work just as well.

Medications, psychotherapy and behavior modifications would follow.

22.

Which of the following would a community health nurse recommend adult men and women over the age of 50 receive yearly?

A) Electrocardiogram B) Tetanus booster C) Flexible endoscopy D) Hemoccult stool testing Ans: D Feedback: Men and women over the age of 50 should receive yearly physical exams and hemoccult stool testing, electrocardiograms every 3 years, tetanus booster every 10 years, and flexible endoscopy every 3 to 4 years.

23.

A community health nurse, who is working with a program to foster early detection of prostate cancer, recommends prostate-specific antigen testing and a digital rectal exam for men with average risk starting at which age?

A) 40 years B) 45 years C) 50 years D) 55 years Ans: C Feedback: The American Cancer Society recommends that screening of men who are at average risk should begin at age 50 years and should include a blood test to assess PSA levels and a digital rectal examination.

Chapter 22 Older Adults 1.

When describing the changes occurring in the older adult population globally, which of the following would be most accurate?

A) The over-80 years age group is the fastest growing segment of the group.

B) Males have a longer projected life expectancy when compared with females.

C) Most countries have adequate numbers of social programs for older adults.

D) Adults over age 65 are expected to account for about 25% of the population by 2050.

Ans: A Feedback: In most of the world, the population of those over 80 years of age is growing faster than any other population age group. A higher life expectancy at birth for females compared with males is almost universal. Many countries have few or no social programs available for older adults. By the year 2050, one tenth of the population is expected to be over the age of 65 years.

2.

A community health nurse is working with an older adult population ranging in age from 75 to 85 years. The nurse correctly classifies this group as which of the following?

A) Young-old B) Old-old C) Oldest-old D) Elite-old Ans: B Feedback: Those between the ages of 65 and 75 are classified as “young-old,” while those between 75 and 85 are labeled “old-old.” The number of people living into “older” old age (75 years and older) is increasing. Forty percent of elderly people in the United States are among the “oldestold” (85 to 100 years), while more than 200,000 are among the eliteold, or centenarians.

3.

While working with another group of community health nurses, a nurse overhears one of the nurses saying, “That older man should just retire. He's 70 years old. How productive can he be?” The nurse interprets this statement as reflecting which of the following?

A) Prejudice B) Bias C) Ageism D) Insight Ans: C Feedback: The one nurse's statement reflects stereotyping and a negative image of an older adult.

This is called ageism. It may be due to negative personal experiences, myths, or a general lack of information. It is not reflective of prejudice or bias. Insight would reflect an understanding of the older adult, which this statement does not do.

4.

Which of the following statements are common misconceptions about older adults?

Select all that apply.

A) It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become “senile.”

B) As older adults age, they become more different and less alike other older adults.

C) Older people are very capable of learning new things.

D) As age increases, older adults withdraw, become inactive, and cease being productive.

Ans: A, D Feedback: The misconceptions or myths about older adults include the following: It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become “senile”; As age increases, older adults withdraw, become inactive, and cease being productive; As older adults age, they lose their individual differences and become progressively more alike; older adults are forgetful, unable to learn new things, and set in their old ways of doing things.

5.

Which of the following are characteristics of healthy older adults?

A) They are able to perform functional activities of daily living.

B) They are able to adapt, to continue to handle stress, and to be active in life and living.

C) They maintain the maximum degree of physical, mental, and social vigor.

D) They are likely to be dependent on others.

E) They reside in institutions.

Ans: A Feedback: Healthy older adults' ability to function is a key indicator of health and wellness and is an important factor in understanding healthy aging. They are able to adapt, to continue to handle stress, and to be active in life and living. They maintain the maximum degree of physical, mental, and social vigor. The vast majority of older adults, even those with chronic diseases or other disabilities, are living outside institutions and are relatively independent.

6.

The nurse educator is aware that the nursing student has a grasp of the primary prevention needs of older adults when the nursing student makes which of the following comments?

A) It is unnecessary for older adults to receive immunizations.

B) All older adults must restrict their sodium intake.

C) Older adults don't need to drink as much fluid as they are often less thirsty.

D) The oral health of older adults is often neglected and so it is important that they see a dentist regularly.

Ans: D Feedback: The oral health of older adults is often neglected, and so it is important that they see a dentist regularly. It is necessary for older adults to receive immunizations. Neither of these statements is true: All older adults must restrict their sodium intake and older adults don't need to drink as much fluid as they are often less thirsty.

7.

When visiting a local senior center, a community health nurse engages several of the older adults in a discussion about immunizations. Which statement best reflects the importance of older adult immunization?

A) “We're at greater risk of dying from the flu or pneumonia.”

B) “You don't get the flu from the flu shot.”

C) “The doctor told us that we should get it.”

D) “Many of us get the shot here at the center for free.”

Ans: C Feedback: Older adults are at risk of not only contracting influenza or pneumonia but of dying from them, underscoring the importance of obtaining the immunizations. The statement about not getting the flu from the shot addresses one of the common reasons for not getting it, the belief that the flu shot will give them the flu. The statement about the doctor telling them to get it indirectly reflects another reason for not getting it, lack of knowledge about the need. The statement about getting the shot for free suggests that finances may be a barrier to obtaining the shot but not why it is important.

8.

A community health nurse is teaching a group of older adults at a senior center about strategies for successful aging. Which of the following would the nurse include?

A) “Limit drinking alcohol to once or twice a month” B) “Avoid eating too many fruits and vegetables” C) “Keep in touch with friends and family” D) “Get up early in the morning” Ans: C Feedback: Strategies for successful aging include maintaining contacts with family and friends and staying active through work, recreation, and the community. Moderation in drinking is key. The older adult should eat a healthy diet of fruits, whole grains, vegetables, and lean meat. They also should get as much sleep and rest as needed. Getting up early in the morning may or may not be appropriate.

9.

An older adult interested in nutrition asks the community health nurse about the number of calories that he or she should eat every day. Which of the following would be most appropriate?

A) 800 to 1,200 calories B) C) D) Ans:

1,200 to 1,600 calories 1,600 to 2,000 calories 2,000 to 2,400 calories B Feedback: It is generally believed that older people need to maintain their optimal weight by eating a diet that is low in fats, moderate in carbohydrates, and high in proteins with a daily calorie count of 1,200 to 1,600.

10.

An older adult comes to the community health center for a checkup. During the visit, he or she mentions that he or she is somewhat constipated. Which of the following suggestions would be most appropriate?

A) Use a laxative about once or twice a week B) Increase your intake of fresh fruits and vegetables

C) day D) Ans:

Drink about four 8-oz. glasses of fluid each

Walk around the block once a week B Feedback: Older adults should add more fiber and bulk to their diet with fresh fruits and vegetables instead of relying on the habitual use of laxatives. Also inadequate fluid intake can contribute to bowel and bladder problems. Consuming a diet that includes eight or more 8-oz. glasses of fluid (water, juices, tea) each day assists the gastrointestinal and genitourinary system in their functions.

Increased physical activity and exercise, such as a daily walk, help keep an older adult's bowel patterns regular.

11.

A community health nurse meets with a group of adults at the local senior center. They range in age from 65 to 70 years. The nurse would recommend vision screening at which frequency?

A) B) C) D) Ans:

Every year Every 2 years Every 5 years Every 10 years B Feedback: Currently, vision screening is recommended every 2 years for adults aged 65 years and older. Blood pressure screening should occur yearly, and total cholesterol evaluation should occur every 5 years. Tetanus and diphtheria immunizations should be administered every 10 years.

12.

A community health nurse is assessing an older adult's ability to perform activities such as shopping, doing the laundry, using the telephone, and handling finances. Which assessment tool would be most appropriate for the nurse to use?

A) Barthel Index B) Instrumental Activities of Daily Living Scale C) Katz Index of Activities of Daily Living D) Modified Rankin Scale Ans: B Feedback:

The Instrumental Activities of Daily Living Scale looks at an older adult's ability to perform such activities as using the telephone, shopping, doing laundry, and handling finances.

The Barthel Index assesses functional independence and is often used to determine levels of disability or dependence of stroke victims in respect to ADLs. The Modified Rankin Scale (MRS) is another common tool used for this purpose. The Katz Index of Activities of Daily Living is based on an evaluation of the functional independence or dependence of clients with respect to bathing, dressing, toileting, and related tasks.

13.

A community health nurse is preparing a teaching program that addresses chronic diseases common among older adults. Which of the following would be most appropriate to include?

A) Forty percent of older adults are diagnosed with diabetes.

B) Weight-bearing exercises are related to increased cases of osteoporosis.

C) Postural hypotension can be related to falls in elders.

D) Older White men have the highest rates of hypertension.

Ans: C Feedback: Older adults need to have sufficient cerebral circulation to avoid dizziness. Dizziness can lead to falling. A normal to high-normal blood pressure for the elder should be maintained.

Based on the most current statistics, 15.1% of men and 13.0% of women report having diabetes.

Weight-bearing exercises are a way to prevent osteoporosis. Older African American men have the highest rates of hypertension.

14.

After teaching a group of older adult women about preventing osteoporosis, which of the following if stated by the group indicates the need for additional teaching?

A) “We should eat foods that are high in calcium and vitamin D.” B) “We need to get bone density screenings regularly.”

C) “We should avoid activities that involve weight bearing.”

D) “We need to make sure that maintain a healthy weight.”

Ans: C Feedback:

Weight-bearing activities are encouraged to promote strong bones. In addition, individuals should be encouraged to eat diets that are rich in vitamin D and calcium, and include calcium supplements as needed. Not smoking, maintaining a healthy weight, and receiving ongoing bone density screenings are positive health behaviors that can contribute to strong bones throughout life.

15.

After teaching a group of students about the most common health problems affecting older adults in the community, which of the following if identified by the students would alert the instructor to the need for additional teaching?

A) Arthritis B) Hypertension C) Emphysema D) Peripheral vascular disease Ans: C Feedback: Emphysema is not considered a common health problem of older adults. The most common health problems of older people in the community are arthritis, reduced vision, hearing loss, heart disease, peripheral vascular disease, and hypertension.

16.

When describing elder abuse to the families of older adults who are attending a local community presentation, which of the following would the community health nurse identify most commonly as the perpetrator?

A) Elder's adult child B) Elder's partner C) Elder's neighbor D) Elder's grandchild Ans: B Feedback: The most common perpetrators of elder abuse are spouses or partners of elders. The next most frequent abuser is the adult child of the elder. Although it may be possible that the perpetrator is the elder's neighbor or grandchild, this situation would be quite rare.

17.

Which one of the following statements about elder abuse is most accurate?

A) Elder abuse is a problem that is under recognized and underreported.

B) It is more common for elderly men to be abused rather than elderly women.

C) If there is long-term domestic violence in an elderly couple, it is not considered elder abuse for the perpetrator to continue to abuse the victim.

D) Self-neglect is not considered to be a form of mistreatment.

Ans: A Feedback: Elder abuse is a problem that is under recognized and underreported. It is more common for elderly women to be abused rather than elderly men. The most common perpetrators of elder abuse are spouses or partners of elders, often in a relationship with long-term domestic violence.

In some states, self-neglect is also considered a form of mistreatment.

18.

Which of the following comprise the primary criteria for effective programs for older adults?

A) Coordination B) Accessibility C) Comprehensive D) Complex E) Quality Ans: A, B, C, E Feedback: The primary criteria for effective programs for older adults include coordination, accessibility, comprehensive, and quality.

19.

Which of the following are included in a comprehensive set of services? Select all that apply.

A) Adequate financial support B) Health education C) Encouragement to spend much time alone D) Adult day care programs E) Access to high quality health care services

F) Ans:

In-home services A, B, D, E, F Feedback: A comprehensive set of services for senior citizens should include the following: adequate financial support, adult day care programs, access to high quality health care services, health education, in-home services, recreation and activity programs that promote socialization (not encouragement to spend much time alone), and specialized transportation services.

20.

A community health nurse is making a home visit to a family who is providing care to an older adult member with Alzheimer's disease for the past 6 months. During the visit, which of the following would be most important for the nurse to assess?

A) Cognitive status B) Medication regimen C) Personality changes D) Caregiver's status Ans: D Feedback: Although assessment of the various aspects of the patient's status is important, that of the caregiver is even more important. Often, the person with AD is cared for at home until very late in the disease course. The intense care given to these clients can be a constant drain on the emotional and physical reserves of their families. The stress of providing care puts the caregiver's health at risk, as well.

21.

A group of community health nurses who work in continuing care retirement centers are asked to talk to a group of seniors about what they do. Which of the following would the nurses identify as unique for this setting?

A) Accept clients who primarily need skilled nursing services B) Are similar to board and care homes C) Are respite centers for family members of older adults D) Provide a variety of housing and care options that elders need as they age Ans: D Feedback:

Continuing care retirement centers are comprehensive centers and have become the last place an older adult needs to live, meeting independent to dependent needs, including skilled nursing and Alzheimer's disease services. They can age in place without moving to another location as their needs increase. They accept residents at all stages of need, from totally independent living to assisted living to skilled nursing care. In some settings, residents cannot enter the residence at the skilled nursing level. These beds are filled by residents with increasing needs as they move from independent living, to assisted living, to skilled nursing care. Skilled nursing facilities provide skilled nursing care along with personal care that is considered nonskilled. Board and care or personal care homes offer 24 hours basic custodial care but provide no skilled nursing services. Respite care centers provide time off for caregivers. It can take place in an adult day center, home, or residential setting.

22.

Which of the following care options would be most appropriate for an older adult who experiences confusion, requires daily insulin injections and blood glucose monitoring, and needs assistance with bathing, dressing, and feeding?

A) Personal care home B) Respite care C) Intermediate care facility D) Skilled nursing facility Ans: D Feedback: Based on the situation, a skilled nursing facility would be most appropriate. A skilled nursing facility provides skilled nursing care, such as injections and blood glucose monitoring, along with personal care that is considered nonskilled such as bathing, dressing, and feeding. A personal care home offers 24 hours basic custodial care but no skilled services. Respite care provides time off for caregivers and can take place in a variety of settings. An intermediate care facility provides health care, but the amount and type of skilled care is less than that provided in skilled nursing facilities.

23.

Which one of the following statements is most accurate when differentiating hospice from palliative care?

A) Both palliative care and hospice focus on cure; however, hospice focuses on terminal illnesses, and palliative care focuses on diseases that are more chronic in nature.

B) Palliative care consists of comfort and symptom management and is often a part of hospice care.

C) Hospice is more of a specific place than a concept of care, whereas palliative care is more of a concept of care.

D) Hospice is intended for people who have a projected life expectancy of 6 months or more, and palliative care is intended for people who are actively dying.

Ans: B Feedback: Palliative care consists of comfort and symptom management and is often part of hospice care. Neither palliative care nor hospice focuses on cure. Hospice does focus on care of people who are known to be at end of life, and palliative care can be provided to people who have chronic ongoing health conditions even when death is not imminent. Hospice is more of a concept of care than a specific place. Palliative care should be a major focus of care throughout the aging process, regardless of whether death is imminent within 6 months.

24.

When working with the older adult population in the community, which of the following would be most important for the community health nurse to do?

A) Develop case management programs to channel clients to appropriate services B) Place the older adult in skilled nursing facilities for the best care available C) Raise funds to support the needs of the older adults in the community D) Emphasize tertiary prevention at this stage in the lives of the older adult Ans: A Feedback: Services for the older adult should be proactive. Nurses should design interventions that maximize nursing resources and provide the greatest benefit to elderly clients. Skilled nursing facilities are for people with skilled needs, not for older adults managing chronic diseases independently. One's own home is most often the best place for elders and where they want to be. This is not something that is always needed or possible for a community health nurse to become involved in. Nurses can identify the needs for additional funding, advocate for more funding, and facilitate a community group's efforts to raise funds. This is how a nurse can best serve the elderly and support their needs rather than by actually raising the funds. Prevention should be

proactive and focus on primary prevention regardless of the client's age.

Chapter 23 Working with Vulnerable Populations 1.

Which of the following would a community health nurse use to define vulnerable populations?

A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illness Ans: C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.

2.

When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply.

A) Resource availability B) Relative risk C) Health status D) Housing E) Education Ans: A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.

3.

A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor?

A) Insurance B) Acculturation C) Knowledge of disease D) Marital status

Ans:

A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

Acculturation, knowledge of disease, and marital status are examples of predisposing factors.

4. population for socioeconomic resources.

Which of the following would the nurse address?

A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providers Ans: C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.

5.

When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor?

A) Social support networks B) Crime rates C) Transportation D) Living conditions Ans: D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

6.

When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk?

A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse Ans: D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.

7.

When describing the causes of vulnerability to a group of students, which of the following would the instructor include?

A) Vulnerable populations are fairly similar across the nation and globally.

B) Statistics about vulnerable populations are highly accurate.

C) The most important causative factor is race or ethnicity.

D) Many of the factors and conditions suggest vulnerability overlap.

Ans: D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

8.

Which one of the following statements about relative risk is most accurate?

A) Lifestyle, behaviors, and choices do not relate

to relative risk.

B) Relative risk refers to exposure to risk factors identified from a substantial body of research.

C) Relative risk means that if a risk exists, the illness or adverse event will occur.

D) Any factor that is likely to cause increased risk is considered relative risk.

Ans: B Feedback: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.

9.

A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community?

A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizations Ans: D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.

10.

Which one of the following statements is true regarding social capital?

A) Social capital includes investments in individuals' capabilities and skills.

B) Social capital includes marital status and family structure.

C) Social capital includes jobs, income, housing, and education.

D) Examples of social capital are education and job training.

Ans: B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations.

Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.

11.

Which of the following would a community health nurse include when describing the differential vulnerability hypothesis?

A) Exposure to risk factors affects the population's social and human capital.

B) Everyone is at risk because of stressful events occurring in life.

C) A risk for a negative outcome increases with lower education and income levels.

D) Certain groups are impacted by stressful events more than others.

Ans: D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.

12.

After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor?

A) B) C)

Homelessness Acute illness Income

D) Ans:

Immigrant status B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.

13.

A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful?

A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in care Ans: A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.

14.

Which of the following would be most important for a community health nurse to do first when working with vulnerable populations?

A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedback Ans: C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.

15.

A community health nurse is working to empower clients of a vulnerable population.

Which of the following client behaviors indicates that the nurse is achieving this goal?

A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as nonchangeable Ans: A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.

16.

Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients?

A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining grounded Ans: C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.

17.

A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective?

A) Keeping the clients to a firm schedule of

visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitations Ans: B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).

18.

A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion?

A) Avoiding political involvement in issues B) Working with schools to reduce the dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needs Ans: A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.

19.

After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and

health is which of the following?

A) B) C) D) Ans:

Direct Inverse Positive Unequal B Feedback: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.

20.

Which one of the following statements is true regarding the socioeconomic gradient of health?

A) The behavior of smoking is lowest among those who have low income and low educational levels.

B) The socioeconomic gradient of health has been found in populations around the world.

C) All persons who have a low socioeconomic status will develop particular health problems.

D) The socioeconomic gradient of health is universal.

Ans: B Feedback: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.

21.

Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply.

A) Patients feel that they are unable to trust the information given to them and may not follow it as explained.

B) Limited access to appropriate level of care C) Poor access to quality care D)

Overt discrimination

E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts Ans: A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected.

Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.

22.

Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply.

A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless persons Ans: A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.

Chapter 24 Clients with Disabilities 1. develop effective plans to meet the needs of people with disabilities, the community health nurse reviews the statistics involving individuals with disabilities. Which of the following would the nurse identify as accurately reflecting the number of persons with ongoing disability?

A) 10 million people—less than 5% of the US population B) 27 million people—about 10% of the US population C) 36 million people—about 12% of the US population D) 150 million people—almost 50% of the US population Ans: C

Feedback: An estimated 36 million people or 12% of the population is living with some ongoing level of disability. The other statistics of 10 million, 27 million, and 150 million are inaccurate.

2.

When explaining the concept of disability to a local community group, which of the following descriptions would be most appropriate for the nurse to include?

A) A disability is a condition someone has, not something one is.

B) The plan of care for two persons with the same disability would be the same.

C) A disability refers to a person's inability to do something.

D) Handicap and disability are two terms that go hand in hand.

Ans: A Feedback: Long-held negative views of disabilities are being replaced with new and more positive approaches that view individuals and their challenges from a more holistic standpoint. Thus, a disability is something that a person has, not something one is. Even persons with the same disability but their plan of care can be quite different. Earlier terminology equated disability with an inability or incapacity or handicap that presents a more negative view of the condition.

3.

In Healthy People 2020, what is the emphasis of the categories of objectives that relate to the goal of “Disability and Health to promote the health and well-being of people with disabilities?”

A) A growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services B) A growing realization that healthy-life years for persons with disabilities do not equate to decreased health costs at local, state, and national levels, unlike they do for persons without disabilities C) Focus on personal responsibility for healthy lifestyle by persons with disabilities

D) Concept that persons with disabilities are always dependent on others Ans: A Feedback: In Healthy People 2020, the emphasis of the categories of objectives that relate to the goal of “Disability and Health to promote the health and well-being of people with disabilities” is a growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services. It also indicates a growing realization that healthy life years for persons with disabilities equate to decreased costs at local, state, and national levels, just as they do for persons without disabilities. There is not a focus on personal responsibility for healthy lifestyle by persons with disabilities or a concept that persons with disabilities are always dependent on others.

4.

Which of the following are the three areas has Healthy People identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health? Select all that apply.

A) Improve the conditions of life for persons with disabilities B) Address the inequitable distribution of resources among people with disabilities and those without disabilities C) Expand the knowledge base and raise awareness about determinants of health for people with disabilities D) Ensure the health of people with disabilities by influencing many social and physical factors E) Public health activities need to focus only on preventing disability Ans: A, B, C Feedback: The three areas that Healthy People has identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health include improve the conditions of life for persons with disabilities; address the inequitable distribution of resources among people with disabilities and those without disabilities; and expand the knowledge base and raise awareness about determinants of health for people with disabilities.

The plan to ensure the health of people with disabilities by influencing many social and physical factors is too broad. Public health activities need to focus only on preventing disability is a misconception.

5.

The community health nurse is invited to speak to a group of students about clients with disabilities. As part of the class, the nurse intends to describe The International Classification of Functioning, Disabilities, and Health (ICF) and its attempts at standardized language. Which of the following would the nurse include as terminology that was standardized? Select all that apply.

A) Disability impairment issues B) Body functions C) Handicapping conditions D) Activities E) Environmental factors F) Personal Factors Ans: B, D, E, F Feedback: The ICF included definitions for body functions and structures, activities, and environmental and personal factors. Terms such as disability, impairment, and handicap have been removed from the definition and replaced with functioning, which is more holistic and positive.

6.

After teaching a group of students about leading health risks, the instructor determines that the teaching was successful when the students identify which of the following as the #1 leading health risk?

A) Unsafe sex B) High blood pressure C) Underweight D) Tobacco consumption Ans: C Feedback: The ten leading health risks are (1) underweight; (2) unsafe sex; (3) high blood pressure; (4) tobacco consumption; (5) alcohol consumption; (6) unsafe water, sanitation, and hygiene; (7) iron deficiency; (8) indoor smoke from solid fuels; (9) high cholesterol; and (10) obesity.

7.

A community health nurse is preparing for a presentation on disabilities and is planning to include information about Healthy People 2020 goals. When addressing these goals, the nurse identifies differences from the goals addressed by Healthy People 2000. Which of the following would the nurse identify as different? Select all that apply.

A) Rather than individuals with disabilities and/ or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole.

B) The approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/or chronic illness.

C) The goals for Healthy People 2000 have an entire section on disability and secondary conditions.

D) A growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

Ans: A, B, D Feedback: A comparison among Healthy People plans over the last decades underscores the emergence of new approaches to identifying priority areas and planning to improve the health of individuals with disabilities and chronic illness. In Healthy People 2000, only one priority was devoted to disability and chronic illness. Over the past two decades, interest in disability has accelerated. Areas that are focused on with Healthy People 2020 include rather than individuals with disabilities and/or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole; the approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/ or chronic illness; and a growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

8.

A community health nurse is compiling a list of organizations that serve the needs of persons with disabilities. Which of the following would the nurse categorize as a

federal agency?

A) National Organization on Disability B) National Council on Disability C) National Association of the Deaf D) American Foundation for the Blind Ans: B Feedback: The National Council on Disability is an independent federal agency. The National Organization on Disability, National Association of the Deaf, and American Foundation for the Blind are private organizations.

9.

Which of the following is a major difference between Healthy People 2010 and Healthy People 2020 with respect to people with disabilities?

A) Healthy People 2010 emphasized the disparities that persons with disabilities experience.

B) The emphasis on “secondary conditions” in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities.

C) People with disabilities do not experience health disparities any more than people in the general population.

D) Healthy People 2020 continues to emphasize secondary conditions.

Ans: B Feedback: The emphasis on “secondary conditions” in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities. Key to addressing the barriers is for people with disabilities to “(1) be included in public health activities; (2) receive well-timed interventions and services; (3) interact with their environment without barriers; and (4) participate in everyday life activities. Without these opportunities, people with disabilities will continue to experience health disparities, compared to the general population.”

10.

An instructor is reviewing the principles that resulted from the 2011 reassessment of global progress on addressing disability with a class. Which of the following would the nurse include?

A) The government must focus solely on seeking improvement in the lives of individuals and families living with disability.

B) Government must play the only role in addressing disability.

C) It is unimportant for service providers, academic institutions, the private sector, communities, and people with disabilities and their families to address disability.

D) The importance of all persons, including those with disabilities to participate in their country's development.

Ans: D Feedback: In 2011, the World Health Organization and the World Bank reassessed global progress on addressing disability in light of the 2006 Convention on the Rights of Persons with Disabilities. It was determined that not only must governments seek improvements in the lives of individuals and families living with disability, but every citizen needs to participate in their country's development.

Government at every level may play a most significant role, but there are important roles for service providers, academic institutions, the private sector, communities, and especially people with disabilities and their families.

11.

When describing the importance of the World Health Report to a group of students, the instructor would emphasize which of the following?

A) It challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality.

B) Lifestyle choices are not one of the key contributors to morbidity and mortality levels in either affluent or poor countries.

C) Infectious disease is the major threat.

D) Malnutrition is the only threat.

Ans: A Feedback: The World Health Report challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. It recognized that although infectious disease and malnutrition require ongoing vigilance because

they continue to plague many parts of the world, they are not the only threat. Lifestyle choices are also one of the key contributors to morbidity and mortality levels in both affluent and poor countries.

12.

After teaching a class about the International Classification of Functioning, Disability, and Health (ICF), the instructor determines that the teaching was successful when the students identify which of the following as a personal factor?

A) Problems with ambulation B) Working C) Coping styles D) Amputation Ans: C Feedback: Personal factors are the features of an individual's background, life, and living that are not part of a health condition or health status, such as gender, race, age, other health conditions, fitness, lifestyle habits, upbringing, coping styles, social background, education, profession, past and current experience, overall behavior pattern and character style, individual psychological assets, and other characteristics. Problems with ambulation would be considered an activity limitation. Working would be an activity. Amputation would be an impairment.

13.

A community health nurse is planning to apply the International Classification of Functioning, Disability, and Health to clinical care in the community. The nurse could use this document as a basis for which of the following?

A) Curriculum design B) Needs assessment C) Quality of life measures D) Policy design Ans: B Feedback: In clinical care, the ICF document would be helpful with a needs assessment. Using the ICF document for curriculum design would reflect education; using it for quality of life measures would reflect research; using it for policy design would reflect social policy.

14.

A community health nurse is working with a group of visually impaired individuals and is developing a program to promote self- confidence and self-respect. Which of the following organizations would be a valuable resource for the nurse?

A) American Foundation for the Blind B) American Council of the Blind C) Guide Dogs for the Blind D) Ans:

National Federation of the Blind D Feedback: The nurse would contact the National Federation of the Blind whose focus is on helping blind individuals achieve self- confidence and self-respect. The American Foundation for the Blind advocates for the visually impaired through increased state and federal funding. The American Council of the Blind provides services such as information and referral, scholarship assistance, public education, and industry consultation, governmental monitoring, consultation, and advocacy. The Guide Dogs for the Blind makes guide dogs available for the visually impaired.

15.

A community health nurse is making a home visit to a family. The family has a son with a disability who requires a motorized wheelchair. The family asks for the nurse's assistance.

Which response by the nurse would be most appropriate?

A) “His disability should automatically cover the cost of the chair.”

B) “We'll need to check with the insurance company about coverage.”

C) “You'll probably be able to get it if you pay for half the cost.”

D) “You might be able to get a regular wheelchair, but a motorized one is impossible.”

Ans: B Feedback: One major obstacle for families with a disabled or chronically ill member may be obtaining needed assistive devices and technology. Just because the technology exists does not mean that it can be obtained. Often the insurance carrier, whether private or governmental, sets

limits on which products can be obtained or which brands are acceptable. Thus the nurse working with the family would need to check with the insurance company first and determine what if anything is covered and then determine how to go about obtaining what the son needs.

16.

A community health nurse is developing a plan of care for a family who is providing round-the-clock care in their home for a daughter who is chronically ill. Which of the following would be most important for the nurse to integrate into the plan?

A) Insurance limitations B) Skill teaching C) Flexible visiting D) Respite care Ans: D Feedback: Respite care is another area of great importance for families of the disabled and the chronically ill. It can be emotionally draining to meet the daily needs of a member who cannot perform self-care. This often leads to caregiver fatigue and increased stress. It is also important to recognize the effect of the situation on noncaregivers in the family, particularly nondisabled siblings of a disabled child. Respite care offers some needed relief to the family and allows for uninterrupted attention to the nondisabled children.

Whatever the source, some type of respite care is often vital to the family's health and should be a priority in the overall treatment plan of the family. Although insurance considerations, teaching, and flexible visiting would be issues to be addressed, respite care is a priority.

17.

When developing programs to assist individuals with disability and chronic illness, which of the following would be most important?

A) Narrow focus B) Holistic practice C) Orientation to the present D) Episodic care Ans: B Feedback: The role of the community health nurse with respect to disabilities and chronic illness requires a holistic practice and broad focus. Strong and sustained efforts are needed to achieve results. The community health nurse addresses current needs and plans for the

future.

18.

A community health nurse is providing information handouts that describe the need for annual gynecologic exams to local health clinics that provide care for individuals with disabilities. The nurse is fulfilling which role?

A) Advocate B) Coordinator C) Researcher D) Educator Ans: D Feedback: Providing information handouts is a method for teaching. Therefore, the nurse is assuming the role of an educator at the community level. In the advocate role, the nurse would assist in arranging for the population to receive the appropriate screening, ensuring that any special modifications or adaptations would be available. In the coordinator role, the nurse might arrange for screening to be performed during a routine visit made by a client to a facility or make arrangements for transporting the clients to a facility for the screening. In the researcher role, the nurse might contact other community health nurses about their experience in ensuring screening for this population to discover if they have similar needs or problems.

19.

A community health nurse is reviewing the effects of the Americans with Disabilities Act of 1990. Which of the following would the nurse identify as a major result of this legislation?

A) Employers with five or more employees must abide by the American with Disabilities Act. B) Architectural barriers must be removed from pathways so that they are accessible by wheelchair.

C) The disabled are eligible to receive telephone services in their home at no cost to them.

D) Individuals with disabilities who wish to vote must be provided transportation to polling places to vote.

Ans: B Feedback: A major accomplishment of this law was the removal of architectural barriers; curbs, stairs, handicap toilets, etc. so that the disabled in wheelchairs can freely move about.

Employers with 15 or more employees must follow this law. Adapted telephone services are provided for those who are hearing or physically impaired, but the telephone service is not free.

Polling places must be accessible to the disabled and absentee ballots and voter registration can be done from home.

20.

When reviewing the concept of universal design with a group of community developers, the community health nurse recognizes that the emphasis is on which of the following as the underlying theme?

A) Disability needs B) Adaptation C) Access D) Safety Ans: C Feedback: The underlying theme of universal design is ensuring access. Universal design is the design of products and environments to be usable by all people, including those with disability needs as well as chronic illness. The concept incorporated issues of adaptive design and safety measures such as reinforcement in bathroom walls to allow for installation of grab bars, but the key issue is accessibility.

21.

Which one of the following statements about the benefits of universal design for all persons is the most accurate?

A) It is the right thing to do to allow access to the built environment for all persons including persons with disabilities.

B) A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions.

C) The built environment refers to the naturally occurring features of the planet.

D) Access implies universal design.

Ans: B Feedback: A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions.

Universal design is the right thing to do for persons with disabilities but is not the most accurate or best reason to ensure universal design. The built environment refers to the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure).

Universal design incorporates access, but access does not necessarily imply universal design.

Chapter 25 Behavioral Health in the Community 1.

A community health nurse is meeting with a group of individuals who have been diagnosed with a serious mental illness. The nurse interprets this to mean which of the following?

A) The clients have impaired level of functioning and quality of life.

B) The clients' disorder is chronic and persistent.

C) The clients have issues of impaired control and dependency.

D) The clients have a significant behavior syndrome with present distress.

Ans: A Feedback: Serious mental illness (SMI) is mental illness that has compromised both the client's level of function and his or her quality of life.

Serious and persistent mental illness (SPMI) is the preferred term for serious mental illness of a chronic nature. Impaired control and dependency are components of addiction. A significant behavior syndrome with present distress characterizes a mental illness.

2.

When developing appropriate programs for adult mental health promotion, the nurse incorporates knowledge about the most prevalent mental disorders. Which of the following would the nurse identify as the most prevalent?

A) Major depression B) Bipolar disorder C) Anxiety disorders D) Schizophrenia Ans: C Feedback: For American adults, the most prevalent mental disorders are anxiety disorders, followed by mood disorders, especially major depression and bipolar disorders.

Schizophrenia, which affects approximately the same number of adults as bipolar disorder, is problematic because it is so persistently

disabling.

3.

After teaching a group of women in the community about common mental health disorders affecting them, the community health nurse determines that the teaching has been effective when the group identifies which one of the following?

A) Anxiety disorders and mood disorders occur twice as frequently in men as in women.

B) Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population.

C) The three main types of eating disorders affect more men than women.

D) The three main types of eating disorders include undereating due to food unavailability.

Ans: B Feedback: Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. Anxiety disorders and mood disorders occur twice as frequently in women as in men. The three main types of eating disorders affect more women than men. The three main types of eating disorders (anorexia, bulimia nervosa, and binge eating) also affect more women than men.

4.

A community health nurse is part of community discussion group on alcohol. The nurse recommends that adult males should have less than A) 6 standard drinks weekly.

B) 8 standard drinks weekly.

C) 10 standard drinks weekly.

D) 14 standard drinks weekly.

Ans: D Feedback: For the general male adult population, the recommended drinking limits are fewer than five standard drinks daily or 14 weekly. For the general female adult population, the recommended drinking limits are fewer than four standard drinks daily or eight weekly, and for

people age 65 and older, recommended drinking limits are no more that one standard drink daily or seven standard drinks weekly.

5.

When determining a target population for education about alcohol use, which age group would the community health nurse most likely plan to address?

A) 18- to 25-year-olds B) 30- to 40-year-olds C) 45- to 55-year-olds D) 65 years of age and older Ans: A Feedback: Trends in alcohol use in the United States differ across subsets of the population. Young adults (age 18 to 25) have the highest incidence of problem drinking. Thus the community health nurse would most likely address this age group.

6.

After teaching a class about commonly used illicit substances, the instructor determines that the teaching was successful when the class identifies which of the following as the most frequently reported illicit drug?

A) Heroin B) Methamphetamine C) Marijuana D) Cocaine Ans: C Feedback: Although heroin, methamphetamine, and cocaine are frequently used illicit drugs, marijuana is the most frequently reported illicit drug.

7.

A community health nurse is discussing alcohol use disorders and is explaining what is meant by a standard drink. Which of the following would the nurse include as an example? Select all that apply.

A) Two 12-oz. cans of beer B) 5-oz. glass of wine

C) D) E) Ans:

1.5 oz. of an 80-proof spirit 3 oz. of a cordial Two bottles of wine cooler B, C, D Feedback: A standard drink contains about 14 g of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-oz. bottle of beer or wine cooler; 8 to 9 oz. of malt liquor; one 5oz. glass of table wine; 3 to 4 oz. of fortified wine, 2 to 3 oz. of cordial, liqueur, or aperitif; 1.5 oz. of brandy; or 1.5 oz. of 80proof distilled spirits.

8.

When assessing a group of individuals for factors related to an increased risk for alcohol use disorders, which of the following would the nurse expect to find? Select all that apply.

A) Academic engagement/achievement B) Antisocial peer affiliations C) Decreased impulsivity D) Positive mother–child/father–child relationships E) Stressful life events Ans: A, B, E Feedback: Individual factors associated with the development of AUDs include problems with academic engagement/achievement, antisocial peer affiliations, problems in the mother– child/father–child relationship, and other stressful life events.

9.

Which one of the following statements regarding the etiology of substance use disorders is most accurate?

A) It is believed that nurture has substantially more influence on the development of substance use disorders than nature.

B) With the mapping of the human genome, hope has decreased that the genes related to substance use disorders could be identified.

C) Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene–environment interaction).

D) Only genetic heritability is involved in the etiology and course of substance use disorders.

Ans: C Feedback: Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene–environment interaction). It is believed that genetics is a risk factor in the range of 50% to 50%. With the mapping of the human genome, hope has increased that the genes related to substance use disorders could be identified. In addition to genetic heritability, both personal and environmental factors are involved comparably in the etiology and course of substance use disorders.

10.

The community health nurse is using effect theory to design a prevention program for behavioral health. Which of the following would be the most likely place for the nurse to start?

A) Identifying antecedent factors leading to the problem B) Identifying the specific health problem C) Determining the desired health problem impact D) Specifying the health problem outcome Ans: B Feedback: When using effect theory to design a prevention program for behavioral health, a good place to start is to identify the specific health problem and then the desired health problem impact and health problem outcome. As the program is developed, the community health nurse starts by identifying the antecedent factors that lead to behavioral health problems. This provides a clear rationale for why the intervention should provide the desired impact.

11.

A community health nurse is providing an in- service program to the agency staff about effect theory, which will be used to develop behavioral intervention programs. The nurse determines that the staff needs additional teaching when they identify which of the following as a component of the theory?

A) Determinant theory

B) C) D) Ans:

Intervention theory Impact theory Process theory D Feedback: Process theory is a theoretical framework used in community/public health science. It is not a component of effect theory. Effect theory has four components: determinant theory, intervention theory, impact theory, and outcome theory.

12.

A community health nurse is applying the Institute of Medicine model based on Gordon's Classification of Disease Prevention model to address prevention of alcohol use during pregnancy and prevention of fetal alcohol syndrome. Which of the following populations would the nurse target indicated prevention strategies?

A) Local women in the community of childbearing age B) Women of childbearing age living in a city C) Women of childbearing age considered at risk D) Pregnant women who have a child with fetal alcohol syndrome Ans: D Feedback: Indicated prevention strategies would be designed to prevent the use of alcohol in pregnant women who had screened positive for alcohol use during pregnancy or already had a child diagnosed with FAS or FASD. Universal prevention strategies would address the entire population of women of childbearing age (national, local community, school, neighborhood), with messages and programs aimed at preventing the use of alcohol if pregnancy is a possibility.

Selective prevention strategies would target subsets of women of childbearing age who are deemed to be at risk for alcohol use by virtue of their membership in a particular population segment.

13.

A community implements a plan to enforce the underage drinking law. The community health nurse interprets this action as reflecting which public health model?

A) Primary prevention B) Behavioral prevention

C) D) Ans:

Environmental prevention Clinical prevention C Feedback:

Environmental prevention relies on a societal commitment for the implementation of the interventions and aims to alter the environment by reducing risk (e.g., community-wide decrease in availability of the substance; underage drinking law enforcement). Primary prevention is conducted when no disease is present in the target population with the primary goal being prevention of disease development.

Behavioral prevention includes a broad array of strategies aimed at changing lifestyles (e.g., exercise, smoking cessation, balanced nutrition). The goal of the intervention is to change behaviors that put the person at risk for developing the disease or to prevent consequences of the disease. Clinical prevention is based on the medical model for preventive services. It relies on one-to-one, provider-to-patient interaction and occurs within the traditional health care delivery system.

14.

Which of the following statements about the National Alliance on Mental Illness (NAMI) is most accurate?

A) NAMI focuses on the needs of the people who actually have mental illness.

B) NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected.

C) The NAMI Web site contains some information that is intended to be used exclusively by care providers.

D) All services of NAMI are provided at the main headquarters.

Ans: B Feedback: NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected.

NAMI focuses on the needs of the families, peers, and consumers of Mental Health services. The NAMI Web site contains extensive information that can be utilized by both consumer and care providers. NAMI is a nationwide organization with chapters in each state and county.

15.

Which one of the following statements about nonprofit organizations that serve those with mental health issues is most accurate?

A) They are all associated with the government.

B) A for-profit organization that promotes mental health is Mental Health America, which was established in 1909.

C) The organization National Mental Health Association is a scam.

D) They focus on advocacy, education, service, and funding research endeavors.

Ans: D Feedback: Nonprofit organizations focus on advocacy, education, service, and funding research endeavors. They are not all associated with the government. Mental Health America was formerly known as National Mental Health Association, which is a leading nonprofit organization that promotes mental health.

16.

Healthy People 2020 objectives focus on tobacco, alcohol, and illicit drug use education.

Which of the following are steps in the process to providing this education?

Select all that apply.

A) Identifying the impact of substance use on the environment B) Identifying trends of substance use to develop a prevention program C) Understanding the consequences of substance use that affect a community as a whole D) Differentiating between legal and illegal substance use E) There are no differences in prevention programs for different populations Ans: B, C, D Feedback: The three steps in the process for providing tobacco, alcohol, and illicit drug use education are in order (1) identifying trends, (2) differentiating legal versus illegal use, and (3) consequences of use. Identifying the impact of substance use on the environment is not one of the steps. There are differences in prevention programs—if the target population is young adults, the prevention of binge drinking might be a top concern; if homeless adults, the focus will be on chronic alcohol, cocaine, and heroin use; cultural and ethnic differences in alcohol and

SUDs are noted in American Indians with increased rates of fetal alcohol syndrome and increased prevalence in prison and jail populations.

17.

A community health nurse is involved in a screening program for alcohol use with an ethnically diverse population. Which of the following would be the best instrument to use?

A) Alcohol Use Disorders Identification Test (AUDIT) B) CAGE questionnaire C) Michigan Alcoholism Screening Test (MAST) D) Drug Abuse Screening Test (DAST) Ans: A Feedback: For alcohol use, the screening instrument recommended by the NIAAA is the AUDIT. WHO developed this instrument for use across populations, and it has established high reliability and validity across ethnic groups.

Other tests that can be used include the CAGE questionnaire and MAST. The DAST would be appropriate to screen for drug use.

18.

Which of the following would the community health nurse identify as a major limitation for using biological markers for screening for substance use?

A) Sensitivity of the test B) Cost of the test C) Factors influencing the test D) Ease of obtaining a specimen Ans: B Feedback: Biological screening tests are rarely used in a community-based screening program due to the cost and the problems with obtaining biological specimens. In addition, numerous factors can influence sensitivity and specificity of biological markers, including other metabolic disorders or other diseases, medication use, and reliability of the method.

19.

Which of the following statements about Healthy People 2020 and reducing substance use and addressing mental health needs is most accurate? Select all that apply.

A) After a diagnosis is established, the nurse can decide on an intervention that can address the specific public health issue identified in the diagnosis using the Healthy People 2020 objectives.

B) It could be considered a priority as two of the top ten health indicators relate to substance use and mental health.

C) Target benchmarks and data derivation for each objective can be used to guide program development.

D) Reducing substance abuse and addressing mental health needs are not priority with Healthy People 2020.

E) The goals are to improve mental health through prevention and to reduce substance abuse to protect the health, safety, and quality of life for all, especially children.

Ans: A, B, C, E Feedback: Reducing substance abuse and addressing mental health needs is a priority with Healthy People 2020.

20.

Which of the following would a community health nurse address as a means for enhancing the life of the public?

A) Proper nutrition B) Healthy sleep patterns C) Use of community supports D) Creative outlets Ans: D Feedback: Life-enhancing activities to enhance public well-being include meaningful work, whether through or outside of employment, creative outlets, interpersonal relationships, recreational activities, and opportunities for spiritual and intellectual growth. Proper nutrition, healthy sleep patterns, and use of community supports are life-sustaining activities.

21.

A community health nurse has completed a community assessment. Which of the following would be next?

A) Decide on an intervention B) Locate an appropriate the specific focus area in Healthy People 2020 C) Establish a community diagnosis D) Ans:

Determine the level of prevention C Feedback: After completing a community assessment, the nurse then establishes a community diagnosis. Once this is done, the next step is to decide on an intervention that can address the specific public health issue identified in the diagnosis. A good starting point in the development of community/public health intervention is to begin with the Healthy People 2020 objectives, locating the specific focus area that matches the community diagnosis. Once the nurse identifies the focus of the intervention, the next step is to determine the level of prevention.

22.

A community health nurse is working with a political group to lobby for changes in funding for a mental health promotion program. The nurse is functioning in which role?

A) Educator B) Collaborator C) Advocate D) Case manager Ans: C Feedback: The advocacy role requires being politically involved by serving on decision-making boards and committees, lobbying for legislative changes, and helping to influence mental health policy development that will better serve this population. In the educator role, the community mental health nurse teaches clients individually and in groups about their mental health conditions, their treatment protocols, ways to function more independently in the community, prevention and health-promoting strategies, and much more. In the collaborator role, the nurse works with others, pooling the groups professional expertise to enhance the quality and effectiveness of services. In the case manager role, the nurse is involved with screening, assessment, care planning, arranging for service delivery, monitoring, reassessment, evaluation, and discharge, often within the context of a community mental health center (CMHC). Case management helps the person with an SMI to access services and live as independently as possible.

23.

Which one of the following are the primary roles that the community health nurse must use to understand and serve populations with mental illness?

A) Advocate B) Educator C) Case manager D) Consumer of epidemiologic data Ans: D Feedback: The access and use of epidemiologic data to understand and serve populations with mental illness are primary.

24.

Which of the following are involved in accessing and using epidemiologic data to understand and serve populations with mental illness? Select all that apply.

A) Identifying the incidence and prevalence of mental disorders B) Understanding that all data are accurate C) Examining the causes and risk factors associated with mental illness D) Identifying the needs of people with mental disorders Ans: A, C, D Feedback: This means identifying the incidence and prevalence of mental disorders, examining the causes and risk factors associated with mental illness, and identifying the needs of populations with mental illness. However, not all data are accurate.

Chapter 26 Homeless Populations 1.

An instructor reviews the definition of homelessness according to the McKinney Vento Homeless Assistance Act with a group of community health nursing students. The instructor determines that the students need clarification when they include which of the following as homeless?

A) Someone living in a public shelter B) Someone living in a park C) Someone who is incarcerated D) Someone who lives in his or her car Ans: C Feedback:

The McKinney–Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a person as homeless who lacks a fixed, regular, adequate night time residence including supervised public or private shelters that provide temporary accommodations, institutional settings providing temporary shelter, or public or private places that are not designed for or used as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds).

Incarcerated individuals, however, are not considered homeless under this definition.

2.

When addressing homeless children and youth, which of the following situations are also considered homeless according to the education subtitle of the McKinney–Vento Homeless Assistance Act? Select all that apply.

A) Children who share housing with others due to economic hardship or loss of housing B) Children who are abandoned in hospitals C) Children who are awaiting placement in foster care D) Children who are living in motels, trailer parks, or camping grounds E) Children who are living apart from one or more of their parents Ans: A, B, C, D Feedback: The education subtitle of the McKinney– Vento Homeless Assistance Act expands on the definition of homelessness when addressing homeless children and youth. The act includes as homeless those children who share housing with others due to economic hardship or loss of housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in motels, trailer parks, or camping grounds. Children who are living apart from one or more of their parents may not be homeless.

3.

Which of the following would likely provide the best estimate of the number of persons who are homeless?

A) Counting the number of homeless people on a particular day B) Counting the persons who are homeless in a given week C) Counting the number of persons who are homeless at a specific time on a specific date

D) The number of people who have been homeless over the course of a year Ans: D Feedback: Rather than trying to count the number of homeless people on a given day or week (point in time counts), it may be more prudent to measure the number of people who have been homeless over a longer timeframe such as over the course of a year (period prevalence counts).

4.

Which of the following are reasons why it is difficult to estimate the number of persons who are homeless? Select all that apply.

A) It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition.

B) It is difficult to locate and account for people who are homeless.

C) Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity.

D) In rural areas, there are fewer housing options and resources for the homeless and as a result people may be forced to live temporarily with friends or family.

E) Homelessness is increasing due to poverty and the growing shortage of affordable rental housing.

Ans: A, B, C, D Feedback: The following are reasons: It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. It is difficult to locate and account for people who are homeless. Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. In rural areas, there are fewer housing options and resources for the homeless, and as a result, people may be forced to live temporarily with friends or family. It is true that homelessness is increasing due to poverty and the growing shortage of affordable rental housing, but this is not a reason why it is difficult to estimate the number of people who are homeless.

5.

After reviewing statistics on homelessness, which of the following would a community health nurse identify as the fastest growing segment of the homeless population?

A) Children under age 18 years B) Families headed by a female single parent C) Families headed by a male single parent D) Families with children Ans: D Feedback: Families with children are the fastest growing segment of the homeless population based on statistics, accounting for approximately 34% of the homeless population. Single female parents account for most of the homeless families. However, because many two-parent families and families headed by single fathers are becoming homeless because of the recession, and most homeless provider organizations serving families are geared to serving single women with children, it can be harder for intact families and families headed by men to access shelter.

6.

Which of the following are subpopulations that are more likely to be sheltered homeless in urban areas? Select all that apply A) Adult males B) African Americans C) Veterans D) Disabled E) Migrant workers Ans: A, B, C, D Feedback: When compared to their housed counterparts nationwide, the sheltered homeless are more likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural areas, the homeless are more likely to be White, Native American, or migrant workers.

7.

Which of the following are reasons for the increase in poverty rates over recent years?

Select all that apply.

A) Declining wages B) Decline in public assistance C) Loss of jobs that offer security and carry benefits D) A decline in manufacturing jobs in favor of lower paying service jobs E) Globalization and outsourcing F) Homelessness

Ans:

A, B, C, D, E Feedback:

The increase in poverty rates over recent years may be attributed to declining wages, loss of jobs that offer security and carry benefits, and increase in temporary and part- time employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in favor of lower paying service jobs, globalization and outsourcing, and a decline in public service.

As wages drop, the potential to secure adequate housing wanes. This does not mean that homelessness is a cause of poverty. Actually, it is poverty that is known to cause homelessness.

8.

Which one of the following statements regarding mental illness and homelessness is most accurate?

A) 75% of the sheltered homeless report a severe mental illness.

B) Deinstitutionalization or being released from institutions into the community contributes to the number of persons who have a severe mental illness who are homeless.

C) Mental illness only contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions.

D) Mental illness and substance abuse are not often comorbid conditions that contribute to homelessness.

Ans: B Feedback: Deinstitutionalization or being released from institutions into the community contributes to the number of severely mentally ill persons represented in the homeless population.

Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. Mental illness and substance abuse are often comorbid conditions, which, coupled with poor physical health, make it especially difficult to secure employment and safe, affordable housing.

9.

Which of the following would a community health nurse expect to assess in the population of homeless men?

A) Marital status B) Substance abuse C) Permanent employment D) Frequent use of shelters Ans: B Feedback: The majority of homeless men are single adults. Homeless men are more likely to be employed than their homeless female counterparts; yet, they usually hold temporary, low wage jobs that offer little security. They are also more likely than homeless women to have uncontrolled substance abuse issues. This makes it more difficult for them to access shelters, which tend to require abstinence for admission

10.

A community health nurse is preparing a program for a local community group about homelessness. A portion of the program will address homeless men. Which of the following would the nurse include?

A) Homeless men are not looked down upon less than other groups.

B) Homeless men are usually eligible for social services.

C) Homeless men are perceived as blameless for their situation.

D) Single, low-income men only qualify for medical assistance if disabled.

Ans: D Feedback: Single, low-income men only get medical assistance if they are disabled. Homeless men are more likely to be treated with disdain than other homeless subgroups. Some people perceive homeless men as largely to blame for their plight, believing that they are able bodied and should be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough to warrant eligibility for health and social services. Often health and social programs give priority to women and children.

11.

The nurse educator knows the nursing student understands the effect of homelessness on the health of children when the nursing student identifies which of the following?

A) “Homeless children are four times more likely to become ill.”

B) “While approximately 87% of homeless children are enrolled in school, only about 77% attend regularly.”

C) “Fewer than 25% of homeless children graduate from high school.”

D) “Homeless children are twice as likely as their housed counterparts to repeat a grade in school.”

Ans: A Feedback: Only one of these statements that directly relates to the effect of homelessness on the health of children is, “Homeless children are four times more likely to become ill.”

12.

For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually transmitted infections?

A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infections.

B) They lack education or job training skills and may resort to prostitution or survival sex, which increases their risk for HIV, hepatitis, and sexually transmitted infections.

C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility.

D) It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

Ans: B Feedback: The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually transmitted infections is that they lack education or job training skills and may resort to prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infection; they may have difficulty accessing emergency shelter because of

shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

13.

Which one of the following statements about mental health issues and homeless young people is most accurate?

A) 87% of homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence.

B) Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem.

C) It is not common for homeless youths to be arrested for running away, breaking curfews, or being without supervision.

D) Homeless youth are persons under age 18 who lack parental, foster, or institutional care.

Ans: B Feedback: Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. One in six homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision. Homeless youth are persons under age 18 who lack parental, foster, or institutional care, but this is not necessarily related to mental health issues.

14.

The community health nurse is explaining the reasons for health problems in the homeless population. Which of the following would the nurse identify as the most likely reason?

A) Issues related to storage of medications B) Lack of transportation to keep appointments C) Time and energy focus on survival needs D) Limited access to health care services Ans: C Feedback: Although issues related to medication storage, lack of transportation, and limited access to health care play a role, many homeless people expend their time and energy trying to meet basic survival needs such that health care takes a backseat to finding food, clothing, or shelter.

15. community-based organization to develop programs to provide quality accessible health care to the homeless population. Which of the following would be the most appropriate source from which to seek funding for this program?

A) Projects for Assistance in Transition from Homelessness (PATH) B) Health Care for the Homeless (HCH) C) The Interagency Council on Homelessness D) U.S. Department of Housing and Urban Development Ans: B Feedback: The HCH program (a provision of the McKinney Act) awards grants to communitybased organizations that seek to provide quality, accessible health care to the homeless and would be the most appropriate source for funding. PATH is a grant program created under the McKinney Act to support the delivery of services to persons with severe mental illnesses, including those who are homeless or at risk of becoming homeless.

The Interagency Council on Homelessness coordinates the federal response to homelessness and creates a national partnership with public and private sectors to reduce and end homelessness in the United States. HUD provides funding for supportive housing for low-income families, as well as low-income individuals with disabilities, and low-income elderly.

16.

After teaching a group of community health students about public and private sector programs and initiatives aimed at combating homelessness, the instructor determines that they need additional teaching when they identify which of the following as a private sector organization?

A) National Coalition for the Homeless B) National Alliance to End Homelessness C) National Resource Center on Homelessness and Mental Illness D) National Low Income Housing Coalition Ans: C Feedback: The National Resource Center on Homelessness and Mental Illness is a federally sponsored public program for addressing the needs of the homeless. The National Coalition for the Homeless, the National Alliance to End Homelessness, and the National Low Income Housing Coalition are private sector resources.

17.

A community health nurse who will be working with a homeless population is planning care. Which of the following would the nurse need to do first?

A) Develop trust with the population B) Clarify personal values and beliefs C) Focus on the issue of homelessness D) Visit the local shelter where the clients are Ans: B Feedback: When working with the homeless population, it is crucial that the nurse clarify personal beliefs and values about poverty, homelessness, addictions, and mental disorders to ensure nonjudgmental care. Trust too is essential, but this would need to occur after the nurse has clarified his or her values and beliefs. Biases or judgments on the nurse's part would undermine the development of trust. The nurse needs to use a comprehensive, holistic approach or focus, not just focus on the population's homelessness. Visiting the local shelter may be helpful to gather information about what the nurse might expect, but it isn't the first thing the nurse would do.

18. women who are victims of intimate partner violence, the nurse develops interventions aimed at the primary level of prevention. Which of the following would be most appropriate for the nurse to include?

A) Assisting them to locate a safe shelter B) Providing immunizations C) Screening for sexually transmitted infections D) Teaching about basic hygiene measures Ans: A Feedback: For women who are victims of intimate partner violence, counseling and helping them locate a safe shelter can assist in preventing homelessness. Providing immunizations and teaching about basic hygiene may be appropriate, but these would not priorities at this time.

Screening for sexually transmitted disease would be a secondary level of prevention activity.

19.

A community health nurse is working with a group of homeless clients with substance abuse problems. Which of the following would be appropriate for the nurse to do at the tertiary level of prevention?

A) Conduct mass screening for common communicable diseases

B) Institute a mobile van to assist in early diagnosis of common illnesses C) Advocate for counseling programs to address high risk behaviors and abuse D) Assist in ensuring participation in substance abuse rehabilitation programs Ans: D Feedback: Tertiary prevention level activities include treatment of complications of advanced disease, providing rehabilitative care, such as participation in a substance abuse rehabilitation program, and offering counseling and support. Conducting mass screenings for common communicable diseases associated with substance abuse and a mobile van program to assist in early diagnosis are secondary prevention level activities. Advocating for counseling programs to address risk behaviors and abuse would be a primary prevention level activity.

Chapter 27 Rural, Migrant, and Urban Health Care 1.

When describing the term “frontier area,” which of the following would the nurse include as the most common description?

A) A population density of fewer than 1,000 people per square mile B) Population density of 1,000 people or more per square mile C) Fewer than 10,000 residents in the community D) Fewer than six people per square mile Ans: D Feedback: Fewer than six people per square mile is one of the most common descriptions of a “frontier area.” Fewer than 10,000 residents or population density of less than 1,000 people per square mile is the definition of “rural.” A population density of 1,000 or more people per square mile refers to an urbanized area or urban cluster.

2.

The nurse educator is aware that the nursing student needs further instruction on the terminology related to rural, frontier, migrant, and urban issues when the nursing students identifies which of the following?

A) A rural area has six or fewer persons per square mile.

B) There are many factors that are considered when determining if a community is rural or frontier other than population density.

C) Urban areas are much more densely populated than urban areas.

D) An urban area consists of at least 2,500 people per square mile with at least 1,500 of those who reside outside institutional group quarters.

Ans: A Feedback: If a nursing student would identify that a rural area has six or fewer persons per square mile, the student would need further instruction as it is a frontier area that has six or fewer persons per square mile. There are many factors that are considered when determining if a community is rural or frontier other than population density. Urban areas are much more densely populated than rural areas.

Urban areas consist of at least 2,500 people per square mile with at least 1,500 of them living outside institutional group quarters.

3.

When attempting to describe the characteristics of a typical rural population to a group of community health nurses, which of the following would the nurse include?

A) Older, White, with a lower income and less formal education B) Young minorities with a lower income and less formal education C) Wealthier, more highly educated, older White Americans D) A reflection of the population as a whole Ans: A Feedback: Population characteristics include older adults as the largest segment of the population, majority as White, with lower educational attainment, and, on the average, a lower income.

4.

Which of the following reasons is most likely to force a rural hospital to close?

A) Rural hospitals have a high risk for financial problems and closures.

B) Rural hospitals do not have access to high tech equipment and services.

C) Rural hospitals are able to attract many specialty physicians.

D) Many rural residents depend heavily on public health department services.

Ans: A Feedback: Rural hospitals have a high risk for financial problems and closures. Rural hospitals usually have less high-tech health care equipment and services, but this does not directly influence closure of the hospital.

Rural hospitals are usually not able to attract many specialty physicians, and indeed physician and nurse and pharmacist shortages in rural areas make it difficult to operate a hospital. Many rural residents depend heavily on public health department services, but this is more likely an effect of lack of access to acute care services than a cause of lack of access to acute care services.

5.

Which of the following are barriers to access to health care that may be experienced by rural clients? Select all that apply.

A) Adequate numbers and types of providers B) Unpredictable and hazardous weather conditions C) Lack of transportation D) Physical distance between the residence and the location of health care services E) Less high-tech health care equipment and services available Ans: B, C, D, E Feedback: The barriers to access to health care that may be experienced by rural clients include unpredictable and hazardous weather conditions, lack of transportation, physical distance between the residence and the location of health care services, and less high- tech health care equipment and services available. There are often not adequate numbers and types of providers of health care in rural areas.

6.

Which one of the following statements about migrant workers and their families most accurately describes their lifestyle?

A) They are usually paid fairly and treated justly by their employers.

B) Often the men are the only ones who perform

the migrant work.

C) They often work 6 days a week from sunrise to sunset.

D) Their earning power is dependent only upon their skill level.

Ans: C Feedback: Migrant workers often work 6 days a week from sunrise to sunset. They are often paid unfairly and treated unjustly. The entire family is often involved in performing the migrant work.

Their earning power is variable depending on the variables of weather and crop conditions.

7.

When assessing a group of migrant farmworkers, the community health nurse notes that the group leaves their home base for part of the year to travel to the same place along a route during the agricultural season, usually returning on yearly basis. The community health nurse identifies this as which of the following?

A) Restricted circuit migration B) Point-to-point migration C) Nomadic migration D) Migrant stream migration Ans: B Feedback: Point-to-point migration entails leaving a home base for part of the year to travel to the same place or series of places along a route during the agricultural season, usually returning on a yearly basis. In a restricted circuit, many people travel throughout a season within a small geographic area, following the crops. Nomadic migration involves traveling away from home for several years, working from farm to farm and crop to crop, relying on word of mouth about job opportunities. Migrant stream migration involves following the harvest seasons of agricultural crops, moving from place to place, usually along predetermined routes (migrant streams).

8.

A community health nurse is working to improve the health children of migrant families.

Which of the following issues would be of least importance for the nurse to address?

A) Adolescent substance abuse B) Exposure to domestic violence C) Mental health problems D) Participation in chores

Ans:

D Feedback:

Many migrant children are called upon by their families to stay home from school to work, care for younger children, or attend to other household chores, thus affecting the child's academic performance. However, chores and helping the family are necessary to the family's survival and as such would be something the nurse would focus on at a later time. Issues such as adolescent substance abuse, domestic violence, and mental health problems are common and would need to be addressed early on.

9.

Which of the following have a direct and negative influence on the vulnerability of migrant workers? Select all that apply.

A) Many are undocumented aliens and live in fear of deportation.

B) They are often deprived of safe working conditions.

C) Their children are deprived of a quality education.

D) They often lack adequate sanitation and housing.

E) They often have poor nutrition because of poverty.

Ans: A, B, D, E Feedback: Factors that have a direct and negative influence on the vulnerability of migrant workers include many are undocumented aliens and live in fear of deportation; lack of safe working conditions; lack of adequate sanitation and housing; and poor nutrition because of poverty. That their children are deprived of a quality education is also significant, but it is not a direct influence on the vulnerability to health concerns of the migrant workers themselves.

10.

A community health nurse is working to develop programs to address the health status of migrant families. Which of the following would the nurse need to keep in mind when planning these programs? Select all that apply.

A) A greater mortality from injuries, TB, respiratory diseases, and cerebrovascular diseases B) A dramatic increase in use of immunizations for migrant children

C) An infant mortality rate that is 25% to 30% higher than for other infants in the United States D) Health needs compromised by limited access to health care and high mobility E) A much lower life expectancy than that of the general population Ans: A, C, D, E Feedback: The life expectancy of a migrant worker is much lower than the general population, with proportionally increased mortality from “injuries, tuberculosis, mental disorders, cerebrovascular disease, respiratory diseases, ulcers, hypertension, and cirrhosis.” The migrant infant mortality rate is 25% to 30% higher than the national average. Migrant children are delayed for immunizations.

Migrant families have numerous health needs, but they often face many obstacles to accessing health care including their frequent movement from place to place.

11.

A local community has a significant population of migrant workers. In response, a community health nurse plans to prevent a program to the local community about this population. As part of the program the nurse plans to include information about Cesar Chavez, describing him as which of the following?

A) A Mexican president who worked to keep people from crossing the border illegally B) A well-known actor who advocates for increasing the number of Latinos in Hollywood C) The senator who wrote the Children's Health Insurance Program (CHIP) bill D) Founder of the United Farm Workers who spent his life fighting for social justice Ans: D Feedback: Cesar Chavez founded the United Farm Workers (UFW), the first union in agricultural labor history that successfully organized migrant farmworkers. Chavez fought for social justice and is an example of a migrant hero. He was not a senator, well-known actor, or Mexican president.

12.

When providing care for migrant workers, which of the following would be most appropriate for the community health nurse to do?

A) Maintain existing services B) Use standard methods of health care delivery C) Employ information tracking systems D) Use professionals for community outreach Ans: C Feedback: Employing information tracking systems is necessary due to the mobility of this population and the need for continuity of care. The nurse should improve the existing services, use unique methods of health care delivery to reach this population, and use lay personnel for community outreach.

13.

A community health nurse works to offer increased health care services to meet the needs of a local migrant population. Which of the following ideas will work well for this population? Select all that apply.

A) Providing a mobile van clinic that comes to the farms during the day B) Offering a clinic at the migrant camp from 7 to 10 PM C) Asking local doctors to stay open until 6 PM during the summer D) Offering school-based health services for the children E) Providing a breakfast program for the children at school Ans: A, B, D, E Feedback: The van at the work site, services for children in school including a breakfast program, a late evening clinic at the camp would help the greatest number of migrant family members.

Migrant workers are in the fields until dark. In the summer that may be 9 PM; thus, a physician who stays open until 6 PM will not help.

14.

When dealing with urban populations, which of the following issues would a community health nurse most likely face? Select all that apply.

A) Health disparities in the population B) Lower levels of homelessness C) Increased cases of asthma D) High levels of poverty E) Major transportation issues Ans: A, C, D Feedback: Health disparities are very evident in the populated urban setting. There are increased levels of asthma and higher levels of poverty. Homelessness is more evident, yet transportation issues are not as great as in suburban or rural areas.

15.

After teaching a group of community health nursing students about urban sprawl and its effects, the instructor determines that additional teaching is needed when the students identify which of the following as an effect?

A) Water pollution B) Heat islands C) Less exposure to pesticides D) Decreased air quality Ans: C Feedback: Encroachment of housing areas into natural habitats or farmlands can lead to wider human exposure to pesticides, herbicides, and other things such as mosquito-borne illnesses.

Urban encroachment into agricultural areas creates problems with air and water pollution, access to health care, and heat islands.

16.

Which of the following are livability principles that have been identified by the Partnership for Sustainability Communities?

Select all that apply.

A) Diminish economic competitiveness B) Disassemble existing communities C) Coordinate and leverage federal policies and investment D) Provide more transportation choices E) Promote equitable, affordable housing Ans: C, D, E Feedback:

The six livability principles include (1) provide more transportation choices, (2) promote equitable, affordable housing, (3) enhance economic competitiveness, (4) support existing communities, (5) coordinate and leverage federal policies and investment, and (6) value communities and neighborhoods.

17. concept of social justice, which of the following if stated by the group as a component indicates effective teaching?

A) Decreased burden borne by all B) Increased benefits obtained for all C) Narrow isolated view of health D) Diversity viewed as a strength Ans: D Feedback: Social justice occurs when a society provides for the health needs and health care issues of all people by treating people fairly, regardless of where they live or who they are. It deals with concepts of inclusion, participation, empowerment, and the recognition that diversity is a strength. Social justice involves an equal bearing of the burdens and equal reaping of the benefits. Community health nurses who practice social justice have broad and holistic views of health.

18.

A community health nurse working with urban populations integrates the concept of social justice into practice by demonstrating which of the following?

A) Impartiality B) Paternalism C) Self-interest D) Inflexibility Ans: A Feedback: Social justice requires impartiality, that is, ensuring that interventions are just and the outcome is fair when viewed by an uninvolved outsider. Paternalism reflects an individual focus rather than the population focus of social justice. Self-interest and inflexibility would interfere with impartiality and, subsequently, social justice.

19. is describing how rural community health nursing compares with community health nursing in urban and suburban areas. Which of the following would the nurse include about rural community health nurses?

A) Salaries comparable with the other two areas B) More difficulty in initiating planned change C) Nurses viewed as active, highly respected community members D) Less physical isolation from professional

opportunities Ans: C Feedback: Rural community health nurses are active members of their community and are highly respected professionals. Salaries typically are lower than that of urban nurses in comparable positions. However, because the system of health care is smaller, it can be easier to understand the system and initiate planned change. Rural community health nurses may experience the challenge of physical isolation from personal and professional opportunities associated with urban areas. Traveling to cities for basic and continuing education can be a barrier. In addition, rural nurses may feel isolated in clinical practice because of the scarcity of professional colleagues.

20.

A community health nurse implements the use of promotoras to promote health in migrant communities. Which of the following best describes a promotora?

A) Nonprofessional community outreach worker B) Trained childbirth assistant C) Retired nurses knowledgeable of the area D) Language translators Ans: A Feedback: The use of promotoras—lay community outreach workers—or doulas—usually trained childbirth assistants—have promoted health in migrant communities. Promotoras are not retired nurses or language translators.

21.

Which of the following activities best exemplifies a community health nurse forging a relationship?

A) Dealing with sensitive subjects B) Introducing one's self as a community health nurse C) Listening to more than just what is said D) Being aware of the long term commitment to the client Ans: B Feedback: In forging a relationship, CHNs begin with creating a “perception of presence” by identifying themselves as a public health nurse and passing out their card with the instruction to the client to call upon them when needed. Acting as a resource involves dealing with “sensitive subjects” and requires “honesty, asking direct questions, and ignoring rude behavior.” Detecting and asking the next question “means listening to more than what is said.” When a client is truly

heard and all information is on the table, making an informed judgment is then possible. Sense of time includes the awareness of the long-term commitment of the community health nurse to the client and the belief that results can occur, despite the lack of progress or even regression on the part of some clients.

22.

After teaching a class on urban health to a group of community health nursing, the instructor determines that the teaching was successful when the students describe it as which of the following?

A) Providing care to those individuals who are living in ghettos B) Addressing the needs of immigrants living in large cities C) Considering effects of environment on the health of large cities D) Ensuring the appropriate planning of attractive and equitable places Ans: C Feedback: Urban health considers those characteristics of the environment as they relate to the health of the population living within large cities.

Individuals living in ghettos and immigrants living in large cities are but two segments of the urban population. Urban planning works to improve the welfare of individuals and communities by creating more healthful, efficient, attractive, and equitable places.

23.

A rural community health nurse is acting in the role of a mentor. Which of the following activities would the nurse most likely be doing?

A) Providing childbirth classes B) Contacting a specialist for a client C) Collecting immunization data for program development D) Orienting a new rural health nurse to the community Ans: D Feedback: In the role of a mentor, the rural community health nurse would engage in guiding new community health nurses, nursing students, and other nurses new to the rural community.

Childbirth classes would be characteristic of the educator role. Contacting a specialist for a client reflects the nurse's role as a referral agent. Collecting immunization data for program development reflects the nurse's role as a change agent/researcher.

Chapter 28 Public Settings 1.

As a guest speaker for a group of community health nurses who are considering corrections nursing as a career, a corrections nurse provides an overview of the history of corrections nursing. Which of the following would the nurse describe as the historic view of corrections nursing?

A) Health care to inmates occurred primarily as emergency treatment.

B) Inmates were viewed as not deserving care paid by public dollars.

C) The emphasis was on corrections, not punishment.

D) Prisons provided safe havens from communicable diseases.

Ans: B Feedback: Although the correctional system of prisons and jails has been around for a very long time, it historically provided minimal, if any, health care to inmates. Prison was a punishment, and the inmates were viewed as not deserving of care that was being paid for from public dollars.

Communicable diseases were and continue to be a major health issue.

2.

A nurse is considering a career in public health nursing. The nurse determines the need to obtain which of the following for entrylevel practice?

A) Associate's degree in nursing B) Bachelor's degree in nursing C) Master's degree in nursing D) Post-master's degree certification Ans: B Feedback: The American Nurses Association recommends that an entry-level PHN should have a bachelor's degree in nursing. Some states, such as California, require nurses to take additional classes and obtain certification beyond a bachelor's degree if the BSN program does not offer specific content (e.g., child abuse, public health didactic and practicum). PHNs working with specific populations, or in administration, should hold a master's degree. A PHN with a master's

degree in community/public health nursing may take a national certification examination offered by the American Nurses Credentialing Center.

3.

When describing the differences between public health nursing and nursing in general, which of the following would an instructor include as characteristic of public health nursing? Select all that apply.

A) Acute care services B) Focus on the greater good C) Seek out of clients in need D) Community commitment E) Health restoration Ans: B, C, D Feedback: Public health nurses focus on the greater good, seek out clients in need, and are committed to the community. Public health nursing is grounded in social justice and focuses on health promotion and disease prevention. Public health nursing does not usually include acute care services or health restoration.

4.

Which of the following activities best reflects a public health nurse's role in the public health function of assessment?

A) Prioritizing the issues of a community to determine appropriate interventions B) Evaluating for potential safety hazards in a childcare center C) Ensuring that children in a day care center are properly immunized D) Working with officials to develop a program for solving a problem Ans: A Feedback: The public health function of assessment is reflected when a public health nurse identifies the problems in a community and then prioritizes which issue to address first by deciding which issue impacts the most people and what interventions will help the population thrive. Evaluating for potential safety hazards and ensuring proper immunizations reflect the assurance function of public health. Working with officials to develop programs reflects the function of policy development.

5.

Which one of the following statements best illustrates the similarities and differences between public health nursing and other types of nursing?

A) The priorities are the same for both public health nursing and other types of nursing.

B) In hospital nursing, nurses must address the issues that come to them. Whereas in public health nursing, it is necessary for the nurse to actively seek out and identify potential problems and situations.

C) Nurses whose main practice is in the hospital are required to collaborate more effectively than public health nurses.

D) Nurses who work in public health do not use the nursing process as a foundation for their work.

Ans: B Feedback: In hospital nursing, nurses must address the issues that come to them. Whereas in public health nursing, it is necessary for the nurse to actively seek out and identify potential problems and situations. The priorities vary for both public health nursing and other types of nursing and certainly within different communities that a public health nurse practices. Nurses who work in public health must collaborate as must nurses who work in the hospital. However, the types of people and agencies that a public health nurse must collaborate with vary from the types of people and agencies that a hospital nurse must collaborate with. Nurses who work in public health use the nursing process as a foundation for their work, just as nurses who work in hospitals do. In public health nursing, the community is the client but the nursing process may also be applied to individuals and families.

6.

After teaching a group of students about the federal agencies involved in public health, the instructor determines that the teaching was successful when the students identify which agency as the main organization that is involved in public health?

A) Environmental Protection Agency B) Department of Homeland Security C) Department of Agriculture D) Department of Health and Human Services

Ans:

D Feedback: The main organization involved with public health is the Department of Health and Human Services (DHHS). Other federal agencies that also impact public health include the Environmental Protection Agency (EPA), the Department of Homeland Security, the Department of Agriculture, the Department of Education, and the Department of Veterans Affairs.

7.

A public health nurse is employed by the Indian Health Services. This nurse is working at which of the following levels?

A) Local B) Community C) State D) Federal Ans: D Feedback: The Indian Health Service is an agency headed by the Department of Health and Human Services, a federal agency. Thus the nurse would be working at the federal level.

8.

After teaching a group of students about public health nursing and the U.S. Public Health Service Commissioned Corps, the instructor determines that the students need additional instruction when they state which of the following is necessary to qualify for a position in the Corps?

A) Age over 45 years B) Bachelor's degree in nursing C) Valid nursing license D) U.S. citizenship Ans: A Feedback: To qualify as a nurse in the Commissioned Corps, one must be a U.S. citizen, <44 years old, able to pass a physical examination, possess a bachelor's or higher degree from an accredited nursing program, pass the National Council Licensure Examination (NCLEX), and hold a valid nursing license from one of the 50 states, the District of Columbia, Puerto Rico, Guam or the U.S. Virgin Islands.

9.

A public health nurse working with several communities to develop appropriate programs for health surveillance. Which agency would the nurse contact to obtain information on this topic?

A) Centers for Disease Control and Prevention B) National Institutes of Health C) Agency for Health Care Research and Quality D) Food and Drug Administration Ans: A Feedback: The nurse would contact the Centers for Disease Control and Prevention that is responsible for health surveillance and the prevention of disease and bioterrorism. The National Institutes of Health provide medical research. The Agency for Health Care Research and Quality is responsible for research on health care quality and effectiveness. The Food and Drug Administration works to ensure the safety of food, medication, medical procedures, and equipment.

10.

A community health nurse is advocating for the development of school-based health centers in the community high schools as a means to accomplish which of the following?

A) Maintain the current absentee rate B) Provide contraceptive services C) Increase ready access to health care services D) Promote increased use of emergency services Ans: C Feedback: School-based health centers (SBHC) provide ready access to health care for large numbers of children and adolescents during school hours, reducing absences from school due to health care appointments. SBHCs provide a variety of services in a user-friendly manner at a convenient location. Many SBHCs do not provide contraceptive services on the school site due to school district policy or state law. These centers also are a cost-effective way to decrease visits to the emergency department.

11.

Which one of the types of services that may be available in a school-based health center may be controversial and not be supported by all parents and community members?

A) On-site sexually transmitted infections testing and treatment B) On-site provision of contraceptives C) Well-child care

D) Ans:

Sick-child care B Feedback: Many school-based health centers do not provide contraceptive services on the school site because of school district policy or state law.

12.

During a class, an instructor reviews the impact of the Supreme Court decision regarding Estelle v. Gamble. The instructor determines that the students understand the material when they identify which of the following about this decision?

A) It created the need for cleaner, less crowded facilities.

B) It led to major reforms including establishment of inmates' rights.

C) It required the use of managed care organizations for service.

D) It mandated care to be provided in a timely fashion.

Ans:

B Feedback: The Supreme Court ruled that not providing medical services inflicted pain and denied inmates of their Eighth Amendment rights. This decision led to major reforms in the corrections health system. Medical providers were hired and inmates' rights were established. The decision did not address facilities or use of managed care organizations. Treatment in a timely fashion was not part of this decision. However, later lawsuits involve this issue.

13.

Which of the following health conditions would the corrections nurse expect to address as most prevalent? Select all that apply.

A) Heart disease B) Tuberculosis C) Hepatitis C D) Asthma E) Substance abuse Ans: B, C, E Feedback:

Communicable diseases such as tuberculosis and Hepatitis C are of great concern in the correctional community. In addition, drug abuse by inmates is very high. Heart disease and asthma rates vary.

14.

A school nurse functions to promote a healthy school environment. Which of the following would be most appropriate for the nurse to do?

A) Advocating for proper nutrition and exercise to prevent and reduce the incidence of obesity in school-age children B) Providing care for children with asthma C) Developing individualized health plans D) Engaging in incidental teaching about scoliosis Ans: A Feedback: Promotion of healthful school living emphasizes planning a daily schedule for monitoring healthful classroom experiences, extracurricular activities, school breakfasts and lunches, emotional climate, discipline programs, and teaching methods. It also includes screening, observing, and assessing to identify needs early and report illegal drug use, suspected child abuse, and violations of environmental health standards. Health promotion involves the nurse in supporting the physical, mental, and emotional health of school personnel by being an accessible resource to teachers and staff regarding their own health and safety. Providing asthma care and developing individualized health plans are examples of providing health services.

Engaging in incidental teaching reflects the function of health education.

15.

A school nurse who is not a nurse practitioner works in an elementary school (K-4) with 1,200 students. Which of the following would the nurse engage in with this group? Select all that apply.

A) Screening for scoliosis B) Vision and hearing screening C) Teaching basic health practices D) Monitoring chronic illnesses E) Ordering medications F) Providing primary care Ans: B, C, D Feedback:

Vision and hearing screening, teaching basic health practices, and monitoring chronic illnesses are appropriate school nurse activities for children in this age group.

Scoliosis screening would be more appropriate for children in their early adolescent growth spurt years, not at this age. A school nurse would not order medications. A school nurse practitioner would provide primary care and if allowed by the state, prescribe medications.

16.

A school nurse is describing the responsibilities associated with this specialty to a group of students. Which of the following would the school nurse identify as a primary responsibility?

A) Providing care to children with special health needs B) Preventing illness among the school community C) Performing health screenings D) Assessing acute health problems Ans: B Feedback: The primary responsibilities of the school nurse are to prevent illness and to promote and maintain the health of the school community. The school nurse serves not only individuals, families, and groups within the context of school health but also the school as an organization and its membership (students and staff) as aggregates. Caring for children with special health needs, performing health screenings, and assessing acute health problems are aspects associated with the primary responsibilities of preventing illness and promoting and maintaining the health of the school community.

17.

A school nurse is reviewing the population of school age children for chronic conditions.

Which of the following would the school nurse expect to find most often? Select all that apply A) Rheumatoid arthritis B) Asthma C) Diabetes D) HIV/AIDS E) Tuberculosis F) Seizures Ans: B, C, F Feedback: The four chronic conditions most often seen in school-age children are asthma, diabetes, seizures, and severe food allergies.

Rheumatoid arthritis is not as common. HIV/ AIDS and tuberculosis are more commonly seen in correctional settings.

18.

A school nurse is providing care to a group of children with severe food allergies. Which of the following would be most important for the nurse to include in the child's plan of care?

A) Ensuring that the child has ready available access to EpiPen B) Advising teachers to call the child's parents in case of a reaction C) Teaching other students how to administer the EpiPen D) Administering daily medication to control the allergies Ans: A Feedback: Severe food allergies can lead to anaphylactic shock. School nurses coordinate and work with students and their families, along with school personnel to raise awareness and enlist caution. They also work with families and health care providers to ensure that epinephrine via an autoinjector EpiPen is available for the child in case of emergencies. School nurses also work with teachers and lunch room personnel to alert them of the allergy, explain what can happen in a case of anaphylaxis, and provide training on how to use the EpiPen or other needed medication.

Calling the child's parents in case of a reaction would be important but prompt treatment with epinephrine is the priority. Responsible adults, not other children should know how to administer the epinephrine.

Daily medication usually is not required for children with food allergies, however, avoidance of the allergen is.

19.

A corrections nurse is working to develop programs for inmates and reviews the demographics of this population to determine potential issues. Which of the following would the nurse expect to find?

A) Greater portion of inmates who are white B) Increasing numbers of women in prisons C) Equal distribution of socioeconomic backgrounds D) Incarceration primarily for commission of minor crimes Ans: B

Feedback: Looking at the demographics of inmates, there are many differences from the general population. First, inmates have all committed some type of crime, with nearly half (52%) being violent crimes. National statistics indicate a larger portion of Black (3,042 per 100,000) and Hispanic (1, 261 per 100,000) male inmates than White male inmates (487 per 100,000).

Although males are still the majority population (88.6%), trends show an increase in the number of women in state or federal prisons. In addition, the inmate population is drawn disproportionately from lower socioeconomic backgrounds when compared with the general public.

20.

A corrections nurse is proactively working with the institution to develop programs for the facility to address problems to address the trends for the future. Which type of program would be most appropriate for the nurse to recommend?

A) Treatment of typical disorders found in younger inmates B) Dealing with older, sicker, and longer periods of incarceration for many inmates C) Clinics to address acute disease conditions D) Education for release after shorter incarcerations Ans: B Feedback: Typically, inmates are older, sicker, and remain in prison longer than in previous years.

Therefore, the nurse would need to develop programs to address older inmates with more chronic illnesses and longer incarcerations.

21.

A corrections nurse is visiting a local nursing school to describe this career. Which of the following would the nurse include in the discussion?

A) B) C) D) Ans:

Lower salaries than other fields Primarily assessment oriented Extensive employee benefits Low safety risk C Feedback:

Salaries depend upon the state, although they tend to be higher salaries than in other nursing fields. Moreover, corrections nurses usually receive extensive employee benefits and insurance packages as government employees. Corrections nurses must have good mental health and assessment skills.

They must be able to communicate well and be strong nursing advocates and strong advocates for their clients. They work in an intense environment where their safety could be threatened, and they must deal with clients who may be noncompliant, combative, and manipulative.

Corrections nurses must also be very flexible and knowledgeable about a variety of nursing specialties.

22.

A school nurse is addressing the dental health issues of the local community of school children. Which activity would be most appropriate at the community level?

A) Educating parents about the importance of oral health B) Teaching children how to brush and floss properly C) Assisting with finding resources for those without dental insurance D) Advocating for the fluoridation of drinking water Ans: D Feedback: At a community level, school nurses can educate the public about the benefits of dental fluoride treatments. They can advocate for fluoridation of drinking water, school-based fluoride rinses or gels, and dental sealant programs. At the classroom level, school nurses can provide dental education and provide toothbrushes, toothpaste, and floss to ensure that students are able to practice good dental hygiene habits. At an individual level, school nurses can assist in finding resources for those with no dental health insurance.

Finally, school nurses can successfully educate parents regarding the importance of oral and dental health.

23.

Which of the following would the school nurse who is dealing with a primarily adolescent school population focus on? Select all that apply.

A) Substance abuse B) Eating disorders C) Suicide prevention D) Sexual activity

E) Ans:

Dental sealants A, B, C, D Feedback: Many of the health issues that modern adolescents face are a result of their own choices and high-risk activity; for example, sexual activity, substance abuse, injury, and violence. Eating disorders are most prevalent in adolescent females. Dental sealants are more appropriate for elementary school children.

24.

Which one of the following statements about the common roles and functions of public health nurses, school nurses, and corrections nurses is most accurate?

A) Emphasis is placed on the treatment of disease and disability.

B) Nurses in all of these areas serve the population as client as opposed to individuals as clients.

C) All of these specialty nursing fields are paid very well because their setting is supported through public funds.

D) Public health nurses can influence the health of vulnerable populations more than any of the other specialties.

Ans: B Feedback: Nurses in all of these areas serve the population as client as opposed to individuals as clients. Emphasis is placed on prevention of disease or disability. These community nurses all work in settings that are supported by public funds but the amount of pay varies. All of these specialties of nursing can influence the health of vulnerable populations.

Chapter 29 Private Settings 1.

After reviewing the history of nurse-managed health centers, the instructor determines that the teaching was successful when the students identify which of the following as the beginnings of today's model?

A) 1920s B) 1940s C) 1960s D) 1980s Ans: C

Feedback: Today's NMHCs trace their roots to changes in national health care laws begun in the mid-1960s. However, the nursing model of holistic care focusing on vulnerable populations and integrating primary care and public health dates back to the 19th century.

2. centers to a group of students, which of the following would the instructor emphasize?

A) Use as a vital safety net health care provider B) An alternative to primary care for insured persons C) Focus on the individual in the community D) Affiliation with a local acute care facility Ans: A Feedback: Nurse-managed health centers have emerged as a vital safety net health provider in America's health care delivery system. A “safety-net provider” is defined as a provider that by mandate or mission organizes and delivers a significant level of health care and other healthrelated services to the uninsured, Medicaid recipients, and other vulnerable populations. The distinctiveness of these centers is the community orientation. The centers can be a freestanding business or may be affiliated with universities and other service institutions.

3.

After describing the various models for nurse- managed health centers, the instructor determines that the student understand the information when they identify which organization structure as being partnered legally with a human services organization?

A) Academic nursing center B) Freestanding center C) Subsidiary center D) Affiliated center Ans: D Feedback: An affiliated center is one in which there is a legal partnership with a health care or human services organization. An academic nursing center is located within a School of Nursing.

A freestanding center is an independent center with its own governing board. A subsidiary center is part of a larger health care system.

4.

Which of the following statements about the focus of nurse-managed health centers is most accurate?

A) The focus is providing clinical experiences

for nursing students.

B) They are truly community oriented.

C) They all have the same practice models.

D) They only focus on health promotion and wellness.

Ans: B Feedback: Nurse-managed health centers are truly community oriented. They may provide clinical experiences for nursing students but this is not their focus. They vary in practice models. They provide a range of services from health promotion and wellness to conventional primary care.

5.

A nursing instructor is preparing a group of students for a clinical rotation in a nursemanaged health center. Which of the following would the instructor include when describing the students' role?

A) Clinical supervision B) Passive participation C) Use of tertiary-level activities D) Implementation of best practices Ans: D Feedback: Nurse-managed health centers implement evidence-based practice via best practices or the application of the best available evidence to improve practice. Thus students also would follow this approach. Students' roles are similar to their staff mentors; faculty roles would involve clinical supervision. Students assigned to these centers are active participants in the vital activities of the center.

6.

Which of the following would be the most likely source of funding for services provided in a comprehensive primary care center?

A) Government grants B) Medical insurance plans C) Another nurse-managed care center D) Private contracts Ans: B Feedback: In the comprehensive primary care centers, advanced practice nurses provide primary care services. Such services are usually reimbursable under Medicaid and managed care medical insurance plans. In wellness centers, public health nurses and other interdisciplinary team members provide a range of primary and secondary prevention strategies. These services are usually not reimbursed by insurance plans, but are often covered by grants and contracts. Often

one nurse-managed care center partners with one or more nurse-managed care centers or other community based organizations to provide strength to the proposal for funding.

7.

Which of the following criteria must a nurse- managed health center meet to ensure designation as a Federally Qualified Health Center?

A) Located in a densely populated area B) For profit status C) Consumers comprise the majority of the board of directors.

D) Care provision to women and children exclusively Ans: C Feedback: In order to qualify, the centers must: be located in a medically underserved area or serve a medically underserved population; have a nonprofit, tax exempt, or public status; have a board of directors, a majority of whom must be consumers of the center's health services; provide culturally competent, comprehensive primary care services to all age groups; and offer a sliding scale fee and provide services regardless of ability to pay.

8.

Which of the following statements about funding sources for nurse-managed health clinics is most accurate?

A) All nurse-managed health clinics can be reimbursed by Medicaid and managed care medical insurance plans.

B) Grants can be used as a source of initial start up funding and/or to support ongoing activities.

C) It is common for nurse-managed health clinics to receive funding from one primary source.

D) Contracts are awarded based on competition and are renewable when goals and objectives are not met.

Ans: B Feedback: Grants can be used as a source of initial start up funding and/or to support ongoing activities. In comprehensive primary care centers, advanced practice nurses provide primary care

services that are usually reimbursable under Medicaid and managed care medical insurance plans. Most nursing centers operational and salary budgets entail a combination of funding sources. Contracts are usually noncompetitive and renewable when goals and objectives are met.

9.

After discussing nurse-managed care centers with a group of community health nursing students, the instructor determines that the teaching was effective when the students identify which of the following as one of the main challenges?

A) Ensuring adequate populations for services B) Exerting a positive influence on community's health C) Continuing services after funding has stopped D) Managing the multitude of services provided Ans: C Feedback: Sustainability, or the ability to carry on services and health promotion activities when funding is no longer available, is one of the main challenges of NMHCs. The populations served are vast and not predicted to decrease in light of the current status of health care.

Nurse-managed health centers have much to offer toward resolving the national health care crisis facing vulnerable populations who are uninsured or underinsured and exerting a positive influence on the community's health. Management of the multiple services may be challenging, but the sustainability of the center is paramount.

10.

Which party is usually required to describe detailed plans for sustainability after the award period ceases?

A) The client B) The funder C) The providing organization D) The insurer Ans: C Feedback: In the past, funders were often confronted with the task to help organizations find and secure other resources, or extend their own financial support, to ensure the continuity of services.

More recently, both public and private funders are stipulating that organizations describe detailed plans for sustainability after the award period ceases in their application submitted for funding.

11.

Which of the following statements about faith community nursing is most accurate?

A) Nurses are uniquely able to focus on the spiritual influences on health.

B) Faith community nursing is one of the newest nursing specialties, and one of the oldest means of health care delivery.

C) Faith community nursing is restricted to Christian religious institutions in the United States.

D) For hundreds of years, deaconesses, sisters, and lay members of religious communities have been engaged in health promotion.

Ans: B Feedback: Faith community nursing is one of the newest nursing specialties, and one of the oldest means of health care delivery. Nurses have the unique ability to bridge the disciplines of medicine and religion and assist the client in understanding the physical and spiritual influences on health. The parish nursing movement soon spread outside of Christian religious institutions and beyond the borders of the United States to Canada, Australia, and New Zealand. For hundreds of years, deaconesses, sisters, and lay members of religious communities have been involved in ministering to the sick.

12.

A community health nursing instructor is developing a class plan about faith community nursing for a group of community health nursing students. Which of the following would the instructor expect to include?

A) One of the oldest nursing specialties B) One of the newest means of health care delivery C) Diversity in activities and interventions D) Differences from parish nursing Ans: C Feedback: Activities and interventions used by faith community nurses are as diverse as their faith communities. Faith community nursing is one of the newest nursing specialties and one of the older means of health care delivery.

Nurses practicing in the faith community may be referred to a faith community nurses (FCN), parish nurses, health ministry nurses, or congregational nurses depending upon preference and the traditions of the faith community.

13.

Which of the following agencies was instrumental in developing the first Scope and Standards of Parish Nursing Practice?

A) International Parish Nurse Resource Center B) Health Ministries Association C) American Nurses Association D) Parish Nurse Institute Ans: B Feedback: The Health Ministries Association provides additional resources and support for faith community nursing practice and was instrumental in developing the first Scope and Standards of Parish Nursing Practice. The International Parish Nurse Resource Center, formed in the 1980s, has provided educational programs and resources for nurses seeking to practice as a parish nurse for over two decades. The American Nurses Association in conjunction with the Health Ministry Association has developed the Scope and Standards of Practice for this field of nursing. The Parish Nurse Institute is an organization dedicated to the education and support of registered nurses who wish to practice nursing as Parish Nurses or Faith Community Nurses.

14.

Faith community nurses engage in seven diverse nursing roles. Which one of the roles is distinctly unique to faith community nursing?

A) Advocate B) Integrator of faith and health C) Coordinator of volunteers D) Developer of support groups Ans: B Feedback: To achieve the goal of faith community nursing, seven diverse nursing roles are central to incorporate into practice: Health educator, health counselor, advocate, referral agent, developer of support groups, coordinator of volunteers, and integrator of faith and health. A distinctly unique role of the FCN is as integrator of faith and health.

15.

Which of the following roles would be critical to a faith community nurse to assume to achieve the goals of this practice? Select all that apply.

A) Advocate

B) C) D) E) F) Ans:

Health educator Volunteer coordinator Health counselor Case manager Direct care provider A, B, C, D Feedback: The faith community nurse assumes seven diverse nursing roles as essential for practice including: health educator, health counselor, advocate, referral agent, developer of support groups, coordinator of volunteers, and integrator of faith and health. Case manager and direct care provider are not considered roles of the faith community nurse.

16.

A faith community health networks with a local transportation service to provide service to several clients in the community needing rides to health care appointments. The nurse is functioning in which of the following roles?

A) Developer of support groups B) Referral agent C) Advocate D) Health counselor Ans: B Feedback: The faith community health (FCN) nurse functions as a referral agent through networking with community agencies to assist and guide the client through the health care system and connect the client with needed community resources. As a developer of support groups, the faith community nurse develops groups tailored to the faith community needs such as coping with loss and grief, cancer, caregiver stress, chronic illness, single parenting, addiction recovery, and more. The FCN may lead or facilitate the support groups or may train others to fulfill those positions. As an advocate, the FCN uses knowledge of the health care system and awareness of safe and effective care practices to facilitate appropriate, timely intervention. In the health counseling role, the nurse seeks to understand the individual's perceptions, fears, and barriers that prevent the person from taking action.

17.

Place in order, the steps involved in creating a faith community nursing position within a faith community.

A) Seek support of the faith community members and staff.

B) Seek formal approval from the organization's governing body.

C) Assess the community the nurse plans to serve and identify the health needs of the faith community and the roles of the faith community nurse that meet those needs.

D) Solicit input from the staff and spiritual leaders of the faith community.

Ans: C, A, D, B Feedback: First the faith community nurse must assess the community the nurse plans to serve and identify the health needs of the faith community and the roles of the faith community nurse that meet those needs. Then the faith community nurse must seek support of the faith community members and staff.

Then the faith community nurse must solicit input from the staff and spiritual leaders of the faith community. Finally, the faith community nurse must seek formal approval from the organization's governing body.

18.

Which of the following are the main categories of occupational health nursing practice? Select all that apply.

A) Safety B) Compliance C) Health promotion D) Care Ans: B, C, D Feedback: Occupational health nursing practice can be divided into three main categories: compliance, care, and health promotion.

19.

An occupational and environmental health nurse recently treated approximately 20 employees for hand injuries. The employees all work on the factory assembly line. The nurse decides to implement a program for primary prevention. Which of the following activities would be appropriate?

A) Institute an orientation for employees about the equipment B) Conduct hearing screening tests of the employees

C) Institute whirlpool treatments for injured extremities D) Ensure adherence to physical therapy regimen for injured workers Ans: A Feedback: Instituting an orientation program reflects primary prevention, that is, preventing an illness or injury from occurring. Conducting hearing screening would reflect secondary level of prevention. Whirlpool treatments and physical therapy would reflect tertiary level activities.

20.

When describing the major functions of an occupational and environmental health nurse, which of the following would the nurse identify as being the most time consuming?

A) Activities involving safety education B) Care of injured employees C) Programs for improved working conditions D) Teaching activities for healthy nutrition Ans: B Feedback: In addition to emergency care and nursing of ill employees, the activities of many industrial nurses involved safety education, hygiene, nutrition, and improvement of working conditions. Yet, a significantly high number of industrial injuries and sick employees kept many nurses too busy to do anything but care for the ill.

21.

After teaching a group of community health nursing students about the trends affecting occupational and environmental health nursing, the instructor determines that more teaching is needed when the students identify which of the following as a trend?

A) Continued escalation of health care costs B) Upturn in the global economy C) Increase in worldwide competition D) Increase in technologic hazards Ans: B Feedback:

Four critical issues affect the practice of occupational and environmental health nursing.

First, the downturn in the global economy, and in the economy of the United States specifically, has skeletonized many worksites, shut down companies, eliminated night or evening shifts, or moved companies to less expensive communities. Second, increasing worldwide competition requires businesses to remain competitive by reducing or controlling operating costs at the lowest level possible. Third, there has been an increase in technologic hazards that require a sophisticated approach as well as knowledge of toxicology, epidemiology, ergonomics, and public health principles. Fourth, health care costs continue to escalate at faster rates than most company profits do.

22.

Which activity would an occupational and environmental health nurse expect to perform in the future based on current trends?

A) Supervise care for emergency illnesses B) Counsel employees about health risks C) Perform periodic health assessments D) Suggest cost-effective in-house health services Ans: D Feedback: Future occupational health nurse activities will involve recommending more efficient and cost-effective in-house health services. Supervising care for emergency illnesses, counseling employees about health risks, and performing periodic health assessments are current occupational and environmental health nursing activities.

23.

Which of the following would an occupational and environmental health nurse need to keep in mind when selecting the field of nursing?

A) The workplace is very similar to a health care institution.

B) The nurse focuses on health not workforce productivity.

C) Production or service is a primary goal.

D) The nurse functions in a supervisory position.

Ans: C Feedback: Unlike hospitals or ambulatory care centers, the workplace is a non-health care institution in which production or service (not health care) is the primary goal. The occupational and environmental health nurse participates in the organization's goals through activities that

contribute to the productivity of the workforce. An occupational and environmental health nurse in the organization is in a staff position, taking on the role of a consultant, educator, or role model in the workplace, but has no supervisory responsibilities or power to hire or fire workers.

24.

A community health nursing student is interviewing several occupational and environmental health nurses about their experiences. Each of the nurses works in a small organization and is the only nurse for the company. Which of the following would the student most likely note as being similar among the nurses?

A) Use of critical thinking skills B) Collegial relationships C) Decrease in workload D) Role certainty Ans: A Feedback: The occupational and environmental health nurse, especially in smaller organizations, may be the only nurse in the company. As a result, she or he has none of the on-site consultation and direction that are needed for comfortable, competent, and independent decision making.

Nurses who use critical thinking skills to develop a framework for independent problem-solving enhance their efficiency. In addition, the nurse may feel isolated because of being the only health professional. The corporate culture and leadership may foster work overload, be nonsupportive, and have limited career opportunities for the nurse. The nurse may experience role ambiguity due to a lack of professional preparation or inadequate orientation and continuing education.

25.

Which of the following about the educational preparation for occupational and environmental health nursing is most accurate?

A) Any licensed nurse can provide the services necessary.

B) Because it is a specialty of nursing, a Bachelor's degree in nursing is required.

C) Ideally, a nurse would be prepared for these specialties at the graduate level.

D) This career option is restricted to advanced practice nurses.

Ans:

C Feedback: Ideally, a nurse would be prepared for these specialties at the graduate level. It is a minimum requirement that the nurse be licensed but there is a special knowledge set and skill set required for this position. A Bachelor's degree in nursing is not required for this job but would be a good start. This career option is not restricted to advanced practice nurses.

26.

Which of the following are adverse working conditions that may impact the health status of nurses. Select all that apply.

A) Physical hazards B) Radiation hazards C) Biological hazards D) Chemical hazards E) Low pay Ans: A, B, C, D Feedback: Nurses may be exposed to physical, radiation, biological, and chemical hazards. Nursing is not considered to be a low-paying job.

27.

After discussing the effects of shift work on workers' health, the nurse educator knows that the nursing students understand this concept when the nursing students make which of the following comments?

A) “It is beneficial for workers to have their circadian rhythms disturbed.”

B) “Rotating shifts negatively impacts sleep and rest cycles.”

C) “Shift work interferes with a person's social life.”

D) “Insufficient sleep is associated with respiratory problems and weight loss.”

Ans: B Feedback: Rotating shifts negatively impacts sleep and rest cycles. It is not beneficial for workers to have their circadian rhythms disturbed. Shift work may interfere with a person's social life but that is not a primary effect on health.

Insufficient sleep is associated with obesity and diabetes.

28.

Which of the following statements about nurse entrepreneurship in community/public health practice is most accurate?

A) It allows for innovation in meeting needs of the community.

B) Nurse entrepreneurs are most commonly associated with institutions.

C) It is very easy for a nurse to become an entrepreneur.

D) It is most likely to fail.

Ans: A Feedback: Nurse entrepreneurship allows for innovation in meeting the needs of the community.

Nurse entrepreneurs are not most commonly associated with institutions. It is very difficult for a nurse to become an entrepreneur. There may be failure in nurse entrepreneurship but without the risk of failure, it is not possible to advance.

Chapter 30 Home Health and Hospice Care 1.

The nurse educator knows that the nursing student understands the contributions that Lillian Wald made to home care when the nursing student makes which one of the following statements?

A) “Lillian Wald made the earliest known effort to care for the sick poor at home.”

B) “Lillian Wald trained nurses so that wealthy women would hire them as visiting nurses.”

C) “Lillian Wald began home visiting in New York City and is famed for professionalizing visiting nurses.”

D) “Lillian Wald approached congress with the idea of Medicare Home Health Benefit.”

Ans: C Feedback: Lillian Wald began home visiting in New York City and is famed for professionalizing visiting nurses. It was the Ladies Benevolent Society in Charleston, South Caroline who made the earliest known efforts to care for the sick at home. It was Florence Nightingale who trained nurses so that wealthy women would hire them as visiting nurses. Lillian Wald did establish insurance coverage for home care with the Metropolitan Life Insurance Company but this was in the early 1900s and the Medicare Home Health Benefit did not exist until 1965.

2.

After reviewing the various events associated with the history of home health care, the students demonstrate understanding of the events when they state which of the following as the most significant influence on the growth of home care agencies?

A) Creation of the visiting nurse associations B) Era of the Medicare Home Health Benefit C) Enactment of the Balanced Budget Act D) Discharge of nonacute clients Ans: C Feedback: The number of Medicare-certified home care agencies grew rapidly until enactment of the Balanced Budget Act of 1997 that sought explicitly to reduce federal payments for home health care by changing the payment from reimbursement for each visit to the Medicare Prospective Payment System that determined Medicare payment rates based on client characteristics and need for services.

Visiting nurse associations, discharging of nonacute clients, and the Era of the Medicare Home Health Benefit had no effect on the growth of agencies.

3.

Which one of the following statements best describes the family caregiver burdens of providing home care?

A) care.

Family members are expected to contribute financially to cover all of the costs of home

B) Individuals recovering from severe illness or living with debilitating chronic illness rely on family members for unpaid assistance.

C) Informal caregivers assume a considerable physical, psychological, and economic burden in the care of their loved one at home.

D) Caregivers often describe themselves as emotionally and physically drained.

Ans: D Feedback: The best description of family caregiver burdens is that caregivers have other responsibilities but that their caregiver tasks compete for time, energy, and attention leaving them emotionally and physically drained. Informal caregivers assume a considerable physical, psychological, and economic burden in the care of their loved one at home. Individuals recovering from severe illness or living with debilitating chronic illness rely on family members for unpaid assistance. The other two statements describe the burden in part but the best description is where caregivers often describe themselves as emotionally and physically

drained.

4.

When evaluating a client's eligibility for Medicare-reimbursed home care, which of the following is crucial?

A) The client needs visits by a homemaker.

B) The client is homebound.

C) The client is a veteran.

D) The client is terminally ill.

Ans: B Feedback: Homebound status is a requirement and means the person can only leave the home with difficulty and only for medical appointments or adult day care. Medicare requires that the recipient of reimbursable services need skilled services. The services of a homemaker are not considered a skilled service and are not a requirement for receiving services. There are no requirements that the client be associated with the military, either now or in the past. A client must be considered terminally ill to receive hospice services reimbursed by Medicare but not home health care—the person would just require skilled services.

5.

An instructor is describing the various types of home health care agencies and uses the visiting nurse association as an example of which of the following types?

A) Voluntary nonprofit B) Hospital-based C) For-profit proprietary D) Noncertified Ans: A Feedback: Visiting nurse associations are examples of voluntary nonprofit agencies. Hospital-based agencies are those involving a hospital operating a separate department as a home health agency.

It may be nonprofit or generate revenue for the hospital. For-profit proprietary agencies can be governed by individual owners, but many are part of large, regional, or national chains that are administered through corporate headquarters. Many agencies providing services in the home remain outside the federal Medicare system that reimburses skilled nursing. These noncertified agencies are usually private and derive their funding from direct payment by the client or from private insurers.

6.

Assessment of a client in the home reveals that his or her services will be paid by a government source. Which of the following would be a possible source of payment?

A) Insurance company B) Health maintenance organization C) Medicare D) Preferred provider organization Ans: C Feedback: Government payers include Medicare, Medicaid, the military health system (TRICARE), and the Veterans Administration system. Corporate payers include insurance companies, health maintenance organizations (HMOs), preferred provider organizations (PPOs), and case-management programs.

7.

A home health care nurse performs an initial visit to a client and determines that the client meets the criteria for services with Medicare reimbursement. The nurse understands that this service will be reimbursed for which period?

A) 30 days B) 60 days C) 90 days D) 120 days Ans: B Feedback: The Medicare prospective payment system (PPS) pays an agency for a 60-day “episode of care.” All services and many medical supplies must be provided under the payment amount adjusted to geographic location and determined by the client's clinical and functional status at the start of care, as well as the projected need for services over the anticipated 60-day period.

8. home health care agency. Which of the following would the agency want to achieve higher percentage rates?

A) Hospital admissions B) Urgent unplanned medical care C) Deteriorating wound status D) Decreased pain with movement Ans: D Feedback: A home health care agency would want to achieve higher percentages of the measure involving decreased pain with movement. A higher percentage indicates that the clients are improving with care. The agency would want to achieve decreased or lower percentages for hospital admissions, urgent unplanned

medical care, and deteriorating wound status.

9.

A home health care nurse is working with informal caregivers. Which of the following is most important?

A) Include the client's spouse or significant other in the plan B) Visit frequently to manage and maintain equipment C) Focus on caretaker abilities, not their limitations D) Use nurse's intuition to determine what to teach first Ans: C Feedback: Keeping a positive attitude that is focused on abilities, not limitations, of the caregivers is most important. The home health care nurse includes all family members and caregivers in the plan, teaches family members and caregivers how to manage and maintain equipment, and chooses an area to teach first that the client or caretaker is motivated to learn.

10. care?

A) B) C) D) Ans:

When providing home health care, which individual is responsible for coordinating the

Registered nurse Social worker Physician Dietician A Feedback: The registered nurse is considered the coordinator of care. The social worker is another clinical staff member but is not the coordinator of care. The physician directs the skilled care to clients by agreeing (signing the nurse-generated paperwork) with the plan of care established by the registered nurse who coordinates the care. The dietician is another clinical staff member but is not the coordinator of care.

11.

When visiting a client in the home for the first time, which of the following is absolutely critical to remember?

A) There may be dangers lurking around every corner.

B) Clients are glad to have the nurse in their

home.

C) The nurse is a guest in the client's home.

D) The nurse knows what is best for the client.

Ans: C Feedback: Once the nurse arrives at the client's home, there is the challenge of getting through the closed door and making the connection. The nurse must always remember that he or she is a guest in the home. Although there may be dangers, the nurse must focus on the client while maintaining a watchful eye. Clients may be apprehensive or suspicious about a nurse coming to visit, wondering why or what they did. Not all clients are welcoming. The nurse needs to start where the client and family are, not what the nurse thinks is best.

12.

A home health care nurse reviews the most common conditions managed at home. Which of the following are the most common conditions managed at home? Select all that apply.

A) Chronic skin ulcer B) COPD C) Heart failure D) Terminal cancer E) Diabetes Ans: A, C, E Feedback: The most common diagnoses managed at home are diabetes, chronic skin ulcer, essential hypertension, heart failure, and osteoarthritis

13.

When developing the plan of care for a client receiving home health care services, which of the following would be the most important goal?

A) Promotion of client independence B) Complete resolution of the problem C) Detecting family conflicts D) Ensuring access to resources Ans: A Feedback: The most important goal of home health care is to promote independence and selfmanagement. Every effort is made to develop the capacity for self-care so that the home team can safely withdraw. Complete resolution of the problem in many cases is unrealistic. Detecting

family conflicts and ensuring access to resources are areas that the nurse addresses and intervenes if necessary to promote the ultimate goal of self-care.

14.

When providing palliative care to a client receiving hospice care, which of the following would be important? Select all that apply.

A) Assume nothing about what is wrong B) Use the most complex interventions first C) Believe what the client is reporting D) Be persistent in trying different strategies E) Wait until the symptoms recur to relieve them Ans: A, C, D Feedback: When providing palliative care, the nurse should make no assumptions about what is wrong; believe the client's report of symptoms; anticipate the symptoms and relieve them before they recur; choose the least complex and most manageable interventions that clients and families can manage themselves at home; and never give up, but persist in trying different palliative strategies.

15.

The family of a hospice client is holding a vigil at the client's bedside. During a visit, a hospice nurse participates in this vigil and encourages each of the family members to say their good-byes. The nurse is demonstrating which of the following?

A) Palliative care B) Guided letting go C) Connecting D) Responsive use of self Ans: B Feedback: Guiding letting go is a truly unique nursing practice that involves helping the client to let go of former activities and hopes, including life itself. This involves listening to intense emotions and helping the person and family find resolution. Sometimes it involves participating in a vigil at the bedside of the dying person and encouraging loved ones to say their final words of farewell. Palliative care involves the relief of suffering without curing the underlying disease.

Connecting refers to the centrality of relationships in providing hospice care as the nurse seeks to understand the emotional and spiritual distress common to the end of life. Responsive use of self is the process expert nurses use to understand the lives of vulnerable clients in the community resulting in stereotypes and assumptions being overturned.

16.

As part of a group exercise, students are to compare and contrast home care and hospice care. The instructor determines that the activity was successful when the students identify which of the following as reflective of home health care?

A) Emphasis on rehabilitation B) Focus on health of the whole family C) Expert use of opioids for suffering D) Management of symptoms Ans: A Feedback: Home health care emphasizes rehabilitation and stabilization of the client whereas hospice emphasizes the quality of life and comfort.

Focusing on the whole family, expert use of opioids for suffering and management of symptoms are features associated with hospice care. In contrast, home health care focuses on the health of the client; opioids are used hesitantly to reduce suffering; and symptom management may require hospitalization if unmanageable.

17.

A home health care nurse is assigned to visit a client's home. The nurse identifies the area as a problem neighborhood. Which of the following would be most appropriate for the nurse to do?

A) Perform the visit via telephone B) Have another nurse buddy along C) Reschedule the visit for another time D) Leave the cell phone at home Ans: B Feedback: If there is a question of safety, the nurse should have another nurse accompany him or her on the visit. It would be inappropriate to perform the visit over the telephone. The nurse needs to physically see the client to perform the assessment. The agency typically has policies about how soon after a referral the client must be seen. So, rescheduling the visit may not be an option. In addition, rescheduling the visit does nothing to address the safety issues. The nurse should carry his or her cell phone but leave any valuables, such as cash, wallet, or purse locked in the care.

18.

A home health care nurse is invited as a guest speaker to talk to a group of students about challenges of working in the home. As part of the discussion, the nurse describes medication safety. Which of the following would the nurse include as a measure to address this issue?

A) Asking the client what he or she takes the drug for B) Throwing out any medications over 1 month old C) Reconciling drugs in the home with those on the discharge sheet D) Setting up medication boxes to organize the medications Ans:

C Feedback: It is important for the home health care nurse to reconcile the medications in the client's home with those on the discharge sheet. If there are any discrepancies, then the nurse should contact the client's primary care physician to clarify any differences and confirm the orders.

Asking the client what he takes the drug for provides limited information. The nurse needs to know if he or she is taking it currently, and if so, the frequency and dosage. Throwing out any medications that are over 1 month old is inappropriate. A medication may have been ordered previously but was inadvertently missed on the discharge sheet. The nurse must always double check the order and with the physician about any medication. Setting up medication boxes are helpful to organize the medications, but the nurse still needs to verify that the client should be taking the medication.

19.

When describing the philosophy of hospice care to a group of students, which of the following would the instructor include?

A) The right to die and euthanasia B) Working with people in their last year of life C) Holistic and family-centered care to terminally ill clients D) Weaving hospice concepts around curative treatment Ans: C Feedback: The philosophy of hospice care includes holistic and family-centered care to terminally ill clients. Hospice care is delivered to terminally ill people with the recognition that death is a human experience. Euthanasia is not part of the care. Hospice care can be initiated after a physician has declared that a person has 6 months or less to live. Hospice care is initiated in the final phase of a person's illness when he or she is not receiving

curative treatment.

20.

After teaching a group of students about hospice and its view of end-of-life care, which statement by the students indicates a need for additional teaching?

A) Care should attend to the body, mind, and spirit.

B) Death is not considered a taboo topic.

C) Medical technology should be used widely.

D) Clients have a right to truthful discussion.

Ans: C Feedback: The hospice movement has emphasized four major changes in end-of-life care: (1) care should attend to body, mind, and spirit; (2) death must not be a taboo topic; (3) medical technology should be used with discretion; and (4) clients have a right to truthful discussion and involvement in treatment decisions.

21.

A client will receive hospice care under the Medicare Hospice Benefit. The nurse understands that which of the following is true?

A) The client denies terminal prognosis.

B) The client has a prognosis of at least 6 months of life.

C) The client chooses life-extending care.

D) The hospice acts as clinical and financial case manager.

Ans:

D Feedback: The Medicare Hospice Benefit requires that a client, who has a prognosis of 6 months or less, must sign up for the comfort-focused hospice benefit and waive the regular hospice benefit.

This mandates that the client acknowledge a terminal prognosis and choose comforting care instead of life-extending care. When this choice is made, the hospice coordinates care in all settings, functioning both as clinical and financial case manager.

22.

When describing the role of hospice nurses to a group of students, a hospice nurse identifies which of the following as most important?

A) Speaking the truth B) Sustaining oneself C) Encouraging choice D) Strengthening the family Ans: B Feedback: Although speaking the truth, encouraging choice and strengthening the family are key interventions of a hospice nurse, sustaining oneself is the priority. Effective hospice nurses understand that to care for others, they must care for themselves because without a healthy nurse, the client cannot thrive.

23.

Which of the following Medicare definitions prevent people who could benefit from home care services from receiving those services, even when it would be most cost effective for the client to receive home care rather than more expensive emergent and inpatient interventions? Select all that apply.

A) Home-bound status B) Medical necessity C) Prospective payment D) Skilled nursing Ans: A, B, D Feedback: The entire model for service provision in the home must change to a health care delivery system that continuously serves those living with disabling and terminal illness to maximize well-being at home, anticipate and prevent crises, and minimize emergent and inpatient interventions. The Medicare definitions of homebound, medical necessity and skilled nursing must become extinct.

24.

Which one of the following Medicare policies prevent people who could benefit from hospice services from receiving those services, even when it would be most cost- effective for the client to receive hospice rather than inpatient interventions?

A) Controlled cost at the expense of assuring quality of life and comfort B) That a person must discontinue treatment in

order to receive hospice service.

C) Education and support for clients and family caregivers D) Refusing to pay for homemaking and personal care that might keep a person at home as long as possible Ans: B Feedback: The Medicare requirement that patients receiving hospice benefits must have discontinued treatment in order to receive hospice service. It is not appropriate for there to be controlled cost at the expense of assuring quality of life and comfort.

Education and support for clients and family caregivers is important, and homemaking and personal care might keep a person at home as long as possible that would reflect a cost savings in the long run.