Test Bank for Public Health Nursing;Population-Centered Health Care in the Community 10E by Stanhope

TEST BANK

TEST BANK

Chapter 01: Public Health Foundations and Population Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the primary focus to be addressed concerning the improvement of the health of the American people in the twenty-first century? a. Bioterrorism and global health threats b. Delivery of individual care and hygiene c. The need for increased hospital and acute care d. Chronic disease and disability management ANS: A There are new concerns, and of the most serious are bioterrorism and globally induced infections, such as the avian flu. These threats will divert health care funds and resources from other health care programs to be spent for public safety. The others are not related to public health or are concerns that have been present for many years.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 2. A community is concerned about the threat of bioterrorism. Which of the following best describes the basis for this concern? a. Bioterrorism has the potential to dissolve community-based programs. b. This threat could causeN thUeR heSaI lthNcGaT reBs. ysC teO mMto collapse. c. The threat may divert funds from other public safety health care programs. d. Fear of bioterrorism will increase the need for shelters.

ANS: C Bioterrorism may have an impact on the availability of resources for public safety health care programs. Because funds are diverted it is possible that community-based programs would be eliminated, the health care system could experience changes, and that there would be an increase in the need for shelter. However, all the remaining options would happen because of the diversion of funds.

DIF: Cognitive level: Analyzing MSC: NCLEX: Physiological Integrity

TOP: Nursing process: Diagnosis

3. Which statement describes the consequence of the successful implementation of the Affordable Care Act? a. Americans will pay closer attention to their health status. b. Most of the population will be covered by health insurance. c. Public health departments will need to increase the number of nursing positions. d. The prevalence of obesity will decrease.

ANS: B

One consequence of successful implementation of the Affordable Care Act might be that the majority of the population would be covered by insurance and public health agencies will not need to provide direct clinical services in order to assure that those who need them can receive them. The Affordable Care Act will not directly cause Americans to pay closer attention to their health status or decrease the prevalence of obesity.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. The public health nurse (PHN) must participate in the essential services of public health.

What is one of the essential services of public health nursing? a. Monitoring health status by completing a community assessment b. Diagnosing and investigating health problems in the world c. Informing, educating, and empowering people about health issues d. Working in law enforcement to regulate health and ensure safety ANS: C The PHN monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The PHN would not diagnose or solve “world” problems, or work in law enforcement. Rather, the PHN would participate with local regulators to protect communities and empower people to address health issues.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 5. A public health department is using the mission of public health as described by the Institute of Medicine when planningNitsR heaI lth pGrogB ra.mCminMg. Which of the following activities will U S N T O most likely be implemented? a. Tracking avian flu outbreaks and doing surveillance in the United States b. Providing a flu shot for an elderly person at the health department c. Keeping track of alternative therapies in use in the United States d. Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta ANS: A The Institute of Medicine’s stated mission on public health is “to generate organized community and technical knowledge to prevent disease and promote health.” Tracking avian flu outbreaks and doing surveillance applies this concept at a population level. Providing a flu shot for an elderly person only addresses individual care. Keeping track of the use of alternative therapies does nothing to prevent disease or promote health of the population.

Keeping snake antivenom is aimed at disease care for an individual, not health promotion or disease prevention.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a. Policy development

b. Assessment c. Assurance d. Scientific knowledge-based care ANS: C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy.

Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge but is not a core function.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. What is the purpose of public health core functions? a. Clarifying the role of the government in fulfilling the mission of public health b. Ensuring the safety of populations in receiving quality health care c. Providing community-based individualized care to every person in the United States d. Uniting public and private providers of care in a comprehensive approach to providing health care ANS: A As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purposeofclarifying thegovernment’s role.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. Which of the following statements about public health is accurate? a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b. Expenditures and resources for public health have increased in recent years. c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and food safety. d. Reform of the medical insurance system is the single change needed to improve the health of Americans.

ANS: C Fielding and Tilson have asserted that most of the increase in life span has been made through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. Medical treatment has not made as significant of an impact on the life span as public health measures. Funding for public health in recent years has been on a gradual decline. Although reform of the medical insurance system may help improve the health of Americans, there are many other factors that will need to be addressed.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A public health nurse (PHN) collects data and monitors the health status of the population.

Which of the following core public health functions is the nurse addressing? a. Assessment b. Prevention c. Assurance d. Policy development ANS: A Assessment consists of systematic data collection and monitoring health status.

Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. The public health nurse (PHN) compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is the nurse addressing? a. Assurance b. Assessment c. Prevention d. Policy development ANS: B Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a core function, assurance is making sure essential services are N men RStIisNnee GTded B.C M available, and policy developU to O provide leadership in developing policies.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. A public health nurse (PHN) develops and implements local public health policies through partnerships with agencies, organizations, and consumers within the community. Which of the following core public health functions is the nurse addressing? a. Assessment b. Prevention c. Assurance d. Policy development ANS: D Policy development deals with developing and implementing health policies. Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

12. A nurse provides for the availability of essential personal health services for people who would otherwise not receive health care. Which of the public health core functions is the nurse addressing a. Assessment b. Prevention c. Assurance d. Policy development ANS: C Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 13. The nurse manager makes sure that the staff members who work in a local clinic are competent in their job responsibilities. Which of the public health core functions is being demonstrated? a. Assurance b. Assessment c. Prevention d. Policy development ANS: A Assurance refers to making sure a competent health care workforce is available. Prevention is not a core function, assessment refers to systematic data collection, and policy N R I G eB.C M development refers to the neeUd toSproNvidT leadeO rship in developing health policies.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 14. Which intervention is the nurse most likely to implement when addressing one of the primary goals of public health? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old woman ANS: C The correct answer is concerned with the health of many people, while the other answers address individual interventions. According to the Core Functions Project, all levels of health care, including population-based public health care, must be funded or the goal of health of populations may never be reached.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

15. A community health nurse collects data about the number and proportion of persons aged 25 or older with less than a high school education. Which term best describes this type of data? a. Sociodemographic characteristics b. Health status data c. Health risk factors d. Health care resource consumption information ANS: A The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Health risk factors discuss proportions of populations who have particular health conditions or health risks. Health care resource consumption refers to spending on health care per capita.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 16. The public health nurse (PHN) analyzes data related to the number and type of United States Environmental Protection Agency air quality standards that a community failed to meet.

This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional status ANS: C Health risk factors discuss proportions of populations who have particular health conditions or health risks; breathing air of poor quality is a risk to health. The number and proportion N hic RScha IN G eristic.

B.CO M of people is a sociodemograpU ractT Health status includes birth and death rates.

Functional status refers to reports of good health status by members of the population.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is implementing quality performance standards in a public health department.

Which statement best describes the importance of this action? a. Quality performance standards are used to guide improvement in the public health system. b. Quality performance standards rigidly control public health. c. Quality performance standards guide administrators to monitor public health at the national level. d. Quality performance standards can be used as hiring guidelines for nurses.

ANS: A These standards were developed by the Centers for Disease Control and Prevention in 1998.

They set the bar for the level of performance that is necessary to deliver essential public health services (PHSs). These standards were developed around the 10 essential PHSs. They focus on the overall public health system rather than on single organizations and describe an optimal level of performance. They are intended to support a process of quality improvement. State and local communities can assess their performance using certain available tools. They are not meant to control public health or be used for hiring guidelines.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. To better address emerging public health issues, a public health nurse (PHN) plans to complete continuing education in this area. Which content areas should be included in the course that is chosen? a. Leadership b. Ethics c. Communication d. Finance ANS: B Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: (1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory research, (5) policy, (6) law, (7) global health, and (8) ethics.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. The public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management b. Workforce needs assessment c. Acute care services ntURSINGTB.COM d. Curriculum developmeN ANS: A Workforce needs assessment, acute care services, and curriculum developments are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: (1) analytic/assessment, (2) policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems thinking.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 20. Why is public health nursing considered a nursing specialty? a. It has a distinct focus and scope of practice. b. It requires a master’s degree in nursing. c. It is focused on disadvantaged citizens. d. It performs interventions at the acute care level.

ANS: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. The necessary basic preparation for public health nursing is what level of nursing education? a. Associate degree b. Baccalaureate degree c. Master’s degree d. Doctor of Nursing Practice ANS: B A Bachelor of Science in nursing (BSN) is the necessary basic preparation to function as a beginning staff PHN. An Associate degree is not enough for basic preparation. A Master’s degree or Doctor of Nursing Practice degree would be part of preparation for advanced practice.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 22. A public health nurse (PHN) has been prepared at the graduate level. Which activity should the practitioner be able to complete? a. Teaching public and community health nursing b. Assessing and intervening successfully at the aggregate level c. Diagnosing and treating disease while having earned prescriptive authority d. Running for political office as experts in public health policy ANS: B According to the Consensus Conference, specialists should have assessment skills that allow Negat RSe IleN G B.C health M practitioners have a broad range of them to intervene at the aggrU vel.TPublic O practice areas within public health and are not limited to only nursing and medicine.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A public health nurse (PHN) provides clinic-based services for HIV-positive citizens in the community. Which term best describe this activity? a. Primary prevention b. Health education c. Tertiary prevention d. Policy making ANS: C This clinic is for clients who already have a disease process; therefore, it is tertiary prevention (preventing deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care). Primary prevention is using general and specific measures in a population to promote health and prevent the development of disease (incidence) and using specific measures to prevent disease in those who are predisposed to developing a particular condition. Health education would involve providing specific education to this population. Policy making is formulating plans by an organization in order to make decisions.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A nurse is working in the community with an aggregate/population. Who is the nurse most likely to interact with? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who drink coffee ANS: A A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. Members of a community who can be defined in terms of geography or a special interest can be seen as constituting a population. The clients in the first option share a geographical and special circumstance (school) characteristic.

Christians around the world are too large of a geographical space. A patient cannot be an aggregate/population as there is no one to interact with. People who drink coffee share a common interest but may not share a common geographical location to interact.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 25. How is a population best defined? a. High-risk group b. Those interacting within a school or institutional setting c. Collection of individuals who share at least one common characteristic om d. Geographical location w NiUthRinSaIcN GmTuBn.ityCOM ANS: C A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. High-risk groups, school or institutional setting, and geographical location within the community all describe types of populations, not the definition of population.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 26. Population-focused practice concentrates on defining the problems or needs of and implementing solutions for whom? a. Individuals b. Aggregates c. Communities d. Geographical regions ANS: B Aggregates are a defined population made up of individuals in communities of a specific geographical region. Population-focused practice is implemented with defined populations or subpopulations. This is larger than the scope of individual care but may not address the larger needs of the entire community or geographical region.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 27. A nurse is using a population focus when providing public health nursing care. Which statement best describes the care that is being provided? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered.

ANS: C PHNs are concerned with the health of the entire population. Priority is given to the entire population, not just the group at highest risk or those outside of institutional settings. Direct caregiving is not the focus of public health nursing care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 28. A nurse is working in a community health nursing practice setting. Which intervention is the nurse most likely to implement? a. Administering a flu shot to a client in a physician’s office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation center ANS: A Community health nursing practice focuses on the health of individuals, families, and groups and the effect of their health status on the health of the whole community.

Administering a flu shot to an individual is the only example that meets this criterion.

Performing a client assessment focuses only on individual care, not the community.

Providing supervision of staff does not focus on the community. Conducting a flu shot clinic at a community center focuses on protecting the community as a whole and would be considered public health nursing practice.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 29. Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the whole community. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice.

ANS: A

Public health nursing provides care to protect the health of the community as a whole.

Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff PHN; however, this is not a requirement for public health nursing or community health nursing practices.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 30. A nurse is implementing community-based nursing care. Which intervention is the nurse most likely to complete? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a community ANS: B Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition. Assessing the health needs of a community, promoting the health needs of an entire community, and investigating environmental health problems in a community would be considered public health nursing practice.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 31. A nurse is conducting vision screenings on children in the school setting. Which type of U S N T O nursing practice is the nurse performing? a. Community-oriented b. Public health c. Community health d. Community-based ANS: D Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the whole community. Community health nursing focuses on the health status of individuals and the effect of their health status on the whole community.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 32. The nurse is investigating environmental health problems caused by contaminated ground water. Which type of nursing practice is being implemented? a. Community-oriented b. Community-based c. Policy development d. Tertiary care

ANS: A Community-oriented nursing emphasizes the prevention of disease and disability.

Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Policy development seeks to build constituencies that can help bring about change in public policy. Tertiary care focuses on highly specialized medical care.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 33. A public health staff nurse (PHN) who has a clear understanding of population-focused practice, would most likely engage in what activity? a. Volunteering for a local community action coalition b. Performing interventions with individuals in the community c. Improving the effectiveness of care provided d. Considering earning a PHN certification ANS: C Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. PHN specialists are prepared at the master’s level and function in an administrative role.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

N R I G B.C M

34. Public health nurse (PHNs) are looking to improve population-focused care in the community. Which activity best describes a key opportunity for the nurses to accomplish this goal? a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practice ANS: B PHNs must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 35. A local senator has proposed changes to the health care delivery system in the United States.

Based on current trends, what is most likely to occur? a. There will be new opportunities provided for public health specialists. b. It will result in isolated care being provided to individuals.

c. There will be an increased emphasis in specialty care. d. It will increase the utilization of acute care services.

ANS: A Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are considered barriers to public health nursing? (Select all that apply.) a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d. The steady decline in the number of job opportunities in the area. e. The inability to equally distribute the increasing funds.

ANS: A, B, C Barriers exist in thinking that nurses only work in a hospital at the bedside, the process of role socialization in public health which can be a very autonomous profession, and that few nurses have had advanced eNdU ucRaS tioInNinGpTuB bl. icChO eaM lth. The number of job opportunities continues to increase, but the amount of funding allotted to public health continues to decline.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Chapter 02: History of Public Health and Public and Community Health Nursing Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. In the past, what term was used to identify population-centered nurses? a. District nurses b. Almshouse nurses c. Soldier nurses d. Sisters ANS: A In the past, population-centered nurses have been called public health nurses (PHNs), district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses. Many women who performed nursing functions in almshouses and early hospitals in Great Britain were poorly educated, untrained, and often undependable. The original soldier nurses worked with Florence Nightingale at Scutari. Various groups of “sisters” have been used throughout history to care for the poor.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is working in a public health nursing setting. Which statement best describes why this specialty is appealing to nurses? a. Interactions with wealthNyUcR onStrI ibN uG toT rsB to.sC ecOuM re funding b. Autonomy and independence of practice c. Ability to locate the source of diseases and cure patients d. Opportunities to meet a variety of people ANS: B Community health nurses have a long history of autonomous practice, problem solving, and decision making. Community health care nurses engage in the other activities as well, but overall, they have been best known for autonomy of practice.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. What are the newest threats to health in the United States that community health nurses deal with? a. Diphtheria, cholera, and hepatitis b. HIV, influenza, and bioterrorism c. Avian flu, tuberculosis (TB), and radiation d. Polluted water and air ANS: B

The newest threats to health that PHNs are involved in are HIV, H1N1 influenza, and bioterrorism. Hepatitis is also a current threat, but diphtheria and cholera are not concerns in the United States. Avian flu may be a threat, but radiation and TB are ongoing.

Environmental pollution has been reduced; however, there are pollution issues that do raise concerns.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is working to reform a program that was based on the Elizabethan Poor Law of 1601. Which of the following programs is the nurse most likely working on? a. Welfare b. Food Stamps c. Medicaid d. Medicare ANS: C The Poor Law guaranteed medical care for poor, blind, and “lame” individuals, making it most similar to Medicaid since this program provides medical insurance to these types of individuals. Welfare provides more than health care. Food stamps do not provide medical care. The Medicare program provides medical care to the elderly population.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. In early colonial North America, a colonist worked in the public health sector. Which activity would have most liN kely enNtG heTfB oc. uC s?OM URbe SI a. Establishing schools of nursing b. Developing vaccines to administer to large numbers of people c. Collecting vital statistics and improving sanitation d. Developing public housing and almshouses ANS: C The early colonial public health efforts included the collection of vital statistics, improvements to sanitation systems, and control of communicable disease introduced through seaports. Establishing schools of nursing, developing vaccines, and developing public housing are all events that happened after the colonial period.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. A nurse was employed by the Marine Hospital Service. Which of the following tasks would have most likely been the responsibility of the nurse? a. Setting policy on quarantine legislation for immigrants b. Establishing hospital-based programs to care for the sick at home c. Identifying and improving environmental conditions d. Providing health care for merchant seamen ANS: D

Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities. Marine Hospital Service nurses did not establish policies or hospital programs. They also did not identify and improve environmental conditions as Florence Nightingale did. Their sole purpose was to provide care for this population.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. What was Florence Nightingale’s contributions to public health? a. Caring for the sick, poor, and neglected in institutions and at home b. Using a population-based approach that led to improved environmental conditions c. Writing the Elizabethan Poor Law to guarantee medical care for all d. Founding of the district nursing association to provide health care to needy people ANS: B During the Crimean War, Nightingale progressively improved the soldiers’ health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality. The focus of her care was on wounded soldiers, not those who were sick, poor, and neglected at homes and institutions. She did not write the Elizabethan Poor Law. William Rathbone founded the district nursing association.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. What was Lillian Wald’s major contribution to public health nursing? iat. ioC n OM a. Founding the AmericanNNu URrses SIAs NGsoc TB b. Developing the New York Training Hospital for Nurses c. Creating the Public Health Service d. Establishing the Henry Street Settlement ANS: D Lillian Wald established the Henry Street Settlement. Isabel Hampton Robb founded the American Nurses Association. Lillian Wald was a graduate of the New York Training Hospital for Nurses. The Public Health Service was established by the federal government.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. A nurse is providing public health education based on the teachings of Lillian Wald. Which of the following topics will the nurse most likely discuss? a. Taking and recording blood pressures accurately b. Safe and sanitary baby and child care c. Environmental pollutants and their effects on lung disease d. Time management: balancing factory work and the home ANS: B

Lillian Wald provided health care that included educating the community on health care matters. The focus of most of her work was on health services and health promotion for families and children. Because of her focus on health promotion for families and children, her primary role would not have been taking and recording blood pressures, discussing environmental pollutants (as her focus was not occupational health), or time management (at the time, very few women were working outside of the home).

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 10. Nurses who provided care to people in their homes were referred to as what type of nurses? a. Private duty b. Visiting c. Public health d. Community health ANS: B The visiting nurse cared for several families in a day and helped make care of the sick poor at home economical, whereas a private duty nurse may live with a family of clients receiving care and was to be available 24 hours a day. PHNs focused on care of populations.

Community health nurses would be anyone who worked outside of a hospital setting.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. What term was used to identify neighborhood centers that provided health care, education, and social welfare programN s?UR SI NG TB.C OM a. Settlement houses b. Nursing care centers c. Nurse-managed clinics d. Public health services (PHSs) ANS: A Settlement houses were neighborhood centers that provided health care, education, and social welfare programs. Nursing centers, nurse-managed clinics, and PHSs are not necessarily in neighborhoods.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse worked in a school setting during the early twentieth century. Which activity would have been the focus of this nurse’s practice? a. Investigating causes of absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an autonomous practice d. Providing medical treatment to enable children to return to school ANS: A

Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians. Early school nurses did not teach in the schools. Early school nurses did not promote nursing as an autonomous practice.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. The document Visiting Nursing in the United States highlighted the fact that: a. nurses were trained by Boards of Education. b. trained nurses adequately covered less densely populated areas. c. visiting nurse services were concentrated in the northeastern United States. d. nurses were curing diseases such as TB and typhoid fever.

ANS: C This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health. The document did not address how the nurses were educated or the diseases that nurses were curing. This report showed that there was not adequate coverage for nurses in less populated areas.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. During the time when the Rural Nursing Service was operating through the American Red Cross, a nurse needed to demonstrate resourcefulness. Which intervention would the nurse most likely have implemented? a. Using hot bricks, salt, or sandbags to substitute for hot water bottles b. Testing well water for pNollu URtan SIts NG TB.C OM c. Teaching school and developing curricula for rural nursing programs d. Providing post-surgical care ANS: A In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas. They were not involved in testing well water, providing post-surgical care, or teaching in rural nursing programs.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. Local health departments were formed in urban areas in the late 1800s to accomplish what goal? a. Targeting environmental hazards associated with crowded living conditions b. Facilitating interdisciplinary efforts and promoting “practical nursing” c. Providing immunizations and health care services to all citizens d. Offering public health education to nurses who had finished basic training ANS: A

Local health departments were formed to handle environmental issues in cities, including problems associated with crowded living conditions and dirty streets, and to regulate public baths, slaughterhouses, and pigsties. Because sanitation was such an issue, there was not a focus on interdisciplinary care, provision of immunizations, or public health education for nurses.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse was involved in the original work of the National Organization for Public Health Nursing. Which event best describes the influence this has had on nursing practice today? a. Requiring that public health nurses (PHNs) have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing nursing cooperatives d. Opening the Henry Street Settlement ANS: B The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet. Cooperative agreements were made between life insurance companies and visiting nurses’ associations that expanded availability of public health nursing services.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care ing the Am eric an.PCubl ic Health Association (APHA). What 17. A nurse is considering joinN R I G B M U S N T O information about this organization should be considered when making this decision? a. APHA focuses on the public health concerns of the medical profession. b. APHA represents concerns of nursing specialty practices. c. APHA provides a forum for nurses to discuss their public health concerns. d. APHA focuses on providing health promotion education to the public.

ANS: C APHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The Public Health Section within APHA provides nurses with a forum to discuss their concerns and strategies. It also serves as a focus of leadership and policy development for community/public health nursing.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Historically, which statement is true about African American nurses in public health? a. Certificate and graduate education were more difficult to obtain. b. Segregation limited areas where they practiced. c. They often belonged to the Frontier Nursing Service (FNS). d. They were recruited heavily as military nurses.

ANS: A

Due to segregation, certification and graduate education were more difficult to obtain. They were faced with many challenges because of discrimination and had a limited presence in public health nursing practice. They were not part of the FNS or recruited as military nurses.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse working with Mary Breckinridge, would likely have assisted with what activity? a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Teaching birth control measures to large numbers of women in the South ANS: B Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. A nurse providing care through the Frontier Nursing Service (FNS), would most likely have addressed the needs of which client? a. An injured soldier mU alR e SINGTB.COM b. A homebound, elderly N c. A woman in labor d. A child with measles ANS: C The FNS nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality. They would not have seen injured soldiers, males, or a child with measles.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A major provision of the Social Security Act of 1935 was the establishment of which service? a. Frontier Nursing Service (FNS) to provide nursing service to rural communities b. State and local community health services and training of personnel c. District nursing to provide home health care to sick people d. Community-based settlement houses ANS: B Title VI of the Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of PHNs. Nurses completed educational programs in public health and funds were provided to assist states, counties, and medical districts in the establishment and maintenance of adequate health services.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A student is enrolled in a nursing education program during World War II. Which group would the student most likely have joined? a. The Public Health Service of New York City b. The Marine Nurse Corps c. The Frontier Nursing Service (FNS) d. The Cadet Nurse Corps ANS: D The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels. In 1925, Mary Breckinridge established the FNS based on systems of care used in the Highlands and islands of Scotland (before World War II). The first Marine Hospital opened in Norfolk, Virginia, in 1800. The Public Health Service of New York City was not a group during this time frame.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. Which statement best describes one of the health trends that occurred in the United States between 1900 and 1955? a. There was a rise in heart disease and cancer. b. There was a rise in communicable disease. e in crea m. atC icall c. The crude mortality ratN UR SIsed NGdra TB OMy. d. The life span after diagnosis remained the same.

ANS: A Leading causes of death in 1955 were heart disease, cancer, and cerebrovascular disease, whereas in 1900 they were pneumonia, TB, and diarrhea/enteritis. The mortality rate decreased by 47%. There was a decrease in communicable disease, and the life span after diagnosis increased.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A public health nurse (PHN) is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice ANS: B The Healthy People documents propose national strategies to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. The other documents do not address health promotion topics.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 25. A neighborhood health center is researching its origins. Which legislative act most likely provided funds for its development? a. Emergency Maternity and Infant Care Act of 1943 b. Medicaid legislation c. Social Security Act of 1935 d. Economic Opportunity Act ANS: D Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act. The Social Security Act of 1935 expanded opportunities for health protection and promotion through education and employment of PHNs. Medicaid legislation focused on medical care insurance for the poor.

The Emergency Maternity and Infant Care Act of 1943 provided funding for medical, hospital, and nursing care for the wives and babies of servicemen.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A 66-year-old person is retired and no longer has health insurance. Which of the following programs would be appropriate for his or her health insurance needs? a. Medicare b. Medicaid c. Social Security d. Economic Opportunity Act ANS: A The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare. Medicaid focuses on care for the poor. Social Security does not provide health insurance. The Economic Opportunity Act provided funding for neighborhood health centers, Head Start, and other community action programs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A public health nurse (PHN) becomes involved in health care reform. Which of the following best describes the purpose of this action? a. Promotion of the nursing profession b. Increases funding for public health nursing c. Addresses the concerns of nurses d. Improves health care access and reduce health care costs ANS: D PHNs have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life. The focus of health care reform is not on nursing, but rather the population as a whole.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The impact of World War I on public health nursing included which of the following?

(Select all that apply.) a. Many communicable diseases were eradicated. b. The ranks of public health nurses (PHNs) depleted because many went off to war. c. The feeling that the greatest patriotic duty was to stay at home. d. Expanding nursing services in the community was limited by lack of funding. e. More women entered the public health nursing workforce.

ANS: B, C, D Both World Wars I and II depleted the PHN population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front. There was not an eradication of communicable diseases; rather, there was a worldwide influenza pandemic that swept through the United States, killing many people.

Inadequate funding was the major obstacle to extending nursing services in the community.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 03: Public Health, Primary Care, and Primary Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. In the United States, what are most health care dollars spent on? a. Prescription drugs b. Hospital care c. Physician services d. Public health services (PHSs) ANS: B The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item. The money spent for PHSs is significantly lower than the other categories of expenditures. Other significant drivers of the increasingly high cost of health care include prescription drugs, technology, and chronic and degenerative disease.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What has caused the number of uninsured Americans to dramatically increase? a. Medicare took over payment of health care costs. b. With a declining population, the costs for health care rose. c. Nursing salaries greatly increased, causing health care costs to rise. d. Health insurance coverN agU eR wS asIdN roG pT peB d. frC om OMemployment-based health plans.

ANS: D Although most Americans continue to obtain health insurance from their employer as a benefit, employment does not guarantee insurance. Employer-sponsored health insurance is sensitive to both the general economy and changes in health insurance premiums. As costs for insurance premiums rose, employers either shifted more of these costs to their employees or declined to offer employment-based health coverage at all. Medicare provides coverage only to the elderly and other special populations. The costs for health care are continuing to rise regardless of the size of the population. There has not been a significant change to nursing salaries, and a change in nursing salaries would not impact the number of uninsured Americans.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working with a community to decrease the occurrence of influenza. Which of the following U.S. Department of Health and Human Services (USDHHS) or simply HHS) goals is being applied? a. Strengthen Health Care. b. Advance the Health, Safety, and Well-being of the American People. c. Increase Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs. d. Advance Scientific Knowledge and Innovation.

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B One of the objectives of Advance the Health, Safety, and Well-being of the American People is to reduce the occurrence of infectious diseases. The goal of Strengthen Health Care focuses on improving health care services, quality, and coverage. The goal of Increase Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs focuses on improving programming and application of found data. The goal of Advance Scientific Knowledge and Innovation focuses on scientific discovery and application of the new knowledge.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year could be attributed to what cause? a. Cardiovascular disease b. Obesity c. Medical error d. Drug overdose ANS: C In 1999 it was thought that our health care system was expensive, and that access and quality were not optimal, but we had not considered this important fact: many people die of preventable medical errors in the United States. This number is not the correct statistic for cardiovascular disease, obesity, or drug overdose.

DIF: Cognitive level: Remembering : Nursing process: Assessment NURSINGTB.TCOP M MSC: NCLEX: Safe and Effective Care EnviroOnment: Management of Care 5. Residents of rural communities report that they must travel for long distances to obtain health care services. As a result, they seek health care only for emergencies and severe illnesses. Which aspect of the health care system in the United States is illustrated in this situation? a. Access to care b. Cost c. Quality d. Advances in technology ANS: A One significant problem is poor access to care. Access can refer to inability to pay for care and inability to access care. Cost refers to the health care expenditures that happen to pay for the services received. Quality refers to the quality of health care that is provided. Advances in technology refer to the medical advancements made to treat diseases.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is exploring a job opportunity at a community health center. Which expectation would the nurse have about the center? a. Would be situated in a large metropolitan area.

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Public Health Nursing 10th Edition Stanhope Test Bank b. Provides care only to the economically disadvantaged. c. Offers comprehensive primary care services and supportive services. d. Is used for preventive services such as flu shots.

ANS: C Community health centers serve the entire community for primary health care (PHC) services, regardless of income. They are in a high need or medically underserved community, which can be urban or rural.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nursing program has initiated a recruitment campaign focusing on increasing the minority students in its program. Which of the following best describes the rationale for this program? a. The number of minority versus non-minority nurses should be equal. b. Minority health care professionals who share the same culture with the clients may provide more effective care. c. The profession should be more diverse. d. Minority nurses can mentor other nurses when providing care for diverse populations.

ANS: B It is thought that increasing minority representation in the health workforce not only is a commitment to diversity, but also will improve the health care delivery system. Minority health professionals can be expected to practice in underserved areas at a greater rate and health professionals who share the same culture and language with the clients they serve can NIt RhaSsIbN G suggest B.COedMthat the number of minority nurses should provide more effective care. U een T be representative of the population served rather than there being equal numbers of minority and non-minority nurses. Minority nurses are able to mentor other nurses; however, is not the main reason that there is a focus on increasing recruitment of minorities.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A community health nurse is utilizing telehealth. Which factor best describes the rationale for its use? a. Enables clients to get nursing care in their homes. b. Substitutes for health department delivered care. c. Improves access to care in rural areas. d. Replaces face-to-face care for those who cannot afford it.

ANS: C Telehealth provides increased access to health care using a computer monitor and telephone line. It is useful for monitoring clients with chronic disease but is not a substitute for health care. Telehealth may or may not be accompanied by home care nursing.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 9. What is one of the goals of the World Health Organization (WHO)? a. Providing public health nurse (PHC) services to everyone b. Preventing outbreaks of disease c. Preventing the transmission of communicable disease among nations of the world d. Providing humanitarian support in times of disaster ANS: A The WHO adopted a resolution in 1977 accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. This has been adapted to meet the needs of the new century and was deemed “Health for All in the 21st Century.” The focus of this initiative is PHC services. The WHO does not prevent outbreaks of disease, prevention, transmittal of disease, or provide humanitarian support.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A public health agency is considering implementing an electronic health record. Which action best describes one of the benefits the agency will experience? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) standards ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded N R Iessm GTents; B.CinOcorporation M laboratory results and up-to-dUateSassN of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors.

There is no data to support that the agency will have improved client compliance or cost savings. Electronic medical records are not a requirement by JCAHO. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse interacts with a 25-year-old woman at a community health center who is obtaining a gynecological examination and birth control pills. Which of the following types of care is the client receiving? a. Tertiary health care b. Public health care c. Public health care (PHC) d. Specialized care ANS: C PHC includes basic health care services with the emphasis on prevention. Tertiary health care is highly specialized medical care. Public health care focuses on care for populations.

Specialized care focuses on only one aspect of a patient’s health.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A client is receiving public health care (PHC) services. Which of the following expectations would the client have? a. The care would be provided by a physician. b. Private insurance would be necessary to receive care. c. The emphasis of care provided would be on prevention. d. A referral would be made to a specialist after receiving services.

ANS: C The focus of PHC is a broad range of services that are designed to be affordable for the recipients of the care and the governments who provide them. The emphasis of care is on prevention and the means of providing the care is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods. All clients can receive PHC services regardless of insurance status. Those receiving primary care services may or may not need referral to a specialist.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse who was working in public health care (PHC) has gotten a new job in primary care.

Which of the following differences would be seen by the nurse in this new care setting? a. Focus on individuals. b. Services provided by specialists. c. Autonomy in the practice setting. d. Community focused care is provided.

ANS: A Primary care focuses on individuals. It is also provided by generalists, is dominated by health care professionals, and is not community focused.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What initiative began because of a resolution adopted by the WHO in 1977? a. Declaration of Alma Ata b. Medicare c. Healthy People d. Public Health Care (PHC) movement ANS: D The WHO adopted a resolution accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. The name of the resolution that was adopted was the Declaration of Alma Ata. Medicare began as part of the Social Security Act. The Healthy People initiative began as part of the 1979 Surgeon General’s Report addressing the health needs of Americans.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 15. What statement is true about public health care (PHC) in the United States? a. It has dramatically improved since the passage of the Declaration of Alma Ata. b. It focuses on the use of government-funded insurance programs. c. It lacks community participation and a multidisciplinary health care delivery team. d. IT utilizes Preferred Provider Organizations to meet needs of the citizens.

ANS: C Although PHC has been endorsed by the United States, it faces many challenges. PHC emphasizes broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team; however, this is not the primary method of health care delivery in the United States.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A community health nurse reviews Healthy People 2020 when considering the health needs that will be addressed in the community. Which goal would the nurse find in this document? a. Promote healthy behaviors for children. b. Cure cancer. c. Eliminate health disparities. d. Provide primary care to all citizens.

ANS: C Elimination of preventable disease, disability, injury, premature death; achievement of health equity; elimination of health disparities; and creation of social and physical environments that will promote good health and healthy development and behavior at every stage of life are the four maNjor R goaI ls cited G Bin.HCealMthy People 2020.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. An 80-year-old client comes to the community health center with a large bag of medications. The client tells the nurse these medications are unaffordable on just Social Security. Which statement is the best response by the nurse? a. “Let’s go through these medications and see which ones we can delete.” b. “You can get these medicines at this clinic for free.” c. “I will consult with our social worker to see if Medicare will pay for these medications.” d. “These medications are important. Do your best to pay for them.”

ANS: C This elderly patient probably is eligible for benefits through Part C, the Medicare Advantage program, but often a patient needs help negotiating the system. Finding prescriptive coverage through an insurance plan with the help of a social worker is a better choice than eliminating medications, trying to get medications for free (which is only a short-term solution in most cases), and telling the client to find a way to pay for the medications when she does not have the resources.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

18. A nursing student is researching advanced practice nursing options. Which of the following discoveries would most likely be made by the nursing student? a. Nurse practitioners may work independently depending on the state practice act. b. Certified nurse midwives have limited prescriptive authority. c. Clinical nurse specialists typically provide primary care services. d. The Doctorate in Nursing Practice emphasizes the importance of research.

ANS: A Nurse practitioners may work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered. Certified nurse midwives have prescriptive authority in some form in all states. Clinical nurse specialists may provide primary care services, but often work in consultation, research, education, and administration. The Doctorate in Nursing Practice role is a clinical role.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. Which federal agency included in the public health system is most involved with the health and welfare of United States citizens? a. Centers for Medicaid and Medicare Services b. U. S. Department of Health and Human Services c. U. S. Public Health Service (USPHS; or simply PHS) d. Health Resources and Services Administration ANS: B The U. S. Department of Health and Human Services is charged with regulating health care NtusRS I Gricans.

B.CTOheM Centers for Medicare and Medicaid and overseeing the health staU of ANmeT Services develops and oversees the rules and regulations specific to these two insurance programs. The PHS is a major component of the Department of Health and Human Services.

The PHS consists of eight agencies: (1) Agency for Healthcare Research and Quality, (2) Agency for Toxic Substances and Diseases Registry, (3) Centers for Disease Control and Prevention, (4) Food and Drug Administration, (5) Health Resources and Services Administration, (6) Indian Health Service, (7) National Institutes of Health, and (8) Substance Abuse and Mental Health Services Administration.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse works to promote the passage of a public health law to protect the health of the community. Which activity would the nurse most likely be promoting? a. Requiring all persons to have health insurance coverage b. Administering flu shots in the late fall and early winter c. Mandating immunizations for all children entering kindergarten d. Monitoring and licensing nuclear power plants ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Public health laws protect the community. Required immunizations are an example.

Requiring health insurance coverage would not protect the community. Administration of flu shots is not promotion of a law. Monitoring and licensing nuclear power plants are beyond the scope of public health.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is working in a state health department. Which program would the nurse most likely be working with? a. Senior health b. Dental services c. H1N1 flu education d. Mental health ANS: C Typical programs in a state health department include: communicable disease service, H1N1 flu services, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is employed by the Department of Homeland Security. Which activity would be expected by this department? a. Prevention and protection against terrorist attacks nelOM b. Regulation of licensureNofUm Red SIical NGper TBso.nC c. Inspection of the safety of food and cosmetics d. Regulation of managed care organizations ANS: A The Department of Homeland Security was created after the terrorist attacks of September 11, 2001. Its mission is to prevent and deter terrorist attacks and to protect against and respond to threats and hazards to the nation. Regulating the licensure of medical personnel, inspecting the safety of food and cosmetics, and regulating managed care organizations are not responsibilities of this department. These activities are regulated by other state or federal government agencies.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are some of the untoward events categorized in the Institute of Medicine (IOM) report about medical errors? (Select all that apply.) a. Wrong-site surgery b. Adverse drug events c. Improper transfusions d. Restraint-related deaths

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Public Health Nursing 10th Edition Stanhope Test Bank e. Poor staffing patterns ANS: A, B, C, D The untoward events of wrong-site surgery, adverse drug events, improper transfusions, and restraint-related deaths are listed in the IOM report. Although poor staffing patterns may result in medical error, this is not one of the untoward events discussed in this report.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is entering the health care workforce. Which expectation should the nurse have for the workforce? (Select all that apply.) a. There is a shortage of nurses in the United States. b. Schools of nursing turn away qualified applicants due to lack of faculty and limitations of clinical sites. c. By 2026 there are expected to be 438,100 new nursing positions. d. More students are choosing laboratory science, pharmacy technology, and radiology technology over nursing. e. There is a shortage of physician specialists in the United States.

ANS: A, B, C The first three options are true. The laboratory science, pharmacy technology, and radiology technology programs have all seen declining enrollments. There is a shortage of primary care physicians as more physicians are choosing to specialize.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENffeR ctivI e CaGre E ironM ment: Management of Care Bn.vC

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 04: Perspectives in Global Health Care Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the key to achieving the goals of Health for All in the 21st Century (HFA21) worldwide? a. The cure of communicable disease b. The technological development of all nations c. The worldwide availability of health care insurance d. The worldwide implementation of primary health care ANS: D The major key to attaining Health for All by the Year 2000 was the worldwide implementation of primary health care; this has extended into the next century with the document HFA21. The World Health Assembly in 1977 stated that all citizens of the world should enjoy a level of health that would permit them to lead a socially and economically productive life. Curing communicable disease, technological developments of all nations, and availability of health care insurance are not part of the key strategies to achieve the goals of HFA21.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 2. Which health problem is ofgreatest concernin the world’s developed countries? a. Hepatitis b. Malaria c. Polio d. Smallpox ANS: A Current health concerns in more developed countries are hepatitis, infectious diseases, and new viral strains such as hantavirus, SARS (severe acute respiratory syndrome), H1N1, and avian flu. Malaria, polio, and smallpox are more commonly found in lesser-developed countries.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. What disease that was once isolated and rare is now widespread throughout the world? a. Acquired immunodeficiency syndrome (AIDS) b. Smallpox c. Malaria d. Measles ANS: A Smallpox has been eradicated; malaria and measles were not isolated and rare throughout the world. AIDS was once isolated and rare but is now worldwide.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. Which country is referred to as being lesser-developed? a. France b. Japan c. Indonesia d. Sweden ANS: C A country that is not yet stable with respect to its economy and technological development is lesser-developed, which describes Indonesia. France, Japan, and Sweden are considered developed countries.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. The health priorities in HEALTH21 are based on what concept? a. Eradication of communicable disease worldwide b. Social justice and solidarity with an emphasis on the responsibility for health c. World trade and knowledge sharing about health concerns d. Provisions for the creation of the United Nations Children’s Fund (UNICEF) ANS: B HEALTH21 is not a single, finite goal but a strategic process that can lead to progressive improvement in the health of people. It is a call for social justice and solidarity with an N ly,RaSnd IN G B.C M emphasis on individual, famiU comTmunityOresponsibility for health. The concepts of eradication of communicable disease worldwide, world trade and knowledge sharing about health concerns, and provisions for the creation of UNICEF are not part of these health priorities.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. Population health is an approach and perspective that focuses on what? a. Controlling the spread of the HIV virus worldwide b. The broad range of factors and conditions that influence health c. Community-based care for all citizens d. Prevention and diagnosis of disease worldwide ANS: B Population health is a holistic approach that considers the total health system. The focus of population health is broader than only considering spread of the HIV virus. Population health considers more than the community-based care in the community. Population health examines spread of disease on a smaller scale.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 7. A nurse is examining the income levels and social networks of individuals in a community.

Which term is used to identify the factors the nurse is investigating? a. Culture b. Development c. Community d. Determinants ANS: D Determinants are conditions and factors that are important considerations in population health. Culture refers to the beliefs and customs of a certain group. Development refers to something that is being created. Community is a group of people living in the same geographic location.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. What is a characteristic of multilateral organizations? a. Receiving their funding from multiple sources b. Controlling the spread of disease c. Feeding the people of the world d. Using nurses as their main source of information ANS: A Multilateral organizations are those that receive funding from multiple government and nongovernment sources. The other items are specific to the agencies listed, but do not include all the organizations.

N R I G B.C M

DIF: Cognitive level: RemU embSerinNg T TOO P: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse plans to contact a multilateral organization. Which organization would the nurse most likely contact? a. United Nations (UN) b. United States Agency for International Development (USAID) c. Project Hope d. Catholic Relief Services ANS: A A multilateral organization is one that receives funding from multiple governments and nongovernmental sources, which describes the UN. Project Hope and Catholic Relief Services are private voluntary organizations. USAID is funded by one country, the United States.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is caring for a client who has been diagnosed with tuberculosis (TB). Which medication would the nurse most likely administer? a. Isoniazid b. Nevirapine

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Public Health Nursing 10th Edition Stanhope Test Bank c. Amodiaquine d. Bacille Calmette-Guérin (BCG) ANS: A Isoniazid is one of several chemotherapeutic medications used to treat TB. Nevirapine is used to decrease the likelihood of maternal transmission of HIV-AIDS. Amodiaquine is one of several medications used to treat malaria. BCG is a vaccine that has been promoted as effective in inducing active immunity against TB. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A nurse working in a lesser-developed country is caring for the women in the local community. Which existing factor regarding the women would be an important consideration for the nurse? a. They are at risk for a vitamin D deficiency. b. They are likely to have one child. c. They are at risk for death during pregnancy and childbirth. d. They are viewed as the leader of the family unit.

ANS: C Most deaths to women worldwide are related to pregnancy and childbirth. Most of these deaths occur in lesser-developed countries. Common nutritional deficiencies in this population are zinc, iodine, vitamin A, folic acid, and calcium. One of the reasons this problem exists is because women are not seen as valued members of society. In developing nations there is a significant incidence of lack of prenatal care during pregnancy and high fertility rates, often due to a lack of access to contraception and other family planning and N asRwSell INasGcTultural B.CObelief M systems that increase the lifetime risk reproductive health services,U of maternal death.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 12. Which intergovernmental organization focuses its efforts on assisting countries in Latin America? a. Pan American Health Organization b. World Bank c. World Health Organization (WHO) d. United Nations Children’s Fund ANS: A The Pan American Health Organization serves as a regional field office in Latin America for the WHO. The World Bank’s major aim is to lend money to the lesser-developed countries so that they might use it to improve the health status of their people. The WHO addresses the wide scope and nature of the world’s health problems. The United Nations Children’s Fund is an advocate for the health needs of women and children under the age of 5.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 13. An example of a successful campaign against which of the following communicable diseases was carried out during the 1960s and 1970s? a. Tetanus b. Measles c. Pertussis d. Smallpox ANS: D Smallpox was virtually eliminated throughout the world because of immunization. Tetanus, measles, and pertussis all continue to exist throughout the world.

DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is advocating for increased funding for an international agency. Which activity best describes how these funds will likely be used? a. Development and installation of technology b. Food relief, worker training, and disaster relief c. Support of dictatorships and corrupt governments d. Funding of local private organizations ANS: B Many international organizations have an ongoing interest in global health. Despite the presence of these well-meaning organizations, it is estimated that the lesser-developed countries still bear most of the cost for their own health care and that contributions from major international organizations provide for less than 5% of needed costs. Recent reports indicate that most funds raiN sedR

by I internat io. naC l orM ganizations are used for food relief, G B U S N T O worker training, and disaster relief.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse has promoted the introduction of health care technology into lesser-developed countries, but this has led to less-than-satisfactory results. Which statement best describes why this has happened? a. People do not want to use newer technology. b. The cost is so high that they cannot afford to use new technology. c. The community may not be ready for this technology. d. Technology is too complex for people in lesser-developed countries.

ANS: C It is not generally a lack of desire, that is, a barrier to use of the new technological systems, but the lack of knowledge about them. It is essential to conduct needs assessments to learn what a community has, what a community wants, and what it can sustain. Well-intended projects have failed because the most basic needs were not met, nor was recognition given to what resources and services the country could sustain.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 16. A nurse is working with a religious organization to provide food to starving people in a lesser-developed country. Which organization is the nurse most likely working with? a. International Red Cross b. Church World Service c. Maryknoll Missionaries d. Catholic Relief Services ANS: D Catholic Relief Services alleviates suffering and provides assistance to people in need affected by war, starvation, famine, drought, and national disasters without regard to race, religion, or nationality. The Red Cross is not a religious organization, and the Church World Service and Maryknoll Missionaries do other things besides providing food.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A government agency is planning a project in hopes of receiving funding from the World Bank. Which project would most likely receive this funding? a. Development of a sanitation system b. Improvement of roads and bridges c. Creation of a national health insurance plan d. Recovery efforts following a hurricane ANS: A The World Bank lends money to lesser-developed countries so that they might use it to improve the health status of their people. Projects include control and eradication of disease, providing safe drinking water and affordable housing, developing sanitation systems, and N R I ldh GT B.COunizations.

M encouraging family planningUandSchiN ood imm Improvement of roads and bridges, creation of a national health insurance plan, and recovery efforts following a hurricane would not be projects where World Bank funds would be used.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is organizing a fundraiser for a philanthropic organization. Which organization is the nurse most likely working with? a. International Red Cross b. Carnegie Foundation c. Nestlé d. Johnson & Johnson ANS: B The Carnegie Foundation is a philanthropic organization, receiving funding from private endowment funds. The Red Cross is a nongovernmental agency, and Nestlé and Johnson & Johnson are private voluntary organizations.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 19. A nurse is working to improve the health status of a population in a lesser-developed country. Which intervention would the nurse most likely support? a. Decreasing the number of people who need outside resources b. Increasing the number of children who can attend school c. Increasing the monetary resources that can be used to treat disease and illness d. Improving the ability to pay debt to more developed countries ANS: B Health status improvement in children can lead to better education that eventually helps the country’s economic growth. Because children are educated, there is more economic growth.

This allows for additional monetary resources to be spent on economic development rather than on treatment of illness and disease.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A community health nurse is utilizing the health care system in the United Kingdom. Which expectation should the nurse have? a. Employer and citizen share equally in the cost of health care. b. Ownership and operation of the system is by the government. c. Nurse practitioners are the primary providers of care in the system. d. Primary care is provided for in hospitals.

ANS: B The United Kingdom has a tax-supported health system that is owned and operated by the government. Services are available to all without cost or for a small fee. Physicians are the primary providers in this system; nurses and allied health professionals are also recognized Navai RSlabl INeGthTrough B.ChOospitals, M and used. Services are made U private physicians and allied health professional clinics, health outreach programs such as hospice, boroughs, and environmental health services.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A community health nurse is investigating international diseases. Which of the following would the nurse track by using the global burden of disease (GBD)? a. The number of cases of HIV/AIDS in a country b. Losses from premature death and losses of healthy life that result from disability c. The economic impact of disability on lesser-developed countries d. The rate of disability in industrialized nations ANS: B The GBD combines losses from premature death and losses of healthy life that result from disability. The GBD represents units of disability-adjusted life-years (DALYs). This statistic is not specific to a particular disease or a particular developmental stage of a country.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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22. A nurse is analyzing one of the components of a unit of disability-adjusted life-years (DALYs). From which individual would the nurse be able to calculate this measurement? a. A woman who lives to be 100 years old. b. A woman who contracts human immunodeficiency virus (HIV) after working as a prostitute. c. A father with five children who dies at the age of 50 from malaria. d. A woman who gives birth to a premature infant.

ANS: C A male who dies from malaria at age 50 would represent 30 DALYs. Measurement is based on the potential limit for life, which has been set at 82.5 years for women and 80 years for men. To calculate this statistic, the nurse must know the client’s age and the potential limit for life.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. Which of the following diseases is the leading killer of people with human immunodeficiency virus (HIV)? a. Acquired Immunodeficiency Syndrome (AIDS) b. Malaria c. Hepatitis d. Tuberculosis (TB) ANS: D TB is the leading killer of people with HIV, and up to 80% of TB clients are HIV positive in countries with a high prevaN lencRe oI f HIG V. A BI.DCS, mMalaria, and hepatitis are not the leading killer of people with HIV. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 24. A nurse is caring for a client with tuberculosis (TB). Which statement would the nurse recognize as being true? a. Meningitis is the leading cause of death from TB. b. Chemotherapy, if made widely available, could eradicate the disease. c. Many TB cases are associated with HIV. d. The TB bacillus is difficult to isolate.

ANS: C The rise in HIV has led to an increase in TB because the disease depresses the immune system. Chemotherapy is not always effective, especially in the new drug-resistant strains.

Meningitis is not a leading cause of death from TB. TB is becoming more difficult to treat because of the new drug-resistant strains, but the TB bacillus is not difficult to isolate.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 25. A nurse is creating a care plan for a client who is living in an area of the world where malaria is endemic. Which intervention would be appropriate to include?

a. b. c. d.

Receive a dose of intravenous (IV) quinine.

Avoid direct contact with individuals who have malaria.

Use insecticide-treated bed nets.

Apply dichlorodiphenyltrichloroethane (DDT) spray.

ANS: C An effective antimalarial intervention is the use of insecticide-treated bed nets. Malaria is contracted by being bit by an infected mosquito; it cannot be passed by direct person-to-person contact. IV quinine is the drug of choice for treating malaria, not preventing it. Some mosquitoes are resistant to DDT, so this may not be effective.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 26. When preparing for a bioterrorism event, which would be the best strategy for the government to implement? a. Threatening lesser-developed countries so they don’t develop biological weapons b. Banning biological weapons worldwide c. Effectively detecting pathogens and managing services d. Developing antidotes for biological agents ANS: C Health care professionals and public health officials need to be able to effectively detect pathogens, manage services, and communicate during a bioterrorism threat. Any country can develop biological weapons that can be used for bioterrorism, not only lesser-developed countries. By effectively detecting pathogens, one is able to know what antidotes need to be developed.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A nurse concerned about an event of bioterrorism would most likely be focusing on what? a. An outbreak of smallpox b. The bombing of historic buildings c. Exploding land mines d. All threats of war ANS: A Bioterrorism is a term used to describe the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Bombing historical buildings, explosion of land mines, and threats of war may be part of terrorist attacks, but do not include the component of bioterrorism.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse is assessing a refugee who fled the genocide in Darfur. Which disease/disorder should the nurse anticipate finding? a. Tuberculosis (TB) b. Post-traumatic stress disorder (PTSD)

c. Chronic obstructive pulmonary disorder (COPD) d. Malnutrition ANS: B The biopsychological changes seen following genocide include physical stress reactions (cardiovascular, neurological) and mental stress responses, especially PTSD and depression.

The biopsychosocial changes are the major concern over any physical illnesses that may be present.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. Which goals do the Millennium Development Goals address? (Select all that apply.) a. Reduction of child mortality b. Eradication of communicable diseases c. Promotion of gender equality and empowerment of women d. Achievement of universal health care access e. Promotion of specialty practice by physicians ANS: A, C The Millennium Development Goals address reduction of child mortality and promotion of gender equality and empower women. Other goals include eradicating extreme poverty and hunger; achieving universal primary education; improving maternal health; combating HIV/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnerN shUipRfS oI r dNeG veT loB p. mC enO t.M Eradication of communicable diseases, achievement of universal health care access, and promotion of specialty practice by physicians are not part of the Millennium Development Goals.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 2. A nurse is employed by an agency that addresses global health needs. Which roles are the nurse most likely to assume? (Select all that apply.) a. Medications and vaccines for worldwide use b. Direct patient care for members of the community c. Knowledge and skill in countries where nursing is an organized profession d. Consultation to auxiliary personnel e. Facilitation of education and health promotion within the community ANS: B, C, D, E Nurses perform many roles related to global health, including providing direct patient care, facilitating education and health promotional needs of the community, providing knowledge and skill in countries where nursing is an organized profession, and providing consultation to auxiliary personnel. Providing medications and vaccines for worldwide use would not be part of the role of the nurse in relation to global health.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

3. A nurse is working to manage the public health aspects of a bioterrorist event. Which concept does the nurse need to understand? (Select all that apply.) a. Medical management and public health measures b. The names and descriptions of the agent/disease c. The chemical features of the pathogens d. How to address mental health concerns e. The amount of risk that each type of event will have for the public ANS: A, B, D Nurses need to understand the names of the pathogens and the disease they cause, the medical management and public health measures (so that accurate information can be disseminated), and how to help people cope with their feelings. The chemical features of the pathogens and the amount of risk that each type of event will have for the public would not be part of the nurses’ role when managing the public health aspects of a bioterrorist event.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Chapter 05: Economics of Health Care Delivery Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement regarding poverty and health insurance is true? a. Millions of people in the United States are without health insurance. b. The poor in the United States are as healthy as persons with higher incomes. c. Persons with money or health insurance are less likely to seek health care. d. The poor are more likely to receive health care through private agencies.

ANS: A In 2016, 28.1 million people were without health insurance in the United States. The poor in the United States are generally not as healthy as persons with middle or higher incomes.

Persons with money and/or health insurance are more likely to seek health care. The poor are less likely to receive health care through private agencies.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care is referred to by what term? a. Economics b. Health economics c. Public health economics d. Microeconomic theory ANS: B Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care.

Economics is the science concerned with the use of resources, including the production, distribution, and consumption of goods and services. Public health economics focuses on the production, distribution, and consumption of goods and services as related to public health and where limited public resources might best be spent to save lives or increase the quality of life. Microeconomic theory deals with the behaviors of individuals and organizations and the effects of those behaviors on prices, costs, and the allocation and distribution of resources.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Public health economics focuses on what? a. Use of resources. b. Availability and usage of goods and services related to public health. c. Scarcity of resources in the health care industry. d. Management and use of monies to improve the health of populations.

ANS: B Public health economics focuses on producing, distributing, and consuming goods and services related to public health. Economics is the science concerned with the use of resources, including the production, distribution, and consumption of goods and services.

Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care. Public health finance involves the acquiring, managing, and use of monies to improve the health of populations through disease prevention and health promotion strategies.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse discusses services with a federal Congressional representative. Which service would the nurse most likely be discussing? a. Family planning b. Counseling c. Policy making d. Prevention of communicable diseases ANS: C Policy making is offered at the federal level. Family planning, counseling, and preventing communicable and infectious disease are offered at the state and local levels.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care ince itB s e.mCplo 5. A business offers wellness N URntiv SIesNtGo T OMyees and then notices a decrease in the frequency of physician visits among employees. Which term best describes what has happened? a. Macroeconomic theory b. Efficiency c. Supply and demand d. Microeconomic theory ANS: D Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care. Efficiency refers to producing maximum output using a given set of resources. Supply and demand are two basic principles of microeconomic theory. Macroeconomic theory focuses on the “big picture.”

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is using the principles of supply and demand in daily practice. Which situation describes this phenomenon? a. The demand for nurses in public health is low, but the supply is high. b. When few goods or services are available, the price tends to rise. c. When supplies are low, nurses must find alternate resources. d. Lesser-developed countries receive supplies from other countries.

ANS: B Supply and demand is in force when few goods or services are available, and then the price tends to rise. The other examples do not demonstrate the use of the laws of supply and demand.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is faced with a macroeconomics issue. Which situation describes what is happening? a. The evaluation of client access to services b. A health policy that makes the development of a new program possible c. Informing clients and others of the cost of service d. The referral of clients to available services ANS: B Macroeconomics focuses on the “big picture,” such as a program, whereas microeconomics focuses on the individual or organization.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A public health nurse applies the principles of the macroeconomics theory when working with a community. Which statement best describes why this theory would be used? a. The nurse is concerned with factors that determine prices and affect resource allocation. b. The nurse is concerned with the positive effect of competitiveness on health care costs. c. The nurse is concerned with the supply, demand, and costs of services available to their clients. d. The nurse is concerned with the policies to support programs to improve the health of the community.

ANS: D Macroeconomic theory focuses on the “big picture”—the total, or aggregate, of all individuals and organizations (e.g., behaviors such as growth, expansion, or decline of an aggregate). The primary focuses of macroeconomics are the business cycle and economic growth. These cycles are influenced by a number of factors, such as political changes, policy changes, knowledge and technology advances, or simply the belief by a recognized business leader that the cycle is or should be shifting. Microeconomics focuses on the individual or an organization. Factors such as levels of income, employment, general price levels, and rate of economic growth are important in microeconomics.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse implements a teen pregnancy prevention program in a high school that has been shown to decrease the rate of teen pregnancy. Which term best describes the nurse’s action? a. Effectiveness

b. Efficiency c. Microeconomics d. Production ANS: A Effectiveness refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended. Efficiency refers to producing maximum output using a given set of resources. Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care. Production refers to how goods are produced or created.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 10. A nurse conducts a class at a public health clinic on breast self-examination for a group of 50 women. Which term best describes the nurse’s action? a. Supply and demand b. Macroeconomics theory c. Efficiency d. Effectiveness ANS: C Efficiency refers to producing maximum output, such as a good or service, or using a given set of resources or inputs, such as labor, time, and available money. Teaching one topic to many people is an example of this. Macroeconomic theory focuses on the “big picture.”

Supply and demand is in force when few goods or services are available, and then the price N fers RStoIN Gextent B.CtO M tends to rise. Effectiveness reU the T o which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 11. A nurse is promoting efficiency within the public health department. Which activity describes the action the nurse would be taking? a. Evaluating how well a program of service achieves what was intended b. Trying new products provided by sales representatives c. Using time wisely by delegating non-nursing tasks to unlicensed care providers d. Setting up a clinic to look aesthetically pleasing to clients ANS: C Efficiency relates to producing maximal output given a set of resources. Using time wisely through delegation is the best example of using efficiency. Program evaluation, trying new products, and setting up a clinic are not examples of producing maximal output given a set of resources.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

12. A nurse enrolls in a microeconomics course at a local college. Which statement best describes the rationale for taking this course? a. Nurses are often the ones to allocate resources to solve a problem. b. Nurses are often involved in federal policy making. c. Health care policy can be influenced using these principles. d. Health care supplies can be very costly and nurses must use them wisely.

ANS: A Nurses often allocate resources, design, plan, coordinate, and evaluate community-based health services. Policy making addresses a macroeconomics issue. It is true that nurses need to know about microeconomics in order to use resources appropriately, but the scope of quality of care and use of health care supplies is larger than the scope of only microeconomics.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse evaluates a smoking cessation program, the gained or increased financial income, the improvements in the community attributable to the program, and the costs that would result if the program was not offered. Which term best describes the action of the nurse? a. Cost-effectiveness analysis b. Cost-benefit analysis c. Supply and demand d. Microeconomic theory ANS: B Cost-benefit analysis involves the listing of all costs and benefits that are expected to occur N R Iibed GTtime.

B.CCOost-effectiveness M from an intervention during aUpreSscrN analysis expresses the net direct and indirect costs and cost savings in terms of a defined health outcome. Supply and demand is in force when few goods or services are available, and then the price tends to rise.

Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is working with members of the community to assist them with acquiring health insurance. Which individual is most likely to be uninsured? a. An 82-year-old with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business executive who works for a large corporation d. A 32-year-old who works part-time at a small business ANS: D The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The individual who works at the large corporation probably has health insurance, since most large businesses provide it.

DIF:

Cognitive level: Analyzing

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is examining the characteristics that affect one’s health. Which factor is of greatest concern to the nurse? a. Obesity b. Marital status c. Health insurance d. Age ANS: A Personal behavior/lifestyle (obesity) has the greatest effect on health. Environmental factors (marital status) and human biology (age) are next followed by the health care system (health insurance).

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 16. A community health nurse is assisting clients to access health care. Which individual would most likely experience a barrier when accessing health care? a. A 40-year-old who speaks English b. A 25-year-old with health insurance c. A 50-year-old with hypertension d. A 30-year-old who is unemployed ANS: D Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, child care needs, lack of time or information, or N RThe INune GTmploye B.COdMperson is most likely to experience a refusal of services by provideUrs. S barrier because of not having a job, which may reduce his access to health insurance and limit his income.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse plans to implement a primary prevention strategy in the community. The development of which program would the nurse most likely complete? a. Smoking prevention b. Support group for widows c. Hypertension screening d. A hospice care ANS: A Primary prevention’s aim is preventing disease. Development of a smoking prevention program is primary prevention. Development of a support group for widows and development of a hospice care program are examples of tertiary prevention. Development of a hypertension screening program is an example of secondary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

18. The first stage of development of the health care system was characterized by what event? a. The rise in technology b. Epidemics of infectious disease, such as typhoid, influenza, and malaria c. Physicians and nurses who attained their skills in scientifically based programs d. An expansion of hospital clinics and long-term care facilities ANS: B Stage one was concerned with epidemics and infectious disease control. Technology is characteristic of stage four, and physicians and nurses attained skills in scientifically based programs in stage two. Stage three included the expansion of hospital clinics and long-term care facilities.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. What is a characteristic of the fourth developmental stage of the health services delivery framework? a. Nurses in the United States being predominantly women b. The expansion of the number and type of health care facilities c. Dependence on technology for patient care d. The discovery and development of pharmacological advances ANS: C Nurses have become dependent on technologies to monitor client progress, make decisions about care, and deliver care in innovative ways as part of the fourth stage. The discovery and development of pharmacological advances is only one way that technology has increased during the fourth phase. Stage one was concerned with epidemics and infectious N R urse INsGatTtained B.CsOkills M in scientifically based programs in disease control. Physicians anUd nS stage two. Stage three included the expansion of hospital clinics and long-term care facilities.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. Which legislation was considered the first national health insurance plan in the United States? a. Health Maintenance Organization (HMO) Act b. Marine Hospital Service c. Medicare d. Medicaid ANS: B The Marine Hospital Service was created in 1798 by the federal government to provide medical service for sick and disabled sailors and to protect the nation’s borders against the importing of disease through seaports. The HMO Act provided assistance and expansion for HMOs in the 1970s. Medicare and Medicaid were established in 1965 to provide health care services to certain populations.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

21. An employee can receive health insurance from a former employer after changing jobs. The enactment of which legislation makes this possible? a. Health Insurance Portability and Accountability Act (HIPAA) b. Omnibus Budget Reconciliation Act c. Balanced Budget Act of 1997 d. Social Security Act of 1935 ANS: A HIPAA is a federal intervention to protect health insurance coverage for workers and families following a job change or loss. The Omnibus Budget Reconciliation Act was a major effort to regulate and control the costs of physician fees. The Balanced Budget Act of 1997 determined that payments to Medicare skilled nursing facilities (SNFs) would be made on the basis of prospective payment system (PPS). The Social Security Act of 1935 signaled the federal government’s increasing interest in addressing social welfare problems.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. Which statement about the Medicare program is accurate? a. Part A provides coverage for hospitalization. b. Part A requires payment of a monthly premium for coverage. c. Part B provides payment for home health services and extended care facilities. d. Part B is available without cost to all elderly people who have paid social security taxes.

ANS: A Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B is a supplemental program available to all Medicare-eligible persons for a monthly premium.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. Medicare and Medicaid are accurately described by which statement? a. Both are available to any citizen who wishes to enroll. b. They are two federal programs that provide insurance to special groups. c. Both are private insurance providers. d. They are funded by the state government.

ANS: B Medicare provides insurance for persons over 65, and Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels.

Medicare is financed by the federal government. Medicaid is jointly financed by state and federal government. They are not private insurance providers.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

24. A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses, such as laboratory services and equipment. Which part of Medicare is being described? a. Part A b. Part B c. Part C d. Part D ANS: B Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, equipment, and some supplies. Part A provides coverage for hospital care, home care, and skilled nursing care. Part C is an option that can be chosen for additional coverage.

Part C includes services of both Parts A and B. The Part C plans are coordinated care plans that include HMOs, private fee-for-service plans, and medical savings accounts (MSAs).

Part C provides for all health care coverage costs after a high deductible. Part D provides prescription coverage.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. A nurse is caring for a client who has end-stage kidney failure and is on dialysis. The nurse recognizes that this client is eligible for which form of insurance? a. Medicaid b. Blue Cross c. Medicare gaUnR izS atI ioN nG (HTM d. Health Maintenance OrN BO.)COM ANS: C Medicare is available to anyone on dialysis regardless of age. Blue Cross and HMO are both private insurance options. Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nurse is discussing the services that are covered under Medicare Part A with a client who has recently become eligible for Medicare. Which service is the nurse most likely to mention? a. Blood drawing to assess prothrombin time (PT)/International Normalized Ratio (INR) b. Physical therapy rehabilitation c. Skilled nursing facility care d. Ambulance transportation ANS: C Medicare Part A covers hospital care, home care, and skilled nursing care. Laboratory and physical therapy services and transportation by ambulance would be covered by Medicare Part B.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. Which client is most likely to have enrolled in Medicaid? a. An 85-year-old female who has hypertension. b. A 25-year-old female who is pregnant. c. A 50-year-old male who is blind. d. A 70-year-old male who is hearing impaired.

ANS: C Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels. Medicaid does not provide coverage to those who have hypertension, are pregnant, or are hearing impaired unless they meet income guidelines.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. What term is used to describe when a health care organization’s fees for delivery of services are not decided until after they are provided? a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. Capitation ANS: A Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Prospective reimbursement is whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering services to the client. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill. Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount that practitioners will be paid for a unit of care.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse is working with a client who receives health insurance through a managed care organization. Which term best describes this form of insurance? a. Medicare b. Medicaid c. Medical savings accounts (MSAs). d. Health maintenance organizations ANS: D

Health maintenance organizations and preferred provider organizations are types of managed care. Medicare and Medicaid are government insurance programs. MSAs are not a type of health insurance but rather provide tax advantaged monies for eligible health care costs for individuals who have specific health insurance coverage and meet certain qualifications.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 30. What term is used to describe when a third-party payer establishes the amount of money that will be paid for the delivery of a service before offering the service to the client? a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. Capitation ANS: B Prospective reimbursement is the method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client. Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill. Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount that practitioners will be paid for a unit of care.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 31. A physician receives a set amount of money to provide care to a given group of clients for a set period of time. Which term is being described? a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. Capitation ANS: D Capitation describes the practice of paying physicians and other practitioners a set amount to provide care to a given client or group of clients for a set period of time and amount of money. This is similar to prospective reimbursement for health care organizations.

Prospective reimbursement is the method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client. Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care 32. Which statement about the reimbursement of health services for nurses is accurate? a. Reimbursement for health care services can be directed only to physicians. b. Nurse practitioners and clinical nurse specialists are reimbursed for Medicare Part B services. c. Nursing care is a separate budget item in determining hospital service costs. d. Nursing care is reimbursed separately from medical care in outpatient settings.

ANS: B Nurse practitioners and clinical nurse specialists were granted third-party reimbursement for Medicare Part B services only on January 1, 1998 under Public Law 105-33. Nursing care is not billed for or reimbursed for in hospital or outpatient settings.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Factors that influence health care costs include which of the following? (Select all that apply.) a. Technology and intensity b. Demographics—the aging population c. Chronic illness d. Use of the health care system e. Type of health care insurance

N R I

ANS: A, B, C Technology and intensity, demographics (especially the aging population), and chronic illness all influence health care costs. The fact that individuals have, over time, consumed more health care is not an adequate explanation for an influence of health care costs. The type of health care insurance does not influence health care costs.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Chapter 06: Environmental Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency (EPA). d. Many Americans live in areas that do not meet current national air quality standards.

ANS: A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments. Toxicologists do not often consult nurses about environmental pollutants. Pollutant exposures are not routinely reported by nurses.

Although there may be problems with air quality standards in the United States, this would not be the primary reason why nurses should understand environmental health.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation Bn.vC MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Safety and Infection Control 2. Why is it important for a nurse to have knowledge of environmental health and the effects of chemical, biological, and radiological materials? a. They are a major cause of global warming. b. They are often found in the air, water, and products we use. c. They are frequently linked to the development of chronic illnesses. d. They are products that nurses work with daily.

ANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use. These are not a major cause of global warming.

They are not frequently linked to the development of chronic illnesses. These are not products that nurses work with daily.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. A nurse fulfills the environmental health competency of “assessment and referral.” Which of the following actions has the nurse most likely completed? a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

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ANS: C Assessment and referral states that all nurses should be able to successfully complete an environmental health history, recognize the potential environmental hazards and sentinel illnesses, and make appropriate referrals for conditions with probable environmental causes.

Advocating for public policy changes is part of advocacy. Understanding policy framework and legislation is part of legislation and regulation. Describing the scientific principles of environmental health is part of basic knowledge and concepts.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 4. How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients ANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. Extrapolation by toxicologists and biomonitoring are modern methods. Completing a chemistry course does not show how to identify these possible relationships.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

N R I G B.C M

5. What term is used to refer to the basic science applied to understanding the health effects associated with chemical exposures? a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology ANS: A Toxicology is the study of the health effects associated with chemical exposures.

Pharmacology is the branch of medicine concerned with the multiple aspects of drugs.

Chemistry is the branch of science with deals with the way that matter is composed.

Environmental epidemiology is concerned with the discovery of environmental exposures that cause or protect against illness or disease.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. What statement accurately describes the characteristics of epidemiology? a. It is a science that studies the poisonous effects of chemicals. b. It explains the association between learning disabilities and exposure to lead-based paint at the cellular level. c. It helps nurses understand the strength of the association between exposure and

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health effects. d. It is a method for tracking the prevalence of health outcomes.

ANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects. Toxicology is the science that studies the poisonous effects of chemicals. Environmental surveillance provides data with which to track and analyze the incidence and prevalence of health outcomes.

Epidemiology does not examine causes at the cellular level.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. When researching pesticides, the nurse looks at the “family” of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity ANS: B Chemicals are grouped so it’s possible to understand the actions and risks associated with each group. Although some common health risks exist within these families of chemicals, the possible health risks for each chemical should be evaluated individually when a potential human exposure exists.

DIF: Cognitive level: ApN plyiR ng I G B.TC OP:M Nursing process: Assessment MSC: NCLEX: Safe and EfU fectS ive N CareTEnviroOnment: Safety and Infection Control 8. Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature ANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil, etc.). The other examples do not contain an agent, host, and environment.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Identifying areas with an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community ANS: B

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The use of a GIS allows the PHN to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness. An electronic health record (EHR) would be the most appropriate place to record client data from a foot clinic.

Evaluation of effectiveness of a farm safety program would need to be done through some type of assessment or evaluation method—GIS would not be useful to collect this data. GIS is not a scheduling system and would not be helpful when scheduling health promotion programs in the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 10. A public health nurse (PHN) is organizing a multidisciplinary team to address the issue of water pollution in the community. Which group of professionals would be invited to address this issue? a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists ANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists. The other professionals are not experts in the area of water pollution in the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 11. A nurse would identify which as a point source of air pollution? a. A smoke stack b. The number of cars and trucks c. The amount of fossil fuel consumed in a community d. Ground ozone levels ANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack.

Nonpoint sources come from more diffuse exposures, such as from cars and trucks. The amount of fossil fuel that is consumed and ground ozone levels do not identify sources of air pollution.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 12. A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first “P”? a. Present work b. Potential exposures c. Personal protective equipment use d. Past work

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ANS: A Present work is the first “P.” Potential exposures are part of the “I”—investigate potential exposures. Personal protective equipment use is not part of the mnemonic. Past work is the second “P.” DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 13. What is the greatest single source of air pollution in the United States? a. Waste incineration b. Power plants c. Motor vehicles d. Molds ANS: C Mobile sources such as cars and trucks are the greatest single source of air pollution in the United States. Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 14. A nurse wants to find more information about indoor air quality. Which of the following websites would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. “Right to Know” The Occupational Safety and Health Administration (OSHA) ANS: B Indoor air quality is a growing public health concern in office buildings, schools, and homes and is reflected in the alarming rise in asthma incidence in the United States, particularly among children. Sources of information about indoor air quality include the EPA and the American Lung Association. The NIH is part of the U.S. Department of Health and Human Services (USDHHS) and is responsible for health and biomedical research. “Right to Know” is part of a workplace safety legislation. OSHA regulates safety in factories and businesses.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 15. Employees working with hazardous chemicals have the “Right to Know” about the chemicals they are working with through the creation of which resource? a. Material Safety Data Sheet (MSDS) b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency (EPA) ANS: C

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The Hazard Communication Standard requires employers to maintain a list of all hazardous chemicals that are used on site. Each of the chemicals should have an associated chemical information sheet known as an MSDS, which is written by the chemical manufacturer.

Consumer Confidence Reports summarize the results of the annual testing of the public water supply. The EPA sets forth policies, regulations, and public laws for the safety of the environment and the population.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 16. What is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water ANS: B Nonpoint sources come from more diffuse exposures to pollution. Animal waste is the only diffuse exposure given. The others are considered point sources; point sources are individual, identifiable sources such as smoke stacks.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 17. A nurse is completing the first phase of a risk assessment. Which of the following questions would the nurse most likely try to answer? rele ased thB e. enC viro a. Has the chemical been N UR SIint NGo T OMnment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans): Is the chemical known to be associated with a negative health effect? The second step is determining if the chemical has been released into the environment: Has the chemical been released into the environment? The third step is estimating how much and by which route of entry the chemical might enter the human body: How much and by which route of entry can the chemical enter the body? The final step considers the previous steps: What is the prediction for potential harm?

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 18. A nurse working at the individual level to reduce pollution in the environment would most likely be involved in what activity? a. Providing a tax incentive to factories that do not pollute b. Making laws related to allowed levels of pollution in the area c. Recycling paper, glass, cans, and plastic d. Moving to an area with less pollution

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ANS: C Nurses can reduce pollution by doing their part, which can include choosing to recycle paper, glass, cans, and plastic. Providing a tax incentive and creating laws would not be completed at the individual level to reduce pollution in the environment. Moving to an area with less pollution would not help to improve the problem.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 19. What is the first step the nurse would take when addressing the problem of air pollution in the community? a. Setting standards b. Monitoring c. Permitting d. Compliance ANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water. Environmental standards may describe a permitted level of emissions, a maximum containment level, an action level for environmental cleanup, or a risk-based calculation. Monitoring is an ongoing process after an action has happened.

Compliance refers to the processes for ensuring that permit/standard/regulatory requirements are met.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 20. A city sets the standard of an acceptable level of emissions or a maximum contaminant level U S N T O allowed for factories. Which concept is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard ANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed. Although this does help to control pollution, environmental standard is best applied in this example. Setting a standard for emissions does not impact waste minimization or land use planning.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 21. A facility is inspected after it has obtained a permit. The inspection is completed for the purpose of observing whether the plans submitted in the permit application are being implemented as approved. Which of the following environmental protection strategies is being applied? a. Controlling pollution b. Waste minimization c. Land use planning

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d. Environmental monitoring ANS: D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved. Permitting is an important step in controlling pollution. Waste minimization and land use planning are activities aimed at prevention of pollution.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 22. Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act ANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters.

The Safe Drinking Water Act authorized the EPA to establish safe standards of purity and required all owners or operators of public water systems to comply with primary standards.

The Toxic Substance Control Act gives the EPA the ability to track the 75,000 industrial chemicals currently produced or imported into the United States. The Pollution Prevention Act focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials.

N R I G B.C M

DIF: Cognitive level: RemU embSerinNg T TOO P: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. A public health nurse (PHN) working with a family living in poverty is concerned about their exposure to environmental hazards. Which of the following factors should the nurse identify as possibly putting the family at risk? (Select all that apply.) a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education e. Unsafe working conditions ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Substandard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

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2. A nurse is assessing for environmental health risks in the community. Which of the following approaches would be most appropriate for the nurse to use? (Select all that apply.) a. Asking legislators to provide a list of environmental pollutants in the area b. Developing a list of exposures associated with urban, rural, or suburban settings c. Assessing the risk by medium such as air, water, soil, or food d. Dividing the environment into functional locations: home, school, workplace, and community e. Recruiting community members to sign a petition to decrease pollution ANS: B, C, D Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by medium such as air, water, soil, or food, and dividing the environment into functional locations: home, school, workplace, and community are ways a nurse can assess the environment. Asking legislators for a list of pollutants or recruiting community members to sign a petition are not effective means to assess for environmental health risks.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 07: Application of Ethics in the Community Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement regarding Florence Nightingale’s ideas about ethics is correct? a. Nursing is a call to service, and the moral character of persons entering nursing is important. b. Ethical principles are based on the values of the individual nurse. c. Society will dictate the ethical principles to which nurses must adhere. d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers.

ANS: A Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as important. Florence Nightingale did not set up public health centers. Florence Nightingale did not believe that nurses must adhere to society’s view of ethical principles. Ethical beliefs are based on the values of the individual nurse, not ethical principles.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is applying the knowledge and processes of ethics to the examination of ethical problems in health care. WN hiU chRoSf I thN eG foT llB ow.iC ngOdM escribes the actions of the nurse? a. Values b. Morality c. Ethics d. Bioethics ANS: D Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care. Values are beliefs about the worth or importance of what is right or esteemed. Morality is shared and generational societal norms about what constitutes right or wrong conduct. Ethics is a branch of philosophy that includes both a body of knowledge about the moral life and a process of reflection for determining what persons ought to do or be regarding this life.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse who was working in the 1960s used the code of ethics to guide making an ethical decision. Which code of ethics would have been used? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses with Interpretive Statements d. International Council of Nurses (ICN) Code of Ethics for Nurses

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics for Nurses with Interpretive Statements was adopted in 2001, and the ICN Code of Ethics for Nurses was adopted in 2000.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. What term is used to describe an orderly process that considers ethical principles, client values, and professional obligations? a. Moral distress b. Ethical decision making c. A value d. A code of ethics ANS: B Ethical decision making is defined as an orderly process that considers ethical principles, client values, and professional obligations. Moral distress is an uncomfortable state of self when one is unable to act ethically. Values are beliefs about the worth or importance of what is right or esteemed. A code of ethics is a moral standard that delineates a profession’s values, goals, and obligations.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A public health nurse is examining several issues within daily practice. Which of the following issues would be N cons red anTeB th. icC alOdM ilemma?

URide SI NG a. Whether or not to establish a community health center in a rural area b. Allocating resources in a natural disaster c. Deciding to withdraw care on a hospice patient d. Applying the principles of Florence Nightingale in Bangladesh ANS: B When resources are scarce, a dilemma may exist as to how to allocate them. Considering establishing a community health center may be a dilemma, but it probably does not involve ethics. Withdrawing care from a hospice patient would most likely not be an issue encountered by a public health nurse, as this represents community health nursing practice, not public health nursing practice. Applying the principles of Florence Nightingale would not be ethical issue.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The growing multiculturalism of American society can contribute to ethnicity conflicts when considering what? a. Providing care to different cultural groups b. Aligning individual values with the cultural norms c. Ethnic groups overburdening the health care system d. The greater community’s values being jeopardized by specific ethnic values

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: D Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in American culture. Providing care to different cultural groups should not produce an ethnicity conflict. Individual alignment with cultural norms would make it less likely that an ethnicity conflict would occur. Ethnic groups using the health care system will not cause it to be overburdened or result in an ethnicity conflict.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin. There is only enough for one client. Which of the following actions would the nurse take first? a. Identify all options. b. Determining who arrived first. c. Gather additional information. d. Act and assess decisions made.

ANS: C The steps of the ethical decision-making framework are to first identify the ethical issues and dilemmas, then place them within a meaningful context, obtain all relevant facts, reformulate ethical issues and dilemmas if needed, consider appropriate approaches to actions or options, make decisions and take action, and evaluate decisions and action.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 8. Which ethical principle requires “doing no harm?” a. Respect for autonomy b. Nonmaleficence c. Beneficence d. Distributive justice ANS: B Nonmaleficence refers to doing no harm. Respect for autonomy requires that individuals be permitted to choose those actions and goals that fulfill their life plans unless those choices result in harm to another. Beneficence requires that we do good. Distributive justice requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is applying the ethical principle of nonmaleficence. Which of the following describes the action that the nurse is taking? a. Administering medications using the “five rights” b. Allowing clients to be active participants in their care c. Providing patient privacy when delivering care d. Referring a client to a physical therapist

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: A Nonmaleficence requires that one do no harm. It requires that health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible. Providing privacy when delivering care demonstrates the client’s right to privacy.

Allowing clients to be active participants in their care refers to the ethical principle of the right to autonomy. Referring a client to a physical therapist demonstrates the nursing role of referral agent.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is applying the principle of distributive justice. Which of the following describes the benefits that will occur through application of this principle? a. Basic needs, material and social goods, liberties, rights, and entitlements b. Taxes, military service, location of incinerators or power plants c. Entitlement to equal rights and equal treatment d. The right to private property and personal assets ANS: A Distributive justice requires that the distribution of benefits and burdens on a society be fair or equal. Entitlement to equal rights and equal treatment refers to egalitarianism. The right to private property and personal assets refers to libertarianism. Taxes, military service, and location of incinerators or power plants are not benefits associated with justice.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N R I G B.C M

11. A nurse believes everyone is entitled to equal rights and equal treatment in society. Which of the following principles is being applied? a. Distributive or social justice b. Egalitarianism c. Libertarian view of justice d. Communitarianism ANS: B Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society. Distributive justice requires that the distribution of benefits and burdens on a society be fair or equal. The libertarian view of justice holds that the right to private property is the most important right. Communitarianism views that individual rights need to be balanced with social responsibilities; individuals do not live in isolation but are shaped by the values and culture of their communities.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Which statement fits with those of the Liberal Democratic Theory? a. One should reject any idea that societies, states, or collectives of any form can be the bearers of rights or can owe duties. b. Inequalities result from birth, natural endowment, and historic circumstances.

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Public Health Nursing 10th Edition Stanhope Test Bank c. Everyone has a right to private property. d. Government should be limited.

ANS: B Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. According to Leininger and Watson, what is the moral ideal of nursing? a. Caring b. Advocacy c. Responsibility d. Accountability ANS: A This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice from medical practice.

Advocacy, responsibility, and accountability are not part of the moral idea of nursing proposed by Leininger and Watson.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N R I G B.C M

14. A nurse is using the principleU s ofSvirN tue T ethics inOdecision making. Which of the following describes the action that the nurse would take? a. Provide efficient and effective nursing care. b. Identify the meaningful facts in the situation. c. Seek ethical community support to enhance character development. d. Plan ways to restructure the social practices that oppress women.

ANS: C According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to enhance character development. Nurses can demonstrate advocacy when providing efficient and effective nursing care. Identifying the meaningful facts in the situation is part of the ethical decision-making process. Planning ways to restructure the social practices that oppress women is part of the feminist ethics decision-making process.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. Which statement about feminist ethics is correct? a. Feminists include only women in their worldview. b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process.

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Public Health Nursing 10th Edition Stanhope Test Bank c. Feminists believe that men should not be nurses. d. Women’s thinking, and moral experiences are important and should be taken into account.

ANS: D Feminist theory ascribes to the idea that women’s thinking, and moral experiences are important and should be considered. A feminist perspective leads us to think critically about connections among gender, disadvantage, and health as well as the distribution of power in public health processes. Feminists are women and men who hold a worldview advocating economic, social, and political equality for women that is equivalent to that of men.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse is providing care using the idea of “servicing citizens, not customers.” Which of the following ideas is being applied by the nurse? a. Ethical tenets of policy development b. Basic concepts of the feminist theory c. Underlying premise of virtue ethics d. Components of distributive justice ANS: A There are three tenets of both policy and ethics. The approach is based on the voice of the community as the foundation on which policy is developed. The basic concept of feminist theory allows us to think critically about connections among gender, disadvantage, and health as well as the distribution of power in public health processes. The goal of virtue ethics is to enable persons to flourish as human beings. Distributive justice requires that N the RSben INefit GT B.C M there be a fair distribution ofU s and buOrdens in society based on the needs and contributions of its members.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. Public health administrators provide part-time translators to a health department serving indigent immigrants. Which of the following best describes what is being addressed? a. Policy development b. Quality c. Assurance d. Libertarian philosophy ANS: C Assurance refers to the role of public health in making sure that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them. Policy development refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Quality refers to providing the best care possible. Libertarian philosophy refers to the view that the right to private property is the most important right.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse believes that all Americans should receive basic health care services. Which of the following core functions supports this belief? a. Assessment b. Assurance c. Policy development d. Advocacy ANS: B Assurance purports that all persons should receive essential personal health services.

Assessment refers to systematically collecting data on the population, monitoring the population’s health status, and making information available about the health of the community. Policy development refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Advocacy embodies an ethical focus grounded in quality of life.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements? a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates for office. b. The nurse’s primary focus is on acute bedside nursing, followed by community health care to promote seamless care. ima ysC icia c. The nurse owes duty prN Rrily ItoNtGheTpBh. Mn to strive to protect health, safety, U S O and the rights of the patient. d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy.

ANS: D Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concerns as well as be involved with shaping policies through political action. The Code of Ethics for Nurses with Interpretive Statements does not address the practice setting for nursing care. According to the Code of Ethics for Nurses with Interpretive Statements, public health should achieve community health in a way that respects the rights of individuals in the community, not owing duty primarily to the physician. Public health should seek the information needed to implement effective policies and programs that protect and promote health.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse refers to the Code of Ethics for Nurses or the Public Health Code of Ethics. Which of the following describes why the nurse has referred to this document? a. To provide answers for ethical dilemmas b. To guide professional practice related to ethics c. To increase moral leadership in ethics d. To find a framework for ethical decision making

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the profession. They do not provide answers for ethical dilemmas, only serve as a guide. They do not increase moral leadership, nor do they provide a framework for ethical decision making.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is demonstrating advocacy in personal nursing practice. Which of the following actions best demonstrates this principle? a. Offering a smoking cessation program b. Screening for hypertension c. Lobbying for health care reform d. Conducting home visits ANS: C Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, and efficient health care for all. This is best accomplished by performing interventions at the population level.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. The community leaders in a lesser-developed country decide not to tell the citizens of a N R I G mB.C M small village about a chemicaUl spSill aNt a T ajor inOdustrial facility that could produce harmful effects. Which of the following principles is being violated? a. Morality b. Advocacy c. Caring d. Virtue ANS: B Advocacy requires that the community be properly informed, and this was violated in the above scenario. Morality is shared and generational societal norms about what constitutes right or wrong conduct. Caring represents the essence of nursing. Virtue demonstrates behavior showing high moral standards.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which of the following are ethical tenets that underlie the core function of assessment?

(Select all that apply.) a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and populations. b. Moral character: the persons selected to develop, assess, and disseminate

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Public Health Nursing 10th Edition Stanhope Test Bank community knowledge possess integrity. c. Service to others over self: a necessary condition of what is “good” or “right” policy. d. “Do no harm”: disseminating appropriate information about groups and populations is morally necessary and sufficient. e. Providers of public health services should be competent and available.

ANS: A, B, D Service to others over self is an ethical tenet of policy development. Providers of public health services should be competent and available is an ethical tenet of assurance.

Competency, moral character, and “do no harm” are the ethical tenets of assessment.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A community health nurse is applying the Ethical Principles for Effective Advocacy. Which of the following best describes the action(s) of the nurse? (Select all that apply.) a. Act in the health care provider’s best interest. b. Keep the client (group, community) properly informed. c. Maintain client confidentiality. d. Carry out instructions with diligence and competence. e. Provide advice to all members of the community.

ANS: B, C, D Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with diligence and competence are ethical principles for effective advocacy. The nurse should act impartially and offer frank, independent advice, which does N R sho INuld GTbeB.C M not necessarily mean that advUiceS provO ided to all members of the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 08: Achieving Cultural Competence in Community Health Nursing Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about the nursing workforce is true? a. The nursing workforce is overwhelmingly white. b. The number of minority nurses meets the needs of the country’s demographics. c. The nursing workforce is becoming increasingly diverse with increasing minorities. d. Immigrants and refugees make up a large part of the nursing workforce in some areas.

ANS: A The nursing workforce is 83% white. Because of the large percentage of white nurses this does not meet the needs of the country’s demographics. Immigrants and refugees do not make up a part of the nursing workforce.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The Refugee Act of 1980 had what effect on refugees who were immigrating into the United States? a. Allowed specific provisions for refugees from Southern and Eastern Europe. b. Provided a uniform proN ceU dR urS eI foN r rGefTuB ge. esCtO oM be admitted into the United States. c. Permitted refugees to set up communities in or around major metropolitan areas. d. Allowed refugees access to “green cards” allowing them to work in the United States.

ANS: B The Refugee Act of 1980 provided a uniform procedure for refugees to be admitted into the United States. Refugees were immediately eligible to receive Temporary Assistance for Needy Families, Supplemental Security Income, and Medicaid. This procedure was in effect for all refugees not just those from specific countries. It did not provide “green card” access or permit development of specific communities for refugees.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which statement accurately describes a large portion of foreign-born residents of the United States? a. They tend to live in major metropolitan areas. b. Most reside in rural areas. c. Few have a high school education. d. They are refugees and non-immigrants.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Two thirds of the foreign-born population lives in or around major metropolitan areas and works in mainly service-producing and blue-collar sectors. They are also more likely to be poorer. The majority of foreign born are legal immigrants (85%). More than 54% of the foreign-born adults in the labor force have completed high school, which would not be considered a large portion.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A 35-year-old from Russia comes to the United States seeking asylum because of religious persecution in the native country. Which of the following best describes this type of immigrant? a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrant ANS: C Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants. Unauthorized immigrants may have crossed a border into the United States illegally, or their legal permission to stay in the United States may have expired.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 5. A visitor from Japan comes to the United States for a 2-week vacation. Which of the following best describes this person? a. Non-immigrant b. Refugee c. Legal immigrant d. Lawful permanent resident ANS: A A non-immigrant is admitted for a limited duration for a specific purpose. Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties.

Lawful permanent resident is another name for legal immigrants.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is observing behaviors that may be defined by culture. Which of the following is the nurse most likely to observe? a. Speaking a dialect of a language in a local region b. Standing when an older adult gets on the bus to give him or her a seat c. Immigrating to the United States and seeking work

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Public Health Nursing 10th Edition Stanhope Test Bank d. An organizational structure of a cultural group ANS: B Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and is transmitted intergenerationally. Behaviors may be culturally determined, as illustrated in the correct response. This behavior is based on the value of respect of elderly people. Speaking a particular dialect in a local area would not fit the definition of culture. An organizational structure of a group is not an observable behavior.

Immigrating to the United States does not demonstrate culture.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse states that the client has exhibited an explicit cultural behavior. Which of the following has the nurse most likely observed? a. Verbal communication b. Body language c. Use of titles d. Perception of health and illness ANS: A Explicit behaviors such as language, interpersonal distance, and kissing in public can be observed and allow individuals to identify with other persons from the culture. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness.

DIF: Cognitive level: ApN plyiR ng I G B.TC OP:M Nursing process: Assessment MSC: NCLEX: Safe and EfU fectS ive N CareTEnviroOnment: Management of Care 8. A nurse is working with an immigrant population. Which of the following should be the first action taken by the nurse? a. Be aware of one’s own culture. b. Become familiar with traditional practices of the immigrants. c. Try to see things from the immigrant’s viewpoint. d. Learn to speak the language of the immigrant population.

ANS: A Cultural competence is one of the core attributes of public health nurses. Nurses come from a variety of cultural backgrounds and have their own cultural traditions. Nurses also bring their biomedical beliefs and values to the practice environment that may differ from the client’s own beliefs and values. Because nurses recognize their own culture, they are better able to understand that there are differences among cultures. Being aware of one’s own culture should be done before completing the other tasks of increasing familiarity with traditional practices, trying to see things from the other’s point of view, or learning to speak the language.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. Which of the following statements about race is true?

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Public Health Nursing 10th Edition Stanhope Test Bank a. In the United States, children of biracial parents are usually assigned the race of the father. b. Ethnicity and race are synonymous terms. c. Individuals may be of the same race but of different cultures. d. No social significance is usually placed on race.

ANS: C It is often a misconception that persons of the same race have the same culture. For example, African Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very different cultures. In the United States, biracial babies who had one white parent were assigned the race of the nonwhite parent. Ethnicity is a contrasting term to race. Race is a characteristic that allows for some groups to be separated, treated as superior, and given access to power and other valued resources, while others are treated as inferior and have limited access to power and resources.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is working with a population that exhibits a large amount of diversity. The nurse recognizes that skin color of individuals within this population is an example of what? a. Multiculturalism b. Ethnicity c. Race d. Culture ANS: C Race is primarily a social classification that relies on physical markers. Multiculturalism is N R Eth IN GtyB.C M the blending of diverse culturUes. S niciT is theOshared feeling of peoplehood among a group of individuals and relates to cultural factors, such as nationality, geographic region, culture, ancestry, language, beliefs, and traditions. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A client shares with the nurse that her grandparents immigrated to the United States from Germany. Which of the following best describes what she has disclosed? a. Multiculturalism b. Ethnicity c. Race d. Culture ANS: B Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin. Multiculturalism is the blending of diverse cultures. Race is primarily a social classification that relies on physical markers. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse implements nursing interventions considering the uniqueness of the person’s culture. Which of the following best describes this action? a. Cultural diversity b. Cultural knowledge c. Cultural competence d. Cultural awareness ANS: C Providing care based on the uniqueness of the client’s cultural norms and values is one of the three guiding principles of culturally competent nursing care. Cultural diversity refers to the degrees of variation represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time. Cultural knowledge refers to the process of searching for and obtaining a sound educational understanding about culturally diverse groups. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is unable to provide culturally competent care to a population within the community. Which of the following is an effect of this type of care? a. Enhanced communication b. Increased cost of healthNcar URe SINGTB.COM c. Achievement of health indicators d. Improvement in client compliance ANS: B Care that is not culturally competent may increase health care costs and decrease positive client outcomes. Communication is inhibited through care that is not culturally competent. It is not possible to achieve health indicators if culturally competent care is not given. Client compliance decreases if culturally competent care is not provided.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is striving to be culturally competent. Which of the following actions would most likely be taken by the nurse? a. Respect individuals from different cultures and value diversity. b. Immerse himself or herself in different cultures. c. Design care for special ethnic groups. d. Give explicit instructions to avoid client decision making.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Nurses who strive to be culturally competent respect individuals from different cultures and value diversity. Immersing oneself in a different culture, designing care for special ethnic groups, and giving explicit instructions so the client does not have to make a decision does not demonstrate cultural competence.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse wants to obtain information on the alternative methods of health care used by a 45-year-old female Hispanic client. Who would be the best person to ask about this? a. The husband of the client b. A community leader of the ethnic group c. The client herself d. The religious leader of the ethnic group ANS: C Clients provide a rich source of information about their own cultures. The client would be the preferred person to collect this information instead of the husband, community leader, or religious leader.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. Which event best describes a cultural encounter? a. Sharing significant assessment findings with members of a racial minority b. Visiting the native land of the clients served at a community health center at U aR His pan ic T chBu. rcC hO toMdiscuss the health issues of a client c. Telephoning the priest N SI NG d. Learning about traditional healing practices from an American Indian client ANS: D Cultural encounter refers to the process that permits nurses to seek opportunities to directly engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group and possibly avoid stereotyping. Learning about traditional healing practices is an example of a direct cultural encounter. This occurs when a nurse engages in cross-cultural interactions. Sharing significant assessment findings demonstrates the nurse sharing information, not an engagement with the population. When visiting a native land, there may not be interaction with any other culture. Telephoning a priest at a Hispanic church does not demonstrate an interaction, but rather the nurse calling the priest to accomplish a nursing task.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse demonstrates cultural desire to provide culturally competent care. Which of the following actions would be taken by the nurse? a. Relying on a textbook for information about an ethnic group b. Bringing a translator to the local community clinic c. Taking Spanish classes in the evening at a local college d. Judging others using his or her own cultural values

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: C Cultural desire refers to the nurse’s intrinsic motivation to want to engage in the elements necessary to provide culturally competent care. The activity that suits the definition of cultural desire is one that a nurse would want to do instead of being directed to do so, referring to the intrinsic motivation of the nurse. Relying on a textbook for information, bringing a translator, and judging others do not demonstrate the definition of cultural desire as they are not demonstrating the intrinsic motivation of the nurse.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. To meet a client’s needs, it is sometimes necessary to integrate into the client’s care a culturally relevant practice that lacks scientific utility. Which term describes this action? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterning ANS: A Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help people of a particular culture to accept nursing strategies, or to negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values so they can maintain, promote, and restN ore patterning refers to assistive, supportive, URhea SIlth.

NGCul TBtu.raCl re OM facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A Mexican American mother insists on using special candles to help her daughter’s ear infection. The nurse asks the mother if she would also give her daughter antibiotics. Which of the following best describes the action of the nurse? a. Cultural accommodation b. Cultural repatterning c. Culture brokering d. Cultural awareness ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank This means that the nurse supports and facilitates the use of cultural practices with interventions from the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors. Which of the following is being demonstrated by the nurse? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterning ANS: C Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the N clieR nts I of aG parB tic.uC lar cMulture to retain and preserve traditional U S N T O values, so they can maintain, promote, and restore health. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. A city council discusses how former city laws promoted segregation in the community years ago. Which of the following was being demonstrated when segregation occurred? a. Prejudice b. Cultural imposition c. Racism d. Stereotyping ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth. Prejudice is the emotional manifestation of deeply held beliefs about a group. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another country. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. The nurse labels a patient an alcoholic because of his or her ethnicity. Which of the following best describes this action by the nurse? a. Stereotyping b. Prejudice c. Racism d. Ethnocentrism ANS: A Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences. Prejudice is the emotional manifestation of deeply held beliefs about a group. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth. Ethnocentrism is the belief that one’s own cultural group determines the standards by which another group’s behavior is judged.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse advocates and intervenes between the health care system and the client’s cultural beliefs on behalf of the client. Which term best describes the nurse’s action? a. Cultural accommodation b. Culture brokering c. Cultural preservation d. Cultural repatterning ANS: B Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. Which of the following best describes what has happened? a. Ethnocentrism b. Cultural imposition c. Racism d. Stereotyping ANS: A Ethnocentrism is the belief that one’s own cultural group determines the standards by which another group’s behavior is judged. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another culture. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior on the basis of intelligence, morals, beauty, inheritance, and self-worth. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. The tendency to ignore all differences between cultures and to act as though the differences do not exist is identified by what term? a. Cultural conflict d. Cultural imposition b. Culture shock c. Cultural blindness ANS: C Cultural blindness is an inability to recognize the differences between one's own cultural beliefs, values, and practices and those of the client’s culture. In cultural blindness nurses employ health strategies which suggest that health care is devoid of cultural meaning and all populations interpret health care practices in the same way. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from the individual’s culture. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another country.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. Which of the following terms best describes how the nurse is feeling? a. Cultural conflict

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Public Health Nursing 10th Edition Stanhope Test Bank b. Cultural relativism c. Culture shock d. Culture brokering ANS: C Culture shock can happen to individuals within their own culture when they are having experiences such as starting a new job or career. Culture shock is brought on by anxiety from losing familiar signs and symbols of social interaction. Feelings associated with culture shock are helplessness, discomfort, and disorientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse’s personal beliefs. Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A client comes into the clinic and reports visiting an acupuncturist for pain. The nurse suggests taking pain medication instead. Which of the following best describes the action taken by the nurse? a. Cultural conflict b. Cultural blindness c. Cultural relativism d. Cultural imposition NURSINGTB.COM ANS: D This is an example of cultural imposition—the act of imposing one’s cultural beliefs, values, and practices on individuals from another culture. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse’s personal beliefs.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 28. Hispanics tend to believe that the needs of the family take priority over those of the individual. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental control ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Environmental control refers to the person’s relationship with nature and to plan and direct factors in the environment that affect them.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Perception of time ANS: D Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future.

Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 30. Asians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental control ANS: D Environmental control refers to the ability of individuals to control nature and to influence factors in the environment that affect them. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 31. Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. Which of the following types of cultural variations is being demonstrated?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Biological variations Personal space Social organization Perception of time

ANS: A Biological variations are the physical, biological, and physiological differences that exist between racial groups and distinguish one group from another. Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse to provide culturally competent care? (Select all that apply.) a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care. b. Language barriers may interfere with efforts to provide assistance. c. Certain risk factors may be present for a given population.

N ont RS I tion GTalB.C M d. Certain groups may use nU radiN healiO ng practices. e. Introduction of the American culture will be an important part of the encounter.

ANS: A, B, C, D When working with immigrants, it is important to be aware of one’s own beliefs while realizing that language barriers may exist, that different populations experience different risk factors and illnesses, and that nontraditional healing practices may be used. It would not be appropriate to impose the American culture into the encounter.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse will be using an interpreter during a client encounter. Which of the following considerations should be made by the nurse? (Select all that apply.) a. It is appropriate to use family members as interpreters. b. Written materials should be available in the client’s primary language. c. Observe the interpreter’s gestures to assure client understanding. d. The gender, age, and educational level of the interpreter should be evaluated. e. The nurse should face the interpreter when speaking.

ANS: B, D

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Public Health Nursing 10th Edition Stanhope Test Bank Family members should be used with caution. The client’s gestures and nonverbal messages should be observed to assure understanding. Written materials should be available in the client’s primary language. The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered when selecting the proper interpreter. The nurse should face the client during the dialogue, not the interpreter.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 09: Public Health Policy Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse becomes actively involved in the development of a health policy in the community.

Which of the following describes why this is an important role of the nurse? a. Government and policy have a large impact on nursing and health. b. Policy affects nursing values as set forth by Florence Nightingale. c. Political science is a course of study that parallels nursing. d. Nurses must interpret laws to fit their practice.

ANS: A Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care. Policy does not affect nursing values. Political science does not parallel nursing. Nurses are unable to interpret laws to fit their practice.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is employed by the U.S. Department of Health and Human Services (USDHHS).

Which of the following branches of government is the nurse working for? d. Health a. Judicial b. Executive ANS: B c. Legislative The executive branch includes regulatory departments, one of which is the USDHHS. The judicial branch is composed of a system of federal, state, and local courts guided by the opinions of the Supreme Court. The legislative branch is made up of the Senate and the House of Representatives, whose members are elected by the citizens of particular geographic areas. There is not a health branch of the government.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. Which of the following is the nurse becoming involved in? a. Policy b. Politics c. Law d. Health policy ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Politics is the art of influencing others to accept a specific course of action. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end. Law is a system of privileges and processes by which people solve problems based on a set of established rules. Health policy is a set course of action to obtain a desired health outcome for an individual, family, group, community, or society.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. What was the first major federal government action relating to health? a. The Social Security Act b. The National Institutes of Health (NIH) c. The Public Health Service (PHS) d. Medicare and Medicaid ANS: C The first major federal governmental action relating to health was the creation in 1798 of the PHS. The Social Security Act was passed in 1935. The NIH was founded in 1887. Medicare and Medicaid were created in 1965.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. What is one effect of the use of block grants? a. A reduction of federal expenditures tate toIspe b. A decreased ability of sN Bo.nCeyOoMn programming URs S NGndTm c. The guaranteed continuation of programs with demonstrated effectiveness d. The shift from hospital-based to community-based nursing care ANS: A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures. Block grants gave additional monies to state and local areas to improve access to care. Block grants have not caused a shift in care from hospital-based to community-based nursing care. Block grants have not guaranteed program continuation.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. What term described when planning, delivering, and financing responsibility for programs is shifted from the federal level to the state level? a. Evolution b. Devolution c. Block granting d. State administration ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the state level is called devolution. This was a major effort during the Reagan administration. Block grants have increased because of devolution. State administration does not describe this shift of responsibility; rather it describes who is administering the program. Evolution describes how something is gradually developed.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse investigates the interpretation of a state’s right to grant abortions. Which of the following branches of government would the nurse be looking at? a. Executive b. Legislative c. Judicial d. Federal ANS: C The judicial branch interprets laws and their meaning, as in its ongoing interpretation of states’ rights to define access to reproductive health services for citizens of the states. The executive branch suggests, administers, and regulates policy. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address those problems. The federal branch refers to the top level of government agencies.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care heal ty,TaB n. dC welf 8. A nurse acts to protect the N URth,SsIafe NG OMare of citizens, such as requiring immunizations of children before admission to school. Which of the following levels of power is being used? a. Executive b. Legislative c. Judicial d. Police ANS: D Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens. Executive power comes as the executive branch suggests, administers, and regulates policy. Legislative power occurs as this branch of government identifies problems and proposes, debates, passes, and modifies laws to address those problems. Judicial power occurs as the judicial branch interprets laws and their meaning, as in its ongoing interpretation of states’ rights to define access to reproductive health services for citizens of the states.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. A local health department provides a hypertension screening to all individuals. Which of the following general categories of health care functions is being used? a. Direct services b. Financing

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Public Health Nursing 10th Edition Stanhope Test Bank c. Information d. Policy setting ANS: A Direct services are actions that provide health care directly to individuals. Financing occurs as the government pays for health care services. Information is used as all branches and levels of government collect, analyze, and disseminate data about health care and health status of the citizens. Policy setting occurs as all branches of government make policy decisions about health care.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. A nurse is working for the federal government to provide for the protection of the public’s health. Which of the following actions would the nurse most likely complete? a. Interpreting decisions related to women’s right to privacy b. Setting up immunization clinics for smallpox vaccine c. Regulating nursing at the state level d. Monitoring the influx of disease at the borders ANS: D The United States Constitution gives the federal government the authority to provide for the protection of the public’s health. By monitoring the influx of disease at the borders the public’s health is being protected. Interpreting decisions does not support the protection of the public’s health. Smallpox has been eradicated so it would not be necessary to set up immunization clinics. Regulation of nursing at the state level does not support protection of the public’s health by the federal government.DIF: Cognitive level: Applying TOP: Nursing process: ImplementationMSC: NCLEX: Health Promotion and Maintenance 11. A nurse provides health services for women and children in the community. Which of the following provides the provisions to offer these services? a. Sheppard-Towner Act b. Public Protection of Maternity and Infancy program c. Early Periodic Screening and Developmental Testing (EPSDT) program d. Women, Infants, and Children (WIC) program ANS: A The Sheppard-Towner Act also offered well-child and child-development services, provided adequate hospital services and facilities for women and children, and provided grants-in-aid for establishing maternal and child welfare programs. The Sheppard-Towner Act defined the role of the federal government in creating standards to be followed by states in conducting categorical programs, such as WIC and EPSDT programs.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is interested in census data. Which federal department’s website would be a good place to start?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Department of Labor (DOL) USDHHS Commerce Department World Health Organization (WHO)

ANS: C The Commerce Department handles the United States Census and population estimates and projections. The DOL has information about the consumer price index, employment, and earnings. The USDHHS has information about the national vital statistics and several health-related surveys. The WHO has statistics about world health.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse researcher wants to get information on the occurrence of an internationally important disease. Which of the following websites would be the best place to seek this information? a. The United Nations b. The WHO c. The World Bank d. The World Health Assembly ANS: B The WHO publishes day-to-day information about international occurrence of disease, injury, and death. The United Nations deals with human rights, world peace, international security, and the promotion of economic and social advancement of all of the world’s people. The World Health Assembly is the WHO’s policy-making body. The World Bank N eve RS I dGcoTuntries B.CO. M provides funding for lesser-dU lopeN DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What is the focus of the Division of Nursing? a. Enhancing nursing’s competence in providing high-tech skills b. Applying disease prevention, environmental health, and health promotion concepts c. Providing scholarships for advanced nursing education d. Ensuring distribution of qualified nursing personnel to meet the nation’s health needs ANS: D The Division of Nursing is the key federal focus for nursing education and practice, and it provides national leadership to ensure an adequate supply and distribution of qualified nursing personnel to meet the health needs of the nation. The Division of Nursing does not enhance the competency of the profession. The Division of Nursing does not apply nursing concepts. The Division of Nursing does not provide scholarships.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 15. The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. U.S. Department of Health and Human Services (USDHHS). b. Public Health Service (PHS). c. Health Resources and Services Administration (HRSA). d. World Health Organization (WHO).

ANS: A The USDHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency. The PHS was the first major federal government action relating to health. The Health Resources and Services Administration is part of the USDHHS. The WHO is concerned with access to health care across the world.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A doctorally prepared nurse (PhD) at a university wants to submit a grant to study the impact of a nursing activity on patient outcomes. From which of the following federal agencies could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. U.S. Department of Health and Human Services (USDHHS) d. World Health Organization (WHO) ANS: B NINR funds the development of the knowledge base of nursing and promotion of nursing N R,I GTHS, B.C M NDH services in health care. The CUDCS US anO d WHO do not provide funding specific to nursing research.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is working with a member of the military. Which of the following describes the department that provides this person with health care services? a. Defense b. Labor c. Agriculture d. Justice ANS: A The Department of Defense (DOD) delivers health care to members of the military, including their dependents and survivors, and to retired members and their families. The DOL houses the Occupational Safety and Health Administration (OSHA), which imposes workplace requirements on industries. The Department of Agriculture houses the Food and Nutrition Service, which oversees a variety of food assistance activities. The Department of Justice (DOJ) provides health services to federal prisoners.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

18. An occupational health nurse maintains a log of injuries from contaminated sharps. Which of the following describes why the nurse must do this? a. Bloodborne Pathogen Standard b. Occupational Safety and Health Administration (OSHA) c. Department of Labor (DOL) d. Department of Defense (DOD) ANS: A OSHA is part of the DOL. The Bloodborne Pathogen Standard became effective in 2002.

This act clarified the responsibility of employers to select safer needle devices as they become available and to involve employees in identifying and choosing the devices. The updated standard also required employers to maintain a log of injuries from contaminated sharps. The DOD is not involved in these activities.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse supported the passage of needlestick legislation. Which of the following best describes the role of employers because of this legislation? a. Use universal precautions when dealing with all patients. b. Select safer needle devices as they became available. c. Provide needle disposal boxes. d. Incinerate all infectious waste, including needles.

ANS: B Health care facilities by law must select safer needle devices and involve employees in N dev RSices IN. G B.C estick M legislation did not address the use of identifying and choosing the U ThTe needlO universal precautions, provision of needle disposal boxes, or incineration of all infectious wastes.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. The Office of Homeland Security has a mission to rebuild the crumbling public health infrastructures of each state and to provide what service? a. Vaccines for smallpox b. Regulation of nuclear weapons c. Surveillance of bioterrorism threats d. Regulation of foreign nurses entering the United States ANS: C The USDHHS and the federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States. The Office of Homeland Security does not provide vaccinations, regulation of nuclear weapons, or regulation of foreign nurses entering the United States.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 21. The practices of health care providers, nurses, and other health care professionals are differentiated by which of the following? a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. U.S. Department of Health and Human Services (USDHHS) ANS: C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers. HRSA and USDHHS do not differentiate the practices of health care providers. The state board of nursing only addresses the scope of practice of nursing, not the other health care providers.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is sued for malpractice and goes to court. Which of the following types of law is being used? a. Constitutional b. Common c. Judicial d. Institutional ANS: C Judicial law is based on court or jury decisions. Constitutional law provides overall guidance for selected practice situations. Common law means that judges are bound by previous decisions unless they are convinced that the older law is no longer relevant or N a RtySpeIoNfGlaTwB.C M valid. Institutional law is notU that hOas importance in the United States.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. States have certain continuing education requirements for persons to renew a nursing license. Which of the following best describes the type of law that is being used? a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police power ANS: B Licensing is regulated by each state’s nurse practice act as a function of the board of nursing. Constitutional law provides overall guidance for selected practice situations.

Judicial law is based on court or jury decisions. Common law means that judges are bound by previous decisions unless they are convinced that the older law is no longer relevant or valid. Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 24. The state orders a person newly diagnosed with tuberculosis to be quarantined. Which of the following best describes the type of law that allows the state to do this? a. Constitutional b. Common c. Judicial d. State ANS: A Constitutional law provides overall guidance for selected practice situations. Judicial law is based on court or jury decisions. Common law means that judges are bound by previous decisions unless they are convinced that the older law is no longer relevant or valid. State law is not one of the types of law.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. A nurse is found to be negligent. Because of the doctrine of respondeat superior, who is responsible for the negligence? a. The institution’s administrator b. The nurse’s immediate supervisor c. The nurse’s employer d. The nurse ANS: C The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurse’s employer.

In some instances, if the agency isfound liable, the agency may in turn sue the nurse for negligence.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. When a school nurse reports suspected child abuse, there is a breach of confidentiality.

Which of the following best describes why this breach is allowed? a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superior ANS: A The law mandates that a health professional may breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position. Sovereign immunity states that PHN practice has been granted personal immunity to cover all aspects of their practice.

The nurse practice act defines the nurse’s scope of practice. The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurse’s employer.

DIF: Cognitive level: Applying MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank 27. A nursing student is researching various health care services that are provided in prisons.

Which of the following describes these services? a. Funded by the Department of Defense (DOD). b. Focus on health promotion interventions. c. Must be provided at an adequate level. d. Are available to those diagnosed with a chronic illness.

ANS: C Health care services for prisoners are required at an adequate level for all incarcerated individuals. This is administered by the DOJ. Prisoners will receive health care services when diagnosed with chronic illnesses as well as acute illnesses.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse who is working in a home care setting attends a local legislative meeting. Which of the following best describes why the nurse needs to be knowledgeable of health policy? a. Provide safe nursing care. b. Prevent elder abuse. c. Receive payment for the services provided. d. Influence future legislation.

ANS: C Although nurses should be involved in influencing future legislation by contacting their legislators, the best response is that nurses need to be knowledgeable of the current health policies needed so that payment can be received for services they are providing. Health policy does not address safe nursing care provision. Prevention of elder abuse can be part of N heRmSain INrea GTson B.C M health policy, but this is not tU whO y nurses should have this knowledge.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse would like to propose legislation requiring all schools to employ a registered nurse.

Which of the following would be the first step taken as the nurse implements the legislative process? a. Introducing the bill to the legislature b. Moving the bill to the other house c. Developing the policy option into a bill d. Hearings, testimony, and lobbying ANS: C The first step in the legislative process is developing the policy option into a bill. This is then followed by introducing the bill to the legislature; hearings, testimony, and lobbying; and the bill moving to the other house.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 30. A nurse believes additional funding is necessary to support a home-delivered meal program for the elderly. Which of the following would be the best way to share these ideas with a legislator? a. Send an email. b. Write a formal letter. c. Attend a town hall meeting. d. Schedule a face-to-face visit.

ANS: D Face-to-face visits with legislators are viewed as the most effective means of communication. Sending an email, writing a letter, and attending a town hall meeting are all ways to share ideas with a legislator but are not viewed as the most effective method for sharing.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Congress’s legal base for actions in health care includes which of the following? (Select all that apply.) a. Providing for the general welfare b. Raising funds to support research c. Regulating commerce among the states d. Providing spending power e. Increasing revenue by raising taxes

N R I G

ANS: A, B, C, D The legal base for actions in health care includes providing for the general welfare, regulating commerce among the states, providing spending power, and raising funds to support the military. Increasing revenue is not part of Congress’s legal base for actions for health care.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. By what means does the Center for Disease Control (CDC) accomplish its mission? (Select all that apply.) a. Implementing prevention strategies b. Detecting and investigating health problems c. Dictating world health policy d. Fostering safe and healthful environments e. Protecting the population from bioterrorism events ANS: A, B, D The CDC implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments. The CDC operates within the United States, not worldwide. The Department of Homeland Security is concerned with protecting the population from bioterrorism, not the CDC.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is writing to a legislator to advocate for funds to support advanced practice nursing education. Which of the following considerations should be made by the nurse? (Select all that apply.) a. Limit the letter to one page in length. b. Identify oneself as a nurse. c. Provide only factual information. d. Share personal knowledge about the issue. e. Arrange a face-to-face meeting as soon as possible.

ANS: B, D When writing to a legislator, the letter should be a maximum of two pages in length and opinions should be expressed. Additionally, the nurse should identify oneself as a nurse and share knowledge about the issue.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 10: Evidence-Based Practice Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is evidence-based public health (EBPH)? a. An integration of the best available nursing expertise b. Derived from community principles to fit the area where it is practiced c. A health endeavor that makes informed use of evidence d. Comprised of only public health records ANS: C EBPH is a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods. EBPH includes more than public health records. EBPH is not an integration of nursing expertise. EBPH is not derived from community principles.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using clinical experience and client preference to guide clinical decision making.

Which of the following is being demonstrated by the nurse? a. Evidence-based practice b. Internal evidence c. Research utilization ANS: B d. External evidence Internal evidence refers to the use of the nurse’s clinical experiences and the client’s preferences. Evidence-based practice includes the best available evidence from a variety of sources, including research studies, nursing experience and expertise, and community leaders. Research utilization is the process of transforming research knowledge into practice and the use of research to guide clinical practice. External evidence includes research and other evidence, like reports and professional guidelines.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. In what country was the term evidence-based first used? a. Canada b. Great Britain c. the United States d. Australia ANS: A The term evidence-based was first attributed to Gordon Gyatt, a Canadian physician at McMaster University in 1992. Great Britain, the United States, and Australia did not use this term before it was used in Canada.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse providing care in the 1970s follows a process when making clinical decisions.

Which of the following processes would have been used? a. Evidence-based nursing practice b. The science of medicine c. Evidence-based medicine d. Research utilization ANS: D Research utilization projects in the 1970s provided a guide to clinical practice. The term evidence-based was not used until 1992 and was first applied to medicine before it was used in nursing. There was a growing consensus in the 1970s among nursing leaders that scientific knowledge should be used as a basis for nursing practice, so there was a shift away from the practice of medicine.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse makes clinical judgments based upon trial and error and past clinical experiences.

Which of the following problems can result from using these data sources in clinical decision making? a. Not all sources of information are reliable. b. Authority always leads to faulty decision making. taR keSnIinNtoGaTcB co. uC ntO . M c. Ethical knowledge is noNt U d. This process generally leads to poor outcomes.

ANS: A Nurses have always used various resources for problem solving. However, not all of these resources are reliable, and all have not consistently produced desired outcomes. Authority does not always lead to faulty decision making. Ethical knowledge should be taken into account when making clinical judgments. Trial and error may or may not lead to poor outcomes.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is looking for evidence-based practice (EBP) to support the methods used to facilitate smoking cessation. Which of the following types of evidence would be the best for the nurse to examine? a. Scientific literature found in systematic reviews b. Double-blind randomized controlled trial c. Quasi-experimental studies d. Expert opinion ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Because it is difficult to find or perform randomized controlled trials in the community, other types of evidence have been highlighted as the best evidence in public health literature upon which to base EBPH practice; scientific literature found in systematic reviews is one type that is recommended. Although randomized controlled trials are the highest level of evidence with quasi-experimental studies and expert opinion both being lower on the list of evidence. It would not be possible to implement randomized control trials or quasi-experimental studies when studying smoking cessation. Expert opinion would not be as helpful when looking at methods that have literature that support their use.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. Which type of research is defined as the gold standard of evidence in evidence-based practice? a. Clinical expertise b. Randomized controlled trials c. Case studies d. Systematic review ANS: B The double blind randomized controlled trial (RCT) generally provides the highest level of evidence, followed by other randomized controlled trials. Clinical expertise, case studies, and systematic reviews are not at the top of the hierarchy of evidence.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A public health nurse (PHN) would like to incorporate evidence-based practice into the U S N T O clinical practice at the health department. According to Melnyk and associates, which of the following steps should the nurse take first? a. Integrating the evidence with clinical expertise b. Cultivating a spirit of inquiry c. Asking clinical questions d. Searching for the best evidence ANS: B According to Melnyk and Fineout-Overholt et al., the first step is step 0: cultivating a spirit of inquiry. Integrating evidence with clinical expertise is step 4. Asking clinical questions is step 1. Searching for the best evidence is step 2.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. What term is used to identify a summary of the research evidence that relates to a specific question and to the effects of an intervention? a. Evidence-based practice b. Meta-analysis c. Systematic review d. Narrative review

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: C A systematic review is a summary of the research evidence that relates to a specific question and to the effects of an intervention. Evidence-based practice includes the best available evidence from a variety of sources, including research studies, nursing experience and expertise, and community leaders. Meta-analysis is a specific method of statistical synthesis used in some systematic reviews, where the results from several studies are quantitatively combined and summarized. A narrative review is a review done on published papers that support the reviewer’s particular point of view or opinion and is used to provide a general discussion of the topic reviewed.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is reading a systematic review when researching the best practices to promote increased safety among toddlers. Which of the following information would the nurse most likely find? a. Results of randomized controlled trials b. A description of the methods used to search for evidence c. Data compiled on a particular question d. An in-depth review of the literature completed by one person ANS: B A systematic review is usually done by more than one person and describes the methods used to search for the evidence. It is a method of identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research relevant to a particular research question.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse is grading the strength of evidence when critiquing a research study. Which of the following domains will the nurse need to consider? a. Randomness, sample size, and blinding b. Selection, variables, and description c. Nursing, medicine, and physiology d. Quality, quantity, and consistency ANS: D Quality, quantity, and consistency are the three domains for evaluating systems. The others are not criteria used to grade the strength of evidence.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A public health nurse (PHN) uses a published systematic review to determine which exercises should be incorporated into a newly developed older adult exercise program.

Which of the following resources would most likely contain this information? a. Evidence-Based Practice for Public Health Project b. PubMed c. Cochrane Public Health Group (PHRG)

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Public Health Nursing 10th Edition Stanhope Test Bank d. Task Force on Community Preventive Services ANS: C The PHRG works with contributors to produce and publish Cochrane reviews of the effects of population-level public health interventions. The PHRG undertakes systematic reviews of the effects of public health interventions to improve health and other outcomes at the population level, not those targeted at individuals. The Evidence-Based Practice for Public Health Project provides access to numerous databases of interest concerning public health.

PubMed is a bibliographical database that includes references for nursing, medicine, dentistry, the health care system, and preclinical sciences. The Task Force on Community Preventive Services is charged with determining the topics to be addressed by the CDC’s Community Guide and the most appropriate means to assess evidence regarding population-based interventions.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse researcher is planning to use blinding when designing a research study. In which of the following instances would this be most important? a. Using a small sample size b. Measuring outcomes accurately c. Using a control group d. Studying the attrition rate ANS: C Blinding refers to a procedure where the researcher or evaluator does not know which participants are in the expeN rimeRntaI l orG conB tr. olCgroM up. The other factors do not relate to the importance of blinding.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse who is working in a community setting applies evidence-based practice when planning community health education. Which of the following should the nurse use in order to enrich the application of this evidence? a. Randomized clinical trials b. Qualitative studies c. Quantitative studies d. Multiple research methods ANS: D Evidence from multiple research methods has the potential to enrich the application of evidence and improve nursing practice. Qualitative and quantitative studies are both used when using multiple research methods. Randomized clinical trials are difficult to accomplish in a community health setting.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

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Public Health Nursing 10th Edition Stanhope Test Bank

1. Which are barriers to implementation of evidence-based practice? (Select all that apply.) a. Lack of available time b. Inferior quality of available research c. Unwillingness of organizations to fund research d. Inability to understand the evidence e. Limited support from accreditors to implement evidence ANS: A, B, C, D Lack of time, inferior quality of research, unwillingness of organizations to fund research, and inability to understand the evidence are all barriers to the implementation of evidence-based practice. As public health departments are beginning to seek accreditation, there is an increased emphasis on the use of evidence-based practice.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 11: Population-Based Public Health Nursing Practice: The Intervention Wheel Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about the Intervention Wheel is true? a. It provides a graphic illustration of population-based public health practice. b. It describes in detail the components of public health nursing. c. It demonstrates the practice of community health nurses for policy and lawmakers. d. It is a framework used by all health departments in the United States.

ANS: A The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Since the Intervention Wheel was first published in 1998, what related event has occurred? a. It has guided national policy. b. It has been used as a tool in deciding licensure issues for State Boards of Nursing. c. It has been incorporatedNiU ntR oS thI eN puGbT liB c h.eC alO thMcurricula of many nursing programs. d. It has gained wide acceptance internationally.

ANS: C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula.

The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally but is not used widely at the international level.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Public health interventions are implemented with: a. legislators, policy makers, and community leaders. b. individuals and families, communities, and systems. c. children, adolescents, and adults. d. health departments, public health agencies, and visiting nurses’ associations.

ANS: B It is important to know that public health nurses (PHNs) work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan. c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

ANS: D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practiceNisUbRein deGmo ns. trC ated SIg N TB OM? a. Individual b. Systems c. Community d. Government ANS: C Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by “The Wheel.”

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A public health nurse (PHN) uses Assumption 2, “Public health nursing practice focuses on populations,” to guide practice. Which of the following would be considered a population of interest? a. Healthy school children b. Homeless individuals c. A person recently diagnosed with diabetes

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Public Health Nursing 10th Edition Stanhope Test Bank d. Teenage parents ANS: A A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A public health nurse (PHN) is conducting an assessment of the community’s health. Which of the following is being accomplished through this activity? a. Define one problem that will be the focus for a year. b. Assess a social network of interacting individuals usually in a defined territory. c. Minimize the effects of health risks and hazards. d. Intervene at the population level by changing laws and regulations.

ANS: B A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase.

DIF: Cognitive level: ApN plyiR ng I G B.TC OP:M Nursing process: Evaluation MSC: NCLEX: Safe and EfU fectS ive N CareTEnviroOnment: Management of Care 8. A public health nurse (PHN) utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished? a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, systems, individuals, and families d. Utilizing primary, secondary, and tertiary prevention ANS: C PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice. The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Public health nurses (PHNs) across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used? a. Describe the proper order of implementation. b. Emphasize surveillance as the focus of public health practice.

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Public Health Nursing 10th Edition Stanhope Test Bank c. Guide practice and generate agency protocols. d. Improve the health status of communities, systems, individuals, and families.

ANS: D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. What is the purpose of the color-coded wedges on the Intervention Wheel? a. The interventions are grouped together in related wedges. b. The wedges consist of referral information for each wedge. c. The element of health teaching is the predominant feature of each wedge. d. Coalition building must be implemented with each wedge.

ANS: A Each wedge consists of related interventions. The other answers describe some of the individual wedges.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A public health nurse (PHN) is using collaboration, coalition building, and community Nprog RSram ING B.C M organizing to develop a new U inT the comOmunity. Which of the following strategies is the nurse most likely using? a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies ANS: B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. What levels of practice are encompassed by the Intervention Wheel? a. Communities, individuals and families, and systems b. Assessment, diagnosis, and evaluation c. Primary, secondary, and tertiary d. Communities, populations, and aggregates ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. Public health nurses (PHNs) utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits.

Which of the following levels of practice is being implemented? a. Systems b. Community c. Policy d. Individual ANS: D The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by “The Wheel.”

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance seUwRork wG ithTaBn.eC mO plM oyer to develop a workplace wellness 14. An occupational health nurN Is N S program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. Government ANS: B Systems level of practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole.

This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by “The Wheel.”

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A public health nurse (PHN) is implementing interventions at the systems level of practice.

Which of the following interventions would be used by the nurse? a. Involve the entire community in solving the health problem. b. Identify health problems in the community. c. Change laws, policies, and practices that influence population-based issues.

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Public Health Nursing 10th Edition Stanhope Test Bank d. Provide outreach services to populations at risk.

ANS: C Systems level practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A public health nurse (PHN) is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse? a. Participating in the “Great American Smokeout” b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco products ANS: B Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice. Participating in the “Great American Smokeout” occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual level of practice. Advocating for increased taxes on tobaccoproducts occurs atthesystems level of practice, but it is not health teaching.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied? a. Screening b. Referral and follow-up c. Surveillance d. Health teaching ANS: A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and follow-up assist individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data.

Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Health Promotion and Maintenance 18. A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-up ANS: B One example of coalition building is promoting alliances among organizations for a common purpose. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data.

Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented? a. Collaboration d. Screening b. Surveillance c. Health teaching ANS: C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities.

Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. A public health nurse (PHN) is conducting a community assessment. Which of the following is the best example of this action? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse cases ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A public health nurse (PHN) is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse likely use? a. A 50-year-old woman receives annual mammograms. b. School absences in a community decline. c. Teachers have increased awareness of health problems. d. Those in poverty utilize the free mammogram program.

ANS: A Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual level.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A public health nurse (PHN) is addressing the problem of obesity at the community level of U S N T O practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits ANS: C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed.

DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are the cornerstones of public health nursing practice? (Select all that apply.)

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d. e.

Focus on the health of the entire population.

Reflect community priorities and needs.

Promote health through strategies driven by epidemiological evidence.

Are grounded in an ethic of collaboration.

Provide a framework for ethical decision making.

ANS: A, B, C Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 12: Genomics in Public Health Nursing Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. An increased knowledge about genetics and genomics will influence what change in nursing practice? a. How nurses collect and use health histories? b. How nursing students complete clinical experiences? c. How referrals to other disciplines are made? d. How ethical dilemmas are solved?

ANS: A Genetics and genomics will change future practice in several areas including: how students are educated, how nurses collect and use health histories, how nurses learn and apply innovative biotechnology, how prevention and health education is provided, administration of new therapies, and public health debates.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse learns more about the Human Genome Project to better counsel families about the process of genetic testing. Which of the following terms best describes what the nurse is learning? d. Genetic susceptibility a. Genetics b. Genomics ANS: B c. Genes Genomics refers to the study of individual genes to understand the structure of the genome, including the mapping of genes and sequencing the DNA. Genetics refers to the study of the function and effect of single genes that are inherited by children from their parents. Genes are the DNA segments that carry the genetic information. Genetic susceptibility is the likelihood of developing a disease based on the presence of a genetic mutation.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Who is considered the father of genetics? a. Charles Darwin b. Gregor Mendel c. James Watson d. Francis Galton ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Gregor Mendel is considered to be the father of genetics. Charles Darwin expounded on theories of evolution. Francis Galton performed family studies using twins to understand the influence of heredity on various human characteristics. James Watson was the co-discoverer of DNA. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. What is one of the main goals of the Human Genome Project? a. Providing physicians with a national database for information related to genetic disorders b. Developing new medications that can be used in genetics research c. Addressing ethical, legal, and social issues related to this research d. Improving the ability to accurately test for genetic disorders ANS: C The goals of the Human Genome Project were to determine the sequences of the base pairs in human DNA; improve tools for data analysis; transfer-related technologies to the private sector; and address the ethical, legal, and social issues that may arise. The Human Genome Project did not provide physicians with a national database of information for genetic disorders, develop new medications related to genetics research, or improve the ability to accurately test for genetic disorders.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care sU usR edStI oN coGnst ru. ctCoth 5. The blueprint or code that iN B Mer components of cells is referred to by T O what term: a. deoxyribonucleic acid (DNA). b. gene. c. chromosome. d. base.

ANS: A The DNA is the chemical inside the nucleus of the cell that has the genetic instructions for making living organisms. This can be compared to a blueprint or code that is used to construct other components of cells. Genes are the DNA segments that carry the genetic information. DNA is organized into long structures called chromosomes within the cells.

DNA is comprised of four bases.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Which statement regarding mutations is true? a. Mutations in the deoxyribonucleic acid (DNA) sequence occur on a regular basis. b. Mutagens are a result of a mutation. c. Environmental factors can be linked to many mutations. d. Spontaneous mutations occur because of environmental exposure.

ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Many agents are known to cause mutations. These mutations are attributed to known environmental causes. DNA replication is very accurate; thus, mutations do not occur on a regular basis. Mutagens are the factors that cause mutations. Spontaneous mutations occur naturally during DNA replication.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is counseling a client who is considering having genetic testing completed to determine carrier status of the gene linked to Huntington’s disease. Which of the following would be the first assessment the nurse would take? a. Vital signs b. Family history of this disorder c. Client’s past medical history d. Current medications ANS: B Taking a family history is a useful place to begin when considering a genetic connection prior to the onset of testing. The best way to identify whether there is a mutation in a family where a hereditary disease is suspected is to test the person who displays the most evidence of being a mutation carrier. This would take precedent over assessing vital signs, current medications, and past medical history.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 8. While collecting a medicalhistory, a client reports having a family history positive for U Sthe N T statesOnot wanting to have genetic testing Huntington’s disease. However, client performed. Which of the following best describes why the client may refuse genetic testing? a. Impact it may have on obtaining health insurance in the future. b. Legal consequences that may result. c. Inaccuracy of the results that are obtained. d. Decreased quality of life that may occur if the results are positive.

ANS: D Barriers to genetic testing are: some individuals do not have an insurance carrier that reimburses for genetic testing, a high-deductible insurance policy, and feelings that testing may decrease the quality of life and increase anxiety for the future if the results were positive. Others may also feel guilty about passing along a disease to children and grandchildren. Health insurance cannot be denied to individuals because of genetic testing results. There are no legal implications for genetic testing. There is not a high inaccuracy of results that are obtained through genetic testing.

DIF: Cognitive level: Applying MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Evaluation

9. A nurse is caring for a client who has been diagnosed with a multifactorial disease. Which of the following best describes the client’s diagnosis? a. Measles b. Hepatitis B

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Public Health Nursing 10th Edition Stanhope Test Bank c. Eczema d. Type I diabetes ANS: D Disorders that are influenced by multiple factors including genetics/genomics, environment, lifestyle, and other factors are multifactorial. Type I diabetes is a multifactorial disease. The others are not multifactorial diseases.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is eliciting information about a client’s genetic history. Which of the following questions would be most appropriate for the nurse to ask? a. “Have any of your family members ever completed genetic testing?” b. “Do any of your family members have a genetic disorder?” c. “What medical problems have your parents and grandparents experienced?” d. “What environmental exposures have you had?”

ANS: C A client’s family medical history is important to obtain to consider the client’s potential risk for genetic diseases and disorders. The best way to obtain this information is to ask an open-ended question about past medical history of parents and grandparents. Asking about completion of genetic testing by others, familial history specific only to genetic disorders, and environmental exposures do not address the importance of obtaining a family history.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENffeR ctivI e CaGre E ironM ment: Management of Care Bn.vC 11. A nurse is counseling a client who is considering purchasing a genetic testing kit from a vendor advertised on the Internet. Which of the following would be the response by the nurse? a. “It is illegal to purchase genetic testing kits from Internet vendors.” b. “It will be important to follow up with a health care provider after receiving your results.” c. “Many times, online vendors experience inaccuracies with their results.” d. “Internet vendors use the latest technology to perform these tests.”

ANS: B The most important aspect of genetic testing is the counseling that occurs with the testing.

Purchasing genetic testing kits on the Internet makes it easy for the public to access but leaves a health care professional out of the testing process. Meeting with a health care professional is important to counsel a client about the implications and indications for such testing. It is not illegal to purchase genetic testing kits from the Internet. The accuracy and technology used by the Internet vendor may vary depending on the vendor that is used.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 12. A public health nurse (PHN) is implementing the objectives related to genetics from Healthy People 2020. Which of the following describes the action that is being taken by the nurse? a. Educating clients that multiple factors influence the development of disease b. Counseling clients about the results of genetic testing c. Lobbying for legislation to support genetic research d. Providing screening and genetic testing for specific groups of individuals ANS: D The objectives of Healthy People 2020 related to genetics suggest that screening and genetic testing for specific groups still remain the standard of practice while other routine screenings or tests are questioned for their impact on morbidity and mortality. Healthy People 2020 objectives do not address client education, client counseling, or legislation for genetics.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. What activity is associated with the implementation of the Genetic Information Nondiscrimination Act (GINA)? a. Protecting individuals from discrimination based on their genetic information b. Allowing health insurance companies to deny coverage for preexisting conditions c. Allowing state employers to collect genetic information from employees as needed d. Requiring employees to report genetic disorders to their employer ANS: A GINA was designed to prohibit the improper use of genetic information in health insurance Nindi RS I G from B.C M and employment. It protects U viduNals T diO scrimination based on their genetic information, prevents denial of coverage based solely on genetic predisposition to disease, and limits disclosure of genetic information.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A clinic nurse working in the 1970s was employed by a primary care physician. Which of the following describes how the nurse would have applied genetic concepts? a. Providing genetic counseling to those with genetic disorders b. Educating clients about using genetic testing for risk identification c. Explaining the purposes of the Human Genome Project to clients d. Facilitating referrals for specialized genetic services for clients ANS: A In the 1970s, nurses working in genetics provided genetic counseling to persons with genetic diseases or risk factors for such disorders. The other activities performed by the nurse did not occur until the 1990s.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 15. A public health nurse (PHN) reports being able to demonstrate the minimum competencies set forth by the National Coalition of Health Professional Education in Genetics (NCHPEG). Which of the following describes the action that is taken by the nurse? a. Organizing a meeting to discuss the care of cystic fibrosis clients b. Making a referral to a genetics specialist c. Advocating for legislation to support stem cell research d. Educating a client about the results of genetic testing ANS: B The minimum competencies for health care professionals set forth by NCHPEG are: be able to examine competence of practice, understand the social and psychological implications of health-related genetic information, and know how and when to make referrals to a genetics professional. Making a referral is the only example that is described in these competencies.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse understands the significant impact that genetic testing can have on an individual and family. This competency is described by which of the following organizations? a. National Coalition of Health Professional Education in Genetics (NCHPEG) b. Centers for Disease Control and Prevention (CDC) c. American Nurses Association d. International Council of Nurses ANS: A The NCHPEG identifies one competency of health care professionals as being able to understand that health-related genetic information can have social and psychological N ndRS I ilies GT. B.C M implications for individuals aU famN The CO DC, American Nurses Association, and International Council of Nurses do not address any competencies specifically related to genetic testing.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is using the Codes of Ethics developed by the International Council of Nurses and the American Nurses Association. Which of the following describes the action being taken by the nurse? a. Providing confidential genetic testing for a client b. Advocating for the inclusion of genetic content in a nursing curriculum c. Considering the pros and cons of an ethical dilemma d. Becoming competent in genomics ANS: A The Codes of Ethics include in this mandate the right that people may seek and receive genomic heath care, that is, nondiscriminatory, confidential, private, and that enables those served to make informed decisions. Being competent in genomics, considering pros and cons of ethical dilemmas, and advocating for the inclusion of genetic content in a nursing curriculum are not part of the Code of Ethics.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Psychosocial Integrity 18. A nurse is applying genetic and genomic knowledge when completing a client assessment.

Which of the following actions is most likely being taken by the nurse? a. Constructing a pedigree from a collected family history b. Identifying a client who may benefit from genetic counseling c. Referring a client to specialized genetic services d. Incorporating knowledge of genomic risk factors ANS: A Constructing a pedigree from a collected family history demonstrates assessment in the nursing process. Identification is demonstrated by identifying a client who may benefit from genetic counseling. Referral is demonstrated by referring a client to specialized genetic services. Provision of education, care, and support is demonstrated by incorporating knowledge of genomic risk factors.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse considers that clients may not want to have genetic testing done because of the impact that it may have on future life decisions. Which of the following best describes how the nurse is incorporating genetics/genomics into practice? a. Assessment b. Identification c. Referral d. Provision of education, care, and support ANS: B One of the ways that a nurse uses identification is by identifying ethical, cultural, and societal issues related to genetic and genomic information and technologies. Assessment is not being performed here because the nurse is not assessing a particular client’s needs or history. Referral is not taking place, nor is education, care, or support of a patient.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse is assisting a family in compiling a family health history. Which of the following statements would be most appropriate for the nurse to make? a. “When you have completed this history, it will not need to be updated.” b. “Looking back at two generations of biological relatives will be sufficient.” c. “The purpose of completing a family history is to decrease genetic susceptibility.” d. “A family history is a useful tool when considering your future health risks.”

ANS: D A family history is a useful tool to help families know about their health risks and prevent disease in themselves and their close relatives. It is recommended that families develop a three-generation history and update it on a regular basis. Completion of a family history will not decrease genetic susceptibility; rather it will make families more aware of what that susceptibility may be.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is counseling a client whose genetic test results show a genetic susceptibility for breast cancer. Which of the following would be the most appropriate statement by the nurse? a. “You should discuss hormone replacement therapy with your physician.” b. “You are at an increased risk to develop breast cancer.” c. “You should have a bilateral mastectomy as soon as possible.” d. “You should tell all of your siblings and children to get tested.”

ANS: B Persons with a genetic susceptibility are at increased risk for developing the disease.

Although the client may choose to have a bilateral mastectomy and recommend genetic testing to other family members, the most important thing to relay to the client is that having a genetic susceptibility does not mean that one will automatically have the disease.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is considering seeking employment in a career as a genomic nurse. Which of the following roles would be most important role of the nurse in this setting? a. Direct caregiver b. Educator c. Advocate d. Referral agent ANS: C Although the nurse will use all of these roles when providing genomic nursing care, the most important role will be that of advocate. Nurses will increasingly provide guidance on policy discussions and ethical issues that relate to confidentiality, privacy, and commercialization. This is the nursing role of advocate.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is studying the recent increase in Type I diabetes in the community. Which of the following factors should the nurse consider when examining the development of disease?

(Select all that apply.) a. Genetics b. Lifestyle c. Environment d. Technology e. Communication patterns ANS: A, B, C

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Public Health Nursing 10th Edition Stanhope Test Bank The knowledge of human genetics can improve the safety, quality, and effectiveness of care for clients. It is important for nurses to understand the predisposition to disease as well as the impact of behavior and social conditions on overall community health and well-being.

Many genetic disorders have an environmental link. Technology and communication patterns do not have a strong association with the development of genetic disorders.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is counseling a client who has just learned that she is a carrier of the BRCA2 gene.

Which of the following best describes potential reactions by this client? (Select all that apply.) a. Feelings of guilt b. Fear of loss of insurance coverage c. Feelings of anxiety d. Fear for children e. Feelings of insecurity ANS: A, C, D Feelings of guilt, anxiety, and fear for future susceptibility for children are all potential reactions this client may have. The GINA protects clients from losing insurance benefits based upon genetic information. The feeling of insecurity is not a common reaction experienced from those diagnosed with a genetic disorder.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity 3. According to the Center for Disease Control’s (CDC’s) “Genomic competencies for the U S N T O public health workforce,” which of the following should all public health workers be able to do? (Select all that apply.) a. Demonstrate basic knowledge of the role that genomics play in disorders. b. Make appropriate referrals to those with more genomic experience. c. Counsel individuals about their genetic susceptibility for particular disorders. d. Recommend appropriate genetic screening tests for clients. e. Plan appropriate care for those who have positive genetic tests.

ANS: A, B The CDC’s “Genomic competencies for the public health workforce” apply to all public health professionals. All public health workers should demonstrate basic knowledge and be able to make appropriate referrals. The other statements would not be true of competencies of all public health workers.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 13: Epidemiology Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. To understand the causes of health and disease, epidemiology studies which population? a. Individuals b. Families c. Groups d. Populations ANS: D The goals of epidemiology are to monitor health of populations, understand determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health. Epidemiology does not focus on individuals, families, and groups.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What is used to determine patterns of disease using existing factors, exposures, characteristics, and behaviors? a. Descriptive epidemiology b. Analytic epidemiology c. Distribution ANS: D d. Determinants Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental. Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Analytic epidemiology focuses on the investigation of causes and associations. Distribution describes who has the disease and where and when the disease occurs.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. An epidemiologist wants to know what caused severe diarrhea and vomiting in several people at a local banquet. Which of the following principles is being applied in this situation? a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Analytic epidemiology is directed toward understanding the etiology of the disease.

Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Distribution describes who has the disease and where and when the disease occurs. Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 4. John Snow is called the “father of epidemiology” because of his work with which disease? a. Cholera b. Malaria c. Polio d. Smallpox ANS: A John Snow investigated the spread of cholera in the mid-nineteenth century. John Snow did not investigate the other examples.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse who is studying chronic disease considers the multifactorial etiology of illness.

What does this imply? a. Genetics and molecular structure of disease is paramount. ause hO asMcholera, must be studied in more b. Single organisms that cN RaSdIisea Gse, Bsu.cC U N T detail c. Focus should be on the factors or combinations and levels of factors contributing to disease. d. The recent rise in infectious disease is the main focus.

ANS: C Multifactorial etiology implies a focus on combinations and levels of factors. There are many factors to consider other than only genetics or single organisms with multifactorial etiologies. The focus of studying multifactorial etiology is on chronic disease.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. A nurse is investigating a serious epidemic of influenza. Which of the following best describes the amount of cases that are being examined? a. 50 cases b. 100 cases c. 500 cases d. Unable to determine ANS: D One cannot tell the degree of seriousness without a denominator, which represents the total population at risk.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 7. The probability an event will occur within a specified time period is referred to by what term? a. Rate b. Risk c. Epidemiology d. Epidemic ANS: B Risk is the probability an event will occur within a specified period of time. Rate is a measure of the frequency of a health event in a defined population, usually in a specified period of time. Epidemiology is the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems. Epidemic occurs when the rate of disease, injury, or other condition exceeds the usual level of that condition.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 8. A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. Which of the following best describes what is being measured? d. Morbidity rate a. Prevalence b. Incidence ANS: A c. Attack rate Prevalence is the measure of existing disease in a population at a particular time. Incidence quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk who experience the event over some period of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Morbidity rate is the incidence of disease.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. Which statement is true about mortality rates? a. They are informative only for fatal diseases. b. They provide information about existing disease in the population. c. They are calculated using a population estimate at year-end. d. They reveal the risk of getting a particular disease.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Mortality rates are informative only for fatal diseases and do not provide direct information about the level of existing disease or the risk of getting a particular disease. Because the population changes during the course of a year, typically an estimate of the population at midyear is taken as the denominator for annual rates, because the midyear population approximates the amount of person-time contributed by the population during a given year.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A public health nurse (PHN) reports an attack rate. Which of the following has most likely been reported? a. Number of cases of cancer recorded at a medical center. b. Number of people who died of Ebola in a given year. c. Number of beef cattle inoculated against mad-cow disease on a farm. d. Proportion of people becoming ill after eating at a fast-food restaurant.

ANS: D Attack rates are often specific to exposures, such as food-specific attack rates. The number of cases of cancer, exposure to Ebola, and beef cattle are not significant without knowing the total number of people so that a proportion can be calculated.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 11. What is the interaction between an agent, a host, and the environment called? a. Natural history of disease c. Web of causality b. Risk d. The epidemiologic triangle ANS: D The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The natural history of disease is the course of the disease process from onset to resolution. Risk is the probability an event will occur within a specified period of time.

The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 12. Public health professionals refer to three levels of prevention as tied to specific stages in what related factor? a. An epidemiologic triangle b. A web of causation c. The natural history of disease d. The surveillance process ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank The natural history of disease is the course of the disease process from onset to resolution.

The three levels of prevention provide a framework commonly used in public health practice to depict this process. The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease. The surveillance process involves the systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is studying the characteristics of an agent as part of the epidemiologic triangle.

Which of the following is the nurse most likely studying? a. Human population distribution b. Salmonella c. Genetic susceptibility d. Climate ANS: B An agent includes infectious organisms, such as Salmonella, chemical agents, and physical agents. Genetic susceptibility is a characteristic of a host. Human population distribution and climate are characteristics of the environment.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 14. A public health nurse (PHN) implements a primary prevention intervention in the U S N T O community. Which of the following is most likely being implemented? a. Pap smear b. Blood pressure screening c. Diet and exercise d. Physical therapy ANS: C Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Blood pressure screening and pap smears are secondary prevention interventions. Physical therapy is a tertiary prevention intervention.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A public health nurse (PHN) conducts an immunization clinic for measles. Which of the following is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention.

Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 16. Because of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Multifactorial prevention ANS: A Nurses are involved in epidemiologic surveillance by monitoring the potential for disease outbreaks. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention.

Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease,Ninj uRry, bi. litC y.O M IorNdGisaTB Multifactorial prevention is not possible U S with a disease like influenza, which has one cause.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse offers a screening for hearing defects at a local community center. Which of the following best describes the action of the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Screenings are part of secondary prevention interventions. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability.

Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 18. A nurse refers a client diagnosed with a neuromuscular disease to a vocational rehabilitation program. Which of the following best describes the action of the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Referral of a client with a disease is an example of tertiary prevention. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Health promotion is a specific primary prevention strategy.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 19. A nurse implements a program that focuses on secondary prevention. Which of the following is most likely the topic of this program? a. Rehabilitation b. Avoidance of high-risk behaviors c. Immunization d. Mammogram ANS: D Secondary prevention focuses on early detection and prompt treatment of disease, injury, or N R Ining GTtest.

B.CAOvoidance M disability. Mammograms areUa scSreeN of high-risk behaviors and immunizations are examples of primary prevention. Rehabilitation is an example of tertiary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. An intervention that focuses on the tertiary level of prevention is implemented by the nurse.

Which of the following did the nurse most likely complete? a. Rehabilitative job training b. Parenting education c. Testicular self-examination d. Family counseling ANS: A Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Rehabilitative job training would be an example of tertiary prevention. Parenting education is an example of primary prevention.

Testicular self-examination and family counseling are examples of secondary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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21. A nurse is told that a screening test has high specificity. Which of the following is the best interpretation of this information? a. The test provides precise and consistent readings. b. The test accurately identifies those with the condition or trait. c. The test accurately identifies those without the trait. d. The test has a high level of false positives.

ANS: C Specificity refers to the test accurately identifying those without the trait. High specificity is needed when rescreening is impractical and when reduction of false positives is important.

The test would have a low level of false positives.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. What term is used to identify the proportion of persons with positive test results who have a disease, interpreted as the probability that an individual with a positive test result has the disease? a. Sensitivity b. Specificity c. Positive predictive value d. Negative predictive value ANS: C Positive predictive value refers to the proportion of persons with positive test results who actually have the disease, interpreted as the probability that an individual with a positive test result has the disease. Sensitivity quantifies how accurately the test identifies those with the N R icat IN G owB.C M condition or trait. SpecificityUindS es hT accuOrately the test identifies those without the condition or trait. Negative predictive value is the proportion of persons with a negative test who are disease free.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse examines birth and death certificates during an epidemiologic investigation. Which of the following data categories is being used? a. Routinely collected data b. Data collected for other purposes but useful for epidemiologic research c. Original data collected for specific epidemiologic studies d. Surveillance data ANS: A Birth and death certificates are considered to be vital records and are examples of data collected routinely. Data collected for other purposes would be hospital, physician, health department, laboratory, and insurance records. Original data is that which is collected by the National Center for Health Statistics for specific health surveys. Surveillance data is used to assess and prioritize the health needs of populations, design public health and clinical services to address those needs and evaluate the effectiveness of public health programs.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. What is the most important predictor of overall mortality? a. Race b. Age c. Gender d. Income ANS: B The mortality curve by age drops sharply during and after the first year of life to a low point in childhood, then begins to increase through adolescence and young adulthood and then increases sharply through middle and older ages. Race, gender, and income are not the most important predictor for overall mortality.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. A nurse is investigating an outbreak of a gastrointestinal illness from a foodborne pathogen.

The process associated with which of the following terms is being applied? a. Attack rate b. Point epidemic c. Secular trend d. Event-related cluster ANS: B One temporal and spatial pattern of disease distribution is the point epidemic. A point epidemic is most clearly seen when the frequency of cases is plotted against time. The sharp N aph RSs I G tesB.C M peak characteristic of such grU inN dicaT a coO ncentration of cases in some short interval of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Secular trends are long-term patterns of morbidity or mortality rates.

Event-related clusters are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 26. What term is used to identify the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period to observe some health outcome? a. Case-control study b. Cross-sectional study c. Cohort study d. Experimental study ANS: C

A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period to observe some health outcome. A case-control study uses a sample from the cohort rather than following the entire cohort over time. A cross-sectional study provides a snapshot of a population or group at one point in time. An experimental study is one in which the investigator initiates some treatment or intervention that may influence the risk or course of the disease.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is referred to by what term? a. Cross-sectional b. Ecological c. Case-control d. Cohort ANS: A A cross-sectional study collects information on current health status, personal characteristics, and potential risk factors or exposures all at once. A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. An ecological model considers the multiple factors that contribute to disease development.

DIF: Cognitive level: ReN mU em ring :M Nursing process: Assessment Rbe I GTB.TCOP S N O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. Voters have recently decided to have fluoride added to the city water system.

Epidemiologists now want to study the effect of fluoride on dental caries in this population.

Which of the following would be conducted by the epidemiologists? a. Ecological study b. Double-blind study c. Community trial d. Screening ANS: C A community trial is similar to a clinical trial, but the issue is often health promotion and disease prevention rather than treatment of existing disease. An ecological model considers the multiple factors that contribute to disease development. A double-blind study is one in which neither the subject nor the investigator knows who is receiving the treatment. A screening involves the testing of groups of individuals who are at risk for a certain condition but are not yet symptomatic.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse is considering the potential for selection bias. Which of the following best describes the situation that is the nurse has encountered?

a. b. c. d.

Determining the population to be studied Considering how the participants will enter the study Studying cause and effect relationships Documenting results of the study

ANS: B Selection bias is attributable to the way subjects enter a study. It has to do with selection procedures and the population from which subjects are drawn. Determining the population to be studied relates to the design of the study. Studying cause and effect relationship has to do with ecological studies. Documenting the results of the study is completed at the end of the study after the participants have been selected.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. During the twentieth century, a nurse participated in research that examined the epidemiology of various diseases. Which of the following best describes the factors that influenced these studies? (Select all that apply.) a. Increasing rate of poverty b. Declining child mortality rates c. Overcrowding in major cities d. Development of new vaccinations e. Advancements in medical equipment ANS: B, D Factors contributing to the development and application of epidemiologic methods in the twentieth century were: improved nutrition, new vaccines, better sanitation, the advent of antibiotics and chemotherapies, and declining infant and child mortality and birth rates. A rise in the standard of living occurred for many following the Great Depression and World War II. The advancements in medical technology have not influenced the examination of the epidemiology of various diseases.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse states incorporating epidemiology into practice and functions in epidemiologic roles. Which of the following best describes the actions taken by the nurse? (Select all that apply.) a. Policy making b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records e. Law enforcement ANS: B, C, D

Collection, reporting, analysis, and interpretation of data, environmental risk communication, and documentation on patient charts and records are examples of the use of epidemiology in practice. Policy making, and law enforcement do not apply to epidemiology.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Chapter 14: Infectious Disease Prevention and Control Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A community health nurse is caring for a client with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following should the nurse be aware of? a. Persons with MRSA usually have a chronic illness. b. MRSA is a hospital-acquired infection and not often seen in the community. c. Vancomycin-resistant Staphylococcus aureus (VRE) follows MRSA. d. MRSA is becoming more common in the community.

ANS: D MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations. MRSA is still largely a health care-associated infection, but it is becoming more common. VRE was found before MRSA. MRSA is not associated with chronic illness.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. The ability of an agent to produce a severe pathologic reaction is known by what term? a. Antigenicity b. Invasiveness c. Toxicity ANS: D d. Virulence The ability of an agent to produce a severe pathologic reaction is known as virulence.

Antigenicity is the ability to stimulate an immunological response. Invasiveness is the ability to penetrate and spread throughout a tissue. Toxicity is the ability to produce a poisonous reaction.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. What is immunity a characteristic of? a. An agent factor b. A host factor c. An environmental factor d. An epidemiologic triad ANS: B Immunity refers to species-determined resistance to an infectious agent and is determined by the characteristics of the host. The agent is the infection that is causing the infection/disease.

Environmental factors may influence the susceptibility of the host. The epidemiologic triad involves the interaction of the host, agent, and environment.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 4. A nurse is investigating the role of the agent in the cause of an illness. Which of the following best describes what the nurse is examining? a. Host resilience b. Virus c. Infectiousness d. Insect bite ANS: B An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. Host resilience is a host factor. Infectiousness is the measure of the potential ability of an infected host to transmit the infection to other hosts. Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts, such as an insect bite.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 5. A nurse is providing education to a mother about the importance of having her infant immunized for measles, mumps, and rubella. Which of the following best describes the type of immunity that will be provided? a. Active b. Passive c. Natural ANS: A d. Acquired Active immunity refers to the immunization of an individual by administration of an antigen (infectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host. Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual. Natural immunity refers to species-determined, innate resistance to an infectious agent. Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. The nurse teaches food handlers to wash utensils after contact with raw meat. Which of the following best describes the focus of this education? a. Agent b. Host c. Environment d. Food handler ANS: C

Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts. Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment. An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. A food handler is an example of a host, which is a human or animal that can harbor an infectious agent.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 7. What is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease called? a. Communicable period b. Incubation period c. Infectiousness d. Endemic ANS: B The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms. The communicable period is the interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person. Infectiousness is the measure of the potential ability of an infected host to transmit the infection to other hosts. Endemic refers to the constant presence of a disease within a geographic area or a population.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Safety and Infection Control Bn.vC 8. A nurse is teaching members of the community about vertical transmission of a disease.

Which route would the nurse most likely discuss? a. Breast milk b. Sexual contact c. Mosquito bites d. Contaminated food ANS: A Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth. Transmission through sexual contact is horizontal transmission. Transmission from mosquito bites is vector transmission.

Transmission from contaminated food is common vehicle transmission.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. A nurse is discussing the role of a vector in the spread of disease. Which of the following is the nurse most likely referring to? a. Contaminated water b. A tick c. A dirty needle d. An infected person

ANS: B Vectors are arthropods such as ticks and mosquitoes that transmit the infectious agent by biting or depositing the infective material near the host. Contaminated water, a dirty needle, and an infected person would be common vehicles.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 10. One case of smallpox occurs in a population in which it was previously eliminated. Which of the following best describes what has occurred? a. Endemic b. Epidemic c. Pandemic d. Infectivity ANS: B The occurrence of one case of smallpox in a population in which it was previously eliminated is an epidemic. Endemic refers to the constant presence of a disease within a geographic area or population. Pandemic refers to an epidemic occurring worldwide and affecting large populations. Infectivity is the ability to enter and multiply in the host.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 11. Requirements for disease reporting in the United States are mandated by what entity? a. The Centers for Disease Control and Prevention (CDC) N R I G B.C M b. Federal laws c. State laws and regulations d. The World Health Organization (WHO) ANS: C Requirements for disease reporting in the United States are mandated by state laws and regulations. These diseases are then reported to the CDC. State public health officials collaborate with the CDC to determine which diseases should be nationally notifiable. The federal government and WHO are not involved in disease reporting.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A community health nurse has recently become involved in surveillance. Which of the following describes the situation that the nurse is in? a. Educating clients about influenza immunizations b. Collecting information about occurrence of measles c. Evaluating the effectiveness of an HIV/AIDS prevention program d. Advocating for changes in the national disease reporting requirements ANS: B

Surveillance gathers the “who, when, where, and what”; these elements are then used to answer “why.” Nurses are frequently involved in surveillance by collecting data, making diagnoses, investigating and reporting cases, and providing information to the public. Client education, program evaluation, and advocating for changes are not part of the surveillance process.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 13. A nurse is working in a health department when a patient arrives who has been traveling to South America and has been diagnosed with malaria. Which of the following considerations should be made by the nurse? a. The Morbidity and Mortality Weekly Report should be consulted to investigate the rate of malaria in the United States. b. This is a disease that must be reported to the state health department. c. The nurse should take precautions to wear a mask and gown to avoid exposure. d. The patient is very ill and should be sent to the hospital immediately.

ANS: B Malaria is on the list of infectious diseases notifiable at the national level. The Morbidity and Mortality Weekly Report is published weekly with the rates of disease; however, this would not be the first consideration by the nurse. Malaria is not spread by direct contact, rather from a bite from an infected mosquito. Malaria begins with flu-like symptoms, or the client may have very few symptoms.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Safety and Infection Control Bn.vC 14. A public health nurse (PHN) understands that the emergence of new infectious diseases is influenced by the what? a. Increased availability of immunizations b. Globalization of food supplies c. Decreased use of child care facilities d. Creation of sanitation systems in third world countries ANS: B Globalization of food supplies is one of the many factors that can influence the emergence of infectious diseases. The increased use of childcare facilities could contribute to the emergence of new infectious diseases. The lack of sanitation systems in third world countries could contribute to the emergence of new infectious diseases. The increased availability of immunizations should decrease the emergence of diseases.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is providing information to a local newspaper about the presence of infectious diseases in the United States. Which of the following statements by the nurse is accurate? a. “It is the goal of the WHO to prevent the transmission of the plague by avoiding direct contact with inflicted individuals.” b. “Rabies is easily spread by contact with animals.”

c. “The United States is a certified polio-free country.” d. “The onset of tularemia is characterized by a distinct skin lesion often called a bull’s-eye lesion.”

ANS: C The Americas are certified polio free. The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lyme’s disease is characterized by a bull’s-eye lesion.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. The nurse provides footwear and gloves to leprosy clients to prevent trauma to their insensitive and deformed hands and feet. Which of the following best describes the intervention used by the nurse? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Primary health care ANS: C Tertiary prevention reduces complications through treatment and rehabilitation. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Primary health care is the essential health care services provided by physicians and other health care providers.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse administers a rabies immunization post-exposure to an animal bite. Considering the interventions used with infectious disease, which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Tertiary prevention reduces complications through treatment and rehabilitation.

Assessment refers to the systematic collection of data.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

18. A nurse is presenting information to the county health department about potential bioterrorism threats. Which of the following agents would the nurse discuss in this presentation? a. Smallpox b. West Nile Virus c. Severe acute respiratory syndrome (SARS) d. Novel influenza A (H1N1) ANS: A Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20% to 40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and selected hemorrhagic viruses. West Nile Virus, SARS, and H1N1 are not viruses that would be used for bioterrorism.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 19. A public health nurse (PHN) would like to increase the immunization coverage of infants and toddlers. Which of the following strategies would be appropriate for the nurse to use? a. Read the Mortality and Morbidity Weekly Report to learn about vaccinations. b. Require that children have all their immunizations before going to public school. c. Track children known to be at risk for under-immunization. d. Lead teams of health care workers to enforce laws related to immunizations.

ANS: C Tracking children known to be at risk for under-immunization is a function of PHNs who work in health departments where immunizations are given and tracked. Reading the N klyRSRep INort, GTrequiri B.CO M Mortality and Morbidity WeeU ng that children have all their immunizations before attending school, and leading teams of health care workers would not be as effective in increasing immunization coverage for this population.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. What causes food intoxication? a. Toxins produced by bacterial growth and chemical contaminants b. Bacterial, viral, or parasitic invasion of food c. Overcooking of meat and produce d. Adding too many spices or ingredients to food ANS: A Food intoxication is caused by toxins produced by bacterial growth, chemical contaminants, and a variety of disease-producing substances found naturally in certain foods such as mushrooms and some seafood. Bacterial, viral, or parasitic invasion of food is not a cause of food intoxication. Food intoxication is not caused by overcooking meat or adding too many ingredients to food.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

21. What is the most common vector-borne disease in the United States? a. Malaria b. Yellow fever c. Lyme disease d. Rocky Mountain spotted fever ANS: C Lyme disease is the most common vector-borne disease in the United States, with over 30,000 confirmed cases and probable cases reported to CDC in 2012. Yellow fever and Rocky Mountain spotted fever are both vector-borne diseases but are not the most common.

Malaria is most prevalent vector-borne disease worldwide.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 22. A nurse is caring for a client who has been diagnosed with West Nile Virus. Which of the following types of illness does the client have? a. Foodborne b. Vector-borne c. Waterborne d. Zoonoses ANS: B West Nile virus is carried by a mosquito, which is a vector. Foodborne illnesses are carried by food. Waterborne illnesses are transmitted through water. Zoonoses are infections that are transmitted from vertebrate animal to a human under natural conditions.

N R I G B.C M

DIF: Cognitive level: ApplU yinS g N T TOO P: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 23. A community health nurse investigates an outbreak of pinworm at a local daycare center. To minimize the spread of infection, which of the following suggestions would the nurse provide to the daycare workers? a. Close the daycare until all surfaces are cleaned. b. No action is necessary because it is easily treated with oral vermicides. c. Using good hand washing is important to prevent the transmission. d. Every child in the daycare should be treated because they all are probably infected.

ANS: C Transmission of pinworm occurs through the fecal-oral route, so good hand washing after toileting is essential. It is not necessary to treat all children or close the daycare. It is necessary that action be taken, as without any action being taken, the pinworm outbreak will continue.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 24. What is the best method for preventing health care-associated infections? a. Perform good hand washing before and after approaching every patient. b. Prevention is almost impossible due to the high infection rates in hospitals.

c. Isolate every patient having surgery. d. Use contact isolation for every patient at risk.

ANS: A Hand washing is the best way to prevent infection. If good hand washing is in place, it is not necessary to isolate patients or implement contact isolation. Prevention is possible with the use of good hand washing.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 25. A nurse promotes the use of universal precautions by all health care workers. Which of the following best describes the action that was taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health care-associated infection ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Tertiary prevention reduces complications through treatment and rehabilitation. Health care-associated infections are prevented by good hand washing practices.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health ProNmoR tionIandGMB ai. ntC enaM nce 26. A nurse is caring for a client who has been diagnosed with a parasitic infection. Which of the following information should the nurse know when caring for this client? a. The medication to prescribe to treat these infections b. The nature and symptoms of all parasitic illnesses c. What specimens to collect and how and when to collect them d. Public policy about parasitic infections ANS: C Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use. Proper specimen collection is necessary so that the clinical diagnosis can be confirmed. It is not necessary for the nurse to know the signs and symptoms for all parasitic infections in order to provide care for the client. Public policy about parasitic infections is not important to know when providing care for the client.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. Which elements of surveillance does a nurse use? (Select all that apply.) a. Mortality registration b. Epidemic field investigation

c. Laboratory reporting d. Individual case investigation e. Application of research ANS: A, B, C, D There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them.

Application of research is not part of the 10 basic elements of surveillance.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 15: Communicable and Infectious Disease Risks Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse is utilizing the provisions created by the Ryan White HIV/AIDS Treatment Extension Act. Which of the following interventions is the nurse most likely performing? a. Increasing AIDS awareness in the community b. Determining available health care services for HIV-infected individuals c. Preventing the transmission of AIDS to children from their mothers d. Allowing persons in the final stages of HIV to die with dignity ANS: B This act provides emergency services, services for early intervention and care, and drug reimbursement programs for HIV-infected individuals.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which part of the immunological system suffers the greatest damage resulting from HIV infection? a. Dendrite cells b. CD4+ T-lymphocytes c. Macrophages d. Monocytes ANS: B The CD4+ lymphocytes are severely damaged in HIV infection. In 2008 the case definition for HIV infection was revised to include the HIV classification/staging system based on the number of CD4+ T-lymphocytes. The dendrite cells, macrophages, and monocytes are not as severely damaged as the CD4+ cells are.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. HIV transmission can occur through contact with what? a. Contaminated blood b. Insect bites c. Shared eating utensils d. Contaminated toilets ANS: A HIV can be transmitted through exposure to blood. HIV is not transmitted by insect bites, sharing of eating utensils, or toilets.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

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Public Health Nursing 10th Edition Stanhope Test Bank 4. A public health nurse (PHN) is reviewing Healthy People 2020 to determine where to prioritize programming for the county health department. Based on Healthy People 2020, which of the following areas would the nurse most likely plan to implement programming? a. Reduce the rate of HIV transmission among adults and adolescents. b. Eliminate sexually transmitted diseases (STDs) from developed countries. c. Reduce deaths from gonorrhea. d. Increase awareness about HIV in the LGBTQ population.

ANS: A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents. Eliminating STDs from developed countries, reducing deaths from gonorrhea, and increasing awareness about HIV among the LGBTQ population are not addressed by Healthy People 2020.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is examining the route of HIV transmission for a newly diagnosed HIV client.

Which of the following would most likely be discovered by the nurse? a. Having contact with an HIV-positive individual who is coughing b. An infant receiving breast milk from an HIV-positive mother c. Receiving a mosquito bite while in Africa d. Being near an HIV-positive individual who is sneezing ANS: B HIV can be transmitted through breast milk. HIV is not transmitted by coughing, sneezing, or mosquito bites.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. A nurse is caring for a client who has been diagnosed HIV positive. Which of the following roles of the nurse would be the most important for the nurse to implement? a. Advocate, lobbying for AIDS research b. Counselor, discussing implications of future sexual activity c. Role model, providing supportive care d. Policy maker, addressing laws governing privacy rights of HIV-positive persons ANS: C The priority role of the nurse should be role model, as nurses must be role models because many HIV-positive patients are stigmatized. The need to be an advocate and policy maker does not address the individual needs of the client. The nurse can counsel the client while providing supportive care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is working in a public health center. A patient who has been newly diagnosed as HIV positive comes for counseling. By law, which of the following actions must be taken by the nurse?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Give antiviral medications to the patient.

Ask the person to name all his or her sexual contacts.

Refer the patient to the social worker for case management.

Report the HIV-infected person to the state health department.

ANS: D It is mandatory to report HIV cases by name in all states, although not all states require viral load and CD4 counts. There are not laws in place that mandate administration of medications, naming of sexual contacts, or referral to case management.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 8. In comparison with HIV infection in adults, what is true concerning HIV infection in infants and children? a. They present with the same signs and symptoms. b. They have a shorter incubation period. c. They experience a longer survival period. d. They are diagnosed using the same tests.

ANS: B HIV infection in infants and children has a shorter incubation period. The physical signs and symptoms in children are different and include failure to thrive, unexplained persistent diarrhea, developmental delays, and bacterial infections such as tuberculosis (TB) and severe pneumonia. Detection is made through different tests in infants of infected mothers than from those who are over 18 months. They do not have a longer survival period.

N R I G B.C M

DIF: Cognitive level: UndeUrstaSndiN ng T TOO P: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. A nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) test.

Which of the following best describes the rationale for this test? a. To indicate the presence of the antibody to HIV b. To reveal whether the client has AIDS c. To isolate the HIV virus d. To confirm HIV after having a positive Western blot ANS: A The EIA is used to indicate the presence of the antibody to HIV. To minimize false positive results, the Western blot is used as a confirmatory test to verify the results. The EIA does not isolate the virus, nor does it reveal whether the individual has symptomatic AIDS. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 10. A nurse is examining a child in the early stages of HIV infection. Which of the following would the nurse expect to find? a. Failure to thrive and developmental delays b. Kaposi’s sarcoma and developmental delays c. Toxoplasmosis and oral candidiasis

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Public Health Nursing 10th Edition Stanhope Test Bank d. Fatigue and shortness of breath ANS: A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays. Kaposi’s sarcoma and oral candidiasis are common opportunistic diseases later in the disease process. Fatigue may be seen in the later stages and is commonly seen in hepatitis and TB. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 11. What is the most common reportable infectious disease in the United States? a. Gonorrhea b. Syphilis c. Herpes d. Chlamydia ANS: D The most common reportable infectious disease in the United States is chlamydia.

Gonorrhea is the second most commonly reported infectious disease. Syphilis and herpes are not among the most common reportable infectious diseases in the United States.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is caring for a client who has been diagnosed with a bacterial sexually transmitted infection (STI). Which of tN he fR olloI winG g inB fe. ctC ionsMdoes this client most likely have? a. Trichomonas d. Genital warts b. HIV c. Syphilis ANS: C Trichomonas, HIV, and genital warts are caused by viruses. Syphilis is caused by bacteria.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 13. A nurse is assisting an employer who has hired an individual who has been recently diagnosed with HIV. Which of the following interventions would be most appropriate for the nurse to implement? a. Educate about how to reduce the risk of breaching the employee’s confidentiality. b. Explain how to inform coworkers about avoiding HIV transmission. c. Facilitate obtaining medical insurance coverage for the HIV-infected employee. d. Describe the early signs and symptoms of HIV infection.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees. Disclosing a worker’s infection to other workers, terminating employment, and isolating an infected worker are examples of situations that have led to litigation between employees and employers. Thus, the priority will be to protect the employer from litigation.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 14. Pelvic inflammatory disease (PID) is a common complication of which sexually transmitted infection (STI)? a. Gonorrhea b. Syphilis c. Chlamydia d. Herpes ANS: A PID is a common complication of gonorrhea. PID is not a common complication of syphilis, chlamydia, or herpes.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 15. A person diagnosed with syphilis presents with signs and symptoms of rash, sore throat, and muscle and joint pain. Which of the following stages of syphilis is the client most likely experiencing? d. Tertiary a. Congenital b. Primary ANS: C c. Secondary A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis. Primary syphilis occurs when the bacteria produce infection in the form of a chancre at the site of entry. Tertiary syphilis usually occurs several years after initial infection and is rare in the United States because the disease is usually cured in its early stages with antibiotics. Congenital syphilis is transmitted transplacentally.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 16. Which type of hepatitis would likely be found where sanitation is inadequate? a. A b. B c. C d. D ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Hepatitis A would likely be found where sanitation is inadequate. Hepatitis B and C are spread through blood and body fluids. Hepatitis D can only exist in people who are already infected with Hepatitis B. DIF: Cognitive level: Understanding TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 17. Which of the following groups would be most likely to receive an injection of prophylactic immune globulin for possible exposure to hepatitis A? a. Persons who have had direct contact with blood b. Those who ate at the same restaurant as the person with hepatitis A c. All health care workers d. All those who had household or sexual contact with persons with hepatitis A ANS: D Those who have been in close contact with persons who develop hepatitis A should receive immune globulin. The other groups do not describe populations in direct contact with the person who has hepatitis A. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 18. What is the most chronic bloodborne infection in the United States? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. HIV ANS: C The most chronic bloodborne infection in the United States is hepatitis C. Hepatitis A virus is most commonly transmitted through the fecal-oral route. Sources may be water, food, feces, or sexual contact. The hepatitis B virus (HBV) is spread through blood and body fluids and, like HIV, is a bloodborne pathogen. HIV is transmitted through exposure to blood, semen, transplanted organs, vaginal secretions, and breast milk. Although hepatitis B and HIV are both bloodborne pathogens neither are the most chronic infection like hepatitis C. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 19. The case rate of new tuberculosis (TB) is highest among which ethnicity in the United States? a. African American b. Native American c. White American d. Asian American ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Of the new cases, 66% are foreign-born persons living in the United States, with Asians and Hispanics being the most common ethnic groups, representing 30% and 28% of national TB cases. The TB rates for African American, Native American, and White American are lower than the Asian and Hispanic populations.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 20. A nurse screens blood product, donor organs, and tissues for the hepatitis C infection.

Which of the following best describes this nursing action? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Screening blood products, organs, and tissues for infection protects the population from exposure to hepatitis C, which prevents them from contracting the disease. Secondary prevention includes screening for diseases to ensure their early identification, treatment, and follow-up with contact to prevent further spread. Tertiary prevention focuses on chronic care and rehabilitation. Health promotion focuses on the primary prevention activities to promote health and prevent disease.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 21. A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation U S N T O when counseling clients and avoids this topic with clients. Which of the following is the most likely outcome of this avoidance? a. Potential risks and risky behaviors will not be identified. b. Transmission of sexually transmitted infections (STIs) will remain unchanged. c. Clients will develop a trusting relationship with health care providers. d. The nurse will be violating the laws in several states.

ANS: A It is important that nurses be able to discuss these topics to help prevent and control STIs. Without discussion of these topics, it is possible that clients will not be aware that they have an STI and may transmit it to others. Thus, the transmission of STDs may increase. A trusting relationship with a health care provider may or may not develop and is not dependent on whether these issues are discussed. There are not laws that mandate nurses to discuss sexual behavior and sexual orientation with clients.

DIF: Cognitive level: Applying MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Evaluation

22. A nurse is educating intravenous (IV) drug users about sharing equipment. Which of the following information would be appropriate for the nurse to include in this education? a. Tell the clients to throw away their equipment after one use. b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30

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Public Health Nursing 10th Edition Stanhope Test Bank seconds. c. Suggest limiting the number of people who share the equipment. d. Provide clean needles and syringes to whoever wants them.

ANS: B Using bleach on the needles and syringes is a way to decrease cross-contamination. This is the last-resort option. People who inject drugs are difficult to reach for health care services, so providing them education is important so that they can protect themselves and others as they most likely will not throw away their equipment or be selective about whom they share their equipment with. Providing needles and syringes does not provide the appropriate education to prevent the spread of disease.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 23. A nurse is teaching a client diagnosed with gonorrhea how to prevent reinfection and further spread. Which of the following describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary health care ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention focuses on chronic care and rehabilitation. Primary health care refers to the first line of care provided to patients N her RShea IN G B.C vider.

M typically by a physician or otU lth cTare proO DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 24. The nurse teaches the family of an AIDS client about managing symptomatic illness by preventing deteriorating conditions, such as diarrhea, skin breakdown, and inadequate nutrition. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary health care ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

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Public Health Nursing 10th Edition Stanhope Test Bank

25. A community health nurse visits a homeless shelter to provide directly observed therapy (DOT) to several clients who have been diagnosed with TB. Which of the following best describes the rationale for this nursing intervention? a. Homeless clients do not care about their health. b. Homeless clients do not have access to medications. c. Poor adherence can result in drug resistance. d. These medications are so powerful, clients must be observed for reactions.

ANS: C Poor adherence has led to antibiotic-resistant strains. These clients may care about their health but may have difficulty adhering to the treatment regimen. Medications to treat TB are available to the homeless population. The concern with the antimicrobial treatment is with non-adherence, not with side effects.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. The nurse is counseling a female who has recently tested positive for HIV. Which of the following will the nurse educate that the client is responsible for? (Select all that apply.) a. Have regular medical evaluations and follow-ups. b. Donate blood and plasma to others who are positive for the disease. c. Inform health care providers about the HIV infection. d. Consider the risk of perinatal transmission.

N R I G B.C M e. Disclose her HIV infectioUn toSheN r emTployer.O ANS: A, C, D A person who is infected with HIV should have regular medical evaluations and follow-up appointments, not donate blood or plasma, inform health care providers about the HIV infection, and consider the risk of perinatal transmission and follow-up with contraceptive use.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

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Chapter 16: Promoting Healthy Communities Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the goal of the Healthy Communities and Cities initiative? a. Promoting health through community participation b. Reorganizing the current health care system c. Maximizing the cost-benefit ratio of health care d. Improving the quality of care in communities ANS: A The goal of the Healthy Communities and Cities initiative is the promotion of health through community engagement and collaboration. This leads to addressing the health and quality of life for all through a process that includes diverse citizen participation, mobilization of all sections of the community, and community ownership. Reorganization of the current health care system, maximizing the cost-benefit ratio of health care, and improving the quality of care in communities are not part of the Healthy Communities and Cities initiative.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Wearing seat belts is required in many communities. Children of a certain age must be restrained in a car seat or seNaU t bReS lt I wN heG nT riB di. ngCiO nM a car. Which of the following best describes what has happened in this community? a. Unilateral action of lawmakers b. Participation in health fairs c. Healthy public policy d. Media interest in protecting the public ANS: C Examples of healthy public policy are seat belt legislation, nonsmoking policies, and immunization policies for school-age children. Participation in health fairs involves providing health education and resources out in the community. Unilateral action of lawmakers does not demonstrate community involvement. Media interest does not create the legislation.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 3. What occurred when the Healthy Communities and Cities concept was brought to the United States? a. The cities chosen for the initial work were Los Angeles and New York City. b. Canada adopted the program at the same time for continuity across borders. c. The same strict guidelines that were implemented in Europe were used. d. Smaller communities and localities were targeted instead of large cities.

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ANS: D The concept of Healthy Communities was used to incorporate localities that were not necessarily cities. The initial projects were Healthy Cities Indiana and the California Healthy Cities project. Healthy Communities and Cities operate in other parts of the world under different names and national networks have been developed among countries. There are not strict guidelines for implementation of this program.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. The Healthy Communities and Cities initiative supports what idea? a. Healthy cities and communities must be both environmentally and socially sustainable. b. Healthy public policy is the responsibility of elected officials. c. Physical environments cannot be changed; thus, strategies must be developed in order to cope with them. d. The World Health Organization (WHO) is the primary source of information for cities.

ANS: A Healthy cities and communities must be both environmentally and socially sustainable through a strategy of primary care. Healthy public policy should involve collaboration at all levels. Supportive environments should be created. The WHO originally began this movement, but now sharing occurs among those participating in this initiative.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 5. A nurse utilizes the Centers for Disease Control and Prevention’s (CDC’s) Healthy Communities Program. Which of the following factors does the nurse recognize that will influence the continuance of this program? a. Time b. Community participation c. Federal involvement d. Technology ANS: B Community participation can influence the continuance of the Healthy Communities and Cities movement. Time, federal involvement, and technology are not as major of factor to continuation as is participation by the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Healthy Communities and Cities is based on which of the following premises? a. When people can work out their own locally defined health problems, they will find sustainable solutions to those problems. b. When the health of a community is improved, the focus will be on life expectancy rather than quality of life. c. When health professionals assume a leadership role, the health of the community

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will improve. d. When cities recruit enough health professionals to care for those needing medical care, the cities health will improve.

ANS: A Healthy Cities is based on the premise that when people can work out their own locally defined health problems, they will find sustainable solutions to those problems. Healthy Cities aims to add to quality of life. Healthy Cities focuses on collaboration by all members of the community. Healthy Cities uses a multifaceted approach to problem solving when trying to improve health.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse was involved in the initial implementation of the Healthy Communities and Cities initiative in the United States. Which of the following problems would have most likely been addressed? a. Reduction to the amount of pollutants released into the environment b. Provision of fire and police protection c. Creation of a coalition to address health disparities d. Elimination of crime and violence from the community ANS: C The concept of a healthy community or city is based on the belief that the health of the community is largely influenced by the environment in which people live and that health problems have multiple causes: social, economic, political, environmental, and behavioral.

Creation of a coalition engages residents in addressing the problem, which is impacted by N ctiv RSities INof GTthis B.C M multiple factors. The initial aU initO iative focused on the problems of diverse populations. Reduction of the amount of pollutants and provision of fire and police protection do not address problems of diverse populations. Although crime and violence in a community may be decreased, it is not possible to eliminate it.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is implementing interventions to improve the health of the community. Which of the following approaches would be taken by the nurse? a. A top-down approach with rational-empirical problem solving b. A top-down approach with community practice planned by experts c. A bottom-up approach with facilitation of communication d. A bottom-up approach with multisectoral planning and action for health ANS: D

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A bottom-up approach with multisectoral planning and action for health incorporates community participation. A bottom-up approach uses broad-based community problem solving that includes health professionals, local officials, service providers, and other community members, including those at risk for health problems. The top-down approach describes when professionals and experts tell the citizens what to do rather than involving and asking them. Social planning stresses rational-empirical problem solving, usually by outside professional experts with a top-down approach. This approach does not focus on building community capacity or fostering fundamental social change.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is implementing the Community Health Promotion Model. Which of the following underlying principles should the nurse use to facilitate active participation? a. Individuals should work in groups to complete necessary tasks. b. Individuals participating should represent all segments of the population. c. People will work together if they like the leadership. d. People will participate when they see the issues as worthy of their time.

ANS: D People participate when they feel a sense of community and see their involvement in the issues as relevant and worthy of their time. This is the second step of the Community Health Promotion Model. There should be a broad-based representation on the planning committee, but it may not represent all segments of the population. The tasks may need to be completed by both groups and individuals. Although the likability of leadership may influence who participates, it most likely will not influence whether they are able to work together.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is leading a team responsible for evaluating the health of a community using the Community Health Promotion Model. Based on this model, which of the following steps would you expect the nurse to complete? a. Ensuring high technological access before the plan can be implemented b. Soliciting the consent of every member of the community c. Assessing the community d. Restructuring the public health policy in the community ANS: C Assessing the community is one of the nine steps of the Community Health Promotion Model. Restructuring public health policy, soliciting consent of all community members, and ensuring high technological access before implementing the plan are not part of this model.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse performs a community assessment as part of the Community Health Promotion Model. Which of the following best describes the rationale for this action? a. Becoming more acquainted with the multiple factors that influence health status

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b. Surveying the citizens in the community about their wants and needs c. Allowing special interest groups a voice in health policy d. Providing a narrow focus for the committee work ANS: A The purpose of including a community assessment in the implementation of the Community Health Promotion Model is to become more acquainted with the multiple biological, behavioral, social, and physical factors that describe and influence health status of residence.

The assessment provides the frame of reference for identifying the community’s strengths, needs, and resources. The community assessment involves multiple factors, which is more than surveying citizens or asking special interest groups for their opinions. The community assessment has a broad focus, not a narrow focus.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is designing interventions and evaluating results of Healthy Municipalities and Cities. Which of the following considerations would be made by the nurse? a. Influence of individual actions b. Acute care hospital services in the community c. Social results and endorsement of law makers for policy changes d. Effectiveness of health services, including delivery of preventive services ANS: D The effectiveness of health services, including the delivery of preventive services, should be considered when designing interventions and evaluating the results of Healthy Municipalities and Cities. Influence of individual actions, acute care hospital services, and NntRoS ING B.C e M social results and endorsemeU f law mT akers arO not part of Healthy Municipalities and Cities.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is implementing the steps of the Community Health Promotion Model. Which of the following does this most resemble? a. Collaboration process b. WHO’s Ottawa Charter c. Nursing process d. CDC’s monitoring program ANS: C The steps of the Community Health Promotion Model are very similar to the nursing process. The steps include assessment, planning, implementation, and evaluation. The collaboration process, WHO’s Ottawa Charter, and the CDC’s monitoring program do not contain steps like the Community Health Promotion Model.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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14. A nurse is involved in implementing the Community Health Promotion Model. Which of the following best describes the action being taken by the nurse? a. Changing public policy b. Establishing a team to plan and coordinate the work c. Providing nursing diagnoses for the community d. Revising an objective for Healthy People 2020 ANS: B A structure in the community for health promotion should be developed through the establishment of a steering committee that will plan and coordinate the work. The nurse would not change public policy, but rather provide information based on data to policy makers. The nurse would not be revising objectives in Healthy People 2020 as that is not an action that individuals are able to take. Nursing diagnoses are not written as part of this model.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What principles were used in the creation of the Healthy Cities movement? (Select all that apply.) a. Primary care b. Equity in health promotion c. Community participation d. High technologic environments N R I e. Relationship building ANS: A, B, C The Healthy Cities movement was based upon the principles of primary care, equity in health promotion, and community participation. Relationship building and high technologic environments were not part of the creation of the Healthy Cities movement.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. According to the Ottawa Charter for Health Promotion, which of the following are included in the areas for health promotion action? (Select all that apply.) a. Creating supportive environments b. Developing personal skills c. Building healthy public policy d. Reorienting health services e. Developing community partnerships ANS: A, B, C, D Creating supportive environments, developing personal skills, building healthy public policy, and reorienting health services are all areas for health promotion action identified by the Ottawa Charter for Health Promotion in 1986. Developing community partnerships was not addressed by the Ottawa Charter for Health Promotion.

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DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse uses the Community Health Promotion Model to address the problem of increasing teenage pregnancy rates in the community. Which of the following steps would be used by the nurse? (Select all that apply.) a. Identifying interest in the topic through use of community forums b. Building a partnership with parents of teenagers to address this problem c. Counseling teenagers about effective birth control methods d. Contacting other cities with similar problems and issues e. Referring teenagers to Planned Parenthood ANS: A, B The implementation of the Community Health Promotion Model includes identifying interest by community forums and building the partnership. Counseling and referring teenagers and contacting other cities may be used by the nurse but are not part of the steps identified by the Community Health Promotion Model.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 17: Community as Client: Assessment and Analysis Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources ANS: C People, place, and function are the critical attributes in the definition of community. These attributes are found in most definitions of community. The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse has collected data about the services available in the community and is using the 7 “A’s” to evaluate these services. Which of the following questions will the nurse most likely ask? a. Can the community members allocate resources to support the service? b. Can the community meN mU beRrsSaI ffN orG dT thBe. seCrvOicMe? c. Will the community members allow strategies to be implemented to improve the service? d. Will the community members approve of the services provided?

ANS: B The 7 “A’s” include: Is the community aware of its needs and of the service? Is it accessible to community members? Is the service available when the community needs it? Can the community members afford the service? Does the community find the service acceptable?

Is the service adequate to meet the needs of the community? And, are the services appropriate to meet the needs of the community? The following questions do not address the 7 “A’s”: Can the community members allocate resources to support the service? Will the community members allow strategies to be implemented to improve the service? And, will the community members approve of the services provided?

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is caring for the community as the client. Which of the following is most likely the focus of the nurse’s care? a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education. Provision of care for aggregates and families does not address the larger scope of community as client.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A collection of individuals who have one or more personal or environmental characteristics in common is defined as what? a. Community b. Group c. Family d. Aggregate ANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. A community is a group of people that share something in common, such as geographic location, interests, or values. A group is people who are located close together. A family is considered parents and children living together in a household.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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5. Which data source provides iU nfoS rmaN tionTabout tO he function of the community? a. Local restaurant b. Elected officials c. County health department d. Civic groups ANS: C Function refers to the aims and activities of the community. Civic groups and elected officials refer to people. Local restaurant refers to a place.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Why must change for the community as a client often occur at several levels? a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels. Society must also be involved in the change by supporting individual choices. There may be certain geographic areas that have higher health risks than others, but this does not explain why care must occur at several levels.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse centers practice around the principle of doing the greatest good for the greatest number. Which of the following ethical principles is being applied? a. Distributive justice b. Utilitarianism c. Social justice d. Health disparities ANS: B Utilitarianism means doing the greatest good for the greatest number. Distributive justice means treating people fairly and distributing resources and burdens equitably among the members of a society. Social justice means ensuring that vulnerable groups are included in the equitable distribution of resources. Health disparities are the inequalities that exist among different populations.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care e. coC mm 8. A nurse is investigating theNstru Rctu IreNoGf thTB Munity. Which of the following indicators U S O would the nurse most likely collect data about? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization ANS: D The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse focuses intervention strategies on the structural dimension of community health.

Which of the following best describes the focus of these strategies? a. Health services b. Primary prevention c. Health promotion d. Secondary prevention ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Health promotion activities are interventions focused on improving one’s health.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A leader of a support group introduces a nurse to its members and discusses the professional relationship he has with the nurse for the past several years. Which of the functions is the leader performing? a. Gatekeeper b. Insider c. Community health workers d. Advocate ANS: A Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Insiders are those who grew up in the community, have personal ties to the people there or comes from a similar cultural or ethnic background. Community health workers are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. An advocate is someone who speaks up for and supports the needs of the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A community has residents who provide information to the city council so that decisions can be made about the health of the community. Which of the following characteristics is being displayed? a. Active partnerships b. Passive participation c. Gatekeeping d. Focus groups ANS: B Coalitions are active partnerships in which all participants share leadership and decision making to some degree. Unfortunately, some community health efforts view community residents only as sources of information and receivers of interventions; this limits residents to passive participation. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. A focus group is like an interview in that it collects data mainly through asking open-ended questions to participants but to a small group rather than an individual.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

12. A nurse lives in a community that demonstrates commitment. Which of the following would most likely be supported within this community? a. Creation of a community club by the city council to facilitate community involvement b. Collaboration among area restaurant owners to develop healthier menus c. Collaboration with the health department to build a new recreation center d. Development of a cooperative agreement with a neighboring city to share needed services ANS: C Commitment to the health of the community requires a process of change at each appropriate level on the continuum. The most successful change processes often arise from collaborative practice models that involve the community and nurses in joint decision making. Participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision making. Collaboration by restaurant owners to develop healthier menus only addresses one population of the community and does not show involvement by nurses and the larger community. Creation of a community club by the city council does not engage the larger community in this decision. Developing a cooperative agreement with a neighboring city does not show commitment between the members of both communities.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is trying to develop community partnerships. Which of the following interventions would be the most approprN iate the nurs URforSI NG TBe.toCuse OM? a. Involve the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines.

ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines. Partnerships should involve a variety of individuals from various backgrounds. There should be a balance of power and information sharing among all of the participants.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What are the main characteristics of partnership? a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utility ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The main characteristics of partnership are awareness, flexibility, and negotiated distribution of power. Rights, responsibilities, and consensus are not the main characteristics of partnership. Commitment, participation, and articulation are not the main characteristics of partnership. Collaboration, advocacy, and utility are not the main characteristics of partnership.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse has identified the boundaries of the community. Which of the following steps should the nurse take next when completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used.

ANS: A The first step of the community assessment is to define the community. In order to do this, geographic boundaries, the population within the boundaries, the purpose of the assessment, and a data collection plan will be identified. Those inhabiting the community are a primary focus of the assessment. A variety of strategies are used to identify this central core of the community. The next step involves gathering and generating data to learn more about the community. After the community has been completely assessed then nursing diagnoses can be formulated, interventions planned, and finally interventions evaluated.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 16. A nurse is completing a community assessment. Which of the following actions would be most likely for the nurse to complete? a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community.

ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources. The focus of the community assessment is on the needs of the community, not on individuals. The core functions of public health nursing are not all used during the community assessment process. The community assessment should identify both the strengths and weaknesses of the community.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse interviews the school nurses in a community to determine their roles in schools because this data is not available. Which of the following processes is the nurse using? a. Photovoice b. Spatial data

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Public Health Nursing 10th Edition Stanhope Test Bank c. Primary data d. Secondary data ANS: C Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Spatial data involves looking at the locations of places within the community. Photovoice, also called photo elicitation, is a community assessment technique in which community members take photos to represent a topic or theme about community health. Secondary sources include published data about the community, such as census data.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse schedules an appointment with a provider who has a practice in the community to learn more about the community’s beliefs regarding childhood immunizations. Which of the following is being demonstrated? a. Informant interview b. Participant observation c. Active participation d. Windshield survey ANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. Active partnerships are those in which all N and RSdec INisio GTnB.C M participants share leadership U makinOg to some degree. Windshield surveys are a method of simple observation, providing a quick overview of a community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A community health nurse is conducting informant interviews in a small community. Which of the following would the nurse most likely contact? a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area ANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants. Key informants need not hold any formal title, but are generally viewed as community leaders by other community members and often have a long history in the community. The state department of health, surrounding communities, and CDC do not meet the definition of an informant.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 20. A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. Which of the following types of data is being collected? a. Quantitative b. Qualitative c. Focus groups d. Participant observation ANS: B Qualitative data is collected through interviews and observation. This data is the descriptions provided by these individuals through interviews. Quantitative data is the numbers that can be found about the community, such as crime statistics. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse reads the local community newspaper to gather data about the community. Which method of data collection is being used? a. Informant interview b. Focus group c. Participant observation d. Windshield survey ANS: C Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event.

The nurse is deliberately sharing in the life of the community by reading the newspaper. An informant interview is a method of community data collection that involves directed conversation with selected community members. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Windshield surveys are a method of simple observation, providing a quick overview of a community.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation. Which method of data collection is being used? a. Participant observation b. Windshield survey c. Focus group d. Informant interviews ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Windshield surveys are a method of simple observation, providing a quick overview of a community. By making observations of the community, the nurse is completing a windshield survey. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. An informant interview is a method of community data collection that involves directed conversation with selected community members.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse analyzes data from minutes at a community meeting when completing a community assessment. Which of the following methods of data collection is being used? a. Secondary data b. Informant interviews c. Primary data d. Windshield survey ANS: A Secondary sources include published data about the community. The data is secondary because it is collected by someone else. An informant interview is a method of community data collection that involves directed conversation with selected community members.

Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Windshield surveys are a method of simple observation, providing a quick overview of a community.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse is using health status indicators to complete a community assessment. Which of the following best explains what the nurse is doing? a. Interviewing key informants in the community b. Examining morbidity and mortality rates in the community c. Surveying local businesses in the community d. Observing community members ANS: B Health indicators are numerical measures of health outcomes, such as morbidity and mortality, as well as determinants of health and population characteristics. Generally, these data are from secondary sources such as websites or printed materials. Interviewing key informants, surveying local businesses, and making observations are all methods of primary data collection.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. What is the purpose of writing a community nursing diagnosis? a. To assist with developing the evaluation measures for program planning b. To clearly describe the strengths and weaknesses of the community

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Public Health Nursing 10th Edition Stanhope Test Bank c. To lead to the outcomes and strategies to address and improve the identified health problem d. To increase the likelihood that the problem will be solved ANS: C The community nursing diagnosis, no matter which classification system is used, leads to expected outcomes and evidence-based health promotion strategies to address and improve the problem identified in the diagnosis. This becomes the nursing care plan. The expected outcomes and evaluations derived from the nursing diagnosis systems suggest subsequent evaluation measures for identified needs or problems. A community assessment describes the strengths and weaknesses of a community. The likelihood of solving a problem is not influenced by writing a community nursing diagnosis.

DIF: Cognitive level: Understanding TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nurse is writing a nursing diagnosis at the community level using the North American Nursing Diagnosis Association (NANDA) system as a guide. Which of the following diagnoses would most likely be developed? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors, as evidenced by client crying and stating she has no support system ANS: B There are three parts of the NANDA system: (1) identification of the problem or potential problem; (2) its relation to factors, stressors, or health issues; and (3) supporting data that documents the problem. The “risk of” identifies a specific problem or health risk faced by the community. “Among” identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. “Related to” describes characteristics of the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A nurse plans on implementing a community-wide influenza immunization program. Which of the following factors should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The community’s readiness to participate in the program ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank The factors that influence implementation in the community are the nurse’s chosen roles, the type of health problem selected as the focus for intervention, the community’s readiness to take part in problem solving, and characteristics of the social change process. The community’s readiness to participate is more important than public policy, the existence of formal groups in the community, and the number of community members who have already received the vaccine.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse is engaging in the evaluation phase of community health program planning. Which of the following would be part of effective completion of this phase? a. Demonstrate the ability to improve the health of the participants. b. Develop measurable objectives and goals before implementation. c. Encourage full participation by community members. d. Improve the health of the population through the program.

ANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established, and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed.

Participation by community members and improvement of the health of the population may be measured through the evaluation phase but would not demonstrate completion of this phase. The evaluation phase may determine if the participants’ health is improved, but improvement of health is not part of the completion of this phase.

DIF: Cognitive level: AnN alyz :M Nursing process: Planning Ring INGTB.TCOP U S O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which of the following implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media ANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people. The other methods will take much longer for the information to spread to the community members.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

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Public Health Nursing 10th Edition Stanhope Test Bank 1. A nurse is defining the community as part of the community assessment process. Which of the following best describes how the community may be defined? (Select all that apply.) a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern e. Individuals with certain interests ANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions. Individuals comprise a community but would not be an accurate definition of a community.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is assessing the safety in the community using primary data. Which of the following data would be useful for the nurse to collect? (Select all that apply.) a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurse’s own observations e. Morbidity and mortality rates ANS: B, C, D Other nurses, social workers, health care providers, community members, and the nurse’s NsouRrcesIofinformation G B.C M own observations are reliable about the safety of an area. The number of billboards would not be important data to collect when assessing for safety in the community. Morbidity and mortality rates would be considered secondary data.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 18: Building a Culture of Health to Influence Health Equity Within Communities Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse is educating the community about modifiable behaviors. Which of the following is the nurse most likely to discuss? a. Smoking, poor diet, and alcohol consumption b. Cancer, emphysema, and cardiovascular disease c. Age and gender d. Genetic abnormalities ANS: A Modifiable behaviors remain the major contributors to deaths in the United States. Tobacco use, poor diet, physical inactivity, and alcohol consumption are examples of modifiable behaviors. Cancer, emphysema, cardiovascular disease, gender, age, and genetic abnormalities are not modifiable behaviors.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. A nurse is utilizing a disease-oriented approach when providing care to a client. Which of the following interventions will the nurse most likely provide? a. Promotion of a greater N leU veR lS ofIpN osG itT ivB e. heC alO thM b. Education about common disease processes c. Acute care management of chronic disease d. Education about medication compliance ANS: D A disease-oriented approach assumes that humans are composed of organ systems and cells; in this instance, health care focuses on identifying what is not working properly with a given system and repairing it. In this context, health behavior begins with patient compliance with health professionals’ recommendations. This approach does not promote a greater level of positive health as this would be related to health promotion. This approach does not provide education about common disease processes or acute care management of chronic disease.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 3. The biomedical model defines health as what? a. An avoidance of illness b. The absence of disease c. The promotion of healthy behaviors d. A protection from illness and disease states ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. What is a health-oriented perspective viewpoint? a. Health as the absence of disease b. Human lifestyle based on one’s prescribed regime c. Humans as complex and interconnected with the environment d. Community education as the role of the registered nurse ANS: C The health-oriented perspective includes the view that humans are complex and interconnected with others and the environment. Health behavior within this perspective involves a holistic view of lifestyle and interaction with the environment and not simply compliance with a prescribed regimen.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse using the integrative model for community health promotion. Which of the following best describes how the nurse would apply the dimension of client system? a. Concentrating on individual health behaviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients ienUtR edScI arN e GTB.COM d. Focusing on disease-orN ANS: C The client system is multidimensional with nursing and health care targeting the multiple levels of clients. When the individual is the client, the environment includes the family, the broader aggregate, and the community of which the individual is a part. The nurse and health care provider are concerned with how these environments affect the individual’s health. The focus for care is on health promotion, illness prevention, and illness care.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A public health nurse (PHN) collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. Which of the following client systems of the integrative model does this describe? a. Community b. Aggregate c. Family d. Individual ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people. The community is the environment for the aggregate and is the system being applied.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A public health nurse (PHN) collaborates with a physician’s clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed? a. Aggregate level health promotion b. Aggregate level illness prevention c. Family level illness care d. Individual level health promotion ANS: A Each succeeding level of the client system is more complex. In this situation, the PHN is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education. Illness prevention is linked to the negative view of the absence of disease. Illness care is the care provision of someone with the disease.

DIF: Cognitive level: ApN plyi :M Nursing process: Implementation RngSINGTB.TCOP U O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation? a. Family level health promotion b. Individual level illness prevention c. Aggregate level illness prevention d. Individual level health promotion ANS: B The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention. Health promotion focuses on positive measures of health. The family level and aggregate level both focus on inclusion of more than one person.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. When applying the integrative model for community health promotion, a nurse assesses the neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Individual Family Aggregate Community

ANS: D The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions. This is the broadest client system as the nurse is examining the neighborhood. Individual focus is looking at individuals, family focuses on families, and aggregates focuses on populations.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse provides a screening for school-aged children to screen for hearing deficits. Which of the following is being demonstrated by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Health promotion activities are interventions focused on improving one’s health.

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DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 11. According to Leavell and Clark, what does primary prevention consists of? a. Health promotion and rehabilitation b. Health promotion and specific protection c. Early diagnosis and prompt treatment d. Health maintenance and early diagnosis ANS: B Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. A client wears a seat belt whenever riding in an automobile. Which of the following best describes the client’s behavior? a. Illness prevention

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Public Health Nursing 10th Edition Stanhope Test Bank b. Health promotion c. Specific protection d. Health protection ANS: C Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards.

Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health protection strategies include environmental measures to improve health and quality of life.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. A client walks 5 miles a day because of a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection ANS: B The client is exercising to prevent an illness that runs in the family. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable N R I G B.C ocuses M on maintaining health. Health environmental conditions. HeUalthSmaNinteTnance fO protection strategies include environmental measures to improve health and quality of life.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. A client runs 5 miles a day because it improves mood and energy level. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection ANS: A The client is exercising to improve and promote health. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of life.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 15. A community is searching for additional funding so that a bike trail can be built in the community. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Specific protection d. Health protection ANS: D Health protection strategies include environmental measures to improve health and quality of life. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 16. Which of the following statements is correct? a. Genes, biology, and health behavioral choices account for 75% of population health. b. Medical care accounts for 25% of population health. c. Physical and social environments account for 75% of population health. d. Genes, biology, and health behavioral choices account for 25% of population health.

ANS: D Genes, biology, and health behavioral choices account for 25% of population health and N, inc RSlud IN G mB.C M social determinants of healthU ing T edicalOcare; the physical and social environment account for the remaining 75%.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. What does the National Prevention Strategy provide? a. Recommendations on what can be done to improve population health b. Assistance in interpreting Healthy People 2020 c. A basis for public health nursing practice d. Health risk appraisal instruments ANS: A The National Prevention Strategy offers recommendations on what can be done to improve population health in specified contexts and across goal areas. This document does not assist in interpreting Healthy People 2020, providing a basis for public health nursing practice, or providing health risk appraisal instruments.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 18.

Which of the following describes one advantage of the Health Belief Model (HBM)? a. It is one of the most recently developed models based on evidence-based practice

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Public Health Nursing 10th Edition Stanhope Test Bank principles. b. It can reduce the incidence of diseases and disabilities. c. It can assist with planning programs to increase an individual’s motivation to take positive health action. d. It promotes individual’s participation in community-based screening programs.

ANS: C The Health Belief Model (HBM) can assist with planning programs to increase an individual’s motivation to take positive health action. This theory was one of the first theories of health behavior, which began in the 1950s. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. There is nothing to support that the use of this model will reduce the incidence of diseases and disabilities. It focuses on motivation of changing health behaviors, not participating in screening programs.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 19. A nurse is using the Health Belief Model (HBM) when developing health programs in the community. Which of the following is the nurse most likely involved in? a. Conducting group risk appraisal and risk reduction b. Considering the factors that will motivate the participants to change their health behaviors c. Completing a community wellness inventory d. Considering legislative changes that are necessary to improve environmental living conditions and sanitation ANS: B The HBM can assist with planning programs to increase an individual’s motivation to take positive health action. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. Conducting a group risk appraisal and risk reduction, completing a community wellness inventory, and considering legislative changes do not address an individual’s motivation to adopt a health behavior.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 20. A nurse is using Anderson and McFarlane’s model to complete a community health assessment. Which of the following information about the community would the nurse be collecting? a. Resources available to promote health b. Interactions among subsystems c. Physical environment d. Demographics ANS: B A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it. This model does not address the resources available to promote health, physical environment, or demographics.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. The Framingham Heart Study was successful in achieving what goal? a. Providing information on the effectiveness of risk-reduction interventions b. Documenting the relationship between social variables and heart disease c. Identifying factors contributing to the development of coronary heart disease (CHD) d. Demonstrating the effects of mass media in modifying high-risk behavior ANS: C The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. By collecting periodic health assessments and morbidity and mortality data, major risk factors associated with CHD mortality were identified. The investigators used health risk appraisals to relate the risk factors in well individuals to the probability of future cardiovascular disease. This study did not provide information on the effectiveness of risk-reduction interventions, document the relationship between social variables and heart disease, or identify factors contributing to the development of heart disease.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is performing interventions at the individual level of care. Which of the following is NU RS? I(SNelec GTt B.C the nurse most likely comple ting all thaOt M apply.) a. Teaching well-balanced nutrition to a mother with a malnourished child b. Providing a parent age-specific information for immunizations c. Assessing the community for other cases of malnutrition d. Assessing other families on the same street for similar problems e. Planning a social marketing campaign about seat belt safety ANS: A, B Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. Which community-based programs resulted in equally favorable health risk changes for both control and treatment groups? (Select all that apply.) a. Framingham Heart Study b. Stanford Five-City Heart Disease Prevention Program c. North Karelia Study d. Minnesota Heart Health Program e. Dutch Heart Health Community Intervention ANS: B, C, D, E

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Public Health Nursing 10th Edition Stanhope Test Bank The Stanford Five-City Heart Disease Prevention Program, North Karelia Study, Minnesota Heart Health Program, and Dutch Heart Health Community Intervention provided beginning scientific evidence for the implementation of community-level risk reduction programs, although the results were modest and often not statistically significant. The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 19: Health Education Principles Applied in Communities, Groups, Families, and Individuals for Healthy Change Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the goal of providing education across the three levels of prevention? a. Enabling clients to attain optimal health b. Identifying and treating health problems early to eliminate disability c. Enabling populations to break into individuals d. Teaching people about Healthy People 2020 ANS: A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of disability may not be possible. Health education does not teach about the Healthy People 2020 document or break populations into individuals.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which statement about education is true? a. It emphasizes the provider of knowledge and skills. b. It emphasizes the recipient of knowledge and skills. c. It is a process of gaininN gU knRoS wI leN dgG eT anBd.eC xpOeM rtise. d. It results in behavioral change.

ANS: A Education is the establishment and arrangement of events to facilitate learning. Education emphasizes the provider’s role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and skills. Education does not necessarily result in change, as change is typically not easy for most people. Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse uses Healthy People 2020 as a guide when planning health education in the community. Which of the following actions would be taken by the nurse? a. Focus on avoiding cigarette smoking and using alcohol in moderation. b. Educate clients using primary and secondary levels of prevention. c. Use Bloom’s taxonomy when planning educational objectives. d. Design health fairs aimed at individuals.

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Healthy People 2020 focuses on implementing health promotion in priority areas using primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care education. Health fairs targeted at specific populations can provide a venue for providing primary and secondary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. What does the cognitive domain of learning include? a. Changes in attitudes and the development of values b. The performance of skills c. Memory, recognition, understanding, reasoning, and problem solving d. Memorization of one set of skills before moving on to the next ANS: C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain includes changes in attitudes and the development of values.

The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Memorization of skills is only one part of the cognitive domain.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. A nurse is teaching a client about how to complete a wound dressing change. Which of the following conditions must be met before learning will occur? izeUtR heSiI nstr , rel a. Must be able to memorN Gucti Bon.sC May this information to a partner, and N T O demonstrate the dressing change. b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person. c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time. d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to practice the dressing change.

ANS: D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the necessary requirements of the learner.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A health educator is trying to change a client’s attitudes about smoking. Which of the following domains would be used? a. Cognitive b. Affective c. Psychomotor d. Developmental

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. The nurse is teaching a new diabetic client how to give himself an insulin injection. Which of the following domains would be used? a. Developmental b. Cognitive c. Affective d. Psychomotor ANS: D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health ProNmUoR tiS onIaN nG dT MB ai. ntC enOaM nce 8. A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby.

Considering the events of instruction, which of the following should the nurse do next? a. Ask the mother about her previous experience with breastfeeding. b. Demonstrate how to position the baby for breastfeeding. c. Show the mother a video about breastfeeding. d. Have the mother demonstrate breastfeeding.

ANS: A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is “Tune in”: listen before starting to teach; the client’s needs should direct the content. Thus, this should be done before the nurse does any demonstration, shows audiovisual resources, or requests return demonstrations.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. A nurse has evaluated the learning needs of a community support group. Which of following steps should the nurse take first when developing an educational program for them?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Consider any potential barriers to learning.

Establish goals and objectives for the program.

Select appropriate materials for the program.

Assess the dynamics of the group.

ANS: B Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the educational process are: (1) identifying educational needs, (2) establishing educational goals and objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5) evaluating the educational process.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 10. A nurse is developing a goal for a client who is learning how to care for an ostomy. Which of the following would be most appropriate to develop? a. The client will look at his stoma without disgust each time his ostomy bag comes off. b. The client will be able to independently take care of his ostomy bag within 3 months. c. The client will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. The client will successfully describe to the nurse how to care for his ostomy when he is asked.

ANS: B Goals are broad, long-term expected outcomes. The correct answer describes something that N dRoS I GThe B.C M will happen over a long perioU f timNe. T otheOr choices describe objectives.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 11. A community health nurse is writing an objective. Which of the following would be most appropriate for the nurse to write? a. Each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials. b. The client will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms. The objective “each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials” contains the components of a written objective. “The client will perform a blood sugar test on herself with an accurate blood sugar reading” does not provide any measurable terms. “The community will take their children to receive immunizations within 1 month of the immunization due date” does not provide a measurable percentage of the members of the community. “Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment” focuses on a long-term goal, rather than a short-term objective and does not provide a time frame for when this would be measured.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 12. A nurse is using the educational process of selecting appropriate educational methods when planning a community health program. Which of the following steps of the nursing process does this action most resemble? a. Assessment b. Evaluation c. Implementation d. Planning ANS: D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and imNpleR menItatiG on w ld bM e implementing the educational plan.

Bo.uC U S N T O Planning is similar to selecting appropriate educational methods.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 13. A nurse is teaching a group of clients newly diagnosed with diabetes how to give themselves injections. Which of the following formats would be most appropriate for the nurse to use? a. Demonstration b. Health fair c. Lecture d. Non-native language session ANS: A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done. Health fairs target specific populations and are held in a variety of locations. Non-native language sessions are a way to adapt the health fair to a population that does not speak English. Lecture is a non-interactive method of teaching.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 14. A nurse is implementing an educational program about the importance of being physically active. Which of the following steps would the nurse complete first? a. Provide learning guidance. b. Present the stimulus. c. Gain the learner’s attention. d. Ask learners to recall prior learning.

ANS: C Gaining the learner’s attention must happen first before learning can take place. The following steps of implementation include telling the learners the objectives of the instruction, asking learners to recall previous knowledge, presenting the essential materials, helping the learners apply the information, encouraging learning to demonstrate what they have learned, and providing feedback to help learners improve their knowledge and skills.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A nurse is implementing a community health education program at a local church. Which of the following educational principles should the nurse implement when providing this education? a. Refer to trustworthy sources. b. Use an active voice. c. Create the best learning environment. d. Accentuate the positive health behaviors of the participants.

ANS: C The environment must be conducive to learning for educational programs to be effective.

N reeRS I istra GTctions B.CO M The environment should be fU of dN and consistent with the message. The other strategies may assist with the educational program but are not one of the major educational principles discussed in the textbook.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 16. A nurse is working with a group of clients diagnosed with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. Which of the following principles of effective education is the nurse using? a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidance ANS: A The educator should have the learners recall previous knowledge related to the topic of interest. The principle of gaining attention should have been applied as the program started the week before. Recall should be done before new material is presented and before learning guidance is provided.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Health Promotion and Maintenance 17. During a class on newborn care given at a local health department, a nursing student asks the participants to practice with baby dolls. Which of the following steps of promoting effective education is the student using? a. Eliciting performance b. Assessing performance c. Enhancing retention and transfer of knowledge d. Gaining attention ANS: A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned. Gaining attention occurs at the beginning of the program. Assessing performance occurs at the end of the program. Enhancing retention and transfer of knowledge occurs as the learners are asked to apply the information to their lives and situations (not to the care of the dolls).

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 18. A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. Which of the following concepts is being applied? a. Authoritarianism b. Learning style c. Pedagogy d. Andragogy ANS: D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners. In pedagogy the teacher assumes full responsibility for making decisions about what will be learned, and how and when it will be learned. In authoritarianism the leader controls group movement and progress through interpersonal power. Learning style refers to how someone learns best.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 19. A nurse is working for a public health department as the community health educator. Which of the following is a potential barrier that a nurse may experience? a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking necessary knowledge ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information. Clients with low literacy levels and limited vocabularies are learner-related barriers, not a barrier of the educator. Memorizing the information to teach may cause problems with the presentation but would not be a barrier for the educator.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. A nurse is working with an individual who has a low literacy level. Which of the following barriers to learning should the nurse anticipate? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of anxiety d. Being overly dependent on others ANS: B Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home. The level of anxiety may vary among these individuals; it is more common for these individuals to request to read it later.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 21. A client diagnosed with diabetes reports to the nurse that she has been learning more about U S N T O controlling her blood sugars by reading information found on the Internet. Which of the following statements by the nurse would be appropriate? a. “Looking at the date the content was posted on the website is important.” b. “The Internet is an unreliable source of information and should not be used.” c. “The best sources of information are found on pharmaceutical websites.” d. “Your physician will provide you better information than the Internet.”

ANS: A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated. The Internet has reliable information, but the quality of the information must be assessed. Pharmaceutical websites may have biased information. Physicians are another source of information, but this may or may not be better than what is found on the Internet.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 22. When a nurse is evaluating the components of an educational program. Which of the following best describes the action that is being taken by the nurse? a. Short-term evaluation b. Educational product c. Process evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank d. Long-term evaluation ANS: C Process evaluation means looking at the components of an educational program. The educational product is the outcome of the educational process. Short-term evaluation evaluates the immediate effects of a health program. Long-term evaluation is geared toward following and assessing the status of an individual, family, community, or population over time.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 23. A nurse has been working on a regular basis with a group that demonstrates cohesion.

Which characteristic is the nurse most likely to describe? a. Inclusion of several leaders. b. Demonstrates diverse attitudes and values. c. All members share a common goal. d. The group has an efficient number of members.

ANS: C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members. A group with several leaders may have difficulty obtaining cohesion if each of the leaders has a different idea. Common attitudes and values among the group members will be important for the group to obtain cohesion.

Efficiency does not play a role in developing cohesion.

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DIF: Cognitive level: ApplU yinS g N T TOO P: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A nurse recognizes the importance of group norms when planning community health education. Which of the following provides the best explanation for why this is important? a. Allows for creativity and variety among group members. b. Influences members’ perception of community. c. Are helpful in evaluating the effectiveness of the group. d. Maintains the group through various supports to members.

ANS: D Group norms serve to maintain the group through various supports to members. They are the standards that guide, control, and regulate individuals and communities. They suggest what a group believes is important, what it finds acceptable or objectionable, or what it perceives as of no consequence. Group norms may limit the creativity and variety among the group members. Members’ perception of the community could be influenced by group norms, but this is not why this consideration should be made when planning community health education. Group norms are not used to evaluate the effectiveness of the group.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 25. A group member has taken on the role of the “gatekeeper.” Which of the following actions would most likely be taken by this member? a. Seek and accept the authority or direction of others. b. Guide and direct the group activity. c. Control outsiders’ access to the group. d. Focus the movement toward the main work of the group.

ANS: C The gatekeeper controls outsiders’ access to the group. The follower seeks and accepts the authority or direction of others. The leader guides and directs group activity. The task specialist focuses or directs movement toward the main work of the group.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 26. A nurse uses the leadership behavior of reflecting when providing education to community members about how to lead healthy lifestyles. Which of the following actions is most likely being taken by the nurse? a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussion ANS: A Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A leader controls group members through rewards and often keeps members in the dark about the goals and rationale behind prescribed actions. What type of leadership does this describe? a. Democratic b. Patriarchal c. Socialist d. Paternal ANS: B Patriarchal is authoritative and permits one to control members through rewards and threats.

Paternal leaders win respect and dependence through parent-like devotion. Democratic leadership is cooperative in nature and promotes and supports members’ involvement in all aspects of decision making and planning. Socialist leadership supports community ownership and involvement of the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 28. What characteristic should the nurse expect when working with an established education group? a. The group membership will change from week to week. b. The members all have the same interests. c. They prefer lectures rather than demonstrations. d. The group already has operating methods that have been successful.

ANS: D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful. An established group would have a stable group membership. Learning occurs better in all groups with demonstrations instead of lectures. In an established group, they may be together because of a common interest, but may not share all the same interests.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 29. A nurse is working with a group focused on improving the health of the community. Which of the following interventions should be used by the nurse? a. Making decisions for the group to move the process along b. Inviting business leaders to participate in the group process c. Maintaining members through recognition and encouragement d. Teaching topics that are of national importance ANS: C Maintaining members is an important intervention to facilitate group process. The topics that are taught should be of importance to the group. The group should be part of the Ne R I ersh GTipB.C M decision-making process. ThU mS embN of thOe group should be maintained, inviting new members to the group may hinder the processes of the group.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 30. Which Core Competency of communication is used by nurses engaged in group work? a. Soliciting input from individuals and organizations b. Using simple language when presenting information c. Asking the group to develop the program of interest d. Presenting material to lay audiences ANS: A Soliciting input from individuals and organizations is a communication competency.

Various strategies should be used to present the information. The group should assist in determining the topic but not developing the program. The material should be presented to professional and lay audiences.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 31. A nurse is planning to evaluate a group’s progress toward a health goal. Which of the following components should be included in the evaluative process?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Type of teaching strategy used Recognition of accomplishments in the group Conflict that occurred in the group The type of leadership in the group

ANS: B Recognition of accomplishments in the group and of the group is built into the evaluative process. The type of teaching strategies used, types of leadership, and conflict are not part of the evaluative process of the group.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is using basic educational principles when conducting an effective educational program. Which of the following principles would the nurse most likely be using? (Select all that apply.) a. Use a clear, succinct style. b. Use an active voice. c. Refer to Internet sources. d. Use aids to highlight key points. e. Repeat information several times.

ANS: A, B, D Using a clear, succinct style, active voice, and using aids to highlight key points are all basic educational principles that N shU ouRldSI beNuG seT dB b. yC thO eM nurse. Reliable sources must be used, and information found on the Internet is not always reliable. Repeating information is not an education principle.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 20: The Nurse Managed Health Center: A Model for Public Health Nursing Practice Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which type of nursing center actively integrates service, education, and research in its model? a. Special care b. Free-standing c. Fee-for-service d. Academic ANS: D Academic nursing centers actively integrate service, education, and research in their model.

Special care centers provide services and specialized health knowledge and skills to a particular group, and they are an adjunct to comprehensive primary health care models. A free-standing center is an independent center with its own governing board. A fee-for-service center means that payment is provided at time of service and it may include a sliding-scale fee.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

IoNnGg TalBl n.uCrsOinMg centers?

2. Which characteristic is comNmUoR nS am a. Provision of community-based culturally competent care b. Services provided by physicians and health care providers c. Focus on the biological factors contributing to the development of disease d. Fee-for-service reimbursement model ANS: A One characteristic that is common among all nursing centers is the provision of community-based culturally competent care, that is, accessible, acceptable, and responsive to the populations being served. Services are provided by nurses in a nurse center. A variety of reimbursement models are used in nursing centers. Nursing centers use a holistic approach to care.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is employed by a nursing center. Which of the following types of services will be provided here? a. Illness-oriented care b. Direct access to nursing services c. Free services d. Physician diagnosis of health problems ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Nursing centers provide unique opportunities to improve the health status of individuals, families, and communities through direct access to nursing and nursing models of care. A nursing center deemphasizes illness-oriented care, is reimbursed for services, and uses nurses to diagnose and treat.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse working at a nursing center has been asked to develop materials about a health promotion topic that can be used at the center. Which of the following topics would the nurse most likely select? a. Advanced care of the chronically ill elderly at home b. Smoking cessation and weight management techniques c. How to access specialty services d. Providing financial support for nursing students ANS: B Nurse centers are positioned to improve the health and well-being of vulnerable populations.

One way to achieve this is by providing access to comprehensive primary health care and health promotion and disease prevention services. Smoking cessation and weight management techniques focus on health promotion, which address the main focus of the nurse center. Advanced care of the chronically ill and accessing specialty services does not address health promotion and disease prevention services. Providing financial support for nursing students does not address a health promotion and disease prevention topic and does not meet the needs of the broad population that may be served by the center.

DIF: Cognitive level: AnN alyz :M Nursing process: Planning Ring INGTB.TCOP U S O MSC: NCLEX: Health Promotion and Maintenance 5. Which type of nursing center operates under a service model? a. Free-standing center b. Affiliated center c. Comprehensive primary care center d. Proprietary ANS: C The service model includes comprehensive primary care centers, wellness centers, and special care centers. Organizational structure is the typology used to describe a free-standing and affiliated center. Internal Revenue Service Designation is the typology used to describe a proprietary center.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6.

What is the focus of a special care nursing center? a. A demographical group with special care needs b. An affiliation with a school of nursing c. Providing services while maintaining a not-for-profit status d. Providing fee-for-service care with designated Health Maintenance Organization (HMO) providers

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: A Special care centers focus on a particular demographical group or those with special needs.

Examples are those that focus on persons with HIV/AIDS, adolescent mothers, and the frail elderly. An academic nurse-led center has an affiliation with a school of nursing. A 501(c)(3) center is considered a nonprofit business. An HMO provider provides fee-for-service care with contracted rates by an HMO. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A client would like to enroll in a smoking cessation program. Which of the following types of nursing centers would be most likely to provide this type of programming? a. Academic Nursing b. Wellness c. Comprehensive Primary Care d. Special Care ANS: B Wellness centers focus on health promotion, disease prevention, and management programs.

An academic nurse-led center has an affiliation with a school of nursing. A comprehensive primary care center provides health-oriented primary care and public health programs.

Special care centers focus on a particular demographic group or those with special needs.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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8. A nurse executive reports thaU t thS e nuN rsinT g centeO r receives reimbursement through contracted rates. Which of the following types of reimbursement mechanism is being used? a. Fee-for-service b. Federally Qualified Health Center (FQHC) c. Health Management Organization (HMO) provider d. Third-party reimbursement ANS: C HMO providers pay at contracted rates. Fee-for-service means payment is provided at time of service. FQHC has federal designation that allows cost-based reimbursement per encounter. Third-party reimbursement involves client billing to a public program or commercial/private insurance.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Individuals, families, groups, organizations, policy makers, and staff who are involved in community collaboration are identified by what term? a. Nursing center workers b. Policy makers c. Stakeholders d. Diversity ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Stakeholders offer diversity in perspective in community collaborative efforts. Policy makers are those involved in creating the policies. Nursing center workers are those who work as staff within the nursing center. Diversity is demonstrated through working with a variety of populations.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. What was the overarching concept upon which Healthy People 2020 was built? a. Establish nursing centers for improving health promotion. b. Create partnerships among individuals, communities, and systems. c. Eliminate disease in lesser-developed countries. d. Further the agenda of the World Health Organization (WHO).

ANS: B Healthy People 2020 builds upon shared responsibility to improve the nation’s health.

Powerful, productive partnerships among diverse people and groups and long-term commitments to community collaboration are needed to achieve these goals. Healthy People 2020 did not promote the establishment of nursing centers. Healthy People 2020 focuses on the needs of the United States, not that of lesser-developed countries or the agenda of the WHO. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 11. A nurse is working with a group and would like to facilitate successful collaboration. Which of the following would be tN heUm t im Ros SI NGport TBan.tCfact OMor for the nurse to consider? a. Focus of the group b. Planned change that will occur c. Decisions made by executive director d. Open and frequent communication ANS: D Although the focus of the group and its planned change are important, they are not the most important factor for the nurse to consider. To accomplish anything with the group, open and frequent communication is necessary. Decisions should be made through consensus of the group, not the decisions of one person.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Which term addresses the multiple levels of intervention required for bringing about and sustaining change? a. Community collaboration b. Community assessment c. Strategic planning d. Partnership ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Strategic planning addresses the multiple levels of intervention required for bringing about and sustaining change. Community collaboration involves the capacity of those involved to enhance the capacity of another person, group, or organization to achieve the common purpose. Community assessment involves examining the community to determine its needs, strengths, and weaknesses. Partnership involves working together to solve community problems.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse would like to improve the ability of the nursing center to be responsive to the needs of the community. Which of the following best describes how this can be accomplished? a. Having staff examine the needs of the community b. Determining the services to be provided by the center c. Involving the community in assessing its own needs d. Addressing the problems in the community ANS: C Nurses work in close partnership with the communities. As the community and center work together, a multilevel approach is needed. For comprehensive community health improvement, strategies are needed at organizational, community, and sociopolitical levels.

Thus, it is important to involve the community in the planning of a nursing center. Having the staff examine the community needs does not involve the community. If the nurse determines the services to be provided, this does not demonstrate collaboration and communication with the community. The nurse needs to work with the community in order to determine which problems in the community should be addressed.

DIF: Cognitive level: Applying TOP: Nursing process: Planning U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A community health center conducts blood lead screenings on a regular basis for children under 6 years old. Which of the following best describes the level of prevention that is being used? a. Tertiary prevention b. Primary prevention c. Secondary prevention d. Health education ANS: C Secondary prevention often involves screening. Primary prevention involves education.

Tertiary prevention involves rehabilitation. Health education is provided to improve knowledge about a health topic.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A nursing center is going to be placed in a rural community. Which of the following would have the most power and influence on model development and team composition? a. The rural community b. The community’s mayor

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Public Health Nursing 10th Edition Stanhope Test Bank c. The nursing center’s executive d. The center’s staff ANS: A The fundamental premise of any nursing center is that the community has the most power and influence. The mayor, nursing executive, and staff do not have as much power as that of the community.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse executive is managing a nursing center. Which of the following would be an expected responsibility of a nurse in this role? a. Managing the business operations b. Managing the data systems c. Providing patient care and referral d. Overseeing contracts and grants ANS: D The nurse executive has many leadership roles and responsibilities including responsibility for overseeing contracts and grants, annual reports, development of the advisory board, and hiring and retention of highly qualified staff. Other staff members will manage the business operations, data systems, and provide patient care and referral.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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17. A nurse executive would likeUto S hireNa nT eighborO hood resident who is trained in community outreach to work at the nursing center. Which of the following would most likely be the title of this position? a. Community health worker b. Support staff member c. Clinical specialist d. Specialty care provider ANS: A Community health workers are typically neighborhood residents who are trained in community outreach, family case management, or on-site services. A support staff member may include a business or operations manager and data operations personnel. A clinical specialist is an advanced practice nurse. A specialty care provider has had advanced education in a specialty area.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nursing student would like to become involved by working at a nursing center. Which of the following would be an appropriate role for a nursing student? a. Leader b. Follower c. Advocate

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Public Health Nursing 10th Edition Stanhope Test Bank d. Researcher ANS: C Students most often play the role of advocate in a nursing center. Students can promote social justice while engaging in community service learning activities with underserved, vulnerable populations. A student needs to be a leader, but with supervision. A student can collect data but is not yet a researcher.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse needs to make the final decision about establishing a nursing center in the local community. Which of the following factors would be the most important for the nurse to consider? a. Legal and regulatory considerations b. Community involvement c. Nursing interest d. Potential grant funding ANS: A Several essential areas must be explored before a final decision is made about establishing a nursing center, including legal and regulatory considerations. Community interests would be important to consider, not necessarily community involvement. All funding sources, not just grant funding, should be considered. The nursing interest is not a main component that needs to be considered when establishing a nursing center.

DIF: Cognitive level: ApN plyiR ng I G B.TC OP:M Nursing process: Planning MSC: NCLEX: Safe and EfU fectS ive N CareTEnviroOnment: Management of Care 20. A nurse develops a plan to describe the development and direction of the nursing center and identifies how the center will meet its goals. Which of the following best describes this plan? a. Feasibility study b. Business plan c. Strategic plan d. Organizational framework ANS: B A business plan describes the development and direction of the nursing center and how goals will be met. A feasibility study identifies the strengths, limitations, and capacity of an organization and the community to support the establishment and continuation of a nursing center. A strategic plan looks into the future and guides the work of the center in that direction. The organizational framework shows how the organization is organized.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is examining the strengths, limitations, and capacity of an organization and the community to support the establishment and viability of a nursing center. Which of the following best describes what the nurse has completed?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Data collection Feasibility study Focus groups Community forums

ANS: B A feasibility study reveals the strengths, limitations, and capacity of an organization and community to support the establishment and viability of a nursing center. Focus groups, community forums, and data collection are all used to complete a feasibility study.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is using the Health Insurance Portability and Accountability Act (HIPAA). Which of the following situations is the nurse most likely experiencing? a. Counseling an employee that his insurance will remain the same after changing jobs b. Supervising staff to ensure that all work has been completed c. Adhering to client confidentiality when providing care d. An employee takes additional time off of work to care for a sick family member ANS: C HIPAA states that staff must monitor and keep client records secure and have mechanisms to transfer client information securely and appropriately. Counseling about insurance, supervising staff to make sure work has been completed, and taking additional time off of work is not part of HIPAA.

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DIF: Cognitive level: AnalU yzinSg N T TOO P: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse has recently completed a research study in a nursing center. Based on the historical pattern of research in nursing centers, what would likely have been the focus of this research? a. The development and characteristics of nursing centers b. The effects of nursing models of care in nursing centers c. Client outcomes d. Managed competition in nursing centers ANS: A Typically, descriptive data has been collected about clients, types of services, financial support systems, and community relationships over the past three decades. Additional research in the future needs to be done to look at the effects of nursing models of care and client outcomes. There is no need now to look at managed competition in nursing centers.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse executive publishes information about the effectiveness of a prenatal program.

Which of the following describes this essential step of evaluation of this program? a. Focusing on design

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Public Health Nursing 10th Edition Stanhope Test Bank b. Engaging stakeholders c. Ensuring use and sharing lessons learned d. Gathering credible evidence ANS: D A nurse executive providing materials on the effectiveness of a prenatal program is an example of gathering credible evidence. Focus on design, engaging stakeholders, and ensuring use and sharing lessons learned are parts of evaluation. However, these steps are not necessary before publishing information about program effectiveness. Credible evidence must be gathered before publication.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. A nurse is presenting information to community members about the potential development of a retail care clinic in the neighborhood. Which of the following information would the nurse include in this presentation? a. These clinics are typically staffed by physicians. b. These clinics are usually located in community centers. c. These clinics focus on providing information related to health promotion. d. These clinics are often owned by for-profit organizations.

ANS: D Retail care clinics are typically staffed by nurse practitioners, located in a high-volume retail business, and provide a limited scope of care including immunizations, routine school physicals, and care for common acute problems. The majority of retail clinics are owned by for-profit organizations andNitsR maI nageGmeB nt.dC oesM not consider the clinics as nurse-managed health centers.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nursing faculty member is discussing the importance of joining a professional organization as a registered nurse with a group of undergraduate students. Which of the following statements would be most appropriate for the faculty member to include in this discussion? a. “All nurses should be members of the American Nurses Association.” b. “Membership in a professional organization helps nurses organize around critical health issues.” c. “Dues for professional organizations are expensive, so it is important to set aside money to pay these dues.” d. “Membership in a professional organization will foster change in legislation.”

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Membership in a professional organization helps nurses to organize around one or more critical health threats and strategize about what interventions work locally, regionally, and nationally. Membership in organizations should be based on interest, clinical and academic preparation, and employment. Dues for professional organizations vary, but most are not extremely expensive. One of the benefits of membership in a professional organization is that legislation can be influenced, however this in only one of the benefits of belonging to a professional organization.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is looking for financial support when developing a nursing center. Which of the following would be an appropriate source for funding? (Select all that apply.) a. Grant funding b. Charitable organizations c. Private pledges d. Foundations e. State and federal agencies ANS: A, B, C, D Support for nursing centers can come from grants, charitable organizations, private pledges, and foundations. State and federal agencies typically do not provide funding for nursing centers.

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DIF: Cognitive level: ApplU yinS g N T TOO P: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is performing the role of researcher in a nurse center. Which of the following types of data would most likely be collected by a nurse in this setting? (Select all that apply.) a. Client use of services b. Trends in community characteristics c. Staff compliance with HIPAA d. Client satisfaction e. Morbidity rates ANS: A, B, D Trends in health care services, client responses, and changes in community characteristics must be documented and summarized periodically. Outcome measurements such as client use of on-site services, childhood and adult immunization patterns, pregnancy outcomes, emergency department and hospital use, and other health indexes including client satisfaction and quality-of-life measures should also be collected. Staff compliance with HIPAA is a legal responsibility of staff and data should not need to be collected about this topic.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 21: Public Health Nursing Practice and the Disaster Management Cycle Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about disasters is true? a. They can be natural or human-made. b. They can be relieved without assistance. c. There is always injury and death when a disaster occurs. d. The timing of a disaster does not influence the types of injuries that will occur.

ANS: A A disaster is any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance. Although natural incidents like earthquakes of hurricanes trigger many disasters, predictable and preventable human-made factors can further affect the disaster. In the disaster response phase, the incident type and time predict subsequent injuries and illnesses.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Why do acts of bioterrorism or natural disasters often have more casualties? a. They cause the most widespread destruction. b. Victims have little time to make evacuation preparations. c. Those with chronic conN diU tiR onS sI caNnG noTt B es. caCpO eM in time. d. The early warning systems are not effective.

ANS: B The use of weapons of mass destruction or natural disasters, such as earthquakes, will often have more casualties because victims have little time to make evacuation preparations. The other answers are false.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse responding to a natural disaster is most likely responding to what concern? a. Transportation accident b. Pollution c. Communicable disease epidemic d. Fire ANS: C A communicable disease epidemic would be considered a natural disaster. Transportations accidents, pollution, and fire are considered human-made disasters.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 4. A nurse responding to a human-made disaster is responding to what likely source of the event? a. Structural collapse b. Communicable disease epidemics c. Mud slides d. Floods ANS: A A structural collapse would be considered a human-made disaster. Communicable disease epidemics, mud slides, and floods are natural disasters.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is working with an older person following a disaster. Which of the following emotions of the client should be anticipated by the nurse? a. Anger b. Fear of loss of independence c. Violence d. Regression ANS: B A common reaction of older persons experiencing disaster may be fear of loss of independence. Young children may respond with regression. The community in general may respond will feelings of anger, sorrow, guilt, and perceived blame for the disaster or the outcomes of the disaster. Violence should not be anticipated with any of the populations discussed in the text.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse experiencing a stress reaction while working with the survivors of a disaster is likely to experience what problem? a. Making effective decisions to assist with care coordination of the survivors b. Sharing with the supervisor of the disaster the details of the care that was provided c. Crying after returning home at the end of the day d. Refusing to follow orders ANS: D Symptoms that may signal a need for stress management assistance include the following: being reluctant or refusing to leave the scene until the work is finished; denying needed rest and recovery time; feelings of overriding stress and fatigue; engaging in unnecessary risk-taking activities; difficulty communicating thoughts, remembering instructions, making decisions, or concentrating; engaging in unnecessary arguments; having a limited attention span; and refusing to follow orders.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

This study source was downloaded by 100000849631069 from CourseHero.com on 09-12-2022 06:01:02 GMT -05:00

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Public Health Nursing 10th Edition Stanhope Test Bank 7. A nurse is working in a temporary shelter for victims following a natural disaster. Which condition is the nurse most likely to personally encounter? a. Stress b. Communicable disease c. Depression d. Injuries requiring first aid ANS: A Causes of stress can be the shock of the disaster itself, loss of personal possessions, fear of the unknown, living near total strangers, and boredom. Illnesses requiring first aid and communicable diseases are not the primary concern of the nurse working in the shelter.

Immediately following the disaster, it is unlikely that the victims will immediately encounter depression because of the shock of the disaster.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A riverfront community builds a retaining wall to divert flood water away from the town.

Which term describes this action? a. Mitigation b. A natural disaster c. Community resilience d. Rapid needs assessment ANS: A Mitigation is defined as actions or measures that can either prevent the occurrence of a disaster or reduce the severity of the effects. A natural disaster, such as an earthquake or N des RS I tion GT, and/or B.COdevastation M hurricane, causes disruption,U trucN requiring external assistance.

Community resilience is defined as the sustained ability of a community to withstand and recover from adversity. A rapid needs assessment is based on the traditional model of community assessment where there is a rapid appraisal of a sector or region’s population, social systems, and geophysical features.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Community preparedness is being used to plan for a disaster. Which of the following tasks is being implemented? a. Assembling emergency supplies b. Understanding the workplace disaster plan c. Taking a disaster training course d. Developing an evacuation plan to remove individuals from danger ANS: D Community preparedness involves developing an evacuation plan to remove individuals from danger. Assembling emergency supplies is an example of individual preparedness.

Understanding the workplace disaster plan is an example of preparedness in the workplace within the community. Taking a disaster training course is an example of professional preparedness.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. Which statement describes what occurs during the preparedness stage of disaster management? a. Heightened inspection and increased security in the community b. Incorporation of provision for pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car ANS: D Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security in the community is part of the prevention activities. Purchase of personal protective equipment for all citizens and incorporation of provision of pets into local disaster plans are not realistic plans for preparedness.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A public health nurse (PHN) is working with a community during the recovery phase of a disaster. Which of the following attributes would be most important for the nurse to possess? a. Flexibility b. Organization skills c. Personable d. Sense of humor ANS: A Flexibility is key to a successful recovery operation. The role of the PHN in the recovery phase of a disaster is as varied as in the preparedness and response phases, but the PHN’s connection to the community puts the PHN in an incredible position of knowledge and awareness on the interprofessional recovery team. The attributes of being organized, personable, and having a sense of humor are not as important as flexibility when dealing with this phase of the disaster.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is working in a community that is experiencing the honeymoon phase after a disaster. Which of the following is characteristic of this phase? a. First responders work tirelessly to save others. b. Survivors share their stories. c. Medical personnel experience exhaustion. d. Community organizations rebuild the community.

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank During the honeymoon phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the heroic phase. Medical personnel experience exhaustion during the disillusionment phase. The community begins to rebuild during the reconstruction phase.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is assessing persons arriving at an alternate care center following a disaster. Which of the following actions should the nurse take first? a. Assess the amount of equipment and medications needed for each client. b. Determine if the client has a psychological condition requiring special attention. c. Assess whether this type of facility is appropriate for the client. d. Determine if the client has a support system to assist with additional care needs.

ANS: C Alternate care centers may be used to shelter patients with medical needs designated as “non-ambulatory care/hospital overflow,” for example, care of non-ambulatory patients with less intense medical needs. After determination of the appropriateness of the facility, the nurse can then provide medical care as needed. It should not be necessary to initially determine if the client has a psychological condition or calculate the amount of equipment or medications the client will need.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care foll owi ngNaGdis 14. A nurse is triaging victims N R I Bas.teCr. OWMhich of the following describes the action U S T the nurse would take? a. Allocation of treatment based on the victim’s potential for survival b. Assignment of tasks to the appropriate disaster response personnel c. Determination of the level of disaster and agency involvement d. Participation in community preparedness for the disaster response ANS: A The triage process in disaster involves separating the casualties and allocating treatment based on the victim’s potential for survival. Assignment of tasks to the appropriate disaster response personnel, determination of the level of disaster and agency involvement, and participation in community preparedness for the disaster response are not part of the triage process.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is volunteering on a disaster medical assistant team as a first responder. Which of the following tasks would the nurse be prepared to perform? a. Set up immunization clinics. b. Assist in triaging disaster victims. c. Provide all the medical care for disaster victims. d. Complete a needs assessment of the community.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B As a first responder arriving on the scene, the plans for triaging of disaster victims should begin immediately. Setting up immunization clinics would not be a priority following a disaster. In responding to a disaster, it may be impossible to provide all of the medical care for disaster victims. It would not be appropriate to start with completing a needs assessment of the community following a disaster; this should be done before the disaster occurs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A public health worker displayed a competency in disaster medicine and public health.

Which of the following describes what the worker has successfully accomplished? a. Communicating effectively with others b. Participating in the chain of command c. Using a set of standardized activities for every disaster d. Implementing a community assessment ANS: A Communicating effectively with others in a disaster or public health emergency is one of the competencies demonstrated in disaster medicine and public health. Involvement in the chain of command, using a set of preplanned activities for every disaster, and implementing a community assessment are not part of these competencies.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care Nat iona cide tM agement System (NIMS)?

17. What is the purpose of the N Can UR SIl In NG TBn. OM a. Create a new branch of government that deals with bioterrorism. b. Establish a way for the Red Cross to carry out its mission. c. Develop a nationwide all-hazards approach to domestic incident management. d. Extend presidential power to act quickly upon acts of bioterrorism.

ANS: C The National Response Framework is a unified, all-discipline, all-hazards approach to domestic incident management. It is built upon scalable, flexible, and adaptable coordinating structures to align key roles and responsibilities linking all levels of government and organizations. The Homeland Security Act of 2002 created a new branch of government that deals with bioterrorism, the U.S. Department of Homeland Security. The NIMS did not impact the Red Cross or extend presidential power to act upon bioterrorism.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is developing and coordinating an emergency response plan for a community. With which of the following organizations would the nurse collaborate? a. American Red Cross (ARC) b. National Disaster Medical System (NDMS) c. Centers for Disease Control and Prevention (CDC) d. Emergency Management Agency (EMA)

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: D The EMA is responsible for developing and coordinating emergency response plans in a defined area. The ARC works with communities in the preparedness, response, and recovery phases of a disaster. The CDC studies the effect that disasters have on population health and continuously develops new prevention strategies. The NDMS provides nurses the opportunity to work on specialized disaster response teams.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse responding to a disaster places the priority on which disaster response? a. Cleaning up the environment b. Handling the stress reaction of the victims c. Bringing in as many aid workers and nurses as possible d. Reestablishing sanitary barriers and focus on basic needs ANS: D Reestablishing sanitary barriers and focusing on water, food, waste disposal, vector control, shelter, and safety are the first goals. After this has been established, the nurse can address the cleanup of the environment, the stress reactions of the victims, and the need to bring in additional workers.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A bioterrorism attack has occurred in the United States. Which program would be used to provide large quantities of N mU edR icat erican public?

SIion NsGtoTBth.e CAm OM a. Cities Readiness Initiative b. Strategic National Stockpile (SNS) c. Public Health Information Network (PHIN) d. Project BioShield ANS: B The SNS has the capacity to provide large quantities of medicine and medical supplies to protect the American public in a public health emergency. The Cities Readiness Initiative aids cities in increasing their capacity to deliver medicines and medical supplies during a public health emergency. The PHIN helps ensure information access and sharing. Project BioShield is a program to develop and produce new drugs and vaccines against potential bioweapons.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is examining the future of disaster management. Which of the following should the nurse anticipate? a. Vague and unorganized future due to constant emergence of new disasters b. Increasing sophistication in technology and surveillance c. Lack of involvement by national and state officials d. Decreasing need for public health workers to provide care

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B The terrorist event of September 11, 2001, and the anthrax cases have increased the awareness for the need to plan for disasters. Technology and surveillance will continue to advance. Disaster management continues to change and become more organized as learning occurs after each incident, producing progressive best practices. National and state officials are very involved in disaster management. PHNs are particularly critical members of the multidisciplinary disaster health team given their population-based nursing focus and specialty knowledge in epidemiology and community assessment skills.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which populations are at greatest risk for disruption after a disaster? (Select all that apply.) a. Single-parent families b. Children c. Substance abusers d. Middle-class families e. Young adults ANS: A, B, C Single-parent families, children, and substance abusers are all at greater risk for disruption after disaster than a middle-class family or young adults.

DIF: Cognitive level: Understanding : Nursing process: Assessment NURSINGTB.TCOP M MSC: NCLEX: Safe and Effective Care EnviroOnment: Management of Care 2. Which organizations offer volunteer opportunities in disaster work for nurses? (Select all that apply.) a. American Red Cross (ARC) b. Citizens Corps c. American Nurses Association d. National Public Health Training Centers e. Sigma Theta Tau International ANS: A, B ARC and Citizens Corps offer volunteer opportunities. The American Nurses Association and National Public Health Training Centers offer education and training opportunities.

Sigma Theta Tau International is an honor society for nurses.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 22: Public Health Surveillance and Outbreak Investigation Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What occurs during an act of biological terrorism? a. The intentional release of hazardous chemicals into the environment b. Environmental and occupational exposure to biological toxins c. Immunity to toxins related to repeated exposures d. An intentional release of viruses, bacteria, or other toxins ANS: D An intentional release of viruses, bacteria, or other toxins would be described as biological terrorism. Chemical terrorism is the intentional release of hazardous chemicals into the environment intended on harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terrorism.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which problem does a health department usually have the legal authority to investigate? a. Pandemics b. Unusual clusters of illness c. World trends of diseaseNURSINGTB.COM d. Cases of the common cold and pneumonia ANS: B Powers of local government include surveillance of unusual clusters of illness. A health department does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which is a feature of public health surveillance? a. Sharing of the results with others b. Defining public health policy c. Evaluating interventions d. Planning national programs ANS: A One of the features of public health surveillance is sharing of the results with others.

Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

4. A nurse is conducting disease surveillance. Which of the following describes the goal for this action? a. Eradicating a disease before it starts b. Establishing a baseline rate of disease occurrence c. Targeting populations for triage d. Reducing the incidence of heart disease in a community ANS: B Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to eradicate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A hospital is using surveillance. Which of the following describes the rationale for this action? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilator-acquired pneumonia ANS: C Hospital surveillance is used to improve quality of care and outcomes. Reduction of the incidence of ventilator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A community coalition monitors the increasing obesity rate of children in their schools.

Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance? a. Protect the children from diseases that affect obese children. b. Teach parents that obesity will not be tolerated in this community. c. Educate children on surveillance techniques. d. Demonstrate that new clinical and effective protocols need to be developed.

ANS: D Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is using surveillance to collect outcome data. What information would most likely be collected? a. Number of clinic services which use evidence-based protocols b. Proportion of the population vaccinated against influenza c. Incidence of breast cancer in the population d. Probability of a bioterrorism attack occurring in the community ANS: C Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligible population vaccinated against influenza in any 1 year.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special ANS: B In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting types of data and may be a combination of active, passive, and/or sentinel systems.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community.

Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank In the active system, a PHN begins to search for cases through contacts in the community.

The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting types of data and may be a combination of active, passive, and/or sentinel systems.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. What information is shared among agencies when they collaborate to implement a quality surveillance system? a. How to use algorithms to identify which events should be investigated? b. Who is to blame for a disease outbreak? c. What shelters will be used and by whom? d. How political action will be necessary to ensure public health?

ANS: A Collaboration promotes the development of plans and a directory of emergency responses.

How to use algorithms is a key type of information that is shared. Blaming others is not part of collaboration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. What does each state do with the information that it receives about notifiable diseases?

U S N T O a. Utilizes the information for surveillance purposes. b. Reports the information to the local branch of the World Health Organization (WHO). c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC). d. Stores the information for state use only.

ANS: C Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is applying the steps of surveillance from the Minnesota Model of Public Health Interventions book. Which of the following describes the initial action that the nurse would take? a. Analyze data. b. Consider whether surveillance is appropriate to the situation. c. Evaluate the impact of the surveillance. d. Collect data.

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B The first step in this model considers whether surveillance is appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A large amount of data related to hypertension rates in a community is collected and analyzed. What is the next step in the surveillance process? a. Collecting data from multiple valid sources b. Evaluating the impact on the surveillance system c. Interpreting the data and disseminating it to decision makers d. Asking political officials to finance a hypertension clinic ANS: C After data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the impact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What information is included in a case definition? a. The precise point of contact N R d. Clinical symptoms b. Laboratory confirmation U c. Source of contamination ANS: D Each case has a unique set of criteria based on what is known about the disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. What was the purpose of the Centers for Disease Control and Prevention (CDC) creating the first list of standard case definitions for notifiable diseases? a. Some diseases were underreported, and others were overreported. b. There was no central office to collect data. c. Some people refused to notify officials when diseases were seen. d. No one knew where to report the information that was collected.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is assumed that the individual has measles. However, there has been no laboratory evidence documenting that this individual has the disease. Which of the following types of cases is the nurse investigating? a. A suspected case b. A confirmed case c. A prolonged case d. An identified case ANS: A A suspected case is a clinically compatible case of illness without laboratory confirmation.

A confirmed case is a clinically compatible case that is laboratory confirmed by isolation of the organism. A prolonged case and identified case are not types of cases discussed in the text.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over U S N T O several countries. Which of the following terms describes what happened? a. Hyperendemic b. Pandemic c. Mixed outbreak d. Holoendemic ANS: B A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. Holoendemic implies a highly prevalent problem found in a population commonly acquired early in life.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A person recently returning from overseas is diagnosed with Q fever. Which of the following must occur? a. Reporting must occur on the federal level. b. The case must be reported to the state and local health departments. c. The patient must be isolated immediately. d. The patient’s immunization record must be reviewed.

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or an immunization review.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse collecting morbidity data would refer to which source for applicable information? a. Vital statistics reports b. Birth records c. Death certificates d. Specialized disease registries ANS: D There are many sources of morbidity data (rate of disease incidence), including specialized disease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A college student goes to the Student Health Center with an extremely swollen neck where the advanced practice nurse diagnoses the mumps. The student reports that a roommate also is experiencing malaise and a sore throat. Which of the following defines these two students? c. Point source a. Mixed outbreak d. Propagated outbreak b. Common source ANS: C A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is investigating a potential bioterrorism attack. What evidence would a nurse find if a bioterrorism attack occurred? a. Many cases of influenza b. A case of cholera in a local politician following a trip to India c. Dengue fever in a group of students who just returned from a mission trip d. An unusual illness in a population ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Unusual illness in a population should trigger an investigation that may signal a covert bioterrorism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is using public surveillance. Which of the following describes the actions involved?

(Select all that apply.) a. Estimating the magnitude of an influenza outbreak b. Determining the geographical distribution of gonorrhea cases c. Detecting an epidemic of whooping cough d. Reducing the prevalence of obesity e. Determining the incidence of cardiovascular disease ANS: A, B, C Estimating the magnitude of the problem, determining geographic distribution of an illness, and detecting epidemics are all uses of public surveillance. Reduction of the prevalence of obesity and determining the incidence of cardiovascular disease are not how public health surveillance is used.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

N R I G B.C M

2. A staff nurse has demonstrateUd thSe aN bilitT y to be O competent as a participant in surveillance and investigation activities. Which abilities would you expect that nurse to possess? (Select all that apply.) a. Identifying appropriate data sources b. Communicating effectively using written reports c. Collaborating with community agencies d. Creating an appropriate budget e. Correctly interpreting laboratory findings ANS: A, B, C, D The staff nurse must have analytic assessment skills, communication skills, and community dimensions of practice to be a participant in surveillance and investigation. The ability to interpret laboratory findings is not a core competency.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which are the objectives of a disease investigation? (Select all that apply.) a. Enhancing the knowledge of the nurse working in public health b. Controlling and preventing disease or death c. Identifying factors that contribute to the disease outbreak/event occurrence d. Implementing measures to prevent occurrences e. Participating in the core functions of public health

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B, C, D The objectives of an investigation are to control and prevent disease or death, identify factors that contribute to the disease outbreak/event occurrence, and implement measures to prevent occurrences. Enhancing the knowledge of the nurse working in public health and participating in the core functions of public health are not objectives of an investigation.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 23: Program Management Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. The process of program management is similar to: a. the nursing process. b. the medical model of care delivery. c. the requirements for licensure as a registered nurse. d. summative and formative evaluation.

ANS: A The nursing process has the same basic steps as the process of program management. Like the nursing process, the process of program management consists of a rational decision-making system designed to help nurses know when to make a decision to develop a program, where they want to be at the end of the program, how to decide what encompasses a successful program, how to develop a plan to go forward so they will know where they want to be, how to know that they are getting there (formative evaluation), and what to measure to know that the program has successful outcomes (summative evaluation).

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What is a benefit of systematic planning? a. Allowing nurses to oveN rsU eeRmSaI teN riG alsTpBre.sC enO teM d b. Ensuring that resources are used to address the needs of the community c. Linking local politicians with the community d. Educating student nurses about public health nursing ANS: B Systematic planning ensures that available resources are used to address the actual needs of people in the community, and it focuses attention on what the organization and health provider are attempting to do for clients. Systematic planning does not allow nurses to be in charge, link politicians with the community, or educate student nurses about public health nursing.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A provider and a client consider the possibilities of solving a problem using one of the solutions identified. Which of the following phases of the program planning process is being used? a. Conceptualizing b. Detailing c. Implementing d. Evaluating ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank In the detailing phase, the provider details the costs, resources, and program activities needed to choose one of the solutions from the conceptualizing phase. In the conceptualizing stage, options for solving the problem are created and several solutions are considered. In the evaluating phase, each alternative is weighed to judge the costs, benefits, and acceptance of the idea to the client population, community, and providers. The implementing phase requires obtaining and managing the resources required to operationalize the program in a way that is consistent with the plan.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. To increase the immunization rates among children in the community, a nurse manager is considering holding immunization clinics on Saturdays one month before school begins.

Which of the following describes what is happening? a. Formulating b. Planning c. Implementing d. Evaluating ANS: B Planning is selecting and carrying out a series of actions to achieve stated goals. In the formulating phase, the problem is defined, and client need is assessed. The implementing phase requires obtaining and managing the resources required to operationalize the program in a way that is consistent with the plan. Evaluation is determining whether a service is needed and can be used, whether it is conducted as planned, and whether the service actually helps people in need.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse matches client needs, provider strengths and competence, and agency resources.

Which of the following types of planning is being used? a. Strategic planning b. Program planning c. Management planning d. Process planning ANS: A Matching client needs, provider strengths and competence, and agency resources is considered strategic planning. Program planning reflects the desire to implement a reality-based program that can be readily evaluated and can reduce the number of unexpected events that occur in a defined population. Management planning assists managers to determine whether the resources of the agency are used properly to actually implement the agency programs. Process planning is not a type of planning discussed by the text.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 6. A nurse completes a program evaluation to identify if the objectives of the program were met. Which of the following describes the action of the nurse? a. Assessment b. Evaluation c. Formative evaluation d. Summative evaluation ANS: C Formative or process evaluation is used to assess whether objectives are met, or planned activities are completed. Assessment is completed to provide a clear understanding of the overall health status of a community, to identify populations at risk, and to document health needs. Evaluation is determining whether a service is needed and can be used, whether it is conducted as planned, and whether the service actually helps people in need. Summative or impact evaluation is used to assess program outcomes or as a follow-up to the results of the program activities.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse surveys a program’s participants after completion of a wellness program to determine if the participants have increased their involvement in daily exercise. Which of the following describes the action of the nurse? a. Assessment b. Evaluation c. Formative or process evaluation d. Summative or impact evaluation ANS: D Summative or impact evaluation is used to assess program outcomes or as a follow-up to the results of the program activities. Formative or process evaluation is used to assess whether objectives are met or planned activities are completed. Assessment is completed to provide a clear understanding of the overall health status of a community, to identify populations at risk, and to document health needs. Evaluation is determining whether a service is needed and can be used, whether it is conducted as planned, and whether the service actually helps people in need.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. For obtaining information about services needed to meet community needs, business leaders within a community were interviewed. Which of the following describes this method of obtaining needs assessment data? a. Community forum b. Key informant interview c. Survey of existing agencies d. Indicators approach ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Interviewing business leaders within a community is an example of key informant interviews. Community forum is defined as a community, group, organization, or open meeting. Survey of existing agencies provides estimates of client populations via services used at similar community agencies. The indicators approach uses existing data to determine problems.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Focus groups are used to determine the method of cleanup for contaminated groundwater in a neighborhood. Which of the following is a disadvantage of this needs assessment tool? a. Technically demanding b. Expensive c. Bias of leaders d. Time consuming ANS: D Using focus groups to determine the method of cleanup for contaminated groundwater in a neighborhood would be very time consuming. Disadvantages of surveys are that they are expensive and technically demanding. Key informants have the disadvantage of the bias of the leaders.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is planning a health program. Which of the following is the most critical action that should be taken by the nursN e?URSINGTB.COM a. Assessing need of the community b. Considering alternative solutions or options c. Detailing the costs and resources needed d. Weighing each alternative ANS: A Assessing need provides the reasons and rationale for the program plan. The need within the community must be assessed before alternatives can be proposed or weighed, or the details of the costs and resources can be determined.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse wants to have a clear understanding of the overall health status of a community and to identify populations at risk. Which of the following actions should be taken by the nurse? a. Complete a community assessment. b. Perform a population needs assessment. c. Evaluate past programs in the community. d. Develop program resources for the community.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Community assessment is a population-focused approach that views the entire community as the client. A population needs assessment focuses on the need for a service for a specific target population. Development of program resources occurs after the community assessment has been completed. Community assessment involves evaluation of current programs and resources in the community, not past programs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse uses a key informant interview as part of completing a needs assessment. Which of the following describes the primary advantage of using this tool? a. Low cost. b. Provides a picture of services needed. c. Identifies the perspectives of many persons. d. Indicates the extent of services offered by existing programs.

ANS: B The main advantage of using a key informant as a needs assessment tool is that it would provide a picture of the services needed. The main advantage of focus groups is the low cost. The advantages of a community forum are the low cost and identification of the perspectives of large number of persons. The advantages of a survey of existing agencies are to know the extent of services offered in existing programs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care elop ecti ve. sC forOM a program?

13. What is the purpose of devN URing SIobj NG TB a. Giving the speaker-specific topics to cover b. Providing direction for conducting the program c. Providing an enriching experience for participants d. Formulating a mission statement ANS: B Objectives provide direction and provide the mechanism for evaluating specific activities in light of the total program. The formulation of a mission statement clarifies the values and overall purpose of the program and provides a framework for the goals and objectives that follow. The action steps will provide explicit actions to accomplish the objectives, such as giving the speaker-specific topics to cover. An enriching experience for the participants is accomplished through many things, more than the development of program objectives.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A population needs assessment has been completed. Which of the following describes what was done? a. A health status report indicates many people are not using the health department because of long waits. b. The World Health Organization (WHO) encourages all travelers to be up to date on the immunizations when traveling abroad. c. A nurse assesses the health status of older adults with diabetes prior to initiation of

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Public Health Nursing 10th Edition Stanhope Test Bank a health education program. d. An agency uses a television advertisement to encourage healthy eating by the citizens in the community.

ANS: C A population needs assessment focuses on the characteristics of a specific population, its health needs, and the resources available to address those needs. A nurse assessing the health status of older adults with diabetes is an example of a population needs assessment. A health status report indicating that many people are not using the health department because of long waits does not focus on a specific population. The WHO encouraging all travelers to be up to date on the immunizations when traveling abroad does not include the resources available to address those needs. An agency using a television advertisement to encourage healthy eating by the citizens in the community does not focus on assessment of a specific population.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A community identifies cardiovascular disease as a priority need because its mortality rate is four times higher than the rate identified in Healthy People 2020. Which of the following describes the type of approach that was used? a. Pre-active b. Reactive c. Inactive d. Interactive ANS: C The inactive approach defines the problem based on the existing health state of the population to be served. A pre-active approach projects a future need. A reactive approach defines the problem based on past needs. An interactive approach describes the problem using past and present data to project future population needs.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. It is projected that the incidence of diabetes will increase in the future and therefore creates a need for more diabetic health educators. Which of the following approaches was used to identify this need? a. Pre-active b. Reactive c. Inactive d. Interactive ANS: A A pre-active approach projects a future need. Identifying the need for more diabetes health educators based on the projected incidence of diabetes is an example of the pre-active approach. The inactive approach defines the problem based on the existing health state of the population to be served. A reactive approach defines the problem based on past needs.

An interactive approach describes the problem using past and present data to project future population needs.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is implementing basic program planning. Which of the following would occur during the formulating stage? a. The client and provider analyze available solutions. b. The best plan for funding is presented to administrators. c. The provider group identifies solutions. d. The client identifies problems.

ANS: D The first step in the planning process involves the identification of problems, which occurs in the formulating stage. The provider group identifies solutions during the conceptualizing phase. The available solutions are analyzed during the evaluating phase. The best plan is presented and chosen during the implementing phase.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which program planning stage defines the problem based on the existing health status of the population to be served? a. Pre-active b. Reactive c. Inactive d. Interactive ANS: C The inactive stage defines the problem based on the existing health status of the population to be served. A pre-active approach projects a future need. Identifying the need for more diabetes health educators based on the projected incidence of diabetes is an example of the pre-active approach. A reactive approach defines the problem based on past needs. An interactive approach describes the problem using past and present data to project future population needs.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. What question should be answered through a program evaluation? a. Did the audience enjoy the program? b. Is a process evaluation also necessary? c. Are the problems it was designed to solve being solved? d. Was enough information given to change policy?

ANS: C Program evaluation is a means of documenting accountability. The question “Are the problems it was designed to solve being solved?” addresses the aspect of accountability. The other questions should not be the focus of program evaluation.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. According to the Centers for Disease Control and Prevention’s (CDC’s) format for evaluation, what would occur during the focus the evaluation design step? a. Writing the program description b. Specifying the indicators that will be used c. Describing the purpose for the evaluation d. Linking the conclusions to the evidence gathered ANS: C Focusing the evaluation design step involves describing the purpose for the evaluation, the users who will receive the report, how it will be used, the questions and methods to be used, and any necessary agreements. Writing the program description occurs when describing the program. Specifying the indicators that will be used is part of gathering credible evidence.

Linking the conclusions to the evidence gathered is part of justifying the conclusions.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is monitoring program activities, such as hours of service, number of providers used, number of referrals made, and amount of money spent to meet program objectives.

Which of the following aspects of program evaluation is being used? a. Relevance b. Progress c. Efficiency d. Effectiveness ANS: B The monitoring/tracking of program activities is an example of the progress aspect of program evaluation. Relevance is evaluating the need for the program. Efficiency is evaluating the relationship between program outcomes and the resources spent.

Effectiveness is evaluation of the ability to meet program objectives and the results of program efforts.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is creating a program objective. Which of the following would be developed? a. Decrease the incidence of early childhood disease in Center County by providing immunization clinics in all schools between August and December of 2007. b. Provide condoms to sexually active teenagers in the local high school. c. Increase by 25% the number of school-age children wearing seat belts. d. Provide free diabetic screening every other month for 2 years.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank A program objective needs a strong, action-oriented verb, a statement of a single purpose, a statement of a single result, and a time frame for achieving the expected result—To decrease the incidence of early childhood disease in Center County by providing immunization clinics in all schools between August and December of 2007. To provide condoms to sexually active teenagers in the local high school does not include the statement of a result of this action or a time frame. To increase by 25% the number of school-age children wearing seat belts does not have a time frame for achieving the expected result. To provide free diabetic screening every other month for 2 years does not include the statement of a single result of this action or a specific time frame.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse has created the program objective “to decrease the incidence of early childhood disease in Center County by 10% to 25% by providing immunization clinics in all schools before August and December 2018.” Which of the following describes the operational indicator? a. Decrease b. Promoting immunization clinics c. 10% to 25% d. Before August and December 2018 ANS: C The operational indicator is 10% to 25%; decrease is the action verb; promoting immunization clinics is the purpose; and before August and December 2018 is the time frame.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. With the involvement of the local government and health department, a community-wide program is planned to make all public businesses smoke free, thus eliminating exposure to second-hand smoke. Which of the following levels of prevention of program planning and evaluation is being applied? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention refers to screening and early detection.

Tertiary prevention refers to rehabilitation and treatment. Assessment is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 25. A nurse is critiquing the program objective ‘to decrease the incidence of early childhood disease in Center County by providing immunization clinics in all schools between August and December of 2018.” Which of the following critiques is accurate? a. It is accurate as written. b. The results are ambiguous. c. The action verb is not action oriented. d. The purpose is not stated.

ANS: A A program objective needs a strong, action-oriented verb, a statement of a single purpose, a statement of a single result, and a time frame for achieving the expected result. Thus, the objective is correct as written as it contains all these components. The results are clear—to decrease the incidence of early childhood disease in Center County. The action verb is action oriented—by providing immunization clinics in all schools. The purpose is stated—to decrease the incidence of early childhood disease in Cedar County.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. What is the purpose of performing a cost-accounting study? a. To detect what percentage of cost the clients recover b. To measure how long it takes for clients to see a provider c. To note how many cases are associated with other major risk factors d. To find the actual cost of a program ANS: D Cost-accounting studies are performed to find the actual cost of a program. Cost-accounting Nrcen RStag IN G B.C recover, M studies do not detect what peU e ofTclients O measure how long it takes for clients to see a provider or note how many cases are associated with other major risk factors.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A nurse needs to collect baseline data before implementing which type of a study? a. Cost-accounting study b. Cost-benefit study c. Cost-effectiveness study d. Cost-efficiency study ANS: C A study designed to measure the quality of a program as it relates to cost is a cost-effectiveness study. A cost-efficiency study is designed to examine the actual cost of performing program services and to focus on productivity versus cost. A study used to assess the desirability of a program by examining costs and benefits is a cost-benefit study.

Cost-accounting studies are performed to find the actual cost of a program.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 28. A nurse collects data about productivity of staff members to evaluate a program. Which type of study is the nurse completing? a. Cost-accounting study b. Cost-benefit study c. Cost-effectiveness study d. Cost-efficiency study ANS: D A cost-efficiency study is designed to examine the actual cost of performing program services and to focus on productivity versus cost. A study designed to measure the quality of a program as it relates to cost is a cost-effectiveness study. A study used to assess the desirability of a program by examining costs and benefits is a cost-benefit study.

Cost-accounting studies are performed to find the actual cost of a program.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse has provided an organization a philanthropic contribution. Which of the following best describes what the nurse has provided? a. Contract b. Gift c. Grant d. Loan ANS: B Gifts are philanthropic contributions. Contracts are awarded for the performance of a specific task or service, usually to meet guidelines specified by the organization making the N R I it GorTganizat B.COions M to allow the recipient to implement award. Grants are awards to nUonpSrofN activities of their own design that address the interests of the funding agency. A loan is money that needs to be paid back to the lender.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 30. A nurse completes a cost-accounting study on a program that targets obese adults, helping them to adopt healthier lifestyle choices. The nurse would like to compare the cost of the program to the cost savings in the health care system by preventing the occurrence of chronic illnesses. Which of the following types of studies would be most appropriate to use in this situation? a. Cost-accounting study b. Cost-benefit study c. Cost-effectiveness study d. Cost-efficiency study ANS: B A study used to assess the desirability of a program by examining costs and benefits is a cost-benefit study. Cost-accounting studies are performed to find the actual cost of a program. A study designed to measure the quality of a program as it relates to cost is a cost-effectiveness study. A cost-efficiency study is designed to examine the actual cost of performing program services and to focus on productivity versus cost.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. After a need and client demand for a program have been determined through the needs assessment process, the next step in the development of the program is to choose a procedural method that will assist the nurse in planning the program to be offered. Which are possible planning methods? (Select all that apply.) a. Program planning method (PPM) b. Multi-attribute utility technique (MAUT) c. Sustainability method d. Effectiveness method e. Population needs assessment ANS: A, B PPM and MAUT are types of planning methods. The sustainability and effectiveness methods are parts of the PPM. Sustainability is an evaluation method to determine if there are resources available to continue the program. Effectiveness is an evaluation method to determine if the program is able to meet its objectives and to evaluate the results of program efforts. A population needs assessment is one of the first steps in program planning but does not describe the entire process of program planning.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 24: Quality Management Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the purpose of implementing total quality management (TQM)? a. Provide quality care within an organization. b. Provide cost-efficient care across all age groups. c. Provide necessary care to clients in a cost-effective system. d. Provide efficient systems of primary care.

ANS: A TQM is a management philosophy that focuses on the statistical processes by which to assess work done with the goal of organization-wide quality effectiveness. TQM examines multiple aspects of an organization, more than only cost-efficient or cost-effective care, and looks at multiple aspects of care delivery.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What is the purpose of the National Health Quality Report (NHQDR)? a. Report on the Agency for Healthcare Research and Quality’s goals for the year. b. Describe the yearly activities of the agency. c. Ensure national quality of services. d. Document whether heaN lthUcRaS reI qN uaG liT tyB is.sC taO blM e, improving, or declining over time.

ANS: D The NHQDR is intended to serve several purposes, including the documentation of whether health care quality is stable, improving, or declining over time; demonstrating the validity (or lack) of concerns about quality; and providing national benchmarks against which specific states, health plans, and providers can compare their performance. The NHQDR reports on health care quality and is written by the Agency for Healthcare Research and Quality.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. What is one performance area where quality improvement (QI) is used to affect process and outcomes of health care? a. Provision of appropriate and effective care b. Elimination of access barriers c. Reduction of unjustified geographic variation in care d. Application of managed care to all citizens ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank With the application of QI strategies, specific areas of performance can affect both process and outcomes of health. These include reducing unjustified geographic variation in care; consistently providing appropriate and effective care; eliminating avoidable mistakes; lowering access barriers; improving responsiveness to clients; and eliminating racial/ethnic, gender, socioeconomic, and other disparities and inequalities in access and treatment.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A public health nurse (PHN) is providing the core function of assurance to the community.

Which of the following describes what the nurse is doing? a. Providing the same services to all citizens b. Maintaining quality in the public health workforce c. Eliminating low-quality services d. Contracting with outside agencies to evaluate effectiveness ANS: B Assurance relates to ensuring that there is quality in the workforce. Public health must maintain quality in its workforce and continually evaluate service effectiveness whether delivered to the individual, the community, or the population. Assurance does not address provision of the same services to all citizens or contracting with outside agencies to evaluate effectiveness. Assurance does not address elimination of low-quality services.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care qua 5. Which statement about theN URlity SIassu NGran TBce.pCroc OMess is accurate? a. Processes are implemented to maintain quality. b. Community needs are assessed while implementing quality programs. c. Accountability of the provider is the primary concern. d. Standards for care are established and evaluated.

ANS: C Quality assurance is concerned with the accountability of the provider, and it is only one tool in achieving the best client outcomes. QI refers to actions that lead to measurable improvement in health care services and health status. Community needs are not assessed nor are standards for care established and evaluated through the quality assurance process.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is concerned that there is an overuse of services by clients receiving care from a local physician. Which of the following statements describes what is occurring in this situation? a. Treatment decisions are made conservatively. b. Disability and mortality are being reduced. c. Disparities in quality of care provided are increasing. d. Unnecessary tests, surgeries, and treatments are being ordered.

ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank The “overuse of service” category in the Agency for Healthcare Research and Quality (AHRQ) problems of quality of care refers to the ordering of unnecessary tests, surgeries, and treatments. Overuse of services does not mean that treatment decisions are made conservatively; rather, services are being used more than they should. Disability and mortality may not be reduced through overuse of service. Disparities in quality of care do not match the definition of overuse of services.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A public health agency is transitioning from a traditional management model for quality assurance to a total quality management (TQM) approach. Which of the following changes will occur within the agency? a. Increased administrative authority b. Increased participation by all staff c. Additional focus on quality assurance d. Specialized accountability for services provided ANS: B The TQM approach includes increased participation by all staff, process accountability (rather than specialized accountability), and focus on continuous improvement (rather than quality assurance). Administrative authority is part of the traditional management model.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care nito 8. Which of the following moN RrsSaIcces Gs TtoBc.arCe,OthMe cost of care, and protects the Medicare U N Trust? a. Professional Review Organizations (PROs) b. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) c. National Health Quality Improvement Act d. Quality Improvement Organizations (QIOs) ANS: D QIOs monitor access to care and cost of care and protect the Medicare Trust. The QIO replaced the previous PRO. JCAHO developed quality control standards for hospital and home health nursing. The National Health Quality Improvement Act encourages consumers to become informed about their practitioner’s practice record and created a national clearinghouse of information on the malpractice records of providers.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A PHN in the 1960s is measuring quality assurance. Which of the following resources would the nurse most likely have used? a. American Nurses Association (ANA) Standards of Practice b. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Nursing Audit Criteria c. Community Health Nursing Practice Standards d. Phaneuf nursing audit method

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: D Phaneuf’s nursing audit method was one of the first tools, developed in 1965, which has been used extensively in population-centered nursing practice. The ANA’s Divisions on Practice was created in 1966; however, this did not provide practice standards. The JCAHO began developing its standards in the mid-1980s. The Community Health Nursing Practice Standards was developed in 1973.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A student has obtained a Bachelor of Science in Nursing degree. Which of the following describes why the student must be licensed as a registered nurse before beginning practice? a. To formally recognize the student as a competent professional b. To define the scope of professional practice c. To control the quality of professional practice d. To establish standards for educational programs ANS: C Individual licensure is a contract between the profession and the state. Under this contract, the profession is granted control over entry into, and exit from, the profession and over quality of professional practice. The licensing process requires that written regulations define the scope and limits of the professional’s practice.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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11. A nurse is given formal recogUnitS ion N as aTprofessO ional with technical competence in a certain area of nursing practice. Which of the following terms describes what has happened? a. Licensure b. Accreditation c. Recognition d. Credentialing ANS: D Credentialing is the formal recognition of a person as a professional with technical competence, or of an agency that has met minimum standards of performance. Licensure is a contract between the profession and the state which controls the quality of professional practice. Accreditation is a voluntary approach to QI used by institutions. Recognition is a process, whereby one agency accepts the credentialing status of and the credentials conferred by another.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse implements the Institute of Medicine’s definition of quality health care when providing care. Which of the following describes this care? a. Licensed—all health care workers must have a license. b. Safe—avoiding injuries to patients from the care intended to help them. c. Timely—no waiting or delay for health care.

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Public Health Nursing 10th Edition Stanhope Test Bank d. Innovative—new innovations must be used when they become available.

ANS: B The Institute of Medicine states that quality health care is safe—avoiding injuries to patients from the care that is intended to help them. The other parts of this definition are effective, timely, client centered, equitable, and efficient.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is implementing a voluntary approach to quality control within the organization.

Which of the following describes what the nurse is implementing? a. Accreditation b. Licensure c. Certification d. Credentialing ANS: A Accreditation is an example of a voluntary approach to quality control used primarily for institutions. Licensure is a contract between the profession and the state that controls the quality of professional practice. Certification combines features of licensure and accreditation. Credentialing is the formal recognition of a person as a professional with technical competence, or of an agency that has met minimum standards of performance.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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14. A nurse assesses the necessitU y ofSrecN eiviT ng careObefore providing services. Which of the following describes what is being implemented? a. Concurrent audit b. Retrospective audit c. Prospective utilization review d. Retrospective utilization review ANS: C Doing an assessment of the necessity of care before giving service is called a prospective utilization review. A concurrent audit evaluates the quality of ongoing care by looking at the nursing process. A retrospective audit evaluates quality of care through evaluation of the nursing process at the end of a program or as an audit of the long-term impact of a program within the health care system. A retrospective utilization review is an analysis of the necessity of the services received by the client after the care has been given.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. An elderly client was receiving home care after hospitalization for a cerebrovascular accident. After several weeks of physical and speech therapy, the client showed few signs of progress. The utilization review committee considered the client’s condition to be stable and declined reimbursement for further home care. Which of the following describes the process that could be used by the client to reverse the decision?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Prospective utilization review Retrospective utilization review Concurrent utilization review Medicare reversal process

ANS: C A concurrent utilization review is the review of the necessity of services while care is being given. Doing an assessment of the necessity of care before giving service is called a prospective utilization review. A retrospective utilization review is an analysis of the necessity of the services received by the client after the care has been given. This is not an example of the Medicare reversal process.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A staff development program is used to teach nurses and other providers about how to reduce risk by properly documenting interventions provided. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quality care ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. In this case, prevention is aimed at reducing risk. Secondary prevention focuses on early detection and screening. Tertiary prevention focuses on NQua RSlity INcar GT B.CtoMproviding the best services possible and is treatment and rehabilitation. U e refersO not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is using a concurrent audit to review documentation following home health visits.

Which of the following statements describes why this type of audit is most appropriate in this situation? a. It is less costly than a retrospective audit. b. It represents the total picture of care that the client receives. c. It provides more accurate data for planning corrective action. d. It identifies problems at the time that care is given.

ANS: D One reason for using a concurrent audit rather than a retrospective audit is that it identifies problems at the time that care is given. A concurrent audit is costlier to implement than a retrospective audit. Because the intervention is ongoing, it does not present the total picture of the outcomes of the intervention that the client will ultimately receive. A retrospective audit provides more accurate data for planning corrective action.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

18. A nurse is working with a team to learn more about what its most important accomplishments have been and to identify what changes are desired. Which of the following would be the method used to accomplish this task? a. Compare job descriptions b. Analyze mission and goals c. Brainstorm d. Develop charts and diagrams ANS: C The best method of discovering what could be the most important accomplishments of the team and what changes are desirable is brainstorming. Brainstorming involves getting everyone’s input about a possible process situation, with no team member criticizing the suggestion. Comparing job descriptions, analyzing mission and goals, and developing charts and diagrams would not lead to as much discovery as brainstorming.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is using the specific approach to quality improvement (QI). Which of the following describes the action that would be taken by the nurse? a. Evaluate an agency’s ability to meet criteria or standards. b. Implement the plan-do-check-act cycle. c. Provide care to individual citizens. d. Use criteria set forth by regulatory agencies.

ANS: B The specific approaches to QI are methods used to manage a specific health care delivery system in an attempt to deliver care with outcomes acceptable to the consumer. Evaluating an agency’s ability to meet criteria, providing care to individual citizens, and using criteria set forth by regulatory agencies are not specific approaches to QI. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A quality assurance manager does an audit and 6 months later returns to see if the problem has been eliminated. Which of the following describes this step? a. It involves selecting explicit criteria for quality care. b. It includes the review of records. c. It requires a peer review of all cases that do not meet criteria. d. It completes the audit process.

ANS: D The final step in the audit process involves determining whether problems uncovered in an audit have been eliminated. Selecting explicit criteria for quality care is the second step of the process. Reviewing the records is the third step of the process. Completing a peer review for all cases that do not meet criteria is the fourth step of the process.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

21. A nurse is developing a quality improvement (QI) program. Which of the following would be the most important aspect of the program that should be considered? a. Vision and values of the agency b. Standards used to provide care c. Results of nursing care d. Evaluation of process changes ANS: C Outcome (results of nursing care) is the most important part of a QI program because it is the key to evaluating providers and agencies by accrediting bodies, by insurance companies, and by Medicare and Medicaid through PROs, report cards, and other accrediting agencies.

Vision and values of the agency, care standards, and evaluation of process changes are not as important as the outcomes that are demonstrated.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is implementing plan-do-check-act. Which of the following actions is the nurse going to perform? a. Documentation of client care. b. Obtain certification in a specialty area. c. Review data after changing practice. d. Provide equal access to care.

ANS: C Reviewing data is part of the “Check” step, where data is reviewed, results are analyzed, and Nh R Iocess G change B.CisMidentified. Documentation of client what has been learned throug the pr care, obtaining certification, and providing equal access to care are not part of the plan-do-check-act process.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse records the number of clients seen daily as well as the mode of transportation and miles driven. Which of the following types of records is being used? a. Clinical record b. Provider service record c. Financial record d. Central index system ANS: B Information about the number of clients seen daily, the immunizations given, home visits made daily, and transportation and mileage can be found in the provider service record. The clinical record is the client health record. The financial record is from the agency and contains information about the salaries, overhead, and transportation costs. The central index system is a data filing system that indicates the services requested, services offered, active and inactive clients of the agency, and a profile of the agency’s clients.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse is profiling the clients who are served by an agency as well as documenting services requested and provided. Which of the following describes the type of record that would be appropriate to use? a. Clinical record b. Provider service record c. Financial record d. Central index system ANS: D The central index system is a data filing system that indicates the services requested, services offered, active and inactive clients of the agency, and a profile of the agency’s clients. Information about the number of clients seen daily, the immunizations given, home visits made daily, and transportation and mileage can be found in the provider service record. The clinical record is the client health record. The financial record is from the agency and contains information about the salaries, overhead, and transportation costs.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is using a clinical practice guideline. Which of the following describes the situations that the nurse may be facing? (Select all that apply.) a. Recommending the administration of the influenza vaccination to a client N R I G B.C M b. Creating agency policies U andSproN cedT ures O c. Developing a program targeting obesity prevention d. Researching interventions that would improve care for a tuberculosis client e. Documenting the assessment of a client with congestive heart failure ANS: A, C, D Clinical practice guidelines are systematically developed statements to assist practitioner and client decisions about appropriate health care for specific clinical circumstances.

Clinical practice guidelines are not used to create agency policies and procedures or to assist in documentation of assessment findings.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which of the following statements about records are true? (Select all that apply.) a. Records provide complete information about the client. b. Records resolve legal issues in malpractice suits. c. Records provide information for education and research. d. Records allow anyone interested in a client’s progress to view a chart. e. Records allow for easy documentation of the client’s assessment.

ANS: A, B, C

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Public Health Nursing 10th Edition Stanhope Test Bank Records provide complete information about the client, resolve legal issues in malpractice suits, and provide information for education and research. Records are not available for anyone to view as that is a violation of client privacy. Depending on the record being used, assessment documentation may or may not be easy.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 25: Case Management Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse who is using population management needs to be able to work with integrated care delivery systems. Which of the following describes the rationale for this competency? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary.

ANS: A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using population management as part of the nursing care that is provided. Which of the following activities is the nurse most likely completing? a. Census taking to determNiU neRthSeItoNtaGl T nuBm.bC erOoM f people in the population b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually ANS: B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors. Population management does not include census taking, providing case management services for all, or repeating wellness programs on an annual basis.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is referred to by what term? a. Case management b. Care management c. Disease management d. Demand management ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant.

Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A patient with a long history of asthma with many hospital admissions is referred to a case manager for disease management. Which of the following best describes the purpose of this referral? a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring ANS: A Disease management activities target chronic and costly disease conditions that require long-term care interventionN s.UDRem and nt seeks to control use by providing clients SI NGman TBa.geCme OM with correct information. Patients who cannot handle their disease or who need an advanced practice nurse instead of a physician do not explain the referral to disease management.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is assisting clients to improve their health status. Which of the following types of management is being used by the nurse? a. Care management b. Case management c. Disease management d. Demand management ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A bachelor’s prepared nurse is providing case management services. Which of the following activities would most likely be provided by this nurse? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes ANS: C Working with individuals would be the role of this nurse. Working with community aggregates, systems of disease, and outcomes management processes are implemented by an advanced practice nurse (APN).

DIF: Cognitive level: Applying TOP: Nursing process: Implementation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse using a critical path when providing care for a client is most likely engaged in what activity? a. Implementing the six “rights” of case management b. Demonstrating competencies required for practicing case management c. Attempting to achieve a measurable outcome for a specific client d. Effectively managing conflict resolution ANS: C A critical path is a case management tool used to achieve a measurable outcome for a specific client case. The critical path details the essential and sequential activities in care, so that the expected progress of the client was known at a point in time. A critical path does not address the six “rights” of case management or demonstrate the competencies required for practicing case management. A critical path is not used for conflict resolution.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. What are the six “rights” of case management? a. Care, time, provider, setting, price, and outcomes b. Patient, medication, route, time, documentation, and evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank c. Place, setting, patient, plan, outcomes, and documentation d. Disease process, time, place, beneficence, advocate, and care provider ANS: A Care, time, provider, setting, price, and outcomes are used to judge the effectiveness of case management.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is working as a case manager and is in the process of performing interdisciplinary, family and client conferences. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Planning for outcomes d. Implementation ANS: B Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions based on assessment, and using interprofessional teams. Examples of assessment include developing networks with target populations and dissemination of written materials. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions. Examples of implementation include contacting providers and coordinating care activities.

N R I G B.C M

DIF: Cognitive level: ApplU yinS g N T TOO P: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A case manager has contacted providers and has negotiated services and prices. Which of the following phases of the nursing process is being demonstrated? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation ANS: D The implementation phase of the nursing process occurs when a case manager advocates for clients’ interests and arranges for the delivery of service. Examples of assessment include developing networks with target populations and dissemination of written materials.

Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 11. A case manager uses effective collaboration and team strategies to arrange for services.

Which of the following roles is being applied? a. Broker b. Negotiator c. Liaison d. Facilitator ANS: B The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator. The role of broker is used when acting as an agent for provider services that are needed by clients to stay within coverage according to budget and cost limits of the health care plan. When acting as a liaison, the nurse provides a formal communication link among all parties concerning the plan of care management. As a facilitator, the nurse supports all parties in work toward mutual goals.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A case manager provides a formal communication link among all parties concerning the plan of care management. Which of the following roles of the nurse is being implemented? a. Facilitator b. Liaison c. Coordinator d. Negotiator ANS: B The case manager providing a formal communication link among all parties concerning the plan of care management is performing the role of liaison. As a facilitator, the nurse supports all parties in work toward mutual goals. When working as a coordinator, the case manager arranges, regulates, and coordinates needed health care services for clients at all necessary points of services. The case manager who uses effective collaboration and team strategies to arrange for services is performing the role of negotiator.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A case manager is fulfilling the role of coordinator. Which of the following nursing interventions would most likely be completed? a. Providing information to all parties about the situations affecting the client b. Educating the client and providers in order to make informed decisions c. Supporting all parties to work toward mutual goals d. Arranging, regulating, and balancing needed health services for the client ANS: D The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the client. Providing information to all parties about the client’s situation is the role of the monitor/reporter. Educating the client and provider in order to make informed decisions is the role of educator and supporting all parties to work toward mutual goals is the role of facilitator.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. Which knowledge domains are used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning, and legislative change d. Grant application, bargaining contracts, and securing funding ANS: B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research. The other domains listed are not used in case management.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is using life care planning when working with a client. What would be the most appropriate time for planning to be used? a. When organizing a timeline of life events b. When documenting client information and requests c. When assessing present and future client needs d. When estimating future costs for medical care ANS: C Life care planning is a customized, medically based document that provides assessment of N Rlly,IN G eB.C M present and future needs. TypUicaS a lifT care pO lan incorporates medical, financial, psychological, vocational, built environment, and social costs during the remaining life of the client. Life care planning is a tool used in case management. A life care plan assesses the current and future needs of a client for catastrophic or chronic disease over a life span.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse is working as a case manager. Which of the following best describes the diagnoses that the case manager is most likely to encounter? a. Bankruptcy, financial distress, and depression b. Flu, colds, and frequent headaches c. Malaria, bird flu, and Dengue fever d. AIDS, spinal cord injury, and ventilator dependency ANS: D Case-managed conditions include many chronic conditions. AIDS, spinal cord injury, and ventilator dependency are the only chronic conditions listed. The other options are acute or nonmedical conditions.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 17. A public health nurse (PHN) is working with the chronically ill and families with young children needing age-specific health maintenance. Which of the following models of case management is being used? a. Client-focused b. System-focused c. Social service d. Long-term care ANS: A The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. System-focused models address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client-focused b. System-focused c. Social service d. Long-term care ANS: B The system-focused model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations. The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, “Tell me more about how you will work full time and breastfeed.” Which of the following aspects of the advocacy process is being used? a. Verification b. Clarification c. Amplification d. Affirmation ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Clarification is a process in which the nurse and client strive to understand meanings in a common way. Verification is the process used by the nurse advocate to establish accuracy and reality in the informing process. Affirmation is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse upholds a client’s right to make a choice and to act on the choice. Which of the following best describes the action being taken by the nurse? a. Affirming b. Supporting c. Informing d. Amplifying ANS: B Supporters approve and support clients’ actions. Affirming is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals. Informing includes educating clients about the nature of their choices, the content of those choices, and the consequences to the client and is not a one-way activity. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 21. A case manager supports a client’s decision to return home after having a total hip replacement rather than go to a skilled nursing facility. Which of the following phases of the nursing process is being used? a. Assessment b. Planning/outcome c. Implementation d. Evaluation ANS: C The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and supports the client’s decisions. The assessment/diagnosis phase is similar to the advocacy process of information exchange, gathering data, and illuminating values. The planning/outcome phase is like the advocacy process when generating alternatives and consequences and prioritizing actions. The evaluation phase is most similar to the advocacy processes of affirmation, evaluation, and reformulation.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. What term is used to identify the process of moving conflicting parties toward an outcome? a. Negotiation b. Conflict management

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Public Health Nursing 10th Edition Stanhope Test Bank c. Problem-purpose-expansion method d. Brainstorming ANS: A The process of moving conflicting parties toward an outcome is called negotiation. Conflict management has the goal of mutual benefit with limited loss, which is directed toward getting all parties to work together. The problem-purpose-expansion method is a way to broaden limited thinking by restating the problem and expanding the problem statement so that different solutions can be generated. In brainstorming, as many alternatives as possible are generated without placing a value on them.

DIF: Cognitive level: Remembering MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Assessment

23. Mutual benefit with limited loss for everyone is a goal of what process? a. Negotiating b. Assertiveness c. Conflict management d. Cooperation ANS: C Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed toward learning all parties’ needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal. The process of moving conflicting parties toward an outcome is called negotiation. Assertiveness is the ability to present one’s own needs. Cooperationis theability to understand and meet the needs of others.

DIF: Cognitive level: Understanding MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Assessment

24. The nurse is involved in a conflict resolution situation with the parents of a 2-year-old boy.

The parents are deciding if “spanking” the child is a disciplinary method that they will employ. The mother says, “I do not believe in spanking. I see it as abusive and demeaning.”

Which of the following best describes the statement by the mother? a. Cooperation b. Assertiveness c. Bargaining d. Collaboration ANS: B The mother’s statement is an example of assertiveness, the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. Bargaining is part of the negotiation process when debates include gathering facts based on reasoning that will generate understanding and promote relearning. Collaboration is a dynamic highly interactive and interdependent process in which people work together to share resources and a vision for a goal.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Psychosocial Integrity 25. A nurse is working with an individual who pursues neither his concerns nor another’s concerns. Which of the following conflict management behaviors is being used? a. Accommodating b. Collaborating c. Avoiding d. Compromising ANS: C The individual would be “avoiding.” Avoiding is defined as when an individual pursues neither his or her concerns nor another’s concerns. Accommodating occurs when an individual neglects personal concerns to satisfy the concerns of another. Collaborating is when an individual attempts to work with others toward solutions that satisfy the goals of both parties. Compromising occurs when an individual attempts to find a mutually acceptable solution that partially satisfies both parties.

DIF: Cognitive level: Applying MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Implementation

26. What is the first stage of collaboration? a. Trust building b. Consensus c. Collegiality d. Awareness ANS: D The first stage of collaboration is awareness, when one makes a conscious entry into a group process. This is followed by tentative exploration and mutual acknowledgement, trust building, collegiality, consensus, commitment, and collaboration.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A case manager submits documentation that a nursing visit was completed at a client’s home, but it was never performed. According to the general areas of legal risk, how would this action best be categorized? a. Liability for managing care b. Fraud/abuse c. Negligent referral d. Confidentiality/security ANS: B Fraud/abuse occurs when false statements of claims are made and filed.

Confidentiality/security occurs when sensitive information is not secured. Negligent referral occurs when referrals or treatments are inappropriate. Liability for managing care occurs when case management is not used appropriately, when there is harassment, or when care is inappropriately delegated.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse’s excessive attention to cost containment impairs the nurse’s duty to provide measures to improve health. Which of the following ethical principles is being influenced? a. Autonomy b. Beneficence c. Veracity d. Nonmaleficence ANS: B Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to provide measures to improve health or relieve suffering.

Autonomy is the individual’s right to choose a provider. Veracity is truth telling which is important to building trusting relationships with clients. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. Care in a managed system is provided by less experienced providers. Which of the following ethical principles is being influenced in this situation? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice ANS: D Justice calls for equal distribution of health care with reasonable quality. Autonomy is the individual’s right to choose a provider. Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to provide measures to improve health or relieve suffering. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What knowledge and skills are required in order to become a competent case manager?

(Select all that apply.) a. Knowledge of community resources and financing mechanisms b. Written and oral communication skills c. Proficient negotiation and conflict-resolving practices d. Application of evidence-based practices and outcomes measurements e. Experience with ethical decision making ANS: A, B, C, D

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Public Health Nursing 10th Edition Stanhope Test Bank The knowledge and skills required to achieve competency include knowledge of community resources and financing mechanisms, written and oral communication and documentation, proficient negotiating and conflict-resolving practices, and the ability to apply evidence-based practices and outcomes measures. Experience with ethical decision making is not part of becoming a competent case manager.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse would like to reduce the risk of liability. Which of the following interventions should be used by the nurse? (Select all that apply.) a. Provide accurate documentation of client visits. b. Inform clients of their rights of appeal. c. Refer clients to the providers of their choice. d. Utilize care planning whenever possible. e. Promote strong community partnerships.

ANS: A, B To reduce risk exposure, it is important to provide clear documentation of client encounters and inform clients of their rights of appeal. Client choice is important when choosing a provider; however, the nurse is responsible for using reasonable care when selecting referral choices for a client. Although care planning may be helpful for establishing a plan with the client, it is not necessary in reducing the risk of liability.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 26: Working With Families in the Community for Healthy Outcomes Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A public health nurse (PHN) is working with families and communities. Which of the following best illustrates the nursing action that is being implemented? a. Learning about the core competencies for public health professionals b. Facilitating a client discharge from an inpatient facility c. Assessing the structure of a family d. Assisting clients who are uninsured in finding resources and services ANS: D The PHN role is best demonstrated by the action of assisting clients who are uninsured in finding resources and services. Learning about the core competencies is important but does not demonstrate a nurse working with families and communities. The PHN is not typically involved with inpatient client discharge. The PHN may assess family structure, but that is not the best example of how a nurse works with families and communities.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse strives to meet the health care needs of diverse and changing families. Which of the following best describes the consideration that should be made by the nurse? a. Provide culturally compNeU teR ntScI arN e.GTB.COM b. Understand family dynamics. c. Recognize that two-income parent households are less stressful. d. Learn how to care for people in their homes.

ANS: A Immigration and modest difference in natural increases has increased in racial and ethnic diversity, which is reflected in the decline in the white, non-Hispanic population. Culturally competent care is necessary to best meet the health care needs of diverse and changing families. Provision of culturally competent care should be of higher priority than understanding family dynamics, recognizing the stress in two-income parent households, or learning how to care for people in their homes. Culturally competent care is needed to form and maintain a relationship with the family.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is making an appointment with a family for a nursing visit. Which of the following best describes a barrier that the nurse may experience when trying to schedule this appointment? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Often, late afternoon or evening appointments are necessary to accommodate the needs of the family. Limitation of time by the nurses would not be a barrier when scheduling this appointment.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse recognizes that a barrier that may be experienced when providing family nursing care is health literacy. Which strategy should the nurse implement to reduce the occurrence of this problem? a. Write down all necessary information for the family. b. Use multiple colors of ink on written materials. c. Print in upper- and lowercase letters. d. Use as many descriptors as possible.

ANS: C The best techniques used to reduce potential problems with health literacy are to print in upper- and lowercase letters, remove all extra words, have plenty of white space on the paper, and use black ink on white paper.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. The nurse asks, “What has changed between you and your spouse since your child’s head N Rfocu Isesof G the B.C injury?” Which of the following familyMis being used? a. The context b. The client c. A system d. A component of society ANS: C When the family is viewed as a system, the focus is on the family as client, and the family is viewed as an interactional system in which the whole is more than the sum of its parts. The systems approach to families always implies that when something happens to one family member, the other members of the family system also are affected, and vice versa. When the nurse views the family as client, the family is the primary focus and individual family members are secondary. The family as context serves as either a strength or a stressor to individual health and illness issues. The family as a component of society is seen as one of many institutions in society, along with health, education, religious, and financial institutions.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is assessing family structure. Which of the following describes what the nurse should recognize? a. An individual may experience many different family structures over a lifetime.

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Public Health Nursing 10th Edition Stanhope Test Bank b. The variations in family structure are becoming less common. c. The traditional nuclear family is the most common family structure. d. There is great variation among family structures.

ANS: A In assessing family structure, it is important for the nurse to recognize that an individual may experience many different family structures over a lifetime. Variations in family structure are becoming more common, and there can be great variation among family structures. There is no longer a consensus that the traditional nuclear family model is the “best” model.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse makes a visit to a home where several people live. The client says that several people in her family are not related biologically. What action should the nurse take? a. Ask the client why they are living in her home. b. Ask each member to identify his or her health needs. c. Tell the client that these people are not considered family. d. Accept the client’s definition of family.

ANS: D The family may range from traditional notions of the nuclear and extended family to postmodern structures. Family, as defined and implemented by the health care system, continues to be based on using the legal notions of relationships. However, the family system and family nurses use the following broader definition of family: “Family refers to two or more individuals who depend on one another for emotional, physical, and/or N R I G B.C M financial support. The members of the family are self-defined.”

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. Which statement about divorce rates is correct? a. The divorce rate is increasing. b. The divorce rate is decreasing. c. The divorce rate is difficult to measure due to the increase in cohabitation. d. The divorce rate has leveled off and remains relatively constant.

ANS: B Rates for divorce have decreased since 2001 when there were 4.0 divorces per 1,000 total population to 2016 rate of 3.2 divorces per 1,000 total population. As cohabitation has become more acceptable, less divorced people are getting remarried, but this does not make the divorce rate more difficult to measure.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Nurses analyze family developmental changes and stressors when studying what aspect of the family? a. Demographics

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Public Health Nursing 10th Edition Stanhope Test Bank b. Functions c. Structure d. Nursing ANS: A The study of family and household structures and events that alter that structure is called family demographics. Family functions are the ways in which families meet the needs of each family member, the family as a whole, and their relationship to society. Family structure refers to the characteristics and demographics of individual members who make up family units. Family nursing is a philosophy and a science that is based on the following assumptions: health and illness are family events; what affects one family member affects the whole family; and health care practices, decision, and behaviors are made within the context of the family.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. The nurse visits a household that consists of an elderly person living with 2 individuals who rent rooms in the house. Which of the following describes this type of household? a. Single-family household b. Family household c. Non-family household d. Family demographic trend ANS: C A non-family may consist of a householder living alone or a householder living with non-relatives, such as boarders or roommates. Single-family and family households include Ne R I mGemTber B.C M a householder and at least onU otS her N relO ated by birth, marriage, or adoption. This is not a description of a family demographic trend.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse keeps informed and up to date about demographic trends pertaining to families and all types of households. Which of the following best describes why this is important? a. To understand the demographics of the areas they are serving b. To provide safe care to the public c. To predict the needs of families within the community d. To identify households where children may need special attention ANS: C Knowledge about demographic trends is essential so that nurses can forecast and predict family community needs. This knowledge allows nurses to formulate possible solutions to identified family community problems.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Which theory views the family with boundaries that are affected by the environment? a. Family developmental and life cycle theory

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Public Health Nursing 10th Edition Stanhope Test Bank b. Bioecological systems theory c. Microsystems d. Family systems theory ANS: D The family systems theory views the family with boundaries that are affected by the environment. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Microsystems are part of the bioecological systems theory and describe the systems and individuals that the family directly interacts with daily.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which of the following theories is being applied? a. Family systems b. Bioecological systems c. Family developmental and life cycle d. Capacity-building model ANS: C The family developmental and life cycle theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. The family systems theory views the family with boundaries that are affected by the environment. The bioecological systems N RntsIaNnd GTsystems B.COoutside M theory describes how environUmeS of the family influence the development of a child over time. In the capacity-building model, nurses assume that the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates action for and with the family.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse examines family interactions. Which of the following identifies the theory that is being applied? a. Bioecological systems b. Family systems c. Family developmental and life cycle d. Capacity-building model ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank The family systems theory encourages nurses to view clients as participating members of a family. The family developmental theory provides a basis for forecasting what a family will be experiencing at any period in the family life cycle. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. In the capacity-building model, nurses assume that the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates action for and with the family.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse asks, “Where is this family on the continuum of the family cycle?” Which of the following theories is being used? a. Bioecological systems b. Family systems c. Family developmental and life cycle d. Capacity-building model ANS: C The family developmental and life cycle theory provides a basis for forecasting what a family will be experiencing at any period in the family life cycle. The family systems theory encourages nurses to view clients as participating members of a family. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. In the capacity-building model, nurses assume that the family has the most knowleNdge how heC irO hM ealth issues affect the family, supports URabo SIutNG TBt. family decision making, empowers the family to act, and facilitates action for and with the family.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse considers how the environment outside of the family influences the development of a child. Which of the following theories is being used? a. Bioecological systems b. Family systems c. Family developmental and life cycle d. Capacity-building model ANS: A The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. The family developmental theory provides a basis for forecasting what a family will be experiencing at any period in the family life cycle. The family systems theory encourages nurses to view clients as participating members of a family. In the capacity-building model, nurses assume that the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates action for and with the family.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is using the termination component of the nurse-family relationship. Which of the following strategies would the nurse use? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family ANS: B The termination phase includes making referrals when appropriate. It also includes decreasing contact with the nurse, extending invitations to the family for follow-up care, and a summative evaluation meeting for formal closure.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse displays pertinent family information in a multigenerational family tree format.

Which of the following best describes this format? a. Family intervention b. Family assessment c. Genogram d. Ecomap ANS: C A genogram enhances the nurse’s ability to make clinical judgments and connect them to NAnRecom Iapshowsthe G B.Cnature M of the relationship among and family structure and history. between family members and the community. A family intervention is used to work with the entire family to assist with identifying the primary problem confronting the family and accept the family as the priority. A family assessment is a way for a nurse to gather information from a family by using reliable and valid short assessment instruments that are specifically focused on the relevant family situation.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is demonstrating how a family relates to the other units in the community. Which of the following assessment instruments would be appropriate for the nurse to use? a. Family intervention b. Family assessment c. Genogram d. Ecomap ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank An ecomap shows the nature of the relationship among and between family members and the community. A genogram enhances the nurse’s ability to make clinical judgments and connect them to family structure and history. A family intervention is used to work with the entire family to assist with identifying the primary problem confronting the family and accept the family as the priority. A family assessment is a way for a nurse to gather information from a family by using reliable and valid short assessment instruments that are specifically focused on the relevant family situation.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. The nurse chooses to interview a family in the clinic office. Which of the following provides the rationale for this decision? a. Nurse’s territory will provide the nurse with power. b. More formal setting may allow for better discussion of family issues. c. Nurse will feel more comfortable. d. Environment of the family can be assessed.

ANS: B Choosing a more formal, less personal setting might help the family begin discussion of emotionally charged issues, so it is an advantage for the nurse to suggest the clinic office. A disadvantage of not seeing the everyday family environment is that it may reinforce a possible culture gap between the family and the nurse. It should not provide more power to the nurse and should not be done only to help the nurse feel more comfortable.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 21. A nurse is constructing a genogram for a family. Which of the following describes its importance? a. Allows nurses to diagnose disease patterns. b. Brings the family together to do a mutual task. c. Shows family history and patterns of health-related information. d. Provides a visual diagram of the family unit in relation to other subsystems.

ANS: C It is important for some families to construct a genogram because it shows family history and patterns of health-related information. A genogram does not allow the nurse to diagnose disease patterns or bring the family together. An ecomap provides a visual diagram of the family unit in relation to other subsystems.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. Government actions that have a direct or indirect effect on families are called what type of policy? a. Social b. Family c. Public d. Financial

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B All government actions, whether at the local, county, state, or national level, affect the family either directly or indirectly. Thus, it is referred to as family policy. These policies may address social, public, or financial issues that have an impact on families.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions would the nurse take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined amount of time off of work for family events without fear of job loss ANS: D The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.

The Family Medical Leave legislation does not allow for retention of health insurance after resigning from employment, sharing family information with colleagues, or provision of Medicaid to a family who cannot afford insurance.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are the reasons for cohabitation? (Select all that apply.) a. Cohabitants would marry, but do not for economic reasons. b. Cohabitants are seeking a more egalitarian relationship. c. Resources, such as food stamps and budget management, can be shared. d. Cohabitants are using this as a trial period to assess whether to marry. e. Resources can be received by multiple individuals.

ANS: A, B, D It is suggested that people cohabit for three reasons: (1) some would marry but do not for economic reasons, (2) others seek a more egalitarian relationship, and (3) others use it as a trial period to assess whether to marry. Sharing resources is not a reason for cohabitation because food stamps and budget management are not always shared when people live together. Resources may not be able to be received by multiple individuals.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Chapter 27: Family Health Risks Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse uses the term family policy. Which of the following explains what the nurse is describing? a. Anything that is done by the government that directly or indirectly affects families. b. Laws that affect families and family living. c. Requirements for immunizations for the entire family. d. Healthy People 2020 guidelines for healthy families.

ANS: A Family policy demonstrates a government’s understanding of families and its role in promoting their health. Anything that is done by the government that directly or indirectly affects families is considered family policy. It includes more than laws, requirements for immunizations, or Healthy People 2020 guidelines.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is assessing a family. Which of the following behaviors would the nurse recognize as being learned within the family structure? a. Smoking habits and heart disease b. Health values and healtN hU haRbS itsINGTB.COM c. Chronic illness and disease risk d. Societal norms and values ANS: B Health values, health habits, and health risk perception are affected by and acted out within the family environment. Heart disease and chronic illness are not learned behaviors. Societal norms are not learned through the family structure.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. The nurse is assessing factors that determine or influence whether disease or other unhealthy events will occur. What is the process of assessing for these factors called? a. Risk reduction b. Risk appraisal c. Risk factors d. Life-event risk ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Assessing the presence of specific factors within categories that are associated with increased likelihood of illness is called health risk appraisal. Health risk reduction assumes that decreasing the number of risks or the magnitude of risk will result in a lower probability of an undesired event occurring. Risk factors are things that put one at risk for development of a disease. Life-event risks often occur during transitions from one developmental stage to another.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. Which behavioral risk factor is a major contributor to morbidity and mortality in the United States? a. Homicide or suicide b. Motor vehicle accidents c. Chronic disease d. Substance use and abuse ANS: D A major contributor to morbidity and mortality in the United States is substance use and abuse. Drug use, drunk driving, smoking, and exposure to secondhand smoke all are part of this problem. Chronic disease and motor vehicle accidents are not behavioral risk factors.

Homicide and suicide are not the major contributors to morbidity and mortality.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care ibes life 5. Which statement best descrN URthe SIeff NGects TBo.f C OMevents on family health risk? a. Normative events require very little change in family structures and roles. b. Positive events are unlikely to place stress on a family. c. Normative and nonnormative events pose potential risks to the health of families. d. Negative life events require change and place stress on a family.

ANS: C Families can experience stress as a result of normative and nonnormative events. If the event is normative, or anticipated, then it is possible for families to identify needed resources, make plans, learn new skills, or otherwise prepare for the event and its consequences. More often, nonnormative events are unpleasant. Both normative and nonnormative life events pose potential risks to the health of families.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Which health risk category is one of the foremost predictors of health? a. Biological b. Economic c. Lifestyle d. Social ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Economic health risks are one of the foremost predictors of health. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Social risks, such as living in high-crime neighborhoods or in communities without adequate health resources, are receiving more attention, but is not considered to be one of the foremost predictors of health. Biological risk can be determined through a genogram and can consider risk for development of major illnesses or conditions but is not one of the foremost predictors of health. Lifestyle risk relates to personal health habits that continue to be a major contributor to the causes of morbidity and mortality but is not considered to be the foremost predictor of health.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 7. According to Pender, one factor that motivates individuals to participate in health behaviors is the: a. reduction of health risk by examination of the concepts of family risk related to everyone. b. desire to protect health by using behaviors directed toward decreasing the probability of specific illness or dysfunction. c. use of the Neuman Systems Model to define family health in terms of systems stability. d. realization that health can be defined in many ways and within many cultures.

ANS: B Understanding individual and family health behaviors requires looking at the concepts related to motivation and desire for good health. Pender uses Pender’s Health Promotion Model to discuss two major factorsthat motivate individuals to participate in positive health S None’s T ownOhealth and the second is a desire to protect behaviors. One is a desire to U promote one’s health.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 8. A family has experienced a nonnormative life event. Which of the following best describes this situation? a. Adoption of a child b. Loss of a job c. Marriage of a child d. Retirement from work ANS: B Nonnormative life events are unpredictable; loss of a job is an unpredictable event.

Adoption of a child, marriage of a child, and retirement from work are events that can be planned and anticipated, which are normative life events.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A family has experienced a family crisis. Which of the following best describes this situation?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Husband loses job and family is now homeless.

Child dies, and parents go to grief counseling.

Mother is hospitalized for 2 weeks and neighbors help care for the children.

Nurse goes to home to give chemotherapy to child with cancer.

ANS: A A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. This occurs when the demands of the situation exceed the resources of the family, a family crisis exists. The best example of this would be when a husband loses his job and the family becomes homeless. Parents seeking grief counseling after a death of a child, neighbors assisting to care for children, and a nurse giving a child chemotherapy at home all demonstrate appropriate coping mechanisms, although all these events can cause additional stress for the family.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A client is experiencing a social risk. Which of the following best describes this risk? a. Inadequate housing b. Lack of education c. High-crime neighborhood d. Lack of insurance ANS: C A high-crime neighborhood is a social risk. Inadequate housing, not being educated, and not being insured are economic risks.

N R I G B.C M

DIF: Cognitive level: ApplU yinS g N T TOO P: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. The nurse asked the family about its financial resources and the demands on these resources.

Which type of risk factor is being assessed? a. Biological b. Economic c. Lifestyle d. Social ANS: B A nursing asking a family about financial resources is an example of assessing their economic risks. Economic risk is determined by the relationship between family financial resources and the demands on those resources. An example of social risk would be living in high-crime neighborhoods or in communities without adequate health resources. Biological risk considers risk for development of major illnesses or conditions and may be assessed through a genogram. Lifestyle risk relates to personal health habits.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. A nurse is using a genogram when assessing a family risk. Which of the following types of risks is being assessed?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Biological Economic Lifestyle Social

ANS: A The genogram is an effective technique for assessing biological family risks. Economic risk is determined by the relationship between family financial resources and the demands on those resources. An example of social risk would be living in high-crime neighborhoods or in communities without adequate health resources. An ecomap provides information useful in assessing a family’s social risks. Biological risk considers risk for development of major illnesses or conditions and may be assessed through a genogram. Lifestyle risk relates to personal health habits.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 13. A nurse is using an ecomap. Which of the following best describes the situation that the nurse is experiencing? a. Assessing a family’s biological risks b. Considering a family’s economic risks c. Discussing a family’s lifestyle risks d. Examining a family’s social risks ANS: D An ecomap provides information useful in assessing a family’s social risks. The genogram is an effective technique for assessing biological family risks. Economic risk is determined N ami RS Iinan GTcial B.C M by the relationship between fU ly fN resO ources and the demands on those resources.

Biological risk considers risk for development of major illnesses or conditions and may be assessed through a genogram. Lifestyle risk relates to personal health habits.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is assessing the health risks of a family. Which of the following health risks would the family be most likely to voluntarily assume? a. Newly built power plant b. Smoking cigarettes c. Speeding vehicles near playground d. Industrial pollution ANS: B Voluntarily assumed risks are tolerated better than those imposed by others. Smoking cigarettes is a voluntarily assumed risk as a personal health choice. A newly built power plant, speeding vehicles, and industrial pollution are all risks that one does not have personal control over.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 15. A nurse is discussing internal family coping strategies with a family following a family crisis. Which of the following would the nurse be explaining? a. Asking a distant relative for a loan b. Talking to relatives about stresses and worries c. Attending a local worship service d. Using public assistance to obtain food stamps ANS: B An internal coping strategy is sharing thoughts and feelings with others. Attending worship services and using public assistance are also potential strategies for coping, but these are external strategies.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 16. Which statement is true about transitions? a. Transitions are stressful events for all families. b. Transitions require coping skills, which must be taught to some families. c. Transitions address the family skills necessary to meet developmental goals. d. Transitions present new situations and demands for families.

ANS: D Transitions present new situations and demands for families that may require a change in behaviors, schedules, and patterns of communication. Transitions may not be stressful events for all families. Transitions do not necessarily require that coping skills be taught.

Transitions do not address family skills necessary to meet development goals, rather they allow families to use their sNkillR s toIcopG e wB ith.tC he tM ransition.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse assists a family to obtain food stamps. Which of the following best describes the purpose of this resource? a. Provide support for basic needs. b. Offer insurance for the uninsured. c. Provide health-related services to families. d. Allow nongovernmental agencies to operate more effectively.

ANS: A The purpose of government resources for families, such as food stamps, is support for basic needs. Food stamps do not provide health insurance or health-related services to families.

Food stamps are part of a government resource/program.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which is a main disadvantage to home visits? a. Convenience for the client b. Time spent with one client c. Client control of the setting

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Public Health Nursing 10th Edition Stanhope Test Bank d. Ability to individualize services ANS: B Time spent with one client is one of the disadvantages to home visits. Other disadvantages are cost of pre-visit preparation, travel to and from the home, and post-visit preparation.

Advantages include client convenience, client control for the setting, availability of an option for those clients unwilling or unable to travel, the ability to individualize services, and a natural, relaxed environment for the discussion of concerns and needs.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is completing the post-visit phase of a home visit. Which of the following activities is the nurse most likely to complete? a. Document the visit and services provided. b. Conduct a health teaching session. c. Plan the next home visit. d. Seek information about community resources for referrals.

ANS: A A major task of the post-visit phase is documenting the visit and the services provided.

Conducting a health teaching session would occur during the in-home phase. Planning the next home visit is part of the termination phase. Seeking information about community resources for referral occurs during the in-home phase.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and ENffeR ctivI e CaGre E ironM ment: Management of Care Bn.vC 20. A nurse is in the beginning phase of contracting with a family. Which of the following activities will most likely occur during this phase? a. Mutual division of responsibilities b. Mutual development of a plan c. Mutual setting of time limits d. Mutual implementation of the plan ANS: B During the beginning phase of contracting with a family, mutual development of a plan occurs. Mutual division of responsibilities, setting of time limits, and implementation of the plan all occur during the working phase.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse clarifies the purpose of a home visit with a family. Which of the following phases of the home visit process is occurring? a. Initiation b. Pre-visit c. In-home d. Post-visit ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The initiation phase also includes clarifying the source of referral and sharing information regarding the purpose of a home visit with the family. Some aspects of the pre-visit phase include reviewing the referral, addressing personal safety concerns, and determining if the home visit is required or voluntary. The in-home phase is the actual visit to the home. The major task of the post-visit phase is documenting the visit and services provided.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse plans to review the home visit with the family. Which of the following phases of the home visit process is most likely occurring? a. Initiation b. In-home c. Termination d. Post-visit ANS: C When the purpose of the visit has been accomplished, the nurse reviews with the family what has occurred and what has been accomplished. This is the major focus of the termination phase, and provides a basis for planning further home visits. The initiation phase also includes clarifying the source of referral and sharing information regarding the purpose of a home visit with the family. The in-home phase is the actual visit to the home.

The major task of the post-visit phase is documenting the visit and services provided.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse is implementing the termination phase of a home visit. Which of the following U S N T O nursing activities is most likely being demonstrated? a. Conducting a physical assessment b. Identifying household members c. Summarizing accomplishments of the visit d. Teaching about health ANS: C Summarizing the accomplishments of the visit provides a basis for planning further home visits, which is part of the termination phase. Conducting a physical assessment and teaching about health are parts of the in-home visit phase. Identifying household members is part of the pre-visit phase.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse uses a behavioral health risk survey and identifies the factors leading to obesity in the family. Which of the following levels of prevention best describes the nurse’s action? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention focuses on prevention of illness and injury before it occurs.

Tertiary prevention focuses on treatment and rehabilitation. Assessment is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. A nurse is completing an initial home visit with a family. Which of the following nursing actions is most important to include? a. Explore the client’s ideas and perceptions about the purpose of the visits. b. Identify with the client the contradictions in the client’s words and health behaviors. c. Refer the client to others in the health team. d. Teach the client about solutions to his or her problems.

ANS: A During the initial home visit, it is important to explore the client’s ideas and perception about the purpose of the visits. Teaching the client and client referral are part of the in-home visit phase.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which are lifestyle habits that have been shown to decrease morbidity and mortality? (Select all that apply.) a. Sleeping 7 to 8 hours daily b. Eating breakfast c. Eating between meals d. Vigorous daily physical activity e. Maintaining full-time employment ANS: A, B Sleeping 7 to 8 hours daily and eating breakfast have been shown to decrease morbidity and mortality. Eating between meals is discouraged and regular exercise, not vigorous exercise, is encouraged. Maintaining full-time employment is not related to a change in morbidity or mortality rates.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 2. Which of the following are benefits of home visits? (Select all that apply.) a. Promote health for adolescent mothers. b. Identify barriers and provide support for family health promotion goals. c. Allow families to maintain a sense of control in meeting their health care needs. d. Prolong the nurse-client relationship.

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Public Health Nursing 10th Edition Stanhope Test Bank e. Establishment of healthy behaviors.

ANS: B, C Some of the benefits of home visits include identifying barriers and support for family health promotion goals and allowing families to maintain a sense of control in meeting their health care needs.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 28: Child and Adolescent Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A community health nurse is working with adolescents. Which of the following characteristics would most likely be displayed by an adolescent who is at increased risk to engage in risk-taking behavior? a. Poor academic performance b. High self-esteem c. Middle-class income d. Involvement in extracurricular activities ANS: A Factors associated with increased adolescent risk-taking behaviors include: poor academic performance, poor parental role models, low self-esteem, lack of a supportive social environment, and poverty.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is planning to administer an immunization to a child. Which of the following factors would be a medical contraindication for the administration of immunizations? a. Religious beliefs d. Fear of side effects b. Sore throat c. Leukemia ANS: C People with the following conditions are not routinely immunized and require medical consultation: pregnancy, generalized malignancy, immunosuppressive therapy or immunodeficiency disease, sensitivity to components of the agent, or recent administration of immune serum globulin, plasma, or blood. Leukemia would be a medical contraindication for receiving an immunization. Religious beliefs, sore throat, and fear of side effects are not medical contradictions.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is conducting a developmental screening to assess for domain-specific development, including gross and fine motor skills. Which developmental screening tool would the nurse most likely use? a. Pediatric Symptom Checklist b. Ages and Stages Questionnaire c. Parents’ Evaluation of Developmental Status d. Denver II ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank The Denver II screening tool assesses domain specific development (gross and fine motor, social, and language). The Pediatric Symptom Checklist assesses coping and mental health concerns, the Ages and Stages Questionnaire assesses social and emotional development, and the Parents’ Evaluation of Developmental Status assesses general developmental and behavioral screening.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. A family with children has income too high to qualify for state health insurance but does not have enough money to purchase private health insurance. Which program would a nurse refer this family to for the children to receive health care coverage? a. Medicare b. Children’s Health Insurance Plan (CHIP) c. Medicaid d. Social Security ANS: B CHIP is a federal and state partnership that is directed toward uninsured children and pregnant women in families with incomes too high to qualify for state Medicaid programs but too low to afford private coverage. Medicare is a government insurance program primarily offered to the elderly population. Social Security is not a health care insurance program.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is working with a child who lives in poverty. Which of the following best describes U S N T O this child? a. A child who has poor academic performance b. A child whose parents have a college education c. A child of Caucasian descent d. A child living in a single-parent household ANS: D Characteristics that put children at risk for living in low-income families are parents without a high school degree, lack of parental employment, and living in a single-parent household.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Which statement is true about the role of nurses in community health? a. The nurse provides direct services to children and their families. b. A major role of community health nurse is the provision of immunizations. c. Children are not the primary focus of community health, since they are often acutely ill. d. Complementary therapies and environmental toxins are often the focus of the health care of children.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The nurse provides direct services to children and their families: assessing and managing care, education, and counseling. Provision of immunizations is not a major role of community health nurses. Children are not often acutely ill nor are complementary therapies and environmental toxins the focus of health care.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is aware that there is a rising incidence of abusive head trauma (AHT). Which of the following would be a focus of the nurse? a. Taking at-risk babies out of violent households b. Placing babies under the care of community health nurses c. Educating and providing support to new parents d. Helping those affected seek proper legal representation ANS: C Prevention strategies are necessary to reduce the incidence of AHT. Parental education and support is necessary to prevent child maltreatment. Taking at-risk babies out of violent households, placing babies under the care of community health nurses, and helping those affected seek proper legal representation are not prevention strategies.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is actively participating in efforts to reduce gun violence among young people.

Which of the following actions is most likely being taken by the nurse? isk forNG viol en. ceCOM a. Identifying populationsNatUrR SI TB b. Passing legislation to support gun control c. Searching lockers at school looking for weapons and contraband d. Caring for clients who have sustained gunshot wounds ANS: A Nurses can identify populations at risk and target this population for aggression or anger management. The other responses are not activities community health nurses would engage in.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. A nurse assesses the playground safety at a new community center and notices rope swings and a trampoline. Which of the following actions should be taken by the nurse? a. Have signs posted encouraging children to be monitored continuously. b. Explain to the staff that these items are not recommended for playgrounds. c. Supervise the children closely when they are using this equipment. d. Compose a letter to be shared at the next city council meeting.

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Rope swings and trampolines are not recommended for playgrounds. Action should be taken by the nurse because these items are dangerous. Close supervision will not prevent an accidental injury from occurring. Writing a letter to be shared at the next city council meeting is not a timely response by the nurse.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 10. A mother tells the nurse she is afraid to have her infant immunized. Which of the following statements would be the most appropriate response by the nurse? a. “It is normal to be concerned, as some immunizations have been linked to autism.” b. “Researching the Internet will provide you more information as to the importance of immunizations.” c. “Choosing not to vaccinate your child puts your child and others at risk.” d. “Your infant received active immunity at birth, so immunizations are not indicated until 4 months of age.”

ANS: C The child who is not immunized and others around the child are at risk if immunizations do not occur. Scientific studies have not found a relationship between immunizations and autism. Information that is researched on the Internet may not be a reliable source of information as the nurse has no control over the information the client receives. Infants receive natural passive immunity at birth through the placental transfer of maternal antibodies; this protection lasts for about 2 months.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health ProNmUoR tiS onIaN nG dT MB ai. ntC enOaM nce 11. What is the leading cause of death for unintentional injuries among children and teenagers? a. Drowning b. Motor vehicle accidents c. Burns d. Poisonings ANS: B Motor vehicle crashes remain the leading cause of death for unintentional injuries in children and teens. Drowning, poisonings, and burns account for most of the other deaths.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 12. What group has the lowest injury death rate? a. Infants b. Toddlers and preschoolers c. School-age children d. Adolescents ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank School-age children have the lowest death rate among younger age groups. Infants have the second highest injury rate of all groups of children; their small size contributes to some types of injury. Adolescents are at the highest risk of any age group for motor vehicle deaths and fatal poisonings.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 13. Which statement about sudden infant death syndrome (SIDS) is true? a. SIDS occurs most often in female infants. b. Maternal cigarette smoking increases risk. c. Most deaths occur between 2 and 8 months of age. d. Most victims had a previous episode of cyanosis or apnea.

ANS: B Maternal smoking increases risk three to four times. SIDS occurs most often in male infants, most deaths occur between 1 and 5 months, and only a small number of victims have had a previous episode of cyanosis or apnea.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is providing anticipatory guidance to parents who have a child under 1 year of age.

Which of the following would be the most important topic to discuss? a. Choking b. Burns c. Poisoning ANS: A d. Falls Children under 1 year of age are most frequently injured by occluded airways resulting in choking. Burns, poisoning, and falls are risks for all age groups and are more likely to happen with children over age 1.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 15. A nurse is providing a health education program for the community about prevention of lead poisoning. Which of the following information would the nurse most likely include in the program? a. Universal screening for all children ages 1 and 2 years is recommended. b. Lead poisoning can lead to serious respiratory system complication. c. The most common exposure to lead occurs when children play with imported toys. d. Lead-based paints are found in all homes built before 1987.

ANS: A Universal screening is recommended for 1- and 2-year olds. Lead poisoning can cause significant neurological, cardiovascular, and renal disease. The most common exposure is through lead-based paints and lead-contaminated soil and dust in houses built before 1987.

Lead-based paints may be found in some homes built before 1987, but not all.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 16. A nurse is assessing a child with chronic health problems and the child’s family. Which of the following factors should be considered? a. The ability of the family to pay for expensive equipment b. The degree of impairment to the child’s ability to develop c. How often recreational activities will take place d. Special needs “camp” placement for the child in the summer ANS: B The degree of impairment to the child’s ability to develop is a concern of the community health nurse. Financial resources need to be assessed and adaptations may need to be made to avoid expensive equipment. The frequency of other treatments and therapies should be considered in addition to recreational activities. A special needs “camp” placement may not be an appropriate suggestion for every child with chronic health problems.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is caring for a preschool-aged child who has been exposed to environmental tobacco smoke (ETS) on a regular basis. Which of the following is the child at greater risk for because of this exposure? a. Middle ear infections b. Sudden Infant Death Syndrome (SIDS) c. Living in poverty NURSINGTB.COM d. Behavioral disturbances ANS: A Children exposed to ETS experience increased episodes of middle ear infections, asthma, upper respiratory tract infections, and more missed school days. SIDS incidence increases with ETS exposure, but this is not a concern with a preschool-aged child.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 18. A nurse is caring for a client who has a medical home. Which of the following best describes what is being used by the client? a. A building that houses multiple primary care providers and specialists. b. A partnership between a community health nurse, a client, and a family. c. A system that meets the needs of the individual, family, and community. d. A collaboration of care provided by an interprofessional team.

ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank A medical home emphasizes an integrated health system with collaboration of care from an interprofessional team of primary care physicians, specialists and subspecialists, other health professionals, hospitals and health care facilities, and public health and community working with children and families. The medical home may not necessarily all be housed in the same building. The partnership is bigger than only the nurse, client, and family. The medical home is specific to meeting the needs of the child and family.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is using motivational interviewing when communicating with a family about improving their eating habits. Which of the following questions would the nurse most likely ask when using this technique? a. “Do you feel comfortable restricting foods your child eats?” b. “Why do you choose unhealthy snacks?” c. “What changes would you like to make to improve your diet?” d. “Where do you do your grocery shopping?”

ANS: C Motivational interviewing is a focused communication strategy in which the parents are encouraged to set goals, identify personal barriers, and identify potential mechanisms to overcome the barriers to make safety and health promotion changes for their child. Nurses use open-ended questioning and reflection to encourage sharing from the child and parents.

The other questions may be viewed as being judgmental from the perspective of the client and the client may not answer the question truthfully.

DIF: Cognitive level: AnN alyz :M Nursing process: Assessment Ring INGTB.TCOP U S O MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is educating parents about sports safety. Which of the following information would be included in the education? (Select all that apply.) a. Grouping children according to weight, size, and skill level b. Providing adequate supervision by competent teenagers if adults are not available c. Using appropriate-size equipment d. Encouraging attendance at events by medical personnel e. Having an automated external defibrillator (AED) onsite ANS: A, C Grouping children by size and skill level and using appropriate-size equipment are the best actions to promote sports safety. Teenagers cannot adequately supervise children in sports activities, and medical personnel do not need to be present at all sports events. Having an AED onsite is ideal but may not be realistic.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 2. A nurse is counseling a family about the management of childhood obesity. Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Set goals related to having a healthier lifestyle, not dieting. b. Have low-calorie, nutritious snacks available and ready. c. Allow snacking in front of the TV for short periods of time. d. Decrease computer time and replace it with activities and chores. e. Invest in a gym membership at a local facility.

ANS: A, B, D Setting goals for a healthier lifestyle; having low-calorie, nutritious snacks available; and decreasing computer time will assist in managing childhood obesity. Allowing snacking in front of the TV will not decrease childhood obesity. Purchasing a gym membership may be expensive and if not used on a regular basis will have limited effect on obesity.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 29: Major Health Issues and Chronic Disease Management of Adults Across the Life Span Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia has more medical complications than anorexia.

ANS: C Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight, purging is associated with bulimia, and anorexia is considered to have more complications than bulimia.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. An older person is in the last stages of dying. Which type of care would be the best for this client? a. Home health b. Assisted living c. Nursing home ANS: D d. Hospice Hospice would be the best form of care for a person in the last stages of dying. Home health care provides individual and environmental assessments, direct skilled care and treatment, and short-term guidance for individuals in the home. Assisted living offers a wide variety of living choices, from a single shared room to a full-service, life-care community. Nursing homes provide care to meet the health care needs of those needing rehabilitation, as well as for those needing a permanent supportive residence.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is caring for a client who has designated someone else to make health care decisions when they are unable to do so. Which of the following is being used by the client? a. An advanced medical directive b. A living will c. A durable medical power of attorney d. The Patient Self-Determination Act ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Durable medical power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so. An advanced medical directive includes both a living will and a durable medical power of attorney. A living will allows the client to express the wishes regarding the use of medical treatments in the event of a terminal illness. The Patient Safe Determination Act requires those providers receiving Medicare and Medicaid funds to give clients written information regarding their legal options for treatment choices if they become incapacitated.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. The nurse is caring for an elderly client who has written advanced medical directives. Which of the following best describes what this means? a. The client has made decisions regarding treatment if incapacitated. b. The client has a living will. c. The client has a Do Not Resuscitate order. d. The client’s family has decided on a medical treatment regimen.

ANS: A Two parts of advance directives are the living will and a durable power of attorney. An advance directive indicates treatment choices if clients become incapacitated. A living will allows the client to express the wishes regarding the use of medical treatments in the event of a terminal illness. A Do Not Resuscitate order is a specific order from a physician not to use cardiopulmonary resuscitation.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and ENfU feR ctS ivI eN CaGreTE iroOnM ment: Management of Care Bn.vC 5. A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a. Personal Responsibility and Work Opportunity Reconciliation Act b. Women’s Health Equity Act (WHEA) c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA) ANS: D The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is providing home care for several elderly clients in the community. Which of the following situations would most likely be indicative of elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparent’s house breaking items. c. A young man repeatedly steals money from his grandmother. d. An older person demands that the family come for dinner.

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: C Theft or mismanagement of money or resources is an element of abuse. Recognition of abuse includes these other possibilities as well: willful infliction of physical pain or injury, inflection of debilitating mental anguish and fear, or unreasonable confinement or the depriving of services. The other examples do not describe these elements of abuse.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. A nurse is investigating the overall health status of a population. Which of the following indicators would most likely be used by the nurse? a. Life expectancy b. Health status c. Morbidity rate d. Prevalence ANS: A Life expectancy is a measure that is often used to gauge the overall health of a population.

Health status indicators are the quantitative or qualitative measures used to describe the level of well-being or illness present in a defined population or to describe related attributes or risk factors. Morbidity measures rate of disability or illness. Prevalence is the proportion of the population that has a specific disease or illness.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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8. Which of the following charaUcterS istiN cs inTdicatesOa man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent. b. Has not had a prostate-specific antigen (PSA) test. c. Has a father or brother who has had prostate cancer. d. Has benign prostatic hypertrophy (BPH).

ANS: C Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer. Being of African American descent places a man at higher risk for developing prostate cancer. The PSA test is not accurate in terms of sensitivity or specificity, but it is used as a screening test. BPH can cause an elevated PSA test result.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 9. A nurse is educating a community women’s group about the importance of monthly breast self-exam and annual mammograms. Which of the following best describes why this community health education is important? a. Increased screening will lead to a decreased incidence of breast cancer. b. Early detection of breast cancer typically leads to a better prognosis. c. The death rate of breast cancer continues to rise. d. The potential harm from screening needs to be discussed.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B Secondary prevention measures, including screening techniques, make a difference in the death rates for breast cancer. Early detection often means cure, whereas late detection typically results in an unfavorable prognosis. A potential harm from screening does not exist.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 10. A nurse is implementing Wagner’s Chronic Care Model (CCM). Which of the following actions would most likely be taken by the nurse? a. Educate a community group about hypertension control. b. Create a budget for chronic disease management. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

ANS: A Use of electronic health records, provider reminders for key evidence-based care components, interprofessional teams communicating regularly, and community health classes to educate people with chronic diseases are various ways the CCM is being implemented. Creating a budget is not a way to use CCM. Administration of immunizations and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. Testicular cancer is commonly found in which age group?

U S N T O a. 10 to 14 years b. 15 to 40 years c. 41 to 50 years d. 51 to 70 years ANS: B Testicular cancer is commonly found in men 15 to 40 years old, with the peak incidence of age 33.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 12. Which type of cancer is the second leading cause of cancer deaths in the United States? a. Gastrointestinal b. Prostate c. Skin d. Testicular ANS: B Prostate is the most common non-skin cancer and second leading cause of cancer deaths in the United States. Testicular cancer is rare. Skin cancer and gastrointestinal cancer are not among the leading causes of cancer deaths.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 13. Current research on hormone replacement therapy (HRT) has found which statement to be true? a. It does not prevent heart disease. b. It should be used to prevent osteoporosis. c. It is useful with complementary therapies. d. It causes breast cancer.

ANS: A HRT does not prevent heart disease. To prevent heart disease, women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active. HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medications. HRT is not useful with complementary therapies and does not cause breast cancer.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is educating a client about reducing risk factors for the development of colorectal cancer. Which of the following lifestyle changes should the nurse recommend? a. Increase in consumption of dairy products b. Reduction in consumption of processed meats c. Decrease in exposure to the sun feU styRleSINGTB.COM d. Increase in sedentary liN ANS: B Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 15. A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: C Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability. Primary prevention focuses on prevention on disease before it occurs. Secondary prevention aims for early detection and screening.

Health promotion is not a level of prevention.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Health Promotion and Maintenance 16. A nurse is developing a community-based exercise program for a group of women who have cardiovascular disease. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention focuses on prevention on disease before it occurs. Secondary prevention aims for early detection and screening.

Health promotion is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is providing contraceptive counseling to a female. Which of the following goals does the nurse plan to work toward? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

ANS: B The goal of contraceptive counseling is to ensure that women have appropriate instruction to Nt rep RSrod INucti GTon. B.C M make informed choices abouU TheOnurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of preconceptual counseling.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 18. A nurse is providing preconceptual counseling to a woman. Which of the following supplements would be recommended to help prevent neural tube defects? a. Iron b. Calcium c. Folic acid d. Vitamin C ANS: C 400 µg of folic acid are recommended daily. Supplements of iron and Vitamin C are not recommended during preconceptual counseling. Supplements of calcium may be recommended to prevent bone loss but not for preconceptual counseling.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

19. A community health nurse would like to reduce the prevalence of sexually transmitted diseases (STDs) in the community. Which of the following activities would most likely be used? a. Establish immunization clinics to prevent sexual transmitted infections (STIs). b. Educate people with human immunodeficiency virus (HIV) about the mode of transmission. c. Explain to women that HIV is transmitted to women usually by intravenous drug abuse. d. Develop an STD clinic to increase community access to services.

ANS: D The goal of Healthy People 2020 is to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications. Nursing activities should align with these goals through development of an STD clinic to increase community access to services. Immunization clinics will not prevent the spread of most STDs. Education without access to services will not assist with reducing the problem.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 20. Which of the following statements about health disparities is accurate? a. African American women have a much higher incidence of breast cancer. b. Health disparities are the result of negligent health care practices. c. Health disparities vary among racial/ethnic groups. esUtR oS reI ceN ivG inT gB he.aC lthOcMare than women. d. Men have more obstaclN ANS: C Improvements have been made in some areas of health disparities among various populations. However, health disparities vary among each racial/ethnic group. African American women have much higher death rates from breast cancer, not necessarily a higher incidence. The awareness of health disparities remains low among the general public. These health disparities are typically not the result of negligent health care practices.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 21. Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty ANS: D Poverty is a strong and underlying current factor that affects all special groups. Other factors that may also influence disparities are: education, insurance status, segregation, immigration status, health behaviors and lifestyle choices, health care provider behavior, employment, and the nature and operation of the health system in the community.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 22. A nurse plans to address the increasing prevalence of depression in the community. Which of the following would be the best strategy to implement? a. Educate the community about how depression affects men. b. Recognize available community resources. c. Advocate for health policy changes. d. Understand how free clinics are able to provide mental health services to those without health insurance.

ANS: A Depression between men and women is recognized differently in the community. More women than men are classified as having depression. Men with depression often go unrecognized and underreported. Men tend to be stoic and do not verbalize how they feel, are reluctant to talk about health issues, and often do not have positive relationship with their health care provider. Recognition is key in order to get those with depression the necessary services that they need. Once depression has been detected, these individuals can be referred to the appropriate resources. Health policy changes and the understanding of free clinics would not provide the most immediate solution to the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 23. A nurse is working with incarcerated adults who are being released from prison. Which of the following nursing intervNent eC mO osM t appropriate to implement?

URions SIwo NGuld TBb. a. Connect offenders with community-based mental health programs. b. Provide community supervision for mentally ill offenders. c. Advocate for increased prison time to decrease recidivism rates. d. Educate about available state resources.

ANS: A Connecting offenders with community-based mental health programs at the time of release from prison can decrease recidivism rates, as many incarcerated adults experience major psychiatric disorders. It would be impossible for the nurse to supervise all mentally ill offenders in the community. Increased prison time is not shown to decrease recidivism rates and education about available state resources is not the most important nursing intervention to provide for this population.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 24. What is the purpose of adult day health centers? a. Provide support of life until death occurs. b. Provide assistance to people who may need help with activities of daily living (ADLs). c. Provide treatment for those needing rehabilitation. d. Provide respite care relief for caregivers.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: D Adult day health care is for individuals whose mental or physical function requires them to obtain more health care and supervision. It serves as more of a medical model than the senior center, and often individuals return home to their caregivers at night. Hospice provides support of life until death occurs. Assisted living provides assistance to people who may need help with ADLs. Long-term care facilities provide treatment for those needing rehabilitation.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. An elderly person is living independently in a single room in a full-service life care community. Which of the following terms best describes this living arrangement? a. Adult daycare b. Home care c. Nursing home d. Assisted living ANS: D An elderly person living independently in a single room in a full-service life care community is a client of an assisted living facility. Adult day health care is for individuals whose mental or physical function requires them to obtain more health care and supervision; it serves as more of a medical model than the senior center, and often individuals return home to their caregivers at night. Nursing home facilities provide treatment for those needing rehabilitation. Home care provides individual and environmental assessments, direct skilled care and treatment, and short-term guidance for individuals in the home.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which of the following factors are cited as obstacles to improving men’s health? (Select all that apply.) a. Reluctance to consult their primary care provider b. Emphasis of physical strength and competitiveness on masculinity c. Lack of a primary care provider d. Lack of access to health care by African American and Hispanic men e. Emphasis on the male role as the head of the family ANS: A, B, C Obstacles to improving men’s health include reluctance to consult their primary care provider, the concept that masculinity emphasizes physical strength and competitiveness, and the fact that many men do not have a primary care provider.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 2. A nurse is caring for an elderly female population. Which of the following considerations should be made? (Select all that apply.) a. Postmenopausal women are more likely than men to experience hypertension. b. Women use more health services than men. c. Women report lower rates of disability than men. d. Women and men have similar socialization patterns. e. Postmenopausal women are less likely than men to experience depression.

ANS: A, B Postmenopausal women are more likely than men to experience hypertension; prior to menopause, the rate is higher among men. Women use more health services than men.

Women report higher rates of disability than men. Women and men have different socialization, expectations, and lifestyles.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 3. A nurse is planning to implement Wagner’s Chronic Care Model (CCM). Which of the following essential elements would the nurse consider? (Select all that apply.) a. Clinical information systems b. Evidence-based change c. Self-management support d. Community e. Clinical practice guidelines ANS: A, C, D The essential elements of CCM are: the community, the health system, self-management N gn, RSdec IN Gn B.C M support, delivery system desiU isioT suppoO rt, and clinical information systems.

Evidence-based change concepts are found under each of the essential elements and help to foster productive interactions between clients and providers.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 30: Disability Health Care Across the Lifespan Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. An individual has a disability that is considered to be a function of physical characteristics that place him or her at a disadvantage when compared to those without the characteristics.

What definition of disability is being used? a. Social Model of Disability b. Medical Model of Disability c. Webster Dictionary definition of disability d. Social Security Administration definition of disability ANS: B In the Medical Model of Disability, disability is considered to be a function of physical characteristics or conditions that place an individual at a disadvantage as compared to those without the characteristic or condition. This model emphasizes the disabled person and the need to modify the course of illness to give the disabled person a “normal” life. In the Social Model of Disability, emphasis is placed on systemic barriers as well as societal attitudes and stigmas that contribute to the perception that those with limitations or physical illnesses are disabled. Webster’s Dictionary definition describes disability as a condition (such as, illness or injury) that damages or limits a person’s physical or mental abilities. The Social Security Administration uses the Medical Model of Disability for determination of disability.

DIF: Cognitive level: UnN deUrsRtaSnI diN ngGTB.TC OO PM : Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Developmental disabilities that continue throughout a person’s lifetime start before which age? a. 7 b. 12 c. 17 d. 22 ANS: D Developmental disabilities are chronic impairments that occur during development, starting before age 22, and last throughout the person’s lifetime.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working with a client who has been diagnosed with a substance abuse disorder and bipolar disorder. Which of the following terms best describes what is being experienced by the client? a. Disability b. Dual diagnosis c. Handicap d. Functional limitation

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B A substance abuse disorder concurrent with a mental illness disorder is a dual diagnosis.

Disability is a condition (such as, illness or injury) that damages or limits a person’s physical or mental abilities. Handicap is a very powerful word; it symbolizes the person with a disability begging with a “cap in his hand.” Functional limitations occur when individuals have difficulty performing basic activities of daily living (ADLs) because of their disability.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A client has a developmental disability. Which of the following areas would the nurse anticipate limited functioning? a. Dependent living, education, and finances b. Race, gender, and ethnicity c. Care giving, dependence, and limitation d. Self-help, language, and learning ANS: D Disabilities limit functioning in at least three of seven areas, including self-help, language, learning, mobility, self-direction, independent living, and economic self-sufficiency.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is caring for a client who, according to the Social Security Administration, is N R eIfoNllow GTing B.C M considered disabled. Which oUf thS beO st describes the client? a. A wheelchair-bound person b. A person unable to engage in any gainful activity because of a medical impairment c. A handicapped person d. A person who has had a stroke or has lost the use of a lower extremity ANS: B The Social Security Administration defines a disabled person as a person unable to engage in substantial, gainful activity by reason of medically determinable physical or mental impairment. A wheelchair-bound person, a handicapped person, or a person who has had a stroke may be able to engage in gainful activity.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is caring for a client who has a disability. Which of the following would be the correct way to refer to this individual? a. A handicapped person b. A person who has an amputation c. An amputee d. A wheelchair-bound afflicted person ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank The Person First Movement advocates for political correctness in defining persons with disabilities. In other words, refer to a “woman who is blind” rather than a “blind woman” or a “person with diabetes” rather than a “diabetic.”

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. What is the most common disability occurring in the United States in persons aged 18 years and older? a. Diabetes b. Stroke c. Arthritis d. Cancer ANS: C The most common disability found in the United States in persons aged 18 years and over is arthritis. Diabetes continues to be the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness among adults ages 20 to 74. Stroke and cancer are not among the leading causes of disability.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. Which of the following statements about disabilities are true? a. Disability includes sickness. b. Almost everyone will experience disability at some time during life. toUpR hys ical irm ts. c. Disabilities are limited N Cen SI NGimp TBa. OM d. Most disabled individuals require assistance with ADLs. ANS: B Most men, women, and children of all ages, races, and ethnicities will experience disability at some time during their life. As a person ages, the likelihood of developing a disability increases. Disability is a condition (such as illness or injury) that damages or limits a person’s physical or mental abilities.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is providing care to a family who has a child with a disability. Which of the following individuals would most likely report high levels of stress, anxiety, and depression? a. Mother b. Father c. Teacher d. Home health nurse ANS: A Mothers are most often the caregivers in families with a child with a disability. Mothers of children with special health care need report higher levels of stress, anxiety, depression, and feelings of isolation compared with mother of unaffected children.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A congressional mandate for the addition of folic acid to cereals in the United States to reduce neural tube defects in infants has been implemented. Which of the following levels of prevention has been addressed? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention interventions are aimed at screening and early detection. Tertiary prevention interventions are focused on treatment and rehabilitation. Assessment is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 11. A nurse is caring for a disabled individual and her family. Which of the following may be a potential effect on the family? a. High out-of-pocket expenses to receive necessary services b. Alteration of self-concept and self-esteem c. Compliance with necessary legislation to maintain services erR viS ceIsN bG yT thB e. heC alO thMdepartment d. Provision of health careNsU ANS: A The cost of caring for a child with a disability often affects the family’s financial well-being.

One third of children with disabilities who have insurance lack adequate coverage to meet their needs. Alteration of self-concept and self-esteem may affect individuals in the family, but not the family. Compliance with legislation and provision of health care services may be potential effects on the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is working to improve the health and wellness of persons with disabilities. Which of the following actions should be taken by the nurse? a. Treat the whole person, not just the disability. b. Focus on the disability and the related illnesses. c. Acknowledge the ability, not the disability. d. Ensure persons with disabilities have access to home health care.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank To improve the health and wellness of persons with disabilities, the former Surgeon General Carmona suggested that health care providers should see and treat the whole person; educators should teach about disability; the public should focus on the person’s abilities, not just the disability; and the community should ensure accessible health care and wellness services.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 13. Which statement about physically compromised persons who are experiencing poverty is true? a. They are more likely to have access to needed services. b. They are at greater risk for more rapid progression of disease processes. c. Their care is usually better coordinated. d. They require more nursing in-home care than persons not living in poverty.

ANS: B People who are disabled and live in poverty are less likely to have the resources to provide for their own special needs. Those living in poverty are less likely to have access to needed services or coordinated care. Those living in poverty do not require more nursing in-home care than those who are not in poverty.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is working with low-income families with disabilities who have young children.

Which specific form of disaNbil esTthBe.gC reat est risk for abuse?

UiRtyScIaus NG OM a. Physical disabilities b. Developmental delays c. Growth delays d. Cognitive disabilities ANS: D Children with cognitive disabilities under the age of six and from low-income families are at the highest risk for abuse or neglect. Children who have developmental or growth delays or those with physical disabilities are not at the greatest risk.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 15. A nurse implements a health promotion education program for physically compromised adults. Which of the following would be the most important reason to provide programming for this population? a. Health promotion interventions are similar among those with disabilities. b. Establishment of health-promoting behaviors is difficult. c. Information and counseling is needed to prevent other health problems. d. Community resources can be accessed through these presentations.

ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Physically compromised clients need information and counseling for health-promoting behaviors and for prevention of the progression of a condition or pathology. Primary prevention is the most important strategy so that other conditions do not occur. Health promotion strategies may be different depending on the condition. Information about community resources can be provided during the presentation, but they would not be able to be accessed during the presentation. It may be difficult for the client to establish health-promoting behaviors; however, this does not explain why these presentations are important.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 16. How does Healthy People 2020 address persons with disabilities? a. Suggests specific therapies and techniques for working with this population. b. Recognizes individuals with disabilities as productive citizens. c. Recommends the development of community health centers. d. Emphasizes increased access to services for this population.

ANS: D Healthy People 2020 has a greater emphasis on increasing access to services that can increase independence and foster community living. Healthy People 2020 does not suggest specific therapies or techniques, recognize individuals with disabilities as productive or nonproductive citizens, or recommend the development of community health centers.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse speaks on behalf of others who are unable to speak for themselves. Which of the U S N T O following roles is being performed? a. Advocate b. Caregiver c. Coordinator d. Collaborator ANS: A A nurse speaking on behalf of others who are unable to speak for themselves is performing the role of advocate. A nurse is responsible for assisting clients and families by organizing and integrating the resources of other agencies or care providers to meet the clients’ needs most efficiently in the role of coordinator. As a caregiver, the nurse provides direct care to the client. Nurses are collaborators when they take part in joint decision making with clients, families, groups, and communities.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse maintains current information about agencies whose services are of potential use to the disabled and directs clients to the resources that can meet their needs. Which of the following roles is being demonstrated? a. Educator b. Caregiver

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Public Health Nursing 10th Edition Stanhope Test Bank c. Referral agent d. Advocate ANS: C As a referral agent, the nurse directs clients to the resources that can meet their needs. A nurse speaking on behalf of others who are unable to speak for themselves is performing the role of advocate. In the caregiver role, the nurse provides direct care to the client. Nurses serve as educators who provide clients at any level with enough knowledge to enable them to care for their own needs.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. The nurse, with agreement from the family, arranges for families to see social workers on the same day that they bring their children for follow-up care in a pediatric cardiology clinic. Which of the following roles is being performed? a. Caregiver b. Coordinator c. Collaborator d. Case finder ANS: B A nurse is responsible for assisting clients and families by organizing and integrating the resources of other agencies or care providers to meet the clients’ needs most efficiently in the role of coordinator. A nurse arranging for families to see social workers on the same day that they bring children to be followed up in a pediatric cardiology clinic is performing the role of coordinator. A nurse as a case finder identifies individuals with disabilities who need Nator RS I G they B.C M services. Nurses are collaborU s whNen T takOe part in joint decision making with clients, families, groups, and communities. In the caregiver role, the nurse provides direct care to the client.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. The nurse organizes developmental vision and hearing screening of young children to identify those with disabilities. Which of the following roles is being performed by the nurse? a. Caregiver b. Coordinator c. Collaborator d. Case finder ANS: D A nurse as a case finder identifies individuals with disabilities who need services.

A nurse is responsible for assisting clients and families by organizing and integrating the resources of other agencies or care providers to meet the clients’ needs most efficiently in the role of coordinator. Nurses are collaborators when they take part in joint decision making with clients, families, groups, and communities. In the caregiver role, the nurse provides direct care to the client.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. An employee who is blind brings a service animal to work. Which of the following legislative acts includes this provision? a. The Rehabilitation Act of 1973 b. The Americans with Disabilities Act of 1990 c. The Individuals with Disabilities Education Act of 1975 d. The Developmental Disabilities Act and Bill of Rights Act of 2000 ANS: B Service animals are defined and protected under the Americans with Disabilities Act of 1990. Service animals are working animals that are individually trained to perform tasks for persons with disabilities. This legislation allows service animals to accompany a disabled person into all areas open to the general public. The Rehabilitation Act of 1973 was the first legislation designed specifically to eliminate discrimination against the disabled; it required all federal agencies and programs receiving federal funds to hire disabled workers. The Individuals with Disabilities Education Act of 1975 guarantees all children with disabilities ages 3 through 21 the right to a free and appropriate public school education that will meet their individual needs. The Developmental Disabilities Act and Bill of Rights Act of 2000 requires the Administration of Developmental Disabilities under the U. S. Department of Health and Human Services (USDHHS) to ensure that people with developmental disabilities and their families receive the services and support that they need.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is working with individuals who meet the definition of work disability as defined by the United States Census Bureau. Which of the following best describes these individuals?

(Select all that apply.) a. An individual who has resigned from a position because of discrimination. b. An individual who has retired or left a job for health reasons. c. An individual who did not work because of long-term mental illness. d. An individual who did not work in the past 12 months because of illness. e. An individual who has recently been terminated.

ANS: B, C, D Work disability includes a person who has a problem or disability that prevents him or her from working, has a service-connected disability, has retired or left a job for health reasons, did not work because of long-term physical or mental illness, or did not work in the past 12 months because of illness or disability.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which of the following conditions may contribute to disability? (Select all that apply.) a. Violence

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Public Health Nursing 10th Edition Stanhope Test Bank b. c. d. e.

Tobacco use Lack of access to health care Unsanitary living conditions Extended family living arrangements

ANS: A, B, C, D Several conditions and inherited problems can cause disability: genetic disorders, acute and chronic illnesses, violence, tobacco use, lack of access to health care, as well as failure to eat correctly, exercise regularly, or manage stress effectively. Substance abuse, environmental problems, and unsanitary living conditions can cause disability.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 3. A nurse is planning nursing interventions for disabled individuals living in poverty. Which of the following factors should be taken into consideration? (Select all that apply.) a. This population may have difficulty securing employment. b. This population may have less access to health care. c. This population is better able to use community resources. d. This population may make healthier lifestyle choices. e. This population is more independent.

ANS: A, B Persons who are disabled and live in poverty are less likely to have the resources to provide for their own special needs. They often have difficulty securing employment and have barriers obtaining health insurance and accessing health care. This population is limited in their ability to access comm unR ity rI esouGrceB s. anC d isMat greater risk for disabling conditions N U S N T O resulting from lifestyle choices.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 31: Vulnerability and Vulnerable Populations Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is implied by the Web of Causation model? a. Variables interact resulting in higher probability of illness. b. One disease causes another, especially in vulnerable populations. c. The greater the poverty, the more likely people are to have diseases. d. Immunizations are necessary because vulnerable populations spread disease.

ANS: A The web of causation model implies that not only are there more variables, but also the variables interact, resulting in higher probability of illness. The relative risk for poor health is greater for vulnerable populations.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which of the following is a characteristic of a vulnerable population? a. Have worse health outcomes and an increased sensitivity to risk factors than the general population. b. Have a single risk factor but experience worse health outcomes than the general population. c. Have multiple risk factoNrU s bRuS t eIqN uaGl T heBa. lthCoOuM tcomes to the general population. d. Have worse outcomes with better access to health care than the general population.

ANS: A Vulnerable population groups are more sensitive to risk factors and have worse health outcomes. Vulnerable populations experience multiple risk factors. Vulnerable populations have worse health outcomes than the general population. Vulnerable populations have more problems accessing health care than the general population.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Resilience refers to what characteristic? a. Resistance of certain groups to risk factors b. Increased susceptibility to cumulative risk factors among vulnerable groups c. Variability in the effects of stressors according to socioeconomic status d. Increased sensitivity of the very young and the very old to risk factors ANS: A Resilience refers to how vulnerable populations can resist or overcome the effects of the vulnerability. These populations do not succumb to the health risks that impinge on them.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

4. A nurse is working with a vulnerable group experiencing multiple risk factors. Which of the following best describes this group? a. Smokers who use chewing tobacco as well as cigarettes. b. Substance abusers who test positive for HIV. c. Persons with limited access to care because they live in a rural area. d. New mothers needing information about baby and child care.

ANS: B Multiple risk factors are present in substance abusers, including contracting HIV and hepatitis B virus. Homelessness is another risk factor. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is working with a 17-year-old pregnant cocaine addict who is homeless. Which of the following best describes this client? a. At risk b. A special population c. A Healthy People 2020 target group d. A vulnerable individual ANS: D Vulnerable individuals often have multiple risk factors. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or sexually transmitted infections (STIs). Risk is an epidemiological term meaning that some people have a higher probability of illness than others.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The wide variations in health services and health status between certain population groups are identified by what term? a. Vulnerable population groups b. Health disparities c. Disadvantaged populations d. Risk markers ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank The wide variations in health services and health status between certain population groups are called health disparities. Vulnerable populations are typically considered to be those who are at greater risk for poor health status and who have poor access to health care.

Disadvantaged populations have fewer resources for promoting health and treating illness than does the average person in the United States. Risk describes that some people have a higher probability of illness than others.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 7. What is the primary cause of vulnerability? a. Race b. Age c. Poverty d. Illness ANS: C The primary cause of vulnerability is poverty. Race, age, and illness may cause populations to be vulnerable, but these factors are not the primary cause.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 8. Which of the following is most likely to live in poverty? a. Those who work in high-risk jobs. b. Those who have adequate nutrition. anR age c. Those who effectively m NU SIstre NGss.TB.COM d. Those who live-in single-family homes.

ANS: A People who are poor are more likely to live in hazardous environments that are overcrowded and have inadequate sanitation, work in high-risk jobs, have less nutritious diets, and have multiple stressors.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 9. A nurse operates a school-based clinic in a local school where multiple providers and disciplines offer care to children, making it easier for children to access health care. Which of the following best describes this approach? a. Advocacy b. Wrap-around services c. Social justice d. Comprehensive services ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Comprehensive services are health care services that focus on more than one health problem or concern. Stationary or mobile clinics that provide a wide array of health promotion, illness prevention, and illness management services in migrant camps, schools, and local communities are examples of this. Wrap-around services describe a system in which comprehensive health services are available and social and economic services are “wrapped around” these services. Advocacy refers to actions taken on behalf of another. Social justice describes justice with respect to the concepts of egalitarianism and equality.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is caring for a population that has experienced a health disparity. Which of the following best describes the outcome of a health disparity? a. Low childhood immunization rates b. High dropout rates c. Unemployment d. Income below poverty level ANS: A Low childhood immunization rates signify a health disparity. High dropout rates, unemployment, and income below poverty level are social conditions that may lead to health disparities.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance ervi ceTtB o. mC eetOtM he needs of a vulnerable group. Which of 11. A nurse is developing a oneN-sto RpSsI G U N the following would the nurse most likely create? a. Wrap-around services where mental services are linked b. Giving all immunizations on a single clinic visit c. Providing multiple services during a single clinic visit d. Providing free services to the medically indigent ANS: C Providing multiple services during a single clinic visit makes services more responsive to the combined effects of social and economic stressors. Wrap-around services provide comprehensive health as well as social and economic services, so it would include more than the linkage of mental health services. Administering all immunizations or providing free services would not provide a one-stop shop for all needed services.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is working with multiple vulnerable groups. Which of the following would be most sensitive to the adverse effects of vulnerability? a. Pregnant teenager living with her parents for financial support b. Poor, older woman with no means of transportation c. 2-year-old boy of underinsured parents d. Recently unemployed father of five

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B A poor, older woman with no means of transportation has a combination of risk factors. A pregnant teenager, 2-year-old boy, and recently unemployed father are only displaying one risk factor, not multiple risk factors as the older woman displays.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. Which federal program created support for older and poor Americans? a. Social Security Act b. Medicare Amendment c. Medicaid Amendment d. Hill-Burton Act ANS: A The Social Security Act sought direct payments to eligible individuals to ensure a minimum level of support for people at risk of problems from inadequate financial resources. The Social Security Act encompasses the Medicare and Medicaid Amendment. The Hill-Burton Act provided funding to assist with building hospitals.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A client is self-employed as a mechanic and has no health insurance coverage. Which of the following best describes the legislation that will assist this client in obtaining health insurance? a. Balanced Budget Act NURSINGTB.COM b. Health Insurance Portability and Accountability Act (HIPAA) c. Patient Protection and Affordable Care Act (ACA) d. Social Security Act ANS: C The ACA of 2010 provides the opportunity for all to purchase health insurance. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The Social Security Act created the largest federal support program for elderly and poor Americans.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is working with a family who is unable to find adequate health care coverage for the children in the family. Which of the following pieces of legislation will assist in provision of health care coverage for these children? a. Social Security Act b. Balanced Budget Act c. Health Insurance Portability and Accountability Act (HIPAA) d. Affordable Care Act (ACA) ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The Social Security Act provides funds to insure currently uninsured children. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The ACA of 2010 provides the opportunity for all to purchase health insurance.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse considers an audience’s ability to read, comprehend, and act on medical instructions while preparing health education materials. Which of the following factors is the nurse considering? a. Health literacy b. Resilience c. Social justice d. Health disparity ANS: A A measure of a patient’s ability to read, comprehend, and act on medical instructions is health literacy. Resilience has to do with the factors that allow people to resist the effects of vulnerability. Social justice describes justice with respect to the concepts of egalitarianism and equality. Health disparity refers to the wide variations in health services and health status among certain population groups.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care l de term ntsTB of.hC ealt h. Which factor is the nurse looking at?

17. A nurse is examining sociaN UR SIina NG OM a. Ethnicity b. Income c. Gender d. Marital status ANS: B Social determinants of health are such factors as economic status, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk. Ethnicity, gender, and marital status are not considered social determinants of health.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 18. A nurse is caring for a homeless population. Which of the following characteristics should the nurse anticipate as a need of this population? a. Need more nursing care than other vulnerable groups. b. Have no desire to seek medical care. c. Have even fewer resources than poor people who have adequate housing. d. Are living in despair with no hope or resilience.

ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Those who are homeless have even fewer resources than poor people who have adequate housing. Homeless and marginally housed people must struggle with heavy demands as they try to manage daily life because their resources are limited. These individuals must cope with finding a place to sleep at night and a place to stay during the day or moving frequently from one residence to another, as well as finding food, before even thinking about health care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 19. A nurse is working to remove barriers to receiving health care. Which of the following actions is the nurse most likely to support? a. Discrimination against certain groups b. Treatment of pets at the same facility c. Provision of free food at a food bank d. Providing services for a rural population by using a mobile clinic ANS: D Barriers to access are policies and financial, geographic, or cultural features of health care that make services difficult to obtain or so unappealing that people do not want to seek care.

Examples of removing barriers include providing extended clinic hours, low-cost or free health services for people who are uninsured or underinsured, transportation, mobile vans, and professional interpreters, which can help improve access to care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. A set of actions one undertakes on behalf of another is identified by what term?

U S N T O a. Social justice b. Advocacy c. Resilience d. Risk ANS: B A set of actions one undertakes on behalf of another is advocacy. Social justice describes justice with respect to the concepts of egalitarianism and equality. Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. Risk describes that some people have a higher probability of illness than others.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 21. A nurse works with a group of abused women to enhance their levels of self-esteem. Which of the following levels of prevention is being performed? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Health promotion ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention aims to prevent disease and illness before it occurs. Secondary prevention focuses on screening and early detection.

Health promotion is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 22. A nurse is promoting social justice. Which of the following actions would the nurse most likely take? a. Contacting lawmakers about environmental health issues b. Assisting at homeless shelters c. Advocating for policies to improve social conditions d. Serving on a local coalition to prevent obesity ANS: C Social justice refers to providing equitable care and social supports for the most disadvantaged members of society. Nurses can function as advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 23. A nurse is planning and implementing care for vulnerable populations. Which of the following would be the most appropriate action for the nurse to take? ics inS aIwid a. Setting up multiple clinN UR NGe TgeBo.grCaph OMic area b. Advising legal consultants on a variety of issues c. Making laws to protect the homeless d. Teaching vulnerable individuals strategies to promote health ANS: D Teaching vulnerable individuals, families, and groups strategies to prevent illness and promote health is one of the ways nurses provide care for these populations. Setting up clinics, advising legal consultants, and making laws do not address the direct care provision role of the nurse.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which are current trends in providing care for vulnerable populations? (Select all that apply.) a. Community-based care and interorganizational partnerships b. Outreach and case finding c. Elimination of disparities d. Culturally and linguistically appropriate care e. Increased incidence of acute illnesses

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: A, B, D Community-based care and interorganizational partnerships, outreach and case finding, and provision of culturally and linguistically appropriate care are all trends to improve care among vulnerable populations. Elimination of disparities is not a trend related to caring for vulnerable populations. Increased incidence of acute illness is not a trend of care provision for vulnerable populations.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse “sets the stage” when assessing members of vulnerable population groups. Which of the following interventions would be completed? (Select all that apply.) a. Creating a comfortable, non-threatening environment b. Providing culturally and linguistically competent assessment c. Collaborating with others as appropriate d. Providing financial and legal advice e. Developing a free clinic in a low-income neighborhood ANS: A, B, C Nurses set the stage by creating a comfortable, non-threatening environment, providing culturally and linguistically competent assessment, and collaborating with others as appropriate. A nurse should not provide financial or legal advice. Developing a free clinic does not “set the stage.”

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 32: Rural Health Issues Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Why is rurality a subjective concept? a. Everyone has an idea as to what constitutes a rural setting. b. The differences between rural and urban areas are very distinct. c. Rural health has not been very well researched. d. The demographic and social characteristics of urban people are similar.

ANS: A Everyone has an idea as to what constitutes rural as opposed to urban residence. With the increased degree of urban influence on rural communities, the differences are no longer as distinct as they may have been in the past. There has been research done on rural health.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse visited a client living on a farm residency. Which of the following best describes the area the nurse visited? a. A region that has fewer than six persons per square mile. b. A home outside areas zoned as “city limits.” c. A county in a metro area with fewer than 1 million people. d. An area adjacent to a hiN gU hlR yS poI pN ulG atT edBc. ityC.OM ANS: B Farm residency usually refers to residency outside areas zoned as “city limits,” usually implying involvement in agriculture. A frontier is a region having fewer than six persons per square mile. The term small describes counties in a metro area with fewer than 1 million people. Suburban is an area adjacent to a highly populated city.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse builds a vacation home in a remote area having fewer than six people per square mile, so “I can get away from it all.” Which of the following best describes the classification of this area? a. Standard metropolitan statistical area b. Metropolitan county c. Frontier d. Rural area ANS: C A frontier region has fewer than six people per square mile. A standard metropolitan statistical area is a region with a central city of at least 50,000 residents. A metropolitan county describes regions with a central city of at least 50,000 residents. Rural describes communities having less than 20,000 residents or fewer than 99 persons per square mile.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. What percentage of U.S. residents live in rural settings? a. 5% b. 15% c. 20% d. 40% ANS: C According to the Bureau of the Census estimates, almost 20% of all U.S. residents live in rural settings.

DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which group is over-represented in rural areas when compared with urban areas? a. African Americans b. Asian Pacific Islanders c. Caucasians d. Native Americans ANS: C In general, there are a higher proportion of whites (Caucasians) in rural area than in urban areas.

N R I G B.C M

DIF: Cognitive level: RemU embSerinNg T TOO P: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse who had been working in an urban area is now employed in a rural area. Which cohort accounts for an increase in the rural population and thus an increased need for nurses? a. Those under age 18 b. Those over age 50 c. Those who are married d. Those with years of formal education ANS: A Rural communities have a higher-than-average number of residents under 18 years of age and over 65 years of age compared with an urban setting. Rural residents 18 years of age and older are more likely to be, or have been, married than their urban counterparts. As a group, rural adults are more likely to be widowed and have fewer years of formal education than urban adults.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. Compared with urban Americans, which statement is true of rural residents? a. They are more likely to engage in preventive health behavior.

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Public Health Nursing 10th Edition Stanhope Test Bank b. They are less likely to be exposed to occupational and environmental hazards. c. They have a higher rate of chronic illness. d. They rate their overall health status more favorably.

ANS: C Rural residents in America have a higher rate of chronic illness than urban residents. Nearly half of all rural adults have been diagnosed with at least one of the following: heart disease, chronic obstructive pulmonary disease, hypertension, arthritis and rheumatism, diabetes, cardiovascular disease, or cancer, compared with about one fourth of non-rural adults. In general, people in rural areas have a poorer perception of their overall health and functional status than their urban counterparts. Rural residents are less likely to engage in preventive health behavior and are more likely to be exposed to occupational and environmental hazards.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. In comparison with urban adults, which statement is true of rural adults? a. They seek medical care more often. b. They have poorer overall health status. c. They are less likely to identify a usual source of medical care. d. They are usually seen by a specialist rather than a general practitioner.

ANS: B Poorer overall health status is attributed to impaired access to health care providers and services coupled with other rural factors. Rural residents seek medical care less often, are usually seen by a general pN ractR itionIer, G andBa. reCmoM re likely to identify a usual source of medical care.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which of the following considerations should the nurse make when working with the rural population? a. They are likely to have health insurance. b. They are likely to have access to health care providers. c. They are more concerned about their health status. d. They are likely to experience mobility limitations.

ANS: D More rural adults experience at least three of the limitations of walking one block, walking uphill or climbing stairs, bending, lifting, stooping, feeding, dressing, bathing, and toileting.

In general, rural residents are less concerned about their health status, less likely to have access to health care providers, and less likely to have health insurance.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 10. A nurse is assisting with recruitment of health care providers to a primary care facility.

Which of the following facts about the rural population and their patterns of seeking medical care should be considered? a. Fewer rural adults seek medical care than urban adults. b. There is a greater population to serve in rural areas. c. Poor adults in urban areas have less access to care. d. Rural adults do not want to seek care.

ANS: A Despite their overall poorer health status and higher incidence of chronic health conditions, rural adults seek medical care less often than urban adults. There are resources for care in rural areas, but in some cases this may be scarce. The lack of providers or other resources in some rural areas may make it difficult for residents to obtain care. In most rural areas, the population is smaller than in an urban area.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse administrator is educating new nursing staff about the use of health care by rural residents. Which statement about rural adults should be included in the presentation? a. “They are less likely to identify a particular medical provider.” b. “They are more likely to see general practitioners and advanced practice nurses than their urban counterparts.” c. “They are more likely to seek medical treatment from a specialist than those in urban areas.” d. “They usually have to travel an average of 60 minutes to see a provider.”

ANS: B General practitioners and advanced practice nurses are seen more often by rural adults; urban adults are more likely to get specialized care. Rural adults are more likely to identify a particular medical provider. Rural adults are less likely to seek medical treatment from a specialist than those in urban areas. Rural adults are more likely to travel more than 30 minutes to reach their usual source of care.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is providing maternal-child care for rural women. The nurse would like to intervene with pregnant women who are at risk for poor health outcomes. Which of the following populations would be the target population for the nurse’s care? a. Latinos who live in urban environments b. Caucasians who live in remote areas c. Those who live on or near Indian reservations d. Those who seek health from general practitioners ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank As per the National Center for Farmworker Health, pregnant women who are particularly at risk are those who live on or near Indian reservations, migrant workers, and African American women who live in the deep South. Latinos living in urban environments, Caucasians living in remote areas, and those receiving health care from general practitioners are not as much of a concern in comparison to the Indian population.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A client is suffering from stress related to the depressed lumber industry in his county.

Which of the following best describes this client’s condition? a. Manic-depression b. Psychosis c. Anticipatory grieving d. Farm stress ANS: D Stress related to the depressed lumber industry can be classified as farm stress.

Manic-depression is alternating abnormal highs and lows of feelings and behaviors.

Psychosis is a mental illness in which connection with reality is lost. Anticipatory grief refers to grief before an impending loss.

DIF: Cognitive level: Applying MSC: NCLEX: Psychosocial Integrity

TOP: Nursing process: Diagnosis

14. Which of the following describes a barrier to obtaining care in a rural area? atio n NGTB.COM a. Readily available transpNort UR SI b. Inadequate provider understanding about rural health needs c. Short distances to health care facilities d. Available specialists ANS: B One common barrier to health care is inadequate provider attitudes and understanding about rural populations. The barriers to health care among the rural population are associated with one of the following characteristics: whether services and professionals are available, affordable, accessible, or acceptable to rural consumers.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is providing care to a Native Alaskan client. Which of the following exposures should the nurse anticipate may require specialized community nursing care? a. Exposure to toxic substances b. Farmer’s lung c. Field sanitation d. Black lung ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Native Alaskans have special care needs related to exposure to toxic substances/contaminants, hypothermia, interpersonal/domestic violence, infectious diseases, dental caries/loss, and diabetes. Farmer’s lung is associated with farmers/ranchers. Field sanitation is associated with migrant farmworkers. Black lung is associated with coal miners.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. Which is a characteristic of nursing practice in rural environments? a. Anonymity b. Less autonomy c. Professional isolation d. Faster pace ANS: C Concerns with professional isolation are often noted in rural practice environments.

However, technology continues to improve the problems with isolation. A nurse working in a rural environment has no anonymity, has greater autonomy, and works at a slower pace.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is practicing in a rural environment. Which of the following opportunities exist for in the nurse’s practice? a. Variety/diversity in clinical experiences b. Slower pace c. Direct collaborative practice opportunities d. Abundant resources ANS: A Rural nursing offers a great variety and diversity of clinical experiences because care is often given across the life span. Typically, in nursing practice in rural areas, it is a faster pace, has greater independence/autonomy, and sparse resources. In rural areas there are typically less providers, so there may be more indirect collaborative practice opportunities but more limited direct collaborative practice.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is planning to conduct research in a rural setting. Which of the following areas of research may be of most importance to rural nursing practice? a. Information about residents living in the intermountain and Midwestern regions b. Information on the stressors and rewards of rural practice c. Studies related to moving from rural environments to urban ones d. Studies about the effects of air pollution ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Research on the stressors and rewards of rural practice, in particular public and community health nursing, is needed. Other priority areas of research include rural nursing practice, empirical data on the particular nursing needs of rural-client systems, international perspective on the health of rural populations, the use of technology and communication, and rural-urban disparities in health status.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is planning care using the case management model. Which of the following interventions would be most appropriate when implementing this model of care? a. Providing a client-professional partnership b. Delivering accessible care to medically underserved areas c. Defining the characteristics of a community d. Evaluating the outcomes of rural programs ANS: A The case management model provides a client-professional partnership that can be used to arrange a continuum of care for rural clients, with the case manager tailoring and blending formal and informal resources. Collaborative efforts between a client and the case manager allow clients to participate in their plan of care in an acceptable and appropriate way, especially when local resources are few and far between. The case management model does not define the characteristics of the community or evaluate the outcomes of rural programs.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is providing care for at-risk minority groups in rural America. Which of the following health care needs are appropriate for the nurse to address? (Select all that apply.) a. Field sanitation b. Infectious diseases c. Maternal care services d. Oral/dental care e. Chronic diseases ANS: A, B, C, D Field sanitation, infectious diseases, maternal care, and oral/dental concerns are major health care needs for at-risk minority groups in rural America. Chronic diseases are a problem for all Americans, not just the at-risk minority groups in the rural areas.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is planning interventions that will be used when providing care for a rural client.

Which of the following characteristics of rural life should the nurse anticipate? (Select all that apply.) a. Lack of anonymity

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Public Health Nursing 10th Edition Stanhope Test Bank b. c. d. e.

Higher prevalence of high-risk occupations Churches and schools as socialization centers Preference for interacting with outsiders Increased mobility

ANS: A, B, C Characteristics of rural life include lack of anonymity, higher prevalence of high-risk occupations, churches and schools as socialization centers, and preference for interacting with members of own community. Those living in a rural community typically have decreased mobility.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 33: Poverty and Homelessness Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Historically, which of the following population groups would have been least likely to receive community assistance? a. Widowed women b. Orphaned children c. Mentally ill d. Injured laborers ANS: C Mentally ill individuals were considered undeserving poor and did not receive any community assistance. Widowed women, orphaned children, and injured laborers were deserving poor because their poverty was beyond their control.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is trying to provide effective nursing care to poor persons, families, and populations in a variety of settings. Which of the following actions should be taken by the nurse? a. Move to the area where people are living to understand their plight. b. Understand the concept of poverty on many levels. c. Take a trip abroad to seN eU hoRwSpIoN veGrtT yB ex.isC tsOinMother countries. d. Become fully immersed in the concept of poverty for at least a year.

ANS: B Understanding the concept of poverty with historical, social, political, economic, biological, psychological, and spiritual dimensions is the first step in providing effective care to this population. It is not necessary to move to the area, take a trip abroad, or become immersed in the concept of poverty to provide effective nursing care to this population.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is providing care to populations who are from different socioeconomic and cultural backgrounds. Which of the following barriers should the nurse be aware of that may prevent full engagement in a relationship? a. Fears and misconceptions related to poverty b. Lack of tangible and emotional resources c. Lack of knowledge about people who live in poverty d. Perception that the poor don’t need to be poor ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Fears and misconceptions of nurses related to poverty is a barrier that may prevent nurses from fully engaging in relationships with people who come from different socioeconomic and cultural backgrounds. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is forced to evaluate personal beliefs, values, and knowledge about poverty. Which of the following experiences most likely explains the situation the nurse is experiencing? a. A client asking for a small amount of money at a clinic b. Setting up a homeless shelter c. Making a home visit to a home that is unkempt d. Reading about poverty in a textbook ANS: C Nurses’ behaviors in situations are influenced by their relationship with clients. It is important to evaluate clients and populations in the context of the environment to develop nursing interventions. Reading a book is not adequate. Setting up a homeless shelter or having a client ask for money does not force the nurse to self-reflect as much as when the nurse is in the client’s environment.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which factor influences the growing number of poor persons in the United States?

U S N T O a. Increase in company earnings. b. Changes in the labor force. c. Better access to quality education. d. Adequate welfare benefits.

ANS: B Changes in the labor force affect the growing number of poor persons in the United States.

Decreased company earnings, decreased access to education and job skills, and inadequate welfare benefits also influence the growing number of poor persons.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is working with a family who has an income above the federal income guidelines but is unable to meet their living expenses. Which of the following terms best describes this family? a. Persistent poverty b. Near poor c. Impoverished d. Neighborhood poverty ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants.

Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is referring to the federal income guidelines. Which of the following best describes why the nurse is completing this action? a. To determine financial eligibility for government assistance programs b. To calculate statistical occurrences in the community c. To identify those with inadequate resources for basic needs d. To provide guidelines for reform of social programs ANS: A Federal income guidelines are used primarily to determine financial eligibility for government assistance programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The federal income guidelines do not identify those with inadequate resources for basic needs or provide guidelines for reform of social programs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care rIfed l f. ooCdOaM ssistance with a family. Which federal 8. A nurse is discussing eligibNility Rfo Gera B U S N T guideline would a nurse refer to when considering financial eligibility? a. Poverty Threshold Guideline b. Consumer Price Index (CPI) c. Federal Income Poverty Guideline d. Temporary Assistance to Needy Families (TANF) ANS: C The Federal Income Poverty Guideline is issued by the U.S. Department of Health and Human Services and is used to determine if a person or family is financially eligible for assistance or services from various federal programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The CPI is a measure of the average change over time in the prices paid by households for a fixed market basket of consumer goods and services. TANF is a program, not a guideline, that assists families in need.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which group has the highest rate of poverty? a. Children b. Teenagers c. Women d. Older adults

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: A In 2016, the highest rates of poverty occurred among children under the age of 18.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. Which is a characteristic of persons living in poverty? a. Longer life expectancy b. Simple health problems c. Higher rates of chronic illness d. Fewer hospitalizations ANS: C Not only do persons living in poverty have higher rates of chronic illness, but less access to care. They have a shorter life expectancy, more complex health problems, and hospitalization rates greater than those for persons with higher incomes.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse refers a client to an assistance program that requires the individual to find a job and/or enroll in job training program. Which program is being used? a. Aid to Families with Dependent Children (AFDC) b. Medicaid c. Temporary Assistance for Needy Families (TANF) d. Women, Infants, and Children (WIC) ANS: C TANF requires participants to find jobs and/or enroll in job training programs. The current TANF program was formerly called AFDC. Medicaid provides health insurance to poor families but does not require participants to find jobs. WIC provides food vouchers entitling participants to free nutritious foods and infant formulas from local grocers but does not require participants to find jobs.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is conducting a community assessment in a poor neighborhood. Which of the following is the nurse most likely to find? a. Fewer minority groups b. Increased exposure to environmental hazards c. More available health care services d. Lower rates of crime and substance abuse ANS: B Poor neighborhoods are more likely to have exposure to environmental hazards. Lower socioeconomic neighborhoods have been linked with poorer general health status, chronic conditions, mortality, birth outcomes, disability, injury and violence, and other health indicators. They are more likely to have higher rates of crime and poorer access to health care services.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A community health nurse is caring for an individual who is experiencing crisis poverty.

Which of the following characteristics would this individual most likely display? a. Episodic homelessness b. Physical disability c. Mental disability d. Drug abuse ANS: A Episodic homelessness is a characteristic of crisis poverty. Physical disability, mental disability, and drug abuse would be considered in persistent poverty.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. The community health nurse is caring for a client who is living in persistent poverty. Which of the following best describes this client? a. Severe mental illness b. Transient homelessness c. Victim of domestic violence d. Temporary housing ANS: A Those who are in persistent poverty typically are older, with physical and mental N R I buse GT,B.C M disabilities, alcohol and otherUdruSg aN severO e mental illness, chronic health problems, and significant family difficulties. Transient homeless persons, victims of domestic violence, and persons with temporary housing would be considered in crisis poverty.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A person is already homeless and is receiving shelter. Which type of housing is being used? a. Low income b. Supportive c. Emergency d. Adequate ANS: C Emergency housing is shelter for persons who are already homeless. These shelters typically are only open at night and in many cities only on extremely cold nights.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16.

Which statement regarding the effects of homelessness on health is accurate? a. Peripheral vascular disease and hypertension are lessened by this lifestyle. b. The incidence and virulence of infections are decreasing.

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Public Health Nursing 10th Edition Stanhope Test Bank c. Trauma is a significant cause of death and disability. d. Crowded living conditions result in decreased risk for exposure to infections.

ANS: C Intended and unintended injuries such as traumas are a significant cause of morbidity and mortality in the homeless. Those who are homeless are at greater risk for peripheral vascular disease and hypertension. Because of their poor living conditions, a minor skin injury or infections left untreated can result in widespread infection.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is providing primary prevention when working with the homeless. Which of the following best describes what is being implemented? a. Providing emergency housing aid b. Creating drug and alcohol treatment options c. Offering effective job training programs d. Evaluating comprehensive case management programs ANS: C Offering effective job training programs is an example of primary prevention—attempting to prevent the problem before it occurs. Emergency housing is secondary prevention. Drug and alcohol treatment and comprehensive case management are tertiary preventions.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Disease Prevention

N R I G B.C M

18. A nurse is providing secondaU ry pS revN entiT on whenOworking with the homeless. Which of the following best describes what is being implemented? a. Employer incentives b. Safe sex education c. Comprehensive case management d. Soup kitchens ANS: D Secondary preventive services target persons on the verge of homelessness as well as those who are newly homeless. An example of secondary prevention is a soup kitchen. Employer incentives and safe sex education are primary prevention strategies; comprehensive case management is a tertiary prevention strategy.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Disease Prevention 19. A nurse is planning to assist homeless clients at a local shelter with finding community resources to meet their health care needs. Which of the following actions should the nurse take before interacting with this population? a. Change personal views about homelessness. b. Understand the concepts of homelessness. c. Receive special training about where to locate homeless people. d. Have experience in mental health nursing and counseling.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: B To implement effective nursing interventions for homeless clients, nurses need to be aware of their own beliefs and values about the homeless as well as understand the concepts of homelessness.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse is implementing an intervention at both the primary and tertiary levels of prevention. Which of the following best describes the nursing intervention? a. Providing emergency shelter housing b. Offering physical and mental health services c. Developing a targeted case management program d. Establishing a needle exchange program ANS: D Establishing a needle exchange program could be considered both primary (preventing a problem before it occurs by helping clients avoid disease transmission) and tertiary (working with a population who already has a “problem” of drug abuse). Providing emergency shelter housing and offering physical and mental health services are both secondary and tertiary prevention interventions. Developing a targeted case management program is secondary prevention.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Why is it difficult to know the exact number of homeless persons? (Select all that apply.) a. Homeless people refuse to provide demographic information. b. Many homeless people refuse to be interviewed. c. It is difficult to generalize from one location to another. d. Some persons experience short intervals of homelessness. e. Homeless individuals are most likely hiding within the community.

ANS: B, C, D Those who are homeless are hard to find since they may sleep in boxcars, on building roofs, in doorways, or under freeways or pedestrian overpasses; temporarily stay with friends or family; refuse to be interviewed or deliberately hide the fact that they are homeless; have only short or intermittent episodes of being without a home; or may not fit in a general category.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 34: Migrant Health Issues Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about migrant and seasonal farmworkers is true? a. There are more than 10 million working in the United States. b. The majority are Mexican. c. Most are employed in the Northeastern states. d. Thirty-five percent are undocumented workers.

ANS: B The majority of migrant farmworkers are foreign-born (72%) and predominantly Mexican (67%). Estimates suggest there are approximately 1.0 to 1.8 million hired farmworkers. Five states account for 65% of all farmworkers: (1) California, (2) Florida, (3) Washington, (4) Oregon, and (5) North Carolina. Of the migrant and seasonal farmworkers, 52% have legal authorization to work in the United States.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which statement about migrant and seasonal farmworkers is true? a. The economic status of migrant workers has improved over the last decade. b. This is a transient population that does not need nursing care. c. Most migrant workers aNreUeRaS geI rN toGaT ccB ep.t C heOaM lth care services. d. Availability of food in the United States depends on these individuals.

ANS: D Availability and affordability of food in the United States depends on these individuals, yet their economic and social status has not changed significantly over the past decades. Most migrant workers do not seek out health care services.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working with a client whose principal employment is in agriculture on a seasonal basis and has established temporary housing in the area while employed. Which of the following terms best describes this laborer? a. Seasonal farmworker b. Migrant farmworker c. Transient worker d. Share cropper ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank A migrant farmworker is a laborer whose principal employment is in agriculture on a seasonal basis and, for the purposes of such employment, establishes a temporary abode. A seasonal farmworker returns to his permanent residence, works in agriculture for at least 25 days or parts of days, and does not work year-round only in agriculture. A transient worker moves from place to place to find work. A share cropper is a tenant farmer who uses part of the crop to pay for rent.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. Which of the following health problems ranks as one of the top five problems for farmworkers aged 5 to 19 years? a. Dental problems b. Communicable diseases c. Gastrointestinal problems d. Stress ANS: A Farmworkers of all ages consistently have more dental disease than the general population.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which of the following disorders has been identified as an occupational health risk for agricultural workers? a. Stroke d. Cancer b. Heart disease c. Diabetes ANS: D Cancer is an identified but not well-documented health problem for migrant farmworkers associated with their exposure to chemicals. Other identified health risks are musculoskeletal injuries, traumatic injuries, respiratory problems, dermatitis, infectious diseases, and eye problems.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. What effect does alcohol consumption have on migrant farmworkers? a. Provides relaxation and is important for migrant workers’ well-being. b. Adds additional risks to pesticide exposure. c. Poses safety hazards for farmworkers. d. Allows migrant workers to sleep better, thus improving daytime productivity.

ANS: C Alcohol can contribute to farm-related injuries. Drug and alcohol use have been identified as a significant source of stress. Alcohol can also contribute to health problems, greater risk for human immunodeficiency virus (HIV), violence in camps/home sites, domestic violence, and decreased funds for personal and family needs.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 7. Which factor may limit access to care for migrant farmworkers? a. Unwillingness to seek affordable health care b. Lack of knowledge regarding services c. Availability of 24-hour health care services d. Adequate transportation ANS: B Because of isolation, migrant farmworkers lack usual sources of information regarding available services. Migrant workers typically are unable to afford health care, have limited services available, and may not have adequate transportation to get to health care services.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. Which statement is true about health care services for migrant workers? a. Clinics are usually found within walking distance from work. b. Undocumented workers fear deportation when using clinics. c. Health care records are kept by workers to allow for continuation of services. d. Clinics are most often open on weekends and keep evening hours.

ANS: B Unauthorized individuals fear that securing services in a federally funded or state-funded clinic may lead to discovery and deportation. Clinics are usually a great distance from work N Rring INwo GTrkB.C M and offer health services onlyUduS hourO s. Health records do not typically follow the client.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is assessing a client who has had an acute exposure to a pesticide. Which of the following symptoms is the client most likely to display? a. Memory loss b. Musculoskeletal problems c. Cancer d. Infertility ANS: A Memory loss is a symptom that is displayed following an acute exposure to a pesticide.

Musculoskeletal problems, cancer, and infertility are from chronic exposure.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 10. . A nurse is caring for a migrant farmworker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following is the client at increased risk of developing? a. Cancer b. Memory loss c. Skin rashes d. Headaches ANS: A Chronic exposure to pesticides may lead to cancer. Acute exposure to pesticides may cause memory loss, skin rashes, and headaches.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. A nurse is assessing the occupational health risks of a migrant farmworker. Which health risk is the nurse most likely to find? a. Denial of care when going to the emergency room b. Difficulty obtaining affordable health insurance c. Increased exposure to chemicals and work-related injuries d. Episodic violence from farm owners and employers ANS: C Occupational health risks for migrant farmworkers include working conditions, exposure to chemicals, and using machinery. Denial of care and difficulty obtaining health insurance are not occupational health riskNs. ERpisI odicGvioB le. nC ce frM om farm owners is not a known occupational health risk.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Which legislation changed the availability of federal services accessible to certain immigrants to the United States? a. Migrant Health Act of 1962 b. Supplemental Security Income (SSI) c. Welfare reform legislation of 1996 d. Food stamps ANS: C The Welfare reform legislation of 1996 changed the availability of federal services accessible to certain immigrants in the United States. The Migrant Health Act provides funds for primary and supplemental health services to migrant workers and their families.

Because of the welfare reform legislation of 1996, many legal immigrants and unauthorized immigrants are ineligible for services such as SSI and food stamps.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 13. A nurse is implementing a primary prevention strategy for migrant workers. Which of the following activities would the nurse most likely implement? a. Caring for persons afflicted with pesticide exposure b. Setting up clinics for persons with HIV c. Setting up clinics for persons with HIV d. Educating about prevention of such illnesses as HIV and infectious diseases ANS: D The primary level of prevention often includes education for the prevention of diseases, measures to reduce pesticide exposure, and immunizations. Caring for persons afflicted with pesticide exposure, setting up clinics for persons with HIV, and doing research in the field related to heat stress are examples of tertiary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is implementing a primary prevention strategy. Which of the following activities would the nurse most likely implement? a. Urine screening for pesticide exposure b. Tuberculosis (TB) skin testing c. Treatment of lead poisoning d. Reduction of pesticide exposure ANS: D Reduction of pesticide exposure is an example of primary prevention. Urine screening and TB skin testing are secondary prevention, and treatment of lead poisoning is tertiary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A nurse is implementing a secondary prevention strategy. Which of the following activities would the nurse most likely implement? a. Monitoring for prenatal care b. Treatment for anemia c. HIV prevention d. Tetanus immunization ANS: A Monitoring for prenatal care is an example of a secondary prevention strategy. Treatment for anemia is tertiary prevention, and HIV prevention and tetanus immunization are primary prevention strategies.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 16. A nurse is implementing a tertiary prevention strategy. Which of the following activities would the nurse most likely implement? a. Diabetes screening b. Rehabilitation for musculoskeletal injury

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Public Health Nursing 10th Edition Stanhope Test Bank c. Birth control d. Pregnancy testing ANS: B Rehabilitation for musculoskeletal injury is an example of tertiary prevention. Diabetes screening and pregnancy testing are secondary prevention strategies, and birth control is a primary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is working with a client who is part of the Mexican culture and is experiencing a folk illness. Which of the following actions by the client should the nurse anticipate? a. Prefer to seek care with a folk healer. b. Consult the female leader of the family. c. Rely on Western medicine to cure the ailment. d. Become isolated and not seek care.

ANS: A There are four common folk illnesses that a nurse may encounter with the Mexican client: (1) mal de ojo (evil eye), (2) susto (fright), (3) empacho (indigestion), and (4) caida de mollera (fallen fontanel). When faced with one of these illnesses, the traditional Mexican individual would prefer to seek care with a folk healer. Healers known as curanderos, herbalistas, and espiritualistas are often sources of health care for folk illnesses.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health ProNmoR tionIandGMB ai. ntC enaM nce 18. A nurse is polite and non-confrontational when working with the family of a migrant worker. Which of the following concepts is the nurse demonstrating? a. Simpatía b. Respeto c. Dignidad d. Personalismo ANS: A Simpatía means having polite, non-confrontational relationships with others. Respeto means respect, dignidad means dignity, and personalismo is relating to the individual.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is educating migrant women to serve as links between the existing health care agencies and the migrant farmworker family. Which of the following best describes the role of these women? a. Migrant head start workers b. Outreach care workers c. Physician assistants d. Nurse aides ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Physician assistants and nurse aides do not serve in this lay person role in the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse is providing care for a Mexican client who has sustained a farm injury. If a major decision about the client’s treatment needs to be made, who would most likely make that decision? a. The male head of the family b. The wife/mother c. The person needing services d. The crew leader ANS: A The male is considered to be the major decision maker in the family, whereas the female is considered the caretaker.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is planning to provide culturally effective care to Mexican migrant farmworkers.

Which of the following strategies would the nurse use? a. Learn how to speak Spanish to improve communication. b. Understand that traditional beliefs and practices are more common among the well-educated populatioNn.URSINGTB.COM c. Consult the female head of household about health care matters. d. Recognize that cultural backgrounds of the workers will vary depending on their place of origin.

ANS: D It would be incorrect to assume that all Mexicans have the same cultural beliefs. The nurse must remember that beliefs and practices differ between regions and localities of a country, and among individuals. Mexico is a multicultural country; therefore, the cultural backgrounds of Mexican immigrants vary depending on their place of origin.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 22. A nurse is a political advocate for the migrant population. Which of the following best describes the action being taken by the nurse? a. Upholding immigration laws and deporting illegal aliens b. Passing laws to improve the living conditions of migrant farmworkers c. Educating communities about the health problems of migrant farmworkers d. Learning to speak Spanish for better communication with migrant farmworkers ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Political advocacy can include educating communities about these individuals. This education helps to provide legislators and policy makers at local, state, and national levels with the information needed to make policy decisions.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which factors are challenges of the migrant lifestyle? (Select all that apply.) a. Leaving one’s home every year b. Traveling c. Experiencing uncertainty regarding work and housing d. Lack of resources e. Middle income wages ANS: A, B, C, D Leaving one’s home every year, traveling, experiencing uncertainty regarding work and housing, and lack of resources are some of the challenges of the migrant lifestyle. The specifics for payment differ depending on the location and type of work. Reports of average income for farmworkers have varied.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 35: Teen Pregnancy Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the cause of teen pregnancy? a. Changing moral attitudes b. Sexual code c. Economic circumstances d. No uniform reason ANS: D There is no uniform cause of teen pregnancy. The causes of teen pregnancy are diverse and affected by changing moral attitudes, sexual codes, and economic circumstances.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. According to the 2017 Youth Risk Behavior Surveillance System, fewer teens reported engaging in which behavior? a. Riding in a car with a driver who had been drinking b. Current alcohol usage c. Trying marijuana d. Episodic heavy drinking ANS: A Fewer teens reported binge drinking or riding in a car with a driver who had been drinking.

However, these and other significant risk behaviors continued at high rates. Current alcohol use, trying marijuana, and episodic heavy drinking continue at high rates in teens.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which statement best illustrates why the main causes of teen mortality are high-risk behaviors? a. Teenagers generally leave home before they are mature enough. b. Teenagers often engage in activities that put them at risk for life-threatening diseases. c. Teenagers are prone to developing chronic diseases that lead to disability early in life. d. Teenagers want to get pregnant at an early age to be able to enjoy life later on.

ANS: B Teenagers are often engaged in activities that put them at risk for life-threatening diseases.

For example, the human immunodeficiency virus (HIV) infection and newly identified sexually transmitted diseases are prevalent in teenagers.

DIF:

Cognitive level: Understanding

TOP: Nursing process: Evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A high school-aged teen tells the school nurse that she wants to become pregnant. Which of the following would be the appropriate action for the nurse to take? a. Ignore the comment. b. Tell the teen that she should not engage in sexual activity or get pregnant. c. Call the teen’s parents and discuss the situation with them. d. Provide preconceptual counseling.

ANS: D Providing preconceptual counseling and emphasizing the need to achieve good health demonstrates that the nurse has heard what the teen is saying. This provides useful information that may encourage the teen to examine her plans carefully, seriously, and maturely.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 5. What characteristic is common among many teenagers who give birth? a. They are from middle-class families. b. They are honor students. c. They planned to get pregnant. d. They see few advantages in delaying pregnancy.

ANS: D Many teenagers who give birth see few advantages in delaying pregnancy. Many times these teenagers are poor and have limited educational achievements; they do not expect that their NtR I G B.Ct teens M report that their pregnancy was circumstances will improve aU aS laterNtimTe. MosO unplanned.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Which factor has been linked to the decrease in pregnancies among the 15- to 19 year old population? a. Fewer are becoming sexually active. b. More are using complementary and alternative methods of birth control. c. More have tighter parental control at home. d. Fewer are engaging in risky behaviors.

ANS: A The decrease in pregnancies among teens has been attributed to stabilization of the numbers of teens becoming sexually active, increased condom use, and increased use of more effective and long-acting hormonal methods of birth control.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 7. A teenage mother discusses with the school nurse the possibility of having a second child.

Which of the following risk factors would place this client at risk for having a second pregnancy? a. Remaining in school b. Reporting an unplanned first pregnancy c. Being from a small family d. Having a disadvantaged background ANS: D Having a disadvantaged background is a risk factor for a second teen pregnancy. Other risk factors include lower educational and cognitive ability, mental health issues, physical trauma, losses (such as death of a loved one), and substance use.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is providing information about parental consent to an adolescent client who is seeking an abortion. Which of the following information would be accurate? a. Parental consent must be given to the abortion provider. b. Parents must be notified by the abortion provider before the abortion is performed. c. The adolescent’s right to privacy and ability to give consent varies by state. d. Federal protection of the adolescent’s right to privacy makes consent unnecessary.

ANS: C For an adolescent female seeking abortion, her right to privacy and ability to give consent vary by state. No federal protection is extended to adolescents requesting abortion services.

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DIF: Cognitive level: UndeUrstaSndiN ng T TOO P: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which factor increases a young woman’s risk for early sexual experiences and pregnancy? a. History of sexual abuse b. Parents who have high demands for their children to act maturely c. Parents who communicate openly with their teens about birth control and sexuality d. Male partner of the same age ANS: A Having a history of sexual abuse increases a young woman’s risk for early sexual experiences and pregnancy. Parental higher education, family communication, and good family health practices have been associated with decreased sexual risk behaviors. Parents who are extremely demanding and controlling or neglectful and who have low expectations are least successful in instilling parental values in their children. Parents who have high demands for their children to act maturely and who offer warmth and understanding with parental rules have children more likely to exhibit appropriate social behavior and to delay early sexual experiences and pregnancy.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 10. A nurse is providing education to teenagers about prevention of unintended pregnancy.

Which of the following principles should the nurse understand as to why some of these teenagers may get pregnant? a. They often feel invincible and do not recognize risks related to their behaviors. b. They enjoy engaging in sexual activity and want children. c. They influence each other and succumb to peer pressure. d. They have realistic attitudes about school, work, parenting, and socializing.

ANS: A Teens often feel invincible, and they do not think about the negative outcomes they are advised could come true. Many teens believe that they are unique and different and that everything will work out fine. Teenagers often express the unrealistic attitude that they can do it all. Most pregnancies are unintended.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A young man has just learned that his partner is pregnant. Which of the following statements regarding his reaction to the pregnancy is true? a. His reaction often depends on the nature of the relationship before the pregnancy. b. Most young men believe that fathering a child can make them feel manly. c. Most young men are not interested in their partner’s pregnancy. d. His reaction often includes blaming the partner.

ANS: A Young men’s reaction to their partner being pregnant often depends on the nature of the relationship before the pregnancy. A large percentage of young men will continue to Nn R I G renatal B.CO M accompany the young womaU toS somNe pT visits and may even attend the delivery. It is not usual for a young man to be excluded or even rejected by the young woman’s family (usually her mother).

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is providing adoption counseling to pregnant teenagers. Which of the following is an important concept for the nurse to keep in mind? a. Have the father present as well during the counseling session. b. When speaking of adoption, use the words “giving the child away.” c. Describe the details of raising a child to influence adoption decisions. d. Do not impose opinions on the decision-making process of teen mothers.

ANS: D Nurses must keep in mind that they should avoid imposing opinions on the decision- making process of teen mothers. The nurse should also assess the relationship between the pregnant teen and her partner and what role she expects him to play. Sensitive language should be used—avoid saying “giving away a child” or “putting up for adoption.”

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 13. A nurse is assessing a pregnant teen’s weight gain. Which of the following would be the appropriate nursing intervention to implement? a. Advise the teen to pay close attention to weight gain. b. Encourage the teen to gain as much weight as possible. c. Recommend weight gain based on pre-pregnancy weight. d. Instruct about the benefits to the fetus by gaining 2 pounds per week.

ANS: C The weight gain recommendations for the pregnant adolescent are based on the teen’s pre-pregnancy weight. Teenagers who begin the pregnancy at a normal weight should be counseled to begin weight gain in the first trimester and to average gains of 1 pound per week for the second and third trimesters.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is counseling an adolescent female about prevention of iron deficiency anemia.

Which of the following would be the most appropriate nursing intervention? a. Provide information about appropriate weight gain during puberty. b. Educate about consuming foods containing vitamin C. c. Instruct on drinking at least eight glasses of water each day. d. Emphasize the need to follow up with a dietitian.

ANS: B Iron deficiency anemia is the most common nutritional problem among both pregnant and nonpregnant adolescent females. The nurse should educate about iron-rich foods and foods that promote iron absorption, such as those containing vitamin C. Proper hydration and NentRiSron INdef GT B.C anemia.

M weight gain do not help prevU iciencyO Following up with a dietitian is not necessary as the nurse discusses prevention of anemia.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. The nurse plans a home visit to a pregnant teen to discuss proper prenatal nutrition. Which of the following best describes a demonstrated outcome of this nursing intervention? a. Increase in birth weight and utilization of prenatal care and support services b. Increase in family coping skills to prevent crisis c. Coordinated and comprehensive teen pregnancy approach d. Family approach to health care ANS: A An increase in birth weight and utilization of prenatal care and support services is a demonstrated outcome of a nurse planning a home visit to a pregnant teen. Home visits may not lead to an increase in family coping skills to prevent crisis, a coordinated and comprehensive approach, or a family approach to health care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 16. A nurse is teaching a pregnant teenager about the risks of contracting a sexually transmitted infection. Which of the following statements would the nurse most likely make? a. Transmission of sexually transmitted infections is unlikely when you are pregnant. b. Contracting a sexually transmitted infection may cause your infant to require assistance immediately after birth. c. Sexually transmitted infections can cause premature labor. d. The father of the baby is at high risk to contract a sexually transmitted infection.

ANS: C When a young woman is pregnant, sexually transmitted infections can cause premature rupture of membranes, premature labor, and postpartum infection. Periodic screening during pregnancy should be done. Transmission of sexually transmitted infections can occur during pregnancy. There is no indication that transmission will cause a need for the infant to require immediate assistance following birth. Transmission of a sexually transmitted infection to the father is dependent on the father’s sexual activity.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is implementing an intervention at the primary level of prevention related to teen pregnancy. Which of the following would be most appropriate for the nurse to implement? a. Teach well-baby classes to new mothers. b. Teach young people about sexual practices that will prevent untimely pregnancy. c. Provide services for pregnancy detection. d. Counsel a young couple about abortion and adoption.

ANS: B Education often occurs at the primary level of prevention. The primary level of prevention focuses on preventing a problem before it occurs. Teaching well-baby classes to new mothers focuses on tertiary prevention as the teen pregnancy has already occurred.

Providing services for pregnancy detection is secondary prevention. Counseling a young couple about abortion and adoption is tertiary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. What are reasons that adolescents may not seek care for health problems? (Select all that apply.) a. Access to care may be hindered because there are not enough professionals with expertise in dealing with the teen population. b. Cost of care or availability of insurance may limit services. c. Teenagers do not care about their health. d. Health care professionals may not be able to discuss sensitive topics in a nonjudgmental way. e. Parents are unaware of the services available for adolescents.

ANS: A, B, D

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Public Health Nursing 10th Edition Stanhope Test Bank Adolescents may not seek care because their access to care is hindered by either lack of professionals or costs of the care; they may fear that health care professionals will not be able to discuss sensitive topics with them in a nonjudgmental way. Although health may not be a top priority, it shouldn’t be assumed that teenagers do not care about it. Most likely, parents are aware of the services available for adolescents but may not be able to access these services for a variety of reasons.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 2. A nurse is working with adolescent clients. Which of the following describes therapeutic approaches that would be appropriate for the nurse to use when working with this population? (Select all that apply.) a. Creating a caring and understanding atmosphere b. Using neutral words in eliciting symptoms c. Insisting that teens use appropriate terminology when expressing their concerns d. Paying attention to what the teen verbalizes and fails to verbalize e. Encouraging the teen to talk to the school guidance counselor about problems ANS: A, B, D Creating a caring and understanding atmosphere, using neutral words to elicit symptoms, and paying attention to what the teen verbalizes and fails to verbalize are appropriate therapeutic approaches. The nurse can offer more appropriate terms for the client to use once trust is established. The nurse should listen to the teen first before referring the client to someone else.

DIF: Cognitive level: AnN alyz :M Nursing process: Planning Ring INGTB.TCOP U S O MSC: NCLEX: Health Promotion and Maintenance 3. Which objective related to adolescent health is discussed in Healthy People 2020? (Select all that apply.) a. Increasing the age of legal consumption of alcohol to 25 b. Increasing the number of planned pregnancies c. Increasing the proportion of teens who receive formal instruction on reproductive health issues d. Increasing the proportion of teens who consistently use some form of birth control e. Increasing the number of teens who are employed ANS: C, D Healthy People 2020 goals are to increase the proportion of 15- to 19 year olds who use condoms and hormonal contraceptives and increase the proportion of teens who receive reproductive health information through formal instruction as well as from their parents or guardians.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 36: Mental Health Issues Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Who led reform efforts to correct types of inhumane practices in the care of criminals, those with mental disorders, and victims of the Civil War? a. Dorothea Dix b. Philippe Pinel c. Benjamin Rush d. Clifford Beers ANS: A Dorothea Dix led reform efforts to correct types of inhumane practices in the care of criminals, those with mental disorders, and victims of the Civil War. Philippe Pinel and Benjamin Rush led a reform movement that led to hospital expansion, medical treatment, and the community mental health movements. Clifford Beers urged mental health reform and influenced the founding of the National Committee for Mental Hygiene.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What was the first major piece of legislation to influence mental health services in the United States? a. National Mental HealthNAUcR t SINGTB.COM b. Mental Health Study Act c. Social Security Act d. Protection and Advocacy for Mentally Ill Individuals Act ANS: C The Social Security Act was the first major piece of legislation to influence mental health services in the United States. This act was created in response to economic and social problems of the era and shifted the responsibility of care for ill people from the state to the federal government. The National Mental Health Act included the objectives of development of education and research programs for community mental health treatment approaches. The Mental Health Study Act promoted the study of national mental health needs. The Protection and Advocacy for Mentally Ill Individuals Act promoted the development of advocacy programs for mentally ill persons.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. What factor caused many clients with mental disorders to be institutionalized? a. There was a continued fear of people with mental disorders. b. The success rate was higher with hospital treatment. c. It was easier to stabilize clients with psychotropic medications. d. It provided a less stressful environment for clients to recuperate.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: A Many clients with mental disorders were institutionalized because of a continued fear of people with mental disorders. These clients were essentially separated from the community and isolated from their families. This institutionalization combined with minimal information about cause, cure, and care, resulted in overcrowded conditions and exploitation of clients.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. An individual viewed physical and mental illness as interrelated, resulting from physical conditions. Which of the following best describes the era in which this individual lived? a. Ancient times b. Middle Ages c. Colonial d. Greco-Roman ANS: D An individual viewed physical and mental illness as interrelated, resulting from physical conditions during the Greco-Roman era. During the ancient times, Middle Ages, and colonial times, mental illness was viewed as resulting from supernatural forces.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse worked in a psychiatric institution during the hospital expansion era. Which of the following best describes thN e lo catio nuMrse most likely worked?

UR SInNwGher TBe .thCe O a. Near small communities with access to families and activities b. In rural areas removed from family and social activities c. Near urban areas with access to families and low-paying jobs d. In urban areas without access to families and jobs ANS: B During the hospital expansion era, most psychiatric institutions were located in rural areas removed from family and social activities. Clients were essentially separated from the community and isolated from their families. Many were institutionalized for the rest of their lives.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse has specialized knowledge and skills in mental health illness and problems to provide effective nursing care for this population. Which of the following best describes the need for this knowledge and skills? a. Services for people with mental disorders are inadequate. b. The effects of mental health are universal. c. Mental health disorders affect small sectors of the population. d. Current health objectives can be met without the influence of nursing.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank There are two universal truths that require nurses to have specialized knowledge and skills in this area: services for people with mental disorders are inadequate in all countries, and mental illness has a major impact on families, communities, and nations. The effects of mental health are variable. Mental health disorders can affect all populations. Nursing plays a major role in meeting the current health objectives for mental health disorders.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse is employed by the National Institute for Mental Health (NIMH). Which of the following best describes an activity the nurse would be involved in? a. Expansion of psychiatric units in general hospitals b. Development of education programs for community mental health treatment c. Legislation and advocacy for the rights of people with mental disorders d. Deinstitutionalization of patients ANS: B After the National Mental Health Act was passed in 1946, the NIMH administered its programs. Objectives included development of education and research programs for community mental health treatment approaches. The NIMH is not involved with expansion of psychiatric units in general hospitals, legislation and advocacy for the rights of people with mental disorders, or the deinstitutionalization of patients.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care ofIthe 8. Approximately what percenNtag Re S Gadu Blt.pCopu Mlation (ages 18 and older) in the United U N T O States suffers from a mental condition that is severe enough to impair daily function? a. 6% b. 14% c. 18% d. 25% ANS: C Approximately 18% of the adult population in the United States has a mental health condition severe enough to impair daily function. Nearly half of those with any mental disorder meet the criteria for two disorders.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. According to the National Institute for Mental Health (NIMH), which is the leading cause of disability among adults? a. Schizophrenia b. Major depression c. Obsessive-compulsive disorder d. Anxiety ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Major depression is pervasive and is the leading cause of disability among adults ages 15-44. Anxiety disorders, which include obsessive-compulsive disorder, are prevalent, affecting 18% of American adults each year. Schizophrenia is considered a severe mental illness and is part of the mental health illnesses experienced by 5.9% of the population.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A client who has been diagnosed with major depression works with other mental health consumers to advocate for establishment of additional self-help services for individuals and families with mental illness in a community. Which of the following best describes the organization that the client is likely involved with? a. Community Support Program (CSP) b. National Institute for Mental Health (NIMH) c. Mental Health Study d. National Alliance for the Mentally Ill (NAMI) ANS: D NAMI was the first consumer group to advocate for better services. This consumer advocacy group worked to establish education and self-help services for individuals and families with mental illness. The Mental Health Study Act promoted the study of national mental health needs. The National Mental Health Act established the NIMH, which includes the objectives of development of education and research programs for community mental health treatment approaches. The CSP provided grant monies to states to develop comprehensive services for persons discharged from psychiatric institutions and invited consumers to participate.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse is working with a client who is concerned about discrimination in the workplace based on a current mental health diagnosis. Which legislation has prohibited discrimination for persons with mental disorders? a. National Mental Health Act b. American with Disabilities Act (ADA) c. Developmental Disabilities Act d. Protection and Advocacy for Mentally Ill Individuals Act ANS: B The ADA prohibited discrimination and promoted opportunities for persons with mental disorders. The National Mental Health Act established the NIMH, which includes the objectives of development of education and research programs for community mental health treatment approaches. The Developmental Disabilities Act addressed the rights and treatment of people with developmental disabilities and provided a foundation for similar action for individuals with mental disorders. The Protection and Advocacy for Mentally Ill Individuals Act legislated advocacy programs for mentally ill persons.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 12. A client who was deinstitutionalized during the 1960s experienced difficulties living in the community. Which of the following best describes why this difficulty existed? a. Insufficient community mental health services b. Difficulties connecting with community resources c. Lack of affordable housing d. Increased cost of care ANS: A Insufficient community mental health services were available in the community. Families were not prepared for treatment responsibilities. There were no education and support programs for families. Staff in nursing homes lacked skills to treat people with mental disorders, and clients had little or no supervision in independent settings. There were not enough resources in the community, so the primary problem was the lack of resources not connecting with them. The lack of affordable housing or increased costs of care were not reasons this population had difficulties living in the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. Which factor has influenced the advancement in the treatment of mental illness? a. The movement of clients out of mental institutions to the community b. A better understanding of the neurobiology of mental illness c. More interest in helping persons with mental illness d. A change in the culture about what constitutes mental illness ANS: B Two major movements have influenced the treatment of mental illness: (1) consumer N Rtand INing GTofB.C M advocacy and (2) a better undUersS neurO obiology. The movement of clients into the community has not advanced the treatment of mental illness, nor has there been an increased interest in helping this population or a culture change.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse considers the effects of biology and environment, or nature and nurture, on the development of mental illness when providing care for clients with mental illness. Which nursing model/theory is being applied? a. Community mental health model b. Holistic model c. Systems theory d. Diathesis-stress model ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank The diathesis-stress model integrates the effects of biology and environment on the development of mental illness. Certain genes or genetic combinations produce a predisposition to a disorder. When an environmental stressor challenges an individual with a predisposition to a disorder, the expression of a mental disorder may result. The community health model is the primary method of care for people with serious and persistent mental illness. This model includes team care, case management, outreach, and a variety of rehabilitative and recovery approaches to help prevent exacerbations of illness. The systems theory uses a holistic view, which emphasizes the relationship between the elements of a unit and the whole. An understanding of the whole occurs through the examination of interactions and relationships that exist between the parts.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse categorizes mental illness as a biopsychosocial disorder. What is meant by this classification? a. Mental illness is an abnormal brain vasculature that can be detected with angiography. b. Antipsychotic drugs can be used for all types of mental illness. c. Experience and psychosocial factors affect the etiology and treatment of mental illness. d. Mental illness can be cured with the right drugs and therapy.

ANS: C Biochemical changes of the brain are being studied as causes of mental illness. Angiography is used to screen for abnormalities of the vascular system, such as atherosclerosis and brain tumors, that can lead to behNaviR hanG tipsM UorScI Nges.

TBA.nC Oychotic drugs are only appropriate for treatment of certain mental illnesses. More is known about the functions of the brain than any time in history; however, treatment of mental illness continues to be challenging.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse implements a primary prevention intervention related to mental health care. Which of the following interventions has most likely been implemented? a. Group psychotherapy b. Stress reduction education c. Case management d. Monitoring illness symptoms ANS: B Primary prevention refers to the reduction of health risks, thus stress reduction education is the correct response. Group psychotherapy and case management are secondary prevention strategies, and monitoring illness symptoms is a tertiary prevention strategy.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse implements a tertiary prevention intervention related to mental health care. Which of the following interventions has most likely been implemented?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Screening for anxiety Depression education Counseling following a natural disaster Coordination transition from the hospital to the community

ANS: D Tertiary prevention efforts attempt to restore and enhance functioning, thus coordination of transition from the hospital to the community is tertiary prevention. Screening and counseling are secondary prevention activities, and depression education is a primary prevention activity.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 18. The nurse is working in the role of educator with groups of clients. Which of the following interventions would the nurse likely perform? a. Care for clients in acute care settings. b. Coordinate activities with staff members in community settings. c. Use learning principles to increase understanding about mental illness. d. Act as an advocate for mental health support groups.

ANS: C The educator role is foundational to health maintenance, health promotion, and community action. Using learning principles to increase understanding in the community about mental illness is a role of the educator. Caring for clients in acute care settings is the role of clinician. Coordinating activities with staff members in community settings is the role of coordinator. Acting as an aN dvoR cateIforGmeB nt. alCheaM lth support groups is the role of an advocate.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. An undergraduate–level prepared nurse is working with a mental health population. Which of the following roles would be most appropriate for the nurse? a. Prescribe medications and have hospital admission privileges. b. Work as a case manager for large groups of persons with mental illness. c. Assess clients in acute psychiatric hospital settings. d. Provide basic primary, secondary, and tertiary services.

ANS: D The undergraduate level–prepared nurse is prepared to implement primary, secondary, and tertiary services. Roles of the nurse may include clinician, educator, and coordinator.

Prescribing medications and having hospital admission privileges, working as a case manager for large groups of persons with mental illness, and assessing clients in acute psychiatric hospital settings would be roles of an advanced practice nurse who specialized in mental health care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 20. A nurse is counseling a client following an unexpected loss. If given adequate support and adaptation, which of the following best describes what will happen with the client? a. Recover from the crisis and become mentally ill. b. Avoid the loss and potential mental illness. c. Be able to ignore the grief. d. Resume previous lifestyle despite sadness.

ANS: D When people do not have adequate resources, there is an increased risk of altered mental health. However, when given adequate support and adaptation, most persons will resume their lifestyles and will not become mentally ill, avoid the loss, or ignore the grief.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is providing care to an African American population in the community. Which of the following would be the most appropriate intervention for the nurse to implement? a. Build on the cultural traditions of the community. b. Develop a support system in a nearby community. c. Integrate mental health services into primary care settings. d. Focus on migrant health issues.

ANS: C Nurses can promote the mental health of this population by integrating mental health services into primary care settings, providing services in community centers, collaborating with faith communities, providing education to decrease the stigma, working toward the provision of safer communities, and recruiting members of this population to work as N R ers.

INFoc GTusing B.CoOn Mmigrant health issues would occur with the community mental health proUvidS Latino population. Building on cultural traditions is important in the Native American population. Developing a support system outside of the community would not be an appropriate intervention for any population.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 22. A nurse is working with older adults and their caregivers. Which of the following would be the most appropriate intervention for the nurse to implement? a. Work with legislators to advocate for policies that support families. b. Refer clients and families to community support groups to reduce stress. c. Involve clients and families in case management programs to coordinate care. d. Conduct depression screenings with clients and families on a regular basis.

ANS: B Family caregivers and older adults are at risk for health disruptions. Involvement in a community support group can help reduce stress of caregiving and provide networking opportunities for the older adult. Working with legislators to advocate for policies that support families, involving clients and families in case management programs to coordinate care, and conducting depression screenings with clients and families on a regular basis would not be the most effective interventions when working with this population.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse is involved with a group who advocates for improved and effective psychiatric services and consumer empowerment. Which of the following groups is the nurse most likely working with? a. National Alliance for the Mentally Ill (NAMI) Consumer Council b. National Mental Health Consumer’s Association (NMHCA) c. National Association of Psychiatric Survivors (NAPS) d. Consumer/Survivor Mental Health Research and Policy Work Group ANS: A The NAMI Consumer Counsel advocates for improved and effective psychiatric services and consumer empowerment. The NMHCA is a consumer organization that advocates for improvements in the mental health system. The NAPS is a consumer organization that advocates for such things as involuntary treatment and some forms of treatment like electroconvulsive therapy. The Consumer/Survivor Mental Health Research and Policy Work Group is an endeavor sponsored by the Mental Health Statistics Improvement Program of the CMHS to initiate consumer representation in activities of the National Association of State Mental Health Program Directors (NASMHPD).

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse is working with persons with serious mental illness. What does the nurse understand about this population? ntal ui. reCins tM itutionalization until they are a. Persons with severe meN Rilln Iess Greq B U S N T O functional. b. Inadequate community resources have caused problems with homelessness among this population. c. Serious mental illness originates from childhood events and therapy is ineffective. d. Motivation influences a person’s ability to earn a living and purchase necessary medications.

ANS: B Many people with serious mental illness live in poverty because they lack the ability to maintain a suitable standard of living. Brief hospital stays and inadequate community resources have resulted in an increased number of persons with serious mental illness living on the streets or in jail. Persons with severe mental illness need support, not necessarily institutionalization. There are a variety of contributing factors to the development of severe mental illness, and some are unknown. Those with severe mental illness may lack motivation because of their illness.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. A nurse is implementing relapse management. Which of the following interventions would most likely be used by the nurse? a. Use a holistic view of the system. b. Identify triggers.

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Public Health Nursing 10th Edition Stanhope Test Bank c. Understand the individual’s personality. d. Provide crisis intervention.

ANS: B Recognizing triggers that may lead to illness helps the consumer manage the illness and promotes recovery. Examples of triggers are poor social skills, hopelessness, and poor symptom management. Relapse management does not include understanding the individual’s personality, providing crisis intervention, or using a holistic view of the system.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. According to the Surgeon General’s report, where do people receive assistance for mental health problems? (Select all that apply.) a. Specialty mental health systems b. General medical or primary care sectors c. Human service sectors d. Voluntary support networks e. Community agencies ANS: A, B, C, D The Surgeon General’s report defined specialty mental health systems, general medical or primary care sectors, human service sectors, and voluntary support networks as ways through which people could receive assistance.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using Healthy People 2020 as a guide to develop community programming for mental health. Which of the following objectives for mental health would be found in this document? (Select all that apply.) a. Reduce suicide rates. b. Increase employment of persons with severe mental illness. c. Increase the proportion of children treated for mental health problems. d. Decrease the number of juvenile facilities that screen new admissions for mental health problems. e. Reduce rates of violent acts against women.

ANS: A, C Reducing suicide attempts and increasing the proportion of children with mental health problems who receive treatment are two objectives for mental health targeted by Healthy People 2020.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 3. A nurse is referring a client with a mental illness to a community group for additional information and support. Where would the nurse most likely refer a client? (Select all that apply.) a. Alcoholics Anonymous (AA) b. Obsessive-Compulsive Foundation c. Schizophrenics Anonymous d. Anxiety Disorders Association of America e. Salvation Army ANS: A, B, C, D AA, Obsessive-Compulsive Foundation, Schizophrenics Anonymous, and Anxiety Disorders Association of America are all sources of information and help for people with mental illness.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 37: Alcohol, Tobacco and Other Drug Problems Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Why must nurses examine their attitudes about alcohol, tobacco, and other drug (ATOD) abuse and addiction before working with individuals with this health problem? a. Working with clients who have addiction problems often puts the nurse at risk for violence. b. The population of persons with drug and alcohol addiction is found in low-income neighborhoods. c. To be therapeutic, a nurse must develop a trusting nonjudgmental relationship with clients. d. Nurses are the primary persons who treat addiction problems.

ANS: C To be therapeutic, the nurse must develop a trusting, nonjudgmental relationship with clients. Therefore, nurses must examine their own attitudes ahead of time. Working with clients who have addiction problems does not put the nurse at risk for violence. People with drug and alcohol addiction can be found in any neighborhood. Nurses do not treat addiction problems.

DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which health problem causes more deaths, illnesses, and disabilities than any other in the United States? a. Tobacco addiction b. Alcohol abuse c. Substance abuse d. Caffeine addiction ANS: C Substance abuse is the number one national health problem, causing more deaths, illnesses, and disabilities than any other health condition. Tobacco addiction, caffeine addiction, and alcohol abuse are part of substance abuse.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. The use of any substance that threatens a person’s health or impairs his or her social or economic functioning is referred by what term? a. Drug dependence b. Substance abuse c. Drug addiction d. Illegal ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Substance abuse is the use of any substance that threatens a person’s health or impairs his or her social or economic functioning. Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed. Illegal means that it is against the law, not all substances are illegal.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. What does the term dependence refers to? a. Presence and severity of withdrawal symptoms b. Necessary use of drugs to prevent withdrawal symptoms c. Level of intoxication associated with addiction d. Amount of substance needed to satisfy cravings ANS: B Dependence refers to the necessary use of drugs to prevent withdrawal symptoms. This occurs because of a state of neuroadaptation (a physiological change in the central nervous system).

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 5. What happened in the United States because of prohibition? a. Substance abuse declined. b. Violent crime and corruNptio URnSinIcre NGased TB. .COM c. The need for community health nurses declined. d. Facilities to treat substance abuse improved.

ANS: B Prohibition led to increased crime and corruption among law officials related to the illicit market. Because of the problems that were caused, prohibition was eventually recognized as a failure and repealed.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Which factor has contributed to the problem of substance abuse? a. Increased knowledge about the use of drugs b. Social acceptability of certain drugs c. Recognition of substance abuse as a health problem d. Control of the content and strength of illegal drugs ANS: B Social acceptance of certain drugs, such as caffeine, alcohol, and tobacco, contributes to the substance abuse problem. Not all substances that are abused are illegal.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

7. A nurse is caring for a client who is experiencing a drug addiction. Which of the following is the client most at risk for having? a. Infant with a high birth weight b. Easily cured illness or disease c. Accident or committing suicide d. Problem finding employment ANS: C ATOD abuse and addiction is associated with many problems, including neonates with low birth weights and congenital anomalies; accidents, homicides, and suicides; chronic diseases such as cardiovascular disease, cancer, lung disease, hepatitis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS); and mental illness.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. What is the oldest and most widely used psychoactive drug in the world? a. Marijuana b. Heroin c. Alcohol d. Cocaine ANS: C The oldest and most widely used psychoactive drug in the world is alcohol. Marijuana is the most widely used illicit druN g inRtheIUnG itedBS. taC tes.M DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. How much alcohol can the liver metabolize in an hour? a. 1 oz of whiskey b. 3 oz of wine c. 5 oz of wine d. 12 oz of beer ANS: D The amount of alcohol the liver can metabolize per hour is equal to about 3/4 oz of whiskey, 4 oz of wine, or 12 oz of beer.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. What is the most widely used federally prohibited drug in the United States? a. Alcohol b. Heroin c. Cocaine d. Marijuana ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Marijuana is the most widely used drug prohibited by the United States’ federal government. The oldest and most widely used psychoactive drug in the world is alcohol.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11.

Which statement about nicotine and smoking is accurate? a. Cigars contain higher doses of nicotine than cigarettes. b. Tolerance to nicotine takes days to develop. c. Sidestream smoke contains more toxic compounds than mainstream smoke. d. The harsher smoke of pipes and cigars is more hazardous than cigarette smoke.

ANS: C It is true that sidestream smoke contains greater concentrations of toxic and carcinogenic compounds than mainstream smoke. Pipes are less hazardous than cigarettes because the harsher smoke discourages deep inhalation. The body quickly develops tolerance to nicotine.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. The nurse is interviewing a client who reports that he drinks alcohol when snorting cocaine.

Which of the following best describes what is happening with this client? a. Drug addiction b. Polysubstance use c. Substance abuse d. Indiscriminate drug useNURSINGTB.COM ANS: B A client who drinks alcohol when snorting cocaine is suffering from polysubstance abuse.

Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.

Substance abuse is the use of any substance that threatens a person’s health or impairs his or her social or economic functioning. Indiscriminate drug use refers to careless use of drugs.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is caring for a client who has had long-term marijuana use. Which of the following physical effects is the priority concern to the nurse? a. Constipation b. Cardiac dysrhythmia c. Abdominal pain d. Respiratory tract damage ANS: D Respiratory tract damage occurs from smoking the drug and is the greatest physical concern among chronic users. Cardiac dysrhythmias may be a concern of chronic alcohol use.

Constipation and abdominal pain are not of priority concern.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is providing education to a parent-teacher organization about substance use and abuse among children. Which of the following information would the nurse most likely include in this presentation? a. Inhalants are among the first drugs that young children use. b. Implementing the Drug Abuse Resistance Education (DARE) program is the most effective way to prevent drug use. c. Underage drinking is not a problem in most communities. d. Early experimentation with substances decreases the likelihood of future abuse.

ANS: A Inhalants are among the first drugs that young children use. The primary abusers of most inhalants are adolescents who are 12 to 17 years of age. Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use. Underage drinking is seen as the most serious drug problem for youth in the United States. The younger a person is when beginning intensive experimentation with drugs, the more likely dependence will develop.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 15. The nurse is providing community health education about how alcohol affects the body.

Which individual behavior would the nurse describe as being most likely to contribute to the lowest blood alcohol concentration? a. Consuming a drink withNaUhRigh SIcon NGcen TBtr.atCionOMof alcohol b. Drinking alcohol without consuming food c. Being of the female gender d. Having a high body weight ANS: D An individual with a high body weight would likely have the lowest blood alcohol concentration. Increased alcohol concentration, drinking without consuming food, and being a female are all factors that increase blood alcohol concentration.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. What is the leading cause of preventable birth defects in the United States? a. Cigarette smoking b. Fetal alcohol syndrome c. Marijuana use d. HIV from sharing needles ANS: B The leading preventable cause of birth defects in the United States is fetal alcohol syndrome, causing mental and behavioral impairment.

DIF:

Cognitive level: Remembering

TOP: Nursing process: Evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is providing care for a family in which a nonaddict is experiencing a stress-induced preoccupation with an addict’s life, leading to extreme dependence on the addict. Which of the following best describes what is happening? a. Obsession b. Codependency c. Enabling d. Addiction ANS: B Codependency occurs when a person in a close relationship with an addict develops unhealthy coping mechanisms to continue the relationship. Obsession is a thought that continually preoccupies ones’ thoughts. Enabling is the act of shielding or preventing the addict from experiencing the consequences of addiction. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A client has not yet made a commitment to act to change personal health behaviors. Which stage of change is the client experiencing? a. Precontemplation b. Contemplation c. Preparation d. Action ANS: B During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the preparation phase, the individual is prepared for action and may reduce the problem behavior but has not yet taken effective action. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse is working with a client during a smoking cessation program. The client has developed an action plan for smoking cessation but has not yet implemented it. Which stage of change is the client experiencing? a. Precontemplation b. Contemplation c. Preparation d. Action ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank During preparation, the individual is prepared for action and may reduce the problem behavior but has not taken effective action yet. During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A school nurse is coordinating the implementation of a drug education program in the school. Which of the following levels of prevention is being implemented? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Primary health care prevention ANS: A Primary prevention includes education about drugs and guidelines for their use, preventing the problem before it occurs. Secondary prevention aims for early detection and screening.

Tertiary prevention addresses treatment and rehabilitation. Primary health care prevention is not a level of prevention.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. A nurse is assessing a client for addiction. Which of the following primary symptoms of U S N T O addiction should the nurse recognize? a. Anger b. Apathy c. Denial d. Violence ANS: C In assessing for addiction, the nurse should be aware that a primary symptom of addiction is denial. Anger, apathy, and violence are not considered the primary symptoms of addiction.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is giving advice using the acronym FRAMES. Which of the following actions would most likely be taken by the nurse? a. Offer a suggestion as to how the behavior should change. b. Provide clear guidance to change risky behavior. c. Refer the client to a local support group. d. Emphasize the need for others to support the client’s change.

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Providing clear advice to change risky behavior is one of the elements of the FRAMES method of intervention, “A”—advice. The other FRAMES are feedback, responsibility, menu, empathy, and self-efficacy.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 23. A nurse is caring for adolescents who have experienced substance abuse. Which of the following should the nurse recognize as a major influence in this population? a. Family-related factors b. Positive media messages c. Socioeconomic level d. Peer pressure ANS: A Substance abuse among adolescents is influenced most by family-related factors, such as genetics, family stress, and parenting styles. Research suggests that successful social influence-based prevention programs may be driven by their ability to foster social norms that reduce an adolescent’s social motivation to begin using ATODs. Peer pressure and socioeconomic level may play a role in the abuse of substances, but this has not been the major factor identified. Media messages promoting the use of substances may influence this population but is not the major factor that has been identified.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance eU haRrm 24. A nurse is implementing thN Iredu Gctio Bn.mCode Ml. Which of the following will be the S N T O focus of nurse when using this approach? a. Education b. Law enforcement c. Scare tactics d. Rehabilitation ANS: A The harm reduction model accepts the reality that psychoactive drug use is endemic, and it focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug abuse and get treatment for addicts. The harm reduction model encourages nurses to seek the underlying roots of various health problems and plan action that is realistic, nonjudgmental, holistic, and positive. Law enforcement, scare tactics, and rehabilitation are not part of the harm reduction model.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. A nurse recommends to a school board that other methods besides the “just say no” approach be considered when providing drug use prevention education to the elementary students. Which of the following best describes the rationale for this recommendation? a. Children do not like to hear the word “no,” and the approach is too negative. b. Project DARE is more effective and has decreased drug use. c. Children are naturally curious and may experiment with drugs.

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Public Health Nursing 10th Edition Stanhope Test Bank d. “Just say no” to drugs does not include smoking and alcohol abuse.

ANS: C The “just say no” approach does not help young people because children are naturally curious and drug experimentation is often a part of normal development, children from dysfunctional homes often use drugs to get attention and escape intolerable environments, and it does not address the powerful component of peer pressure. Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 26. A nurse is providing comprehensive education about HIV transmission for an injection drug user (IDU). Which of the following would be the most important information to include? a. How and where to acquire needles b. Proper needle usage and possible injection sites c. Spreading of the virus via homosexual activities d. Using bleach between needle uses ANS: D IDUs represent the most rapidly growing source of new cases of AIDS, and they are the greatest risk for spread of the virus in the heterosexual community. Emphasis is being placed on reduction of the transmission of this disease through contaminated needles.

Nurses should provide education on cleaning needles with bleach between uses to decrease the spread of the virus. Education on needle exchange programs is also appropriate; however, this population isNnotRas lI ikelG y toBu. seCtheMse programs even when they are available.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 27. A nurse has collected a urine specimen from a client for drug testing. Which of the following best describes the purpose of a urinalysis? a. To assess whether a certain drug has been used in the recent past b. To determine the degree of intoxication c. To assess the extent of performance impairment d. To determine how much alcohol was consumed ANS: A The nurse collects a urine specimen with the rationale that urinalysis for drug testing can be used to determine whether a certain drug has been used in the recent past. Urine testing indicates only past use of certain drugs, not intoxication. The extent of performance impairment cannot be determined with urine testing. Alcohol is not always included in a urine drug screen.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse is assessing the community for potential settings of drug experiences. Which of the following describes what the nurse would most likely identify?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

A back alley or abandoned building where people are using crack.

An area at the local high school where students are known to smoke cigarettes.

The individuals using the drug, including that individual’s expectations.

The physical, social, and cultural environment within which the use occurs.

ANS: D Setting is the influence of the physical, social, and cultural environmental within which the use occurs. All these environments influence the use of drugs. A back alley, an area at the local high school, and individuals using the drug do not address all of the aspects of setting.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse is assessing the drug use patterns of a client. Which of the following questions would be most appropriate for the nurse to ask? a. Where was the drug acquired? b. Who gave the drug to you? c. Why do you use the drug? d. How often do you use the drug?

ANS: D During an assessment, all relevant drug-use history is collected and aids in the assessment of drug-use patterns. The nurse should note any changes in drug-use patterns over time. Thus, the most appropriate question is the nurse asking how often a client uses drugs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health ProNmoR tionIandGMB ai. ntC enaM nce 30. A nurse refers a client to alcoholics anonymous (AA). Who will play the most important role in the treatment of alcoholism at this support group? a. Self b. Spouses c. Children d. Peers ANS: D AA began a strong movement of peer support to treat a chronic illness. The fellowship, support, and encouragement among AA members provide a vital social network for the person recovering from an addiction.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 31. A nurse partners with multiple agencies in the community to create a support group for those diagnosed with addiction in the community. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: C When using tertiary prevention, the nurse focuses on treatment and rehabilitation. The support group for those with addiction is helping the addict and the addict’s family, who already “have a problem.” Primary prevention focuses on health promotion and disease prevention. Secondary prevention focuses on early detection and screening. Health promotion is not a level of prevention.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 32. A nurse lobbies with legislators for the passage of legislation to prohibit smoking of tobacco products in public places. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion ANS: A When using primary prevention, the focus is on health promotion and disease prevention.

When using tertiary prevention, the nurse focuses on treatment and rehabilitation.

Secondary prevention focuses on early detection and screening. Health promotion is not a level of prevention.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is caring for a client who has a history of chronic alcohol abuse. Which of the following medical problems should the nurse anticipate? (Select all that apply.) a. Gastrointestinal disturbances b. Cardiac dysrhythmias c. Depression d. Organic brain syndrome e. Hepatitis B ANS: A, B, C, D Gastrointestinal disturbances, cardiac dysrhythmias, depression, and organic brain syndrome are some effects of chronic alcohol abuse.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 38: Violence and Human Abuse Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which group has the highest rate of violence? a. Older, Caucasian men b. Young, minority men c. Young, Caucasian women d. Older, minority women ANS: B Young, minority men have the highest rate of unemployment in the United States, ranging upward to 50% even in times of prosperity. Unemployment may precipitate aggressive outbursts. Most analyses conclude that the differential rates of violence between African Americans and Caucasians in the United States have more to do with socioeconomic disparities, such as poverty, unemployment, and overcrowding, than with race.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Homicide is the third leading cause of death among which population? a. Individuals between 15 and 34 years of age b. Native American infants c. Caucasian women betwN eeUnR2S 5I anNdG3T 4B ye.aC rs O ofMage d. African American children between 15 and 19 years of age ANS: A Homicide is the third leading cause of death for individuals between 15 and 34 years of age.

Rates of homicide for children under the age of 1 were highest in Non-Hispanic blacks and American Indian/Alaska Native infants.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. What factor associated with crime and violence is particularly important to community health nursing practice? a. Violence is a universal problem. b. Violence impacts everyone in the United States. c. Nurses must spend a great deal of time on the results of violence. d. Significant mortality and morbidity result from violence.

ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Communities across the United States are concerned about crime and violence rates because of significant mortality and morbidity that often result. These issues are closely related to community health nursing. While it is true that violence is universal, and so to some degree affects all citizens, resulting in the need for nursing care, these issues relate to nursing in general and especially to those nurses involved in direct care of the patient’s physical and emotional needs.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. Which statement about rape is true? a. Rural areas are high-risk areas for rape to occur. b. Most rapes occur in the winter. c. Male victims suffer more emotional trauma than females. d. College women are at high risk for experiencing rape.

ANS: D College women are at particularly high risk for sexual victimization in the United States, with research estimating that approximately 20% to 25% of female college students will experience an attempted or completed rape at some point during their college experience.

It appears that the emotional trauma for a male rape victim is at least as serious as that for a woman.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care oU beRpe rpet 5. Homicides are least likely tN SI NGrate TBd .byCwh OMat cohort? a. Friends b. Acquaintances c. Family members d. Strangers ANS: D Homicides are least likely to be committed by a stranger. When strangers are involved, many of these are related to the illegal substance abuse network. Homicides are usually perpetrated by friends, acquaintances, or family members during an argument.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Of the following, what is the greatest risk factor for suicide in adult women? a. Divorce b. Unemployment c. Intimate partner violence d. Terminal illness ANS: C The second greatest risk factor for actual and attempted suicide in adult women is intimate partner violence. Mental health is the greatest risk factor.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A public health nurse (PHN) is working in a community where there have been multiple closures of large factories, leaving many individuals without employment. Which of the following is this population most at risk for? a. Becoming an abuser at home b. Committing violence in and outside the home c. Developing addictive behaviors d. Neglecting the needs of their children ANS: B Unemployment is associated with violence within and outside the home. Abuse may increase both in and outside of the home due to unemployment. Applying for unemployment benefits is not a risk for this population. Neglecting the needs of their children only addresses what could happen inside of the home and not outside of the home.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. A nurse is developing a community program to prevent violence. Which of the following should be the first action taken by the nurse? a. Talk to people who are victims of violence for their opinion. b. Identify factors that lead to violence. c. Develop a plan of action to combat violence. d. Evaluate current community programs.

ANS: B A community’s population can influence the potential for violence. The starting point is the identification of factors that lead to violence, such as poverty, urban crowding, and racial inequality. In addition, one’s perceptions of the safety in a community can be influenced by racism and perceptions of criminality.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 9. A nurse is counseling a client who has been abusive toward a spouse. Which of the following experiences has the client most likely had in the past? a. Perceived or actual crisis b. History of social isolation c. Previous exposure to violence d. Long-term marital strain ANS: C Perpetrators of intimate partner violence often believe that violence within an interpersonal relationship is a normal behavior pattern, based on their upbringing, living conditions, and increased stress.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

10. A nurse is working with children who may be at risk for experiencing abuse. In which situation involving parents is child abuse most likely to occur? a. When they have high expectations for their children. b. When their sense of control is threatened. c. When they are overly sensitive to their children’s needs. d. When there is a lack of a social support network.

ANS: D Parents with a lack of social support, history of abuse as a child, or who have minimum education, a tendency toward depression, or multiple stress factors may be at risk for abusing their children. Parents who have high expectations for their children or are sensitive to their children’s needs do not have a tendency toward abuse. Parents who have their sense of control threatened do not have a tendency toward abuse.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. What type of abuse is occurring when a child does not receive the basic nurturing and caring needed for healthy development? a. Sexual abuse b. Emotional neglect c. Physical neglect d. Child abuse ANS: B Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child.

Nprov RSide INade GTquate B.CfO M Physical neglect is failure to U ood, proper clothing, shelter, hygiene, or necessary medical care and is most often associated with extreme poverty. Child abuse ranges from violent physical attacks to passive neglect. Sexual abuse is a form of child abuse when a child has had nonconsensual sexual contact of any kind.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. A nurse is caring for a child who lives in extreme poverty. Which of the following types of abuse is this child at greatest risk for? a. Sexual abuse b. Emotional neglect c. Physical neglect d. Child abuse ANS: C Physical neglect is failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care. Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child. Child abuse ranges from violent physical attacks to passive neglect.

Sexual abuse is a form of child abuse when a child has had nonconsensual sexual contact of any kind.

DIF:

Cognitive level: Applying

TOP: Nursing process: Assessment

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Health Promotion and Maintenance 13. A nurse is making a home visit to a low-income, frail, older person’s home. Which of the following would most likely cause the nurse to suspect adult maltreatment? a. The older person reports giving money to family members on a regular basis. b. The house is in need of serious structural repair. c. The older person spends a great deal of time watching television. d. There are dogs running loose in the yard of the home.

ANS: A Older adults are at risk for financial abuse through fraud, coercion to relinquish property rights, and money mismanagement. A low-income, frail, older person would most likely not be giving money to family members on a regular basis, because the client would need the money to meet basic needs.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is working with a recent rape survivor. Which of the following actions would be most appropriate for the nurse to implement? a. Provide continuous care once the victim enters the health care system. b. Examine evidence for its authenticity. c. Work with the criminal justice system to find the rapist. d. Provide long-term therapy for psychological trauma.

ANS: A Not only do nurses often provide continuous care, but also in some states nurses are trained N R gath INerGfTorensic B.COevidence.

M as sexual assault examiners wUho S Nurses provide victims with privacy, respect, and assurance of confidentiality. The nurse would not be providing long-term therapy for the survivor or have the responsibility to find the rapist.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 15. A nurse is completing a community assessment. Which of the following community characteristics would be identified as a factor for violence? a. Lack of family cohesion b. High crime rate c. Social isolation d. Substance abuse ANS: B High crime rate is the only “community characteristic.” Lack of family cohesion is a familial factor. Social isolation and substance abuse are individual factors.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 16. A nurse helps the community to take a stand against violence and advocates for elected officials and local media to make non-violence a priority. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Primary care ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Being an advocate for non-violence demonstrates primary prevention. Secondary prevention refers to interventions aimed at early detection and screening. Tertiary prevention refers to interventions aimed at treatment and rehabilitation.

Primary care is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse assists an injured victim in finding a safe location to live after being abused. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Primary care ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or N R ictim INGofTabuse B.CO M disability. Finding shelter forUa vS demonstrates secondary prevention. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Primary care is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 18. A nurse is providing tertiary prevention. Which of the following interventions should be included? a. Education b. Prevention c. Referral d. Detection ANS: C Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Nurses should know about available community resources for abuse victims and perpetrators.

Education and prevention primarily deal with primary prevention strategies. Detection is part of secondary prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

19. A nurse is assessing an individual who has been the victim of domestic violence. Which part of the body should the nurse assess first? a. Front of the body b. Back of the body c. Proximal parts of the body d. Distal parts of the body ANS: C Attacks are often inflicted on proximal parts of the body that can easily be disguised by clothing, so the nurse should assess this area first.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse is caring for a woman who has been battered for several years. Which of the following has the client most likely seen an increase in over the years? a. Self-blame b. Remorse by the man c. Severity of the abuse d. Emotional strength ANS: C Severity of abuse and its frequency is most likely to increase over time. Both the man and the woman tend to blame the incident on something external. The man’s remorse tends to lessen over time.

N R I G B.C M

DIF: Cognitive level: AnalU yzinSg N T TOO P: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 21. A nurse working at a battered woman’s shelter is counseling a pregnant woman who has just entered the shelter. When assessing the client’s history, which information would the client most likely report? a. Abuse before pregnancy b. Child abuse c. Multiple pregnancies d. Substance abuse ANS: A Abuse before pregnancy is the most important risk factor for physical battery during pregnancy. A history of child abuse, multiple pregnancies, and substance abuse are not as closely associated with the risk of physical battery during pregnancy.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 22. A child has reported to the school nurse that he is being bullied. Which of the following is most likely happening to this child? a. Difficulty talking to the guidance counselor b. Inclusion in group activities

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Public Health Nursing 10th Edition Stanhope Test Bank c. Intimidation by a peer d. Discipline from parents at home ANS: C Bullying has become a major problem in schools. Bullying can be physical and/or psychological abuse, intimidation, or verbal abuse; the exclusion of some children in group activities is another form of bullying.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 23. A community health nurse visits a home and notices multiple bruises on a 4-year-old child.

The mother reports that her husband is an alcoholic and is currently sleeping. What is the most appropriate action for the nurse to take? a. Question the mother about sexual abuse. b. Initiate interventions directed at family violence. c. Report the case of suspected child abuse to authorities. d. Refer the mother to a social worker or Al-Anon group.

ANS: C It is required by law that nurses report all cases of suspected child abuse. The mandatory reporting laws protect reporters from legal action on cases that are never substantiated. It is essential that this is the first action to be taken by the nurse. After this action is taken, it may be appropriate to initiate interventions related to decreasing family violence or asking specifically about abuse. Referral of the mother to a social worker would not assist in decreasing the potential abuse that may be occurring.

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DIF: Cognitive level: AnalU yzinSg N T TOO P: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is assisting with community planning. Which of the following facilities should the nurse encourage be developed to reduce the potential for crime and violence in the community? (Select all that apply.) a. Playgrounds b. Movie theaters c. Swimming pools d. Shopping malls e. Restaurants ANS: A, B, C Recreational facilities including playgrounds, movie theaters, and swimming pools all provide socially acceptable outlets for a variety of feelings, including aggression. Shopping malls and restaurants would not be considered recreational facilities.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank 2. A nurse is providing care to a child who has been abused. Which characteristics are most likely present in this child’s family? (Select all that apply.) a. The parents are unemployed. b. There is no support network willing to help. c. The parents are not knowledgeable about child development. d. The mother seems frightened of her partner. e. There is no primary caregiver in the home.

ANS: A, B, C, D Risk factors for child abuse include unemployed parents, no support network, parents not knowledgeable about child development, and a mother who fears her partner.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 39: The Advanced Practice Nurse in the Community Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about advanced public health nurses (APHNs) and nurse practitioners (NPs) is correct? a. They often work in similar settings. b. They have identical educational preparation. c. Their practices have become more similar during the past decade. d. The clinical nurse specialist role always involves prescriptive practice.

ANS: A APHNs and NPs often work in similar settings. APHNs and NPs have differing educational preparation depending on the specialty focus. The practices have continued to differ during the past decade. The clinical nurse specialist role typically does not involve prescriptive practice.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse practitioner (NP) movement began at the University of Colorado with nurses providing what type of care? a. Maternity d. Diabetes b. Well-child c. Nursing home ANS: B It was determined that educating community-oriented nurses could decrease morbidity among medically deprived children. Nursing practice for pediatric NPs included the identification, assessment, and management of common acute and chronic health problems, with appropriate referral of more complex problems to physicians.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. An advanced practice nurse (APN) uses knowledge and physical, psychosocial, and environmental assessment skills to respond to common health and illness problems. Which of the following best describes this individual? a. Clinical nurse leader b. Advanced public health nurse (APHN) c. Nurse practitioner (NP) d. Clinical nurse specialist ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank An NP applies nursing knowledge with physical, psychosocial, and environmental assessment skills. An advanced practice nurse is a licensed professional nurse prepared at the master’s level or doctoral level to take leadership roles in applying the nursing process and public health sciences to achieve specific health outcomes for the community. An APHN has a minimum of a master’s degree and has specialized courses related to public health. Clinical nurse specialists influence care outcomes by providing expert consultation for nursing staffs and by implementing improvements in health care delivery systems.

Clinical nurse leader is a master’s degree–prepared generalist who functions at the institution’s microsystem level and assumes accountability for health care outcomes for a specific group of clients within a unit or area.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse practitioner (NP) is employed in a primary health care setting. Which services are most likely provided in this setting? a. Primary health services and prison medicine services b. Public health and primary care services c. Family practice and geriatrics care d. Home health and school health services ANS: B Primary health care includes public health and primary care services.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which statement accurately describes how nurse practitioner (NP) programs began?

U S N T O a. Started as a physician’s assistant program. b. Were an offshoot of midwifery. c. Have not always required a master’s degree. d. Began in Europe and didn’t reach the United States until 1970.

ANS: C The early NP degree programs were often continuing education programs and certificate programs that did not require a master’s degree or even a baccalaureate degree. NP programs began with a focus on well children. The NP movement began in 1965 at the University of Colorado.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A student is pursuing a graduate nursing education with preparation as a generalist, functioning at the micro-systems level, and assuming accountability for health care outcomes for a specific group of clients. Which educational preparation is this student receiving? a. Clinical nurse leader (CNL) b. Advanced public health nurse (APHN) c. Nurse practitioner (NP) d. Doctor of Nursing Practice (DNP)

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: A A clinical nurse leader is defined as a nurse who is a master’s prepared generalist who functions at the micro-system level and assumes accountability for health care outcomes for a specific group of clients within a unit or area. An NP applies nursing knowledge with physical, psychosocial, and environmental assessment skills. An APHN has a minimum of a master’s degree and has specialized courses related to public health. A DNP is the preferred educational preparation for specialty advanced practice nurses.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A registered nurse (RN) would like to become a nurse practitioner (NP). Which level of education is required? a. Bachelor of science in nursing degree b. Master’s or higher degree in nursing and NP education c. Bachelor of science in nursing degree and completion of a formal NP program d. Master’s degree with a specialty in public health nursing ANS: B As of 1992, the American Nursing Credentialing Center (ANCC) required a master’s degree or higher for NP certification. The practice doctorate is encouraged for NP certification but is not required.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Opleting the process for certification renewal 8. An advanced public health nuUrseS(APNHNT) is com in the specialty. What time period has passed making renewal necessary? a. 1 year b. 3 years c. 5 years d. 7 years ANS: C Certification for APHNs and NPs is for 5 years.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. An advanced practice nurse (APN) is pursuing professional certification. Who will the nurse need to contact to obtain certification? a. American Nurses Association b. National League for Nursing c. State board of nursing d. Department of Health and Human Services ANS: A Examinations are administered through the ANCC, which is part of the American Nurses Association. The National League for Nursing and state board of nursing do not provide professional certification for advanced practice nurses.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. An advanced practice nurse (APN) has obtained certification. Which of the following provides the rationale for receiving certification? a. Assures competence at an advanced level. b. Verifies minimal competency levels of practice. c. Creates a network for nurses to collaborate. d. Making becoming a nurse a challenging process.

ANS: A The purpose of certification is to assure the public that nurses who claim to be competent at an advanced level have had their credentials verified through examination. Licensure verifies minimal competency levels of practice, not certification. Certification does not regulate the ability to become a nurse; that occurs with licensure. Certification does not create a network of nurses for the purpose of collaboration.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. In which role are the most differences seen between the advanced public health nurse (APHN) and the nurse practitioner (NP)? a. Administrator b. Clinician c. Consultant d. Educator ANS: B Many differences are seen between the APHN and the NP in the clinician role. APHNs are focused on the needs of the overall community, whereas NPs are focused on the care of individuals. APHNs and NPs both provide education within a nursing framework and as a professional nurse educator. Both may have administrative roles within the agency setting.

Both may serve as consultants to help with problem solving for an individual, family, or community to improve health care delivery.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. An advanced public health nurse (APHN) is offering classes on breast self-exam. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Classes on breast self-exam focus on preventing the occurrence of breast cancer. Secondary prevention refers to those interventions aimed at early detection and screening. Tertiary prevention refers to those interventions aimed at treatment and rehabilitation. Assessment is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. A population-focused advanced public health nursing (APHN) activity is implementing a secondary prevention strategy. Which of the following best describes the intervention that is being completed? a. Flu immunizations at churches b. Education on need for early detection c. Screenings for blood pressure and cholesterol d. Follow-up clinics for diabetics ANS: C Secondary prevention focuses on early detection and screening—screenings for blood pressure and cholesterol. Flu immunizations at churches and education on need for early detection are primary prevention strategies, and follow-up clinics for diabetes are a tertiary prevention strategy.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance nur seS(A roC vide 14. An advanced public healthN R IPH GN) Bp. Ms other nurses with information about how U N T O to improve client care. Which of the following roles is being performed? a. Researcher b. Administrator c. Educator d. Consultant ANS: D The consultant role is being practiced when an APHN provides other nurses with information on improving client care. As a researcher, the advanced practice nurse conducts their own investigations and collaborates with doctorate-prepared nurses, answering questions related to nursing practice and primary health care. As an administrator, the advanced practice nurse may be responsible for and have direct or indirect authority and supervision over the organization’s staff and client care. As an educator, the advanced practice nurse provides formal and informal teaching.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. An advanced public health nurse (APHN) is working as an administrator. Which of the following would the nurse most likely be doing? a. Engaging in consultation and problem solving with individuals, families, and the community b. Providing direct authority and supervision over the staff and client care

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Public Health Nursing 10th Edition Stanhope Test Bank c. Working with doctorate-prepared nurses on research projects d. Educating the public on current health care practices ANS: B The APHN functioning in the role of administrator is often responsible for and has direct authority and supervision over the staff and client care. As a consultant, the APHN engages in consultation and problem solving with individuals, families, and the community. As a researcher, the APHN works with doctorate-prepared nurses on research projects. As an educator, the APHN educates the public on current health care practices.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. An advanced public health nurse (APHN) has recently been hired by a public health department. Which of the following best describes what the APHN will most likely be doing in this role? a. Diagnosing health problems b. Managing chronic disease c. Limiting disability d. Conducting community assessments ANS: D Practicing within the role of clinician, the APHN is involved in conducting community assessments; identifying needs of populations at risk; and planning, implementing, and evaluating population-focused programs to achieve health goals. Diagnosing health problems, managing chronic disease, and limiting disability are roles of a nurse practitioner (NP).

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse practitioner (NP) has recently been hired by a public health department. Which of the following best describes what the NP will most likely be doing in this role? a. Disease prevention activities b. Deciding on a treatment plan c. Identifying needs of populations at risk d. Identifying health needs of the community ANS: B In the role of a clinician, the NP diagnoses actual or potential health problems; decides on treatment plans jointly with clients; intervenes to promote health, to protect against disease, to treat illness, to manage chronic disease, and to limit disability; and evaluates with the client and other primary care team members about how effective and comprehensive the nursing intervention may be in providing continuity of care. Disease prevention activities, identifying needs of populations at risk, and identifying health needs of the community are roles of an advanced public health nurse (APHN).

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 18. An advanced public health nurse (APHN) has been working with multiple agencies to establish a nursing center in the community. What is the purpose of creating a nursing center? a. To provide opportunities for collaborative relationships b. To offer specialized care for certain medical conditions c. To promote the autonomy of nurse practitioners (NPs) d. To focus on primary prevention for the community ANS: A Nursing centers provide opportunities for collaborative practice among APHNs, NPs, baccalaureate-prepared nurses, and community members. Nursing centers address the health needs of vulnerable populations. Their central mission is community development; public involvement; interprofessional practice; and health promotion and disease prevention supported by the principles of primary health care.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse practitioner (NP) recently began employment in an emergency department. What would the primary role of the NP be in this setting? a. Triage clients. b. Manage non-emergent client problems. c. Assess medically uninsured clients. d. Provide health education about preventive health care.

ANS: B The primary role of the NP in emergency departments is usually to manage non-emergent N Realth INed GTucation B.COabout M preventive care most likely would uninsured clients. Provision oUf hS occur in an outpatient clinic, not in an emergency department. NPs can treat patients in this setting. Both medically insured and uninsured individuals will be seen in this practice setting.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse is performing a population-focused intervention. Which of the following activities is the nurse most likely completing? a. Setting up a health fair with nursing students at a local university b. Teaching a new mother how to breastfeed c. Completing a physical examination on a preschool child d. Contacting local officials about the rise in crime in one area of the city ANS: A Setting up a health fair with nursing students at a local university is an example of a population-focused intervention. Population-focused interventions address the needs of the community rather than only the needs of individuals. Teaching a new mother how to breastfeed and doing physical examinations on each preschool child are examples of individual-focused interventions. Contacting local officials about the rise in crime is an example of a system-focused intervention.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. An advanced public health nurse (APHN) wants to establish an independent practice. Which is the best method to achieve this goal? a. Act as a legal expert. b. Learn complex assessment skills. c. Market a service package. d. Serve as a liaison for community programs.

ANS: C One of the best ways for an APHN to establish an independent practice is to market a service package, providing certain services for a specific population. Acting as a legal expert, serving as a liaison, and learning complex assessment skills would not be helpful in establishing an independent practice.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse practitioner (NP) is investigating regulations for third-party reimbursement. Which information will the NP most likely discover? a. NPs are reimbursed when directly supervised by a physician. b. NPs only receive reimbursement when working in rural areas. c. NPs are reimbursed at 85% of the physician rate. d. NPs are unable to be reimbursed by Medicare and Medicaid.

ANS: C In 1997, with the passage of the national reconciliation spending bill, NPs can be directly reimbursed, regardless of geographic setting, at 85% of what a physician would have been paid (if the service is covered under Medicare Part B). NPs can have an independent practice and do not need direct supervision by a physician. NPs can receive reimbursement regardless of practice setting. NPs can be reimbursed by a variety of payer sources.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. Which is most likely to be a major stressor for an advanced public health nurse (APHN)? a. Autonomy of practice b. Professional isolation c. Flexible work hours d. Collaboration ANS: B The major stressor for an APHN is likely to be professional isolation, because they are likely to be hired in remote practice employment sites. Autonomy of practice in these sites attracts many NPs and APHNs. Long drives, long hours, lack of social and cultural activities, and lack of opportunity for professional development are often experienced.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

MULTIPLE RESPONSE 1. Which functions are shared by advanced public health nurses (APHNs) and nurse practitioners (NPs)? (Select all that apply.) a. Leadership b. Research c. Comprehensive assessment d. Systems focus e. Community assessment ANS: A, B, C Leadership, research, and comprehensive assessment are functions that are completed by both APHNs and NPs. The APHN is more systems focused and would conduct a community assessment, whereas the NP has an individual/family focus and would conduct an individual health assessment.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which factors cause stress for advanced practice nurses (APNS)? (Select all that apply.) a. Legal issues b. Professional isolation c. Conflicting expectations d. Role confusion e. Advanced education ANS: A, B, C Legal issues, professional isolation, conflicting expectations, liability, collaborative practice, and professional responsibilities all may cause stress for advanced practice nurses. Role confusion and advanced education are not factors causing stress for advanced practice nurses.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 40: The Nurse Leader in the Community Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Why are older adults in the community at high risk for medication errors? a. They are not competent to take their own medications and need supervision. b. They are often taking high-risk medications. c. They are not motivated to take medications correctly. d. They are in need of the assistance of community health nurses.

ANS: B Older adults often take high-risk medications and cannot read instructions for medications.

This is also complicated by polypharmacy and not understanding how to take medications that have been prescribed for them. Many older adults are competent in taking their own medications, are motivated to take it correctly, and do not need additional assistance.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A seamless system of care is created where all client needs are met through the same system. Which of the following best describes what has happened? a. Horizontal integration b. Vertical integration c. Managed care ANS: B d. Alliances Vertical integration means that the system owns all the services that clients might need, such as clinics, hospitals, laboratories, and home health agencies. Horizontal integration is not a type of seamless care. Managed care is a system in which patients only visit certain providers and hospitals. Alliances are special relationships that exist between agencies.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is functioning in the role of a community-oriented nurse manager. Which of the following interventions would most likely be performed? a. Help personnel perform their responsibilities effectively and efficiently. b. Work with others to ensure a healthy community. c. Serve as an advocate for vulnerable and high-risk populations. d. Participate in establishing public and organizational policies.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank One of the goals of nursing management is to help personnel perform their responsibilities effectively and efficiently, so it is most likely the nurse manager who would perform this intervention. Working with others to ensure a healthy community, serving as an advocate for vulnerable and high-risk populations, and participating in establishing public and organizational policies are goals of nursing leadership.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is providing nursing leadership. Which of the following interventions would most likely be completed? a. Monitoring the budget for an immunization program b. Influencing the improvement of the health of clients c. Coordinating an interdisciplinary team d. Using resources when providing clinical services ANS: B Nursing leadership refers to the influence that nurses exert on improving client health, whether clients are individuals, families, groups, or entire communities. Monitoring the budget for an immunization program, coordinating an interdisciplinary team, and using resources when providing clinical services are responsibilities of the nurse manager.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A community health center engages in a partnership with similar organizations agreeing to use common practices and N sharR e daIta w n. prC ovidMing care for diabetic clients. What type of Ghe B U S N T O group is being described? a. Collaborative b. Registry c. Partnership d. Contract ANS: A A collaborative is a group of similar organizations that agree to use common processes for providing clinical care and share certain types of data, so all may learn. Registries are examples of clinical databases dedicated to certain population groups. Partnerships are relationships among community members and community organizations. A contract involves identifying expectations and responsibilities of both parties.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is facilitating the building of community partnerships. Which of the following abilities must the nurse possess? a. Create seamless systems of care. b. Lobby with legislators. c. Listen and collaborate with lay community members. d. Coordinate care across agencies.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: C The building of community partnerships includes increasing involvement of the public to address their needs and concerns. The nurse can best facilitate this by listening and collaborating with lay community members who may have goals and ideas different from that of health care professionals. Lobbying with legislators does not influence partnerships in the community. Creating seamless systems of care is not related to building community partnerships. Coordinating care across agencies does not necessarily mean that there will be partnerships among the agencies.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse manager is evaluating the performance of an organization. Which of the following actions would most likely be taken? a. Examining best practices for organizational evaluation b. Analyzing how the core functions of public health have been implemented c. Developing a standardized nursing language to be used within the organization d. Reviewing the standards held by accrediting bodies and the guidelines for practice ANS: D To know whether an agency is performing as expected, nurses must be familiar with their professional standards of care, the standards held by accrediting bodies, and guidelines for practice. Examining best practices for organizational evaluation does not assist with actual evaluation of the organization. The core functions of public health are not used for evaluation of organizations. The standardized nursing language within the organization would not assist with evaluation of the organization’s performance.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse considers interdependence among organizations when planning health interventions for the community. Which of the following categories of theories is being applied? a. Structural contingency b. Organizational c. Resource dependence d. Systems ANS: D Systems theories and systems thinking emphasize the interdependence of multiple parties.

Organizational theories explain issues at a broader community level. The structural contingency theory suggests that organizations have a backup plan in place to guide organizational change. Resource dependence theory studies how external resources affect the behavior within the organization.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is working with a clinical microsystem. Which of the following best describes what the nurse is working with? a. Evidence-based practices

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Public Health Nursing 10th Edition Stanhope Test Bank b. Managed care organizations c. Electronic health records d. Registries ANS: C Clinical microsystems are the systems, people, information, and behaviors that take place at the point of client care. Managed care organizations are systems in which patients only visit certain providers and hospitals. Electronic health records are where all of the care that is provided is documented. Registries are examples of clinical databases dedicated to certain population groups.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is implementing the consultation process. Which of the following actions would the nurse take first? a. Making initial contact with the client b. Negotiating for higher fees c. Applying interventions d. Collecting data ANS: A The first step is the initial contact with the client. This is made when the client or someone in a family, group, agency, or community communicates with the nurse about a potential problem that requires intervention. After this has happened, a contract will be agreed upon that includes negotiating for fees as needed, collecting the data, and finally applying the interventions.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse is focusing on collaboration between the consultant and the consultee. Which of the following collaboration models is being applied? a. Content b. Doctor-patient c. Process d. Purchase of expertise ANS: C The consultation model that emphasizes collaboration between the consultant and the consultee is the process model. The major goal of this model is to help the client assess both the problem and the kind of help needed to solve it. Content models emphasize the role of consultant as the expert who provides specific answers to problems or issues identified by the client. The doctor-patient model focuses on the collaborative relationship between a physician provider and the client. In the purchase of expertise model, the client defines the problem while the consultant implements the solution to the problem.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 12. A nurse is implementing a secondary prevention intervention. Which of the following is most likely being completed? a. Developing policies and procedures for referral programs b. Designing protocols for lead screening c. Serving as a chair to organize a smallpox vaccination program d. Monitoring implementation of performance-improvement activities ANS: B Screening is performed at the secondary level of prevention. Developing policies and procedures for referral programs is at the primary level of prevention. Serving as a chair to organize a smallpox vaccination program and monitoring implementation of performance-improvement activities are at the tertiary level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. A nurse plans to begin a career working as a nurse in the community. Which of the following skills would be most important for the nurse to possess? a. Technical skills with acute care nursing as a background b. Ability to lobby and collaborate with legislators c. Computer and word-processing skills d. Ability to build coalitions and work with partnerships ANS: D Community-oriented nurses must be able to work comfortably with different types of people and cultures. This can be best accomplished by building coalitions and working with partnerships. Technical skills, the ability to lobby, and computer and word-processing skills N Re I G B.C communicate M are not as important as beingUablS toN effeTctivelyO within the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse leader would like to create a motivating workplace. Which of the following interventions would most likely be implemented? a. Discuss with employees their personal life and home commitments. b. Provide regular feedback to employees. c. Allow employees to take off work whenever necessary. d. Complete spot checks of employee’s work without notice.

ANS: B Creating a motivating workplace involves providing regular feedback to employees. This feedback allows individuals to develop plans for improving their personal capacities for achieving goals. Motivation is internal, so it is important to develop employees so that they have internal motivation to contribute to the workplace.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse would like to implement a strategy to effectively manage time. Which of the following actions will the nurse implement?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

Delegate appropriate tasks.

Arrive at the site early in the morning.

Be available to others.

Complete all tasks.

ANS: A Delegation is an important element of time management. Using this strategy will allow the nurse more time to complete the tasks that cannot be delegated. Arriving early and being available are not effective time management strategies for the nurse leader.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. Which statement about responsibility, accountability, and authority by the registered nurse (RN) when delegating tasks is correct? a. The nurse has the responsibility to delegate selected tasks to unlicensed assistive personnel. b. RNs are not accountable for tasks that have been indirectly delegated. c. If a task has been delegated, it is the responsibility of the unlicensed assistive personnel to perform the task correctly. d. Accountability for performing the task correctly is assumed by the RN. ANS: D Although responsibility may be shared with the person to whom one is delegating, accountability of the nurse is never transferred. Nurses have the authority to delegate tasks to unlicensed assistive personnel, are accountable for all tasks (even those that have been indirectly delegated), and itNis tR he rI espG onsiB bili ty oM f the nurse to assure that the delegated task .C is performed correctly.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse leader seeks input from staff nurses on a regular basis and allows for changes in practice to improve client outcomes with minimal barriers. Which of the following best describes what has occurred? a. Decision making b. Critical thinking c. Empowerment d. Delegation ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Empowerment includes increasing nurses’ authority by ensuring that they have the necessary knowledge, skills, and resources to effectively make the decisions for which they are held accountable. This means removing barriers to decision making and allowing staff nurses the authority to make client decisions in “real time,” as needs demand, rather than requiring nurses to obtain numerous approvals. Decision making is a two-step process in which the nurse first must decide how much input to seek from others and second must generate alternatives for the decision and choose among the alternatives. Critical thinking includes analyzing and synthesizing data, using knowledge and values in making judgments, and using creative approaches in decision making and problem solving. Delegation is used when appropriate tasks are assigned to the first level in the hierarchy if this employee possesses the necessary skills and knowledge to complete the task.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A school has a policy in place that allows unlicensed assistive personnel to administer medications to students after having their competency evaluated by a registered nurse (RN).

Which of the following types of delegation is being used? a. Direct b. Indirect c. Supervised d. Guided ANS: B Indirect delegation results when an agency has policies and procedures in place that allow tasks to be performed by someone other than the person who is accountable. Direct delegation involves speaking toanindividualpersonally and transferring responsibility for a task to UaS O that person. Supervision is not typeNof T delegation—supervision means decision making and implementation of activities in an ongoing relationship. Guided is not a type of delegation.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse leader is using critical thinking skills to address the problem of limited access to health care by low-income families in a community. Which of the following actions would most likely be taken by the nurse? a. Using assertiveness when working with community leaders b. Reading an evidence-based practice article about the problem c. Forming a coalition to brainstorm effective methods to address the problem d. Promoting diversity in the workplace by hiring minorities ANS: C Critical thinking includes analyzing and synthesizing data, using knowledge and values in making judgments, and using creative approaches in decision making and problem solving.

Critical thinking may be fostered using guided group discussions and through activities that stimulate creativity, such as brainstorming. The use of assertiveness, reading an evidence-based practice article, or promoting diversity does not require the use of critical thinking skills.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse leader is developing a plan to coordinate health care services in the community.

Which of the following actions would be most appropriate for the nurse leader to take initially? a. Applying a team approach to assure all points of view are represented b. Monitoring that the plan is correctly implemented c. Organizing the plan in a sequential manner d. Creating a shared vision, goals, and measurable objectives ANS: D Organizing and monitoring occur later in the process. Although planning is a collaborative activity, the foundation of planning rests with creation of the shared vision, goals, and measurable outcomes, which is achieved through a team approach.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which are goals of community-oriented nursing leadership? (Select all that apply.) a. Working with others to ensure a healthy community b. Serving as an advocate for vulnerable and high-risk populations c. Working with interprofessional teams to design ways to coordinate care d. Making policies for the public good N R I G e. Meeting the needs of the U midS dle-NclasTs familO ies ANS: A, B, C Working with others to ensure a healthy community, serving as an advocate for vulnerable populations, and working with interprofessional teams to coordinate care are goals of community-oriented nursing leadership. To make policies for the public good and meet the specific needs of middle-class families are not goals of community-oriented nursing leadership.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is developing a written contract. Which areas would most likely be included in this document? (Select all that apply.) a. Number of students involved in the project b. Client and consultant goals c. Time commitments d. Intervention strategies suggested e. Educational preparation of those involved ANS: B, C, D Client and consultant goals, time commitments, and intervention strategies suggested are areas to include in a written contract. The number of students involved in the project and the educational preparation of those involved are not part of the written agreement.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which skills will be demonstrated by a nurse who has effective communication? (Select all that apply.) a. Active listening. b. Restate the main points. c. Use simple, direct words. d. Maintain eye contact. e. Speak slowly.

ANS: A, B, C Active listening, restating the main points, and use of simple, direct words are all examples of effective communication skills. Maintaining culturally appropriate eye contact is important, which in some cultures may mean avoiding eye contact. It is important to speak clearly, not necessarily slowly.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. Which information is included in an action plan? (Select all that apply.) a. Time frame for completing the activities b. Identification of team members who created the plan c. Program goals and objectives d. Evidence-based practice literature e. Client goals ANS: A, C Information included in an action plan includes the time frame for completing the activities, program goals and objectives, activities to meet the objectives, identification of those responsible for each activity, and the plan for evaluating achievement of the objectives. The identification of team members who created the plan, evidence-based practice literature, and client goals are not part of the action plan.

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 41: The Nurse in Public Health, Home Health, Hospice, and Palliative Care Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. How are official agencies financed primarily? a. Charities b. Individual clients c. Third-party payers d. Tax funds ANS: D Official agencies are financed primarily by tax funds. These agencies are typically operated by state, county, city, or other local government units, such as health departments.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Medicare-certified home health agencies place emphasis on what type of care? a. Chronic b. Distributive c. Intermittent d. Primary ANS: C As part of the Conditions of Participation, Medicare-certified home health agencies must place an emphasis on intermittent care. Home care services that are provided must be intermittent and provide a skilled service. Primary care refers to the care that is often provided in a physician’s office. Medicare-certified agencies provide care following an acute hospitalization or medical change; they do not provide long-term care for chronic illnesses.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A home care nurse is employed by a proprietary agency. Which statement is true about such an agency? a. It is exempt from federal income taxes. b. It is governed by a board of directors. c. It is a profit-making agency. d. It is reimbursed primarily by tax funds.

ANS: C Proprietary agencies are profit-making agencies. Proprietary agencies are free-standing, for-profit agencies that are required to pay taxes. Many are part of large chains and now dominate the home care industry.

DIF:

Cognitive level: Applying

TOP: Nursing process: Evaluation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is coordinating care to ensure a comfortable and peaceful death. Which of the following factors should be an important consideration for the nurse? a. The unique stress dying patients often experience b. The cultural values, expectations, and preferences of the family c. The communication style of each family member d. The abilities of the nurse and health care team ANS: B Cultures vary in their beliefs and responses to death. Nurses should know the differences in cultural responses so that they can effectively help people in their time of need. It will be important for the nurse to take cues from the client and the loved ones regarding their needs.

The stress experienced by dying patients is different based on the client’s culture.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse has referred a home care client to hospice care. Which of the following best explains the rationale for this referral? a. To provide comfort and peace at a difficult time b. To reduce the cost of care for the terminally ill c. To keep clients at home until the end of life d. To provide care for terminally ill clients expected to live longer than 6 months ANS: A The focus of hospice care is comfort, peace, and a sense of dignity at a very difficult time.

N has RS Icont GTinuity B.CoOf M Comprehensive services empU ize N care. Hospice care is provided for those with a life expectancy of less than 6 months. Hospice is the only Medicare benefit that includes medications, medical equipment, 24 hours/7 days a week access to care, and support for family members after death. Hospice care does not reduce the cost of care.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The nurse provides direct care services to a stroke victim to avoid complications. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Thus, direct care for a stroke victim is focusing on limiting disability and encouraging rehabilitation. Primary prevention focuses on preventing the disease before it occurs. Secondary prevention focuses on early detection and screening. Assessment is not a level of prevention.

DIF:

Cognitive level: Applying

TOP: Nursing process: Implementation

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Public Health Nursing 10th Edition Stanhope Test Bank MSC: NCLEX: Health Promotion and Maintenance 7. A nurse is providing a skilled nursing service. Which of the following best describes the intervention the nurse is performing? a. Teaching the client and family about medication administration b. Consulting with other nurses about the care of a client in the home c. Coordinating services for maximum benefit at minimal cost d. Reviewing nursing assistant charting at the end of each day ANS: A Skilled nursing service is the Medicare term that describes the duties of the registered nurse and refers to the requirement of nursing judgment. Those services involve assessment, teaching, and selected procedures. Teaching the client and family to implement a therapeutic plan, such as taking medications, is an example of a skilled nursing service. Consultation, coordination, and review of documentation do not fit the definition of a “skilled nursing service.”

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is employed in home health nursing practice. Which of the following terms best describes the care that is being provided? a. Intermittent nursing care b. Custodial care c. Family caregiving d. Palliative care ANS: A Provision of intermittent skilled visits is a component of home health care nursing.

Custodial care refers to the care given in long-term care facilities. Family caregiving may be an important role of keeping the client at home, but it is not a necessary component of home care. Palliative care is an extended continuum of chronic serious illness to acute serious illness during which stabilization and exacerbations may occur.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which organization publishes the current scope and standards of home care practice? a. Centers for Medicare and Medicaid Services b. American Nurses Association (ANA) c. Robert Wood Johnson Foundation d. Visiting Nurse Association ANS: B The ANA publishes scope and standards for Home Health Nursing and Hospice and Palliative Nursing. The Centers for Medicare and Medicaid Services control the regulations and reimbursement mechanisms for the majority of home care services. The Robert Wood Johnson Foundation provides grant funding for a variety of projects that support nursing.

The Visiting Nurse Association is a home care agency.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse has discovered that a client should be receiving Meals on Wheels. Which of the following steps of the nursing process is the nurse performing? a. Diagnosis b. Planning c. Assessment d. Implementation ANS: C The Standards of Care and the Standards of Professional Performance both include the six steps of the nursing process: (1) assessment, (2) diagnosis, (3) outcomes identification, (4) planning, (5) implementation, and (6) evaluation. As a nurse performs an assessment, the nurse recognizes the current needs of the client.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. Which concepts are used to evaluate client outcomes when using the Omaha System Problem Rating Scale for Outcomes? a. Problem, intervention, and outcome b. Knowledge, behavior, and status c. Knowledge, skill, and attitude d. Problem, category, and modifiers ANS: B The Omaha System Problem Rating Scale for Outcomes uses the concepts of knowledge, behavior, and status.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. After conducting a comprehensive client assessment, the nurse would organize information about the client’s medication regimen into which domain of the Omaha System Problem Classification Scheme? a. Environmental b. Psychosocial c. Physiological d. Health-related behaviors ANS: D The Omaha System Problem Classification Scheme uses four domains to organize client information. The Health-related behaviors domain includes information related to patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease. The environmental domain includes material resources and physical surroundings both inside and outside the living area. The psychosocial domain includes patterns of behavior, emotion, communication, relationships, and development. The physiological domain includes functions and processes that maintain life.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is using the Omaha System Problem Classification Scheme. Which of the following situations is the nurse most likely experiencing? a. Measuring client outcomes b. Collaborating with other professionals c. Providing health education d. Organizing a comprehensive assessment ANS: D The Omaha System Problem Classification Scheme is used to organize a comprehensive assessment according to four priority domains. It’s simple and concrete terms are used to organize a comprehensive assessment, an important standard of nursing practice. It does not measure client outcomes, promote collaboration with other professionals, or provide health education.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A community health nurse is using the Omaha System. Which of the following best describes the rationale for using this system? a. To define each health care provider’s role b. To use nursing diagnoses in community health nursing practice c. To foster collaborative practice d. To provide practitioners a method for communication ANS: C The goals of developing the Omaha System were to develop a structured and comprehensive system that could be both understood and used by members of various disciplines and to foster collaborative practice. Therefore, the Omaha System was designed to guide practice decisions, sort and document pertinent client data uniformly, and provide a framework for an agency-wide, multidisciplinary clinical information management system capable of meeting the daily needs of clinicians, managers, and administrators.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is trying to facilitate interprofessional collaboration. Which of the following actions should be taken by the nurse? a. Understand who oversees the client’s care. b. Make appropriate referrals. c. Recognize what other professionals do and how they view their roles. d. Request assistance when performing complex skills.

ANS: C The factors for successful interprofessional functioning include the categories of knowledge, skill, and attitudes with subheadings including the understanding of the roles of each professional.

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Public Health Nursing 10th Edition Stanhope Test Bank DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A home care agency has applied for accreditation from the Joint Commission. What is the next step the agency will take? a. Attend a conference to learn more about the accreditation process. b. Schedule a site visit with the Joint Commission. c. Complete a self-study of the agency. d. Improve methods of documentation of client visits.

ANS: C After applying for accreditation, a lengthy self-study must be completed that addresses all aspects of the agency’s operation. Following completion of the self-study, an accreditation team schedules a site visit. Attending a conference to learn more about accreditation should be done before applying. A site visit with the Joint Commission occurs after the self-study has been reviewed. Improving methods of documentation of client visits should be addressed before applying for accreditation.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. Which historical event caused dramatic changes in home care nursing? a. Passage of Medicare legislation b. Establishment of Visiting Nurse Associations c. Creation of the Montefiore Hospital Home Care Program d. Provision of funds by the Civil Works Administration ANS: A Medicare introduced regulations for home care practice as well as for reimbursement mechanisms.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is using telehealth technology in the home setting. Which of the following best describes the intervention that is being used by the nurse? a. Uses Web TV to teach clients about their health. b. Shares health information using electronic communications. c. Makes regular visits to clients to check the technology. d. Risks violation of the Health Insurance Portability and Accountability Act. ANS: B Telehealth includes sharing health information between the client and clinicians using electronic communications. Telehealth may or may not include video technology for live interactions. Telehealth allows for monitoring health status and symptom recognition, providing education, increasing communication, and enabling clients to become active partners in their own care.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

MULTIPLE RESPONSE 1. A nurse is coordinating care through a high-intensity transitional care program. Which of the following best describes the populations that the nurse is working with? (Select all that apply.) a. Adults with cognitive impairments b. Women with high-risk pregnancies c. Older adults with heart failure d. People who are moving from one state to another e. Men who have just experienced divorce ANS: A, B, C Transitional care ensures the coordination and continuity of health care as clients transfer between different locations and different levels of care in the same location. High-intensity transitional care programs are designed for populations who have complex or high-risk health problems.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which are categories of classifying interventions according to the Omaha System Intervention Scheme? (Select all that apply.) a. Health education b. Case management c. Treatments and procedures N R d. Direct care services ANS: B, C e. Skilled nursing care The Omaha System Intervention Scheme is comprised of four broad categories of interventions: (1) teaching, guidance, and counseling; (2) treatments and procedures; (3) case management; and (4) surveillance.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which illegal and unethical activities have occurred in health care systems in the past?

(Select all that apply.) a. Inappropriate use of home health services b. Inaccurate billing for services c. Excessive administrative staff d. “Kickbacks” for referrals e. Primary care services provided in the home ANS: A, B, C, D

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Public Health Nursing 10th Edition Stanhope Test Bank Examples of Medicare fraud and abuse in home health and hospice include inappropriate use of services, excessive payments to administrative staff or owners, “kickbacks” for referrals, and billing for visits and/or medical supplies that are not authorized or provided.

The home care nurse must abide by established federal regulations when delivering care to clients.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 42: The Nurse in the Schools Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which legislation required that schools make allowances to balance educational and health care needs of children with special needs? a. Rehabilitation Act b. Individuals with Disabilities Education Act c. No Child Left Behind d. Education for All Handicapped Children Act ANS: B The Individuals with Disabilities Education Act guarantees educational services. The Rehabilitation Act states that children cannot be excluded from schools because of a handicap. No Child Left Behind states that all children must receive standardized education in a healthy environment. Education for All Handicapped Children states all children should attend school in the least restrictive environment.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The National Association of School Nurses (NASN) recommends which educational preparation for school nurses? a. Licensed practical nursN inU g RSINGTB.COM b. Bachelor of science in nursing (BSN) and certification in school nursing c. School nurse practitioner d. Master of science in nursing with specialization in school nursing ANS: B The NASN recommends that school nurses be registered nurses (RNs) with BSNs and special certification in school nursing. Licensed practical nursing education is insufficient.

School nurse practitioner and Master of Science in nursing with specialization in school nursing exceeds the minimum recommendations for school nurses.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A school nurse is demonstrating community outreach in practice. Which of the following interventions is most likely being used by the nurse? a. Coordinating health care of students with complex health problems b. Teaching students about the importance of proper nutrition c. Providing direct care to ill and injured students d. Participating in a community health fair ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank When participating in community outreach, nurses are involved in community health fairs, using that opportunity to teach others. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. The role of direct caregiver is used when providing direct care to ill and injured students.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A school nurse is coordinating the health care for children with complex health problems.

Which of the following roles is being implemented? a. Health educator b. Case manager c. Consultant d. Counselor ANS: B The nurse may perform the role of case manager for the child who is disabled or chronically ill needing to see many health care providers. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their impact on the health of the children. As a counselor, the school nurse may be the person whom the children trust to tell important secrets about their health.

DIF: Cognitive level: ApN plyi :M Nursing process: Implementation RngSINGTB.TCOP U O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A school nurse is providing health information to school administrators, teachers, and parent-teacher groups. Which of the following roles is being implemented? a. Health educator b. Case manager c. Consultant d. Counselor ANS: C As a consultant, the school nurse provides health information to various school groups. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. As a counselor, the school nurse may be the person whom the children trust to tell important secrets about their health.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is employed in the school setting. Which of the following activities would the nurse most likely perform? a. Care for children who are home sick from school. b. Coordinate the health education program of the school.

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Public Health Nursing 10th Edition Stanhope Test Bank c. Facilitate school attendance for students with communicable diseases. d. Schedule appointments to specialists for students with chronic disease.

ANS: B The school nurse’s role is comprehensive and often involves coordinating activities, such as coordinating the school health program. A common misconception is that school nurses only put bandages on cuts and soothe children with stomachaches. However, that is not their major role. School nurses give comprehensive nursing care to the children and the staff at the school. At the same time, they coordinate the health education program of the school, consult with school officials to help identify and care for other persons in the school community, and provide leadership in promoting health and safety.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. What term is used to identify a site that provides primary health care services to children and youths by nurse practitioners in the school setting? a. Primary care clinic b. School-based health center c. School health service d. Child health improvement plan ANS: B A site that provides primary health care services to children and youths by nurse practitioners in the school setting is a school-based health center. Primary care clinic refers to care that is typically provided in a physician’s office. School health services provide the various types of services that are available in schools. A child health improvement plan is Nervi RS I toGbTe B.C M not a setting for health care sU ces N deliveOred.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. What is the leading cause of death in children and teenagers is: a. leukemia. b. injuries. c. suicide. d. diabetes.

ANS: B The leading cause of death in children and teenagers is injuries.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A school nurse is teaching a group of teenagers about the dangers of using “club drugs.”

The nurse provides information that which drug may cause a very high body temperature leading to death? a. Gamma hydroxybutyrate (GHB) b. Rohypnol c. Alcohol

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Public Health Nursing 10th Edition Stanhope Test Bank d. Ecstasy (MSMA) ANS: D A very high body temperature can lead to death when taking ecstasy. GHB, Rohypnol, and Ecstasy are known as “club drugs” but do not present the risk of death related to hyperthermia.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is administering medications at school. Which of the following guidelines should be used by the nurse? a. A current drug reference should be available in case information is needed. b. The nurse should administer medications brought by the child. c. Medications cannot be administered without a physician order. d. Narcotics and controlled substances should be kept in a locked cabinet.

ANS: A A current drug reference should always be available, so it can be consulted for information.

All medications should be kept in a locked cabinet. Medications should be in the original container and have the original prescription label on it. The nurse is responsible for giving the medication and is expected by state law to know its action, side effects, and implications.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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11. A nurse is providing educatioUn toSpreNvenTt healthOproblems in children. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Providing education to prevent health problems in children is part of primary prevention. Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Tertiary prevention is the continued care of children who need long-term health care services, along with education within the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 12. The nurse is caring for children when they need health care. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention

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Public Health Nursing 10th Edition Stanhope Test Bank d. Health promotion ANS: B Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention is the continued care of children who need long-term health care services, along with education within the community.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. A nurse is providing ongoing care to a pregnant teenager. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: C Tertiary prevention is the continued care of children who need long-term health care services, along with education within the community. Ongoing care to a pregnant teenager is part of tertiary prevention. Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

N R I G B.C M

DIF: Cognitive level: ApplU yinS g N T TOO P: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. A nurse identifies a child who may be abused or receives information from a teacher that a child may have been abused. Which of the following actions must the nurse take? a. Call the police immediately to take the child to a safe place. b. Contact the parents and ask about it. c. Contact the legal authorities as well as the school’s principal. d. Examine the child to see if the abuse really occurred.

ANS: C It is the law in most states for child abuse or suspected child abuse to be reported. When a nurse identifies a child who may be abused, or receives information from a teacher about potential abuse, the nurse must contact the appropriate legal authorities as well as the school’s principal. A confidential file should be made about the incident. In all cases, the child must be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A school nurse is preparing to administer a prescription medication to a student. Which of the following information is necessary for the nurse to have?

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Public Health Nursing 10th Edition Stanhope Test Bank a. b. c. d.

A copy of the prescription label on bottle A small container for the medication Signed consent parental consent form A signed order from the physician

ANS: C A current, signed parental consent form for administering the medication is essential for the student’s file. The prescribed drug must have the original prescription label on it and be in the original container so that there are no errors. It is recommended that the physician contacts the school nurse or vice versa, but a signed order from the physician is not necessary.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A child’s parents have requested that their child be exempt from obtaining the required immunizations for a religious reason. What action should a school nurse take related to this request to be compliant with the law? a. Deny entry into school for children without the required immunizations. b. Educate the parents about the need for immunizations. c. Be aware of the state laws regarding acceptable reasons for exemption. d. Allow the student to attend school without the immunizations.

ANS: C The state mandates the rules about having immunizations that the nurse must follow. Thus, it is the responsibility of the school nurse to be aware of the laws in the state regarding acceptable reasons for immN uniR zatioIn eG xemBp. tioCn. M DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is implementing the Centers for Disease Control and Prevention (CDC) School Health Program within a school. Which components of school health will need to be evaluated? (Select all that apply.) a. Health promotion for students b. Nutrition services c. Counseling, psychological, and social services d. Health education e. Community safety ANS: B, C, D Components of the CDC School Health Program includes health education, physical education, health services, nutrition services, counseling, psychological, social services, healthy school environment, health promotion for staff, and family/community involvement.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 2. A school nurse is implementing strategies to prevent violence in the school setting. Which of the following interventions would most likely be used? (Select all that apply.) a. Support policies of zero tolerance for weapons on school property. b. Facilitate student connectedness to the school community. c. Encourage students to lock up and protect their personal property. d. Serve as a positive role model. e. Encourage students to play club sports outside of school.

ANS: A, B, D Supporting policies of zero tolerance for weapons on school property, facilitating student connectedness to the school community, and serving as a positive role model are all strategies that the nurse can use to prevent violence in the school setting. Student connectedness is encouraged if students play sports at school rather than with area clubs.

Locking up and protecting personal property is not an effective strategy to prevent violence.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 3. A school nurse develops emergency plans for students who may need immediate care while at school. Which of the following elements should be included in this plan? (Select all that apply.) a. When to call 911 for local emergency personnel b. Education about standard precautions for staff members c. Role children may play in providing basic first aid d. How to maintain confidentiality and privacy of injured students e. Where the shelter areas are located at the school ANS: A, B, C According to the American Academy of Pediatrics’ (AAP’s) and American Heart Association’s (AHA’s) guidelines, the plan should address when to call 911 for local emergency personnel, education about standard precautions for staff members, and the role that children may play in providing basic first aid. Information related to how to maintain confidentiality and privacy of injured students is not part of the emergency plan. The location of the shelter areas is part of a school-wide emergency or disaster plan, but not for emergency plans for individual students.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 43: The Nurse in Occupational Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Who is considered to be the first industrial nurse? a. Betty Moulder b. Ada Mayo Stewart c. Lillian Wald d. Florence Nightingale ANS: B Ada Mayo Stewart was hired in 1885 by the Vermont Marble Company; she is often considered the first industrial nurse. Betty Moulder provided care of ailing coal miners and their families. Lillian Wald is known as the founder of public health nursing. Florence Nightingale is one of the pioneers of the nursing profession.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which population would have been the focus of care for an occupational health nurse in the early 1900s? a. Injured workers b. All workers c. Families ANS: C d. The community In the early days of occupational health nursing, the nurse’s work was holistic and centered on the family. The care provided by Betty Moulder and Ada Mayo Stewart focused on both ill workers and their families.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working in an occupational health setting. Which of the following roles will the nurse most likely have? a. Administrator b. Clinicians/practitioners c. Consultant d. Educator ANS: B An occupational health nurse could be employed in any of these roles. However, most occupational health nurses work as nurse clinicians/practitioners.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

4. A nurse is pursuing certification as an occupational health nurse. Which organization will provide this certification? a. American Board for Occupational Health Nurses (ABOHN) b. Occupational Safety and Health Education and Research Center c. National Institute for Occupational Safety and Health (NIOSH) d. Occupational Safety and Health Administration (OSHA) ANS: A Certification in occupational health nursing is provided by the American Board for Occupational Health Nurses. The Occupational Safety and Health Education and Research Center supports master’s and doctoral education with emphases in occupational health nursing, industrial hygiene, occupational medicine, and safety. NIOSH examines potential hazards of new work technologies and practices. OSHA educates employers about occupational health and safety.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse in the occupational health arena is implementing a secondary prevention strategy.

Which of the following best describes the action that will be taken by the nurse? a. Providing education on safety in the workplace to prevent injury b. Working with workers who have diabetes to ensure they have appropriate medications c. Screening for hearing loss resulting from noise levels in the plants d. Ensuring that a person with cardiovascular disease attends a rehab program ANS: C Secondary prevention occurs after a disease process has already begun—screening for hearing loss. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—working with workers who have diabetes and ensuring that a person with cardiovascular disease attends rehab. Primary prevention is aimed at prevention of a disease before it occurs—providing education on safety in the workplace to prevent injury.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. The nurse is doing a walk through to identify workplace hazards. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. A walk through is part of an assessment, which is part of primary prevention. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. An employer offers a limited duty program after an employee has experienced a cumulative trauma injury. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—limited duty program after injury. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 8. A nurse is employed in an occupational health setting. Which of the following activities would be a primary role ofN the se?NGTB.COM URnur SI a. Caring for employees and their families b. Providing health promotion and emergency care c. Updating the Material Safety Data Sheets (MSDSs) d. Reporting communicable diseases ANS: B The customary role of the occupational health nurse extends beyond emergency treatment and prevention of illness and injury and also includes the promotion and maintenance of health, overall risk management, care for the environment, and efforts to reduce health-related costs in business. The occupational health nurse does not typically care for families of employees, update MSDSs, or report communicable diseases.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. An occupational health nurse is assessing workplace hazards. Which of the following would be the best method for the nurse to use? a. Review incident reports. b. Walk through the worksite. c. Interview key employees. d. Read the Standard Industrial Classification (SIC) Code.

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank One of the best methods an occupational health nurse can use in assessing workplace hazards is to walk through the worksite. Reviewing incident reports, interviewing key employees, and reading the SIC Code do not provide the nurse with as much information as walking through the worksite.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. Which was the first legislation that specifically required certain prevention programs for workers? a. Occupational Safety and Health Act b. National Institute for Occupational Safety and Health (NIOSH) c. Mine Safety and Health Act d. SIC Code ANS: C The Mine Safety and Health Act was enacted in 1968. It was the first legislation that specifically required certain prevention programs for workers. The Occupational Safety and Health Act established OSHA and NIOSH to carry out the Act’s purpose of ensuring “safe and healthful working conditions for working men and women.” NIOSH examines potential hazards of new work technologies and practices. The SIC Code did not require certain protection programs for workers.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care reUnR oted r hig 11. Which types of industries aN SIfo NG TBh.dCegre OMes of hazards associated with the work? a. Data entry, animal rescue, and hospice b. Engineering, science, and laboratories c. Manufacturing, mining, and agriculture d. Aeronautics, plastics, and nursing ANS: C Manufacturing, mines, construction, and agriculture are noted for their high degree of hazards associated with their work. However, no worksite is free of occupational health and safety hazards.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. An occupational health nurse is educating employees about work-related hazards. Which of the following hazards would the nurse most likely discuss in the presentation? a. Workplace stress leading to hypertension and cardiovascular disease b. Asbestos, plastics, lead, and solvents leading to dermatitis c. Cement dust and metals leading to bronchitis d. Hormones and nitroglycerine leading to reproductive effects ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Work-related stress or burnout has been defined as an important problem for many individuals. Responses to negative interpersonal relationships, particularly those with authority figures in the workplace, are often the cause of vague health symptoms and increased absenteeism. Education about stress would be pertinent to all workers, regardless of specific job or setting.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is assessing host factors as part of the epidemiologic triad. Which of the following factors would the nurse most likely assess? a. Crowding b. Shift work c. Worker’s family d. Chemical exposure ANS: C The worker’s family is considered a part of the host factor. Crowding and shift work are environmental factors, and chemical exposure is the agent factor.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. Which population is at the greatest risk for experiencing work-related accidents with subsequent injuries? a. Workers of child-bearing age 1U yeRarSoIfN exGper b. Workers with less thanN TBie.ncCeOM c. Workers with diminished sensory abilities d. Workers with chronic illnesses ANS: B New workers with less than 1 year of experience on the current job are at the greatest risk for experiencing work-related accidents with subsequent injuries. The highest percentages were in mining; agriculture, forestry, and fishing; construction; and wholesale and retail trade.

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is assessing a worker who has had a health reaction to a “safe” low-level exposure.

Which of the following most likely describes what has happened? a. An allergic reaction b. A compromised immune system c. Hypersusceptibility d. Malnutrition ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Several host factors appear to be associated with this hypersusceptibility: light skin, malnutrition, compromised immune system, glucose-6-phosphae dehydrogenase deficiency, serum alpha1-antitrypsin deficiency, chronic obstructive pulmonary disease, sickle cell trait, and hypertension. A worker who has a health reaction to “safe” low-level exposures is experiencing hypersusceptibility.

DIF: Cognitive level: Applying TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. Which statement about chemical agents is accurate? a. Chemicals are not ordinarily found in the body tissues of the general population. b. Most chemicals have been studied to determine the effects of exposure on humans. c. Chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk. d. Human effects of chemical exposure are associated with single agents rather than with the interaction of agents.

ANS: C It is true that chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. As a consequence of general environmental contamination with chemicals from work, home, and community activities, a variety of chemicals have been found in the body tissues of the general population. Predicting human responses to chemical exposures are complicated because multiple chemicals often combine and interact to create a new chemical agent.

DIF: Cognitive level: UnN ders ding :M Nursing process: Evaluation Rtan I GTB.TCOP U S N O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. An occupational health nurse has conducted a walk-through assessment and has identified potential hazards in the workplace. The nurse recognizes that it will be easiest to modify exposure to which hazard? a. Bacteria b. Aerosols c. Noise d. Burnout ANS: C Controlling physical agents, such as noise, can usually be accomplished through engineering strategies and personal protective equipment. It is much harder to change biological agents (bacteria), chemical agents (aerosols), and psychosocial agents (burnout).

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. An employee has come into contact with a biological agent. Which consideration should be made by the nurse? a. The biological agent may cause accidents in the work environment. b. The biological agent is commonly found in the agriculture industry. c. The biological agent may potentiate stress in the workplace.

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Public Health Nursing 10th Edition Stanhope Test Bank d. The biological agent indicates exposure to bacteria, viruses, fungi, or parasites.

ANS: D Biological agents are living organisms whose excretions or parts are capable of causing human disease, usually by an infectious process. Biological hazards are common in workplaces such as health care facilities and clinical laboratories where employees are potentially exposed to a variety of infectious agents, including viruses, fungi, and bacteria.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. An occupational health nurse is assessing slippery floors as a safety hazard in the work setting. Which of the following best describes the type of hazard the nurse is assessing? a. Enviromechanical b. Physical c. Chemical d. Psychosocial ANS: A Enviromechanical agents are those that can potentially cause injury or illness in the workplace. They are related to the work process or to working conditions, and they can cause postural or other strains that can produce adverse health effects when certain tasks are performed repeatedly. Slippery floors are known as enviromechanical hazards. They can cause or potentiate accidents, injuries, strain, or discomfort.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and ENffeR ctivI e CaGre E ironM ment: Management of Care Bn.vC 20. An occupational health nurse refers an employee to an employee assistance program. Which of the following problems would most likely be addressed? a. Obesity b. Smoking c. Alcohol abuse d. Lack of exercise ANS: C Employee assistance programs are designed to address personal problems such as marital/family issues, substance abuse, or financial difficulties. These issues are addressed because they affect the employee’s productivity. These efforts are cost-effective for businesses.

DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is conducting an occupational health assessment. Which of the following best describes the rationale for this assessment? a. It is required by the Occupational Safety and Health Act (OSHA). b. It is required by National Institute for Occupational Safety and Health (NIOSH). c. It helps to identify agent and host factors that place employees at risk. d. It helps to educate workers about potential hazards.

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: C The purpose of this assessment is to become knowledgeable of the work processes and the materials, the requirements of various jobs, the presence of actual or potential hazards, and the work practices of employees. This assessment allows the nurse to identify agents and host factors that place employees at risk. An occupational health assessment is not required by any organization.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. What is the purpose of the Occupational Safety and Health Act (OSHA)? a. Educating occupational health and safety professionals b. Identifying and research occupational health and safety hazards c. Distributing research findings relevant to occupational health and safety d. Educating employers about occupational health and safety ANS: D OSHA educates employers about occupational health and safety. NIOSH identifies and researches occupational health and safety hazards, distributes research finding relevant to occupational health and safety, and educates occupational health and safety professionals.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. What is the purpose of the National Institute for Occupational Safety and Health (NIOSH)? a. Examining potential hazards of new work technologies and practices bou t en viro taC l ris ks and hazards b. Educating employees aN UR SI NGnme TBn. OM c. Developing and maintain a database of work-related deaths d. Setting standards that regulate workers’ exposure to potentially toxic substances ANS: A NIOSH examines potential hazards of new work technologies and practices. Occupational Safety and Health Act (OSHA) educates employees about environmental risks and hazards, develops and maintains a database of work-related deaths, and sets standards that regulate workers’ exposure to potentially toxic substances.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. An occupational health nurse is assessing the need for safety data sheets (SDSs) at the worksite. Which of the following items would require an SDS? a. Hand soap b. Eye goggles c. Aprons d. Earplugs ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank The Hazard Communication Standard requires that all worksites with hazardous substances inventory their toxic agents, label them, and provide information sheets, called MSDSs, for each agent. Hand soap is a toxic agent. Eye goggles, aprons, and earplugs are not toxic agents and therefore, do not need an SDS. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. Which is a requirement of the Superfund Amendment and Reauthorization Act (SARA)? a. Applying stricter rules to determine Superfund sites b. Sharing written disaster plans with key resources in the community c. Authorizing each industry to write their own disaster plan d. Evaluating the effectiveness of a written disaster plan ANS: B SARA requires that written disaster plans be shared with key resources in the community, such as fire departments and emergency departments. SARA does not apply stricter rules, authorize each industry to write their own disaster plan, or evaluate the effectiveness of a written disaster plan.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. An occupational health nurse is involved in disaster planning. Which of the following actions would be most appropriate for the nurse to take? a. Assess for possible disasters. wI ork ers. b. Prevent injuries and deaNthUoRf S NG TB.C OM c. Store Medical Data Sheets in a safe place. d. Collaborate with government authorities to plan disaster management.

ANS: B The occupational health nurse is a key player in occupational disasters. The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of different personnel within the company and community. There are not Medical Data Sheets rather MSDSs. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. An occupational health nurse is working in an occupational health and safety program.

Which of the following services is the nurse most likely to provide? (Select all that apply.) a. Health/medical surveillance b. Health screening c. Case management d. Job task analysis e. Counseling

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: A, B, C, D The services provided by onsite occupational health programs range from those focused only on work-related health and safety problems to a wide scope of services that includes primary health care. An occupational health and safety program may include health/medical surveillance, health screening, case management, and job task analysis.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. An occupational health has become a member of the American Association of Occupational Health Nurses (AAOHN). Why would a nurse join this organization? (Select all that apply.) a. To promote the health and safety of workers b. To lobby in Congress for safer work places c. To advance the profession by supporting research d. To promote and provide continuing education in the specialty e. To obtain certification as a specialist in occupational health nursing ANS: A, C, D The AAOHN is the professional organization for occupational health nurses. It supports the work of the occupational health nurse and advances the specialty by: promoting the health and safety of workers, defining the scope of practice and setting the standards of occupational health nursing practice, developing the code of ethics for occupational health nurses with interpretive statements, promoting and providing continuing education in the specialty, advancing the profession through supporting research, and responding to and influencing public policy issues related to occupational health and safety. A nurse joining the AAOHN would most likely not go to lobby in Congress; rather, AAOHN provides a lobbyist to address pertinenNt U isR sues inin AM AOHN will not assist the nurse in I. Jo G Bg .thCe O S N T obtaining specialty certification.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 44: Forensic Nursing in the Community Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What has been the focus of the majority of scientific research in forensic nursing? a. Role of the forensic nurse and client population b. Sexual assault team response c. Client satisfaction with forensic nurses d. Collaboration with other disciplines ANS: A Scientific research in forensic nursing is in its early stages. Currently, research is largely a description of the forensic nursing role and client population.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A forensic nurse has collected trace evidence. Which of the following best describes what has been collected? a. Fingerprints b. Hairs c. Hand gun d. Autopsy report ANS: B The most common types of trace evidence from victims of violence are hairs, fibers, and small pieces of material, such as fragments of metal, glass, paint, and wood.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse uses the scope and standards for forensic nursing practice to differentiate this practice from other nursing specialties. Which parameter best describes the practice of forensic nursing? a. Assessment includes assessing the community for potential violence. b. Identification of outcomes of care is accomplished by collaborating with health care professionals. c. Coordination of care involves education and other strategies to prevent injuries well after the occurrence. d. Evaluation of outcomes relates to program evaluation.

ANS: D

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Public Health Nursing 10th Edition Stanhope Test Bank Coordination of care relevant to forensic outcomes often involves education and other strategies to prevent injuries well after the occurrence, perhaps after the death of an individual who has been injured. Assessment includes the collection of forensic data, identification of realistic outcomes of care is most commonly performed in collaboration with a team of professionals outside of nursing and medicine, and evaluation of outcomes may involve dissemination of results to the client and the community.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A forensic nurse assesses a child who has injuries that indicate possible abuse. What is the best way to document the assessment findings? a. Tape recorded statements from the child b. Digital photographs of injuries c. Video recording to record statements and show injuries d. Written documentation and photography ANS: D Documentation of all forms of violence should include written documentation as well as photography.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. What is the main purpose of the National Center for Injury Prevention and Control? a. Assist victims of violence. iden b. Maintain records of theNinc UR SIceNoGfTinBju.riCes.OM c. Coordinate the prevention of injuries, violence, and their consequences. d. Encourage collaboration among professionals from various disciplines.

ANS: C The National Center for Injury Prevention and Control was established to coordinate the prevention of injuries, violence, and their consequences. The work of this center includes providing grants that fund prevention programs, dissemination of research findings, and maintenance of a website, blogs, podcasts, and electronic newsletters. This funding helps to inform the public of the epidemiology of injury and to provide other resources for professionals.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A forensic nurse is demonstrating the role of advocate. Which of the following best describes the intervention being performed by the nurse? a. Partner with public health professionals to implement programming. b. Promote programs that prevent injuries. c. Investigate injuries in the community. d. Provide holistic care to victims of violence.

ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Forensic nurses can demonstrate the role of advocate by promoting programs that prevent injuries. Partnering with public health professionals to implement programming demonstrates collaboration. Investigating injuries in the community demonstrates the role of epidemiologist. Providing holistic care to victims of violence demonstrates the role of caregiver.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A homicide has occurred in a community. To whom would this information need to be reported? a. United States Public Health Service b. World Health Organization (WHO) c. Centers for Disease Control and Prevention (CDC) d. National Violent Death Reporting System (NVDRS) ANS: D The NVDRS was initiated by the CDC to develop a national state-based surveillance system that could identify the cause and manner of death, leading to prevention efforts by pulling together data on violent deaths, unintentional firearm injury deaths, and deaths of undetermined intent. The United States Public Health Service and WHO have the goal of reducing injury, but homicides are not reported to these organizations.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care ono inju 8. What is the extent of the ecN URmic SIbur NGden TBo.f C OMries in the United States? a. It is extensive, including medical treatment and lost productivity. b. It is minimal, as limited funds are spent treating injuries. c. It varies depending on the extent of the injury. d. It has been reduced through risk reduction strategies.

ANS: A The economic burden of injuries in the United States is extensive, especially when considering the costs of medical care and treatment, productivity losses (lost wages, accompanying fringe benefits), and lost ability to perform normal household responsibilities.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is providing emergency care to an assault victim. Which of the following would be the most appropriate action for the nurse to take? a. Support the privacy of the victim. b. Assess the socioeconomic status of the victim. c. Question the victim about the details of the assault. d. Educate the victim about violence prevention.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Supporting the privacy of the assault victim is the most appropriate action for the nurse to take when providing care. When providing emergency care, it is not the most appropriate time to assess the client’s socioeconomic status or educate the victim about violence prevention. The forensic nurse will need to document the victim’s account of the assault; however, there will be law enforcement involved to collect this data.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A forensic nurse implements a program aimed at preventing domestic abuse. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A Primary prevention focuses on preventing violence and injuries before they occur—program focused on preventing domestic abuse. Secondary prevention occurs following the occurrence of injuries and crime. This includes direct care provided to victims and perpetrators as well as the collection of evidence. If disability, incarceration, or death occurs, tertiary prevention is applied in settings appropriate to address rehabilitation or identify factors that have put individuals at risk.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 11. A nurse collects evidence from a victim following a sexual assault. Which of the following U S N T O levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: B Secondary prevention occurs following the occurrence of injuries and crime. This includes direct care provided to victims and perpetrators as well as the collection of evidence.

Primary prevention focuses on preventing violence and injuries before they occur. If disability, incarceration, or death occurs, tertiary prevention is applied in settings appropriate to address rehabilitation or identify factors that have put individuals at risk.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 12. A nurse is providing direct client care while working in a correctional setting. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: C If disability, incarceration, or death occurs, tertiary prevention is applied in settings appropriate to address rehabilitation or identify factors that have put individuals at risk.

Primary prevention focuses on preventing violence and injuries before they occur.

Secondary prevention occurs following the occurrence of injuries and crime. This includes direct care provided to victims and perpetrators as well as the collection of evidence.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. A nurse is conducting a community assessment in a healthy community. Which of the following findings should the nurse anticipate? a. Low crime rates b. High rates of injury c. Significant health disparities d. Low mortality rates ANS: A The rate of injury and crime is lower in communities that promote good health. Where inequities of resources and education exist, health disparity, violence, and other crimes rise and accidental injuries occur more often.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is caring for an individual who has been a victim of trauma. Which of the following NUntRthSatItNheGnTurse B.C M for? most likely describes the clie isO caring a. A middle-class, Caucasian female b. A middle-class, African American male c. A low-income, Caucasian male d. A low-income, African American female ANS: D Trauma victims are overrepresented in minority, disenfranchised, and disadvantaged groups.

Where inequities of resources and education exist, health disparity, violence, and other crimes rise, and accidental injuries occur more often.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse assesses the factors that may place a client at risk for injury from a violent act by considering the role these factors play before, during, and after the violent act. The work of which theorist is being applied? a. Matrix b. Maslow c. Haddon d. Hammer ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank Haddon developed a matrix when examining methods to identify the risk of injury. The matrix looks at factors related to personal attributes, vector or agent attributes, and environmental attributes before, during, and after an injury or death. Hammer recognized that in forensic nursing practice, the caring component must address caring for oneself as well as caring for clients. Maslow’s theory focuses on clients’ meeting their hierarchy of needs.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse is employed as a forensic nurse during the 1950s. Which of the following tasks would the nurse most likely have been implementing? a. Working in a sexual assault clinic b. Identifying indicators of assault c. Implementing protocols for sexual assault care d. Receiving sexual assault nurse examiners (SANE) training ANS: B During the 1940s through the 1960s, nurses became aware of their role in identifying indicators of assault. The first nurse-run sexual assault clinic opened in 1974, with subsequent development of the first protocols for sexual assault care. SANE programs appeared in the 1990s.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A forensic nurse is implementing H Sammer’s N TdefinitionOof caring. Which of the following actions would the nurse mostUlikely perform? a. Utilizing intuition when assessing a client b. Providing self-care and care for the client c. Assuring that the client’s basic needs are met d. Assessing the biopsychosocial and spiritual characteristics of the client ANS: B Hammer recognized that in forensic nursing practice the caring component must address caring for oneself as well as caring for clients. A sense of self-worth must be cultivated and nurtured to the degree that caring is conscientious, objective, and demanding of the scientific truth. Caring must also be curious and questioning; it should be directed toward colleagues; and finally, caring should be about firm and valued concepts that inform practice.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which setting is a forensic nurse most likely to be employed? a. Physician’s office b. Urgent care center c. School-based health center d. Medical examiner’s office

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Public Health Nursing 10th Edition Stanhope Test Bank ANS: D Practice arenas for forensic nurses include health care facilities such as private clinics and emergency departments, criminal justice centers for victims of crime, medical examiner offices, police departments, correctional facilities, and mental health centers.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse may need to use medical coercion with a client. Which of the following medical diagnoses would the client most likely have? a. Human immunodeficiency virus (HIV) b. Depression c. Schizophrenia d. Hypertension ANS: C Medical coercion may be necessary in certain situations. These situations include incapacity to make decisions and making decisions that could result in harm to self or harm to others in the absence of interventions. For instance, mentally ill inmates may be medically coerced to take psychotropic medications against their will if the mental disorder is serious, the inmate is dangerous to himself, and the medication prescribed is in the inmate’s best medical interest. Schizophrenia is the diagnosis most likely to require medical coercion.

DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care at S aI gro upToB f. reC fuge 20. A nurse vocalizes a concernNth UR NG OMes in the community is not receiving equal access to health care services when compared to the other residents in the community.

Which of the following concepts is being applied? a. Victimization b. Perceptivity c. Questioning d. Beneficence ANS: A Victimization occurs when individuals or groups are treated unfairly; generally, when there is an imbalance of power. Perceptivity, as an element of intuitiveness, is one tool the forensic nurse uses to investigate injury; it involves an increased awareness of human behavior and environment that is interpreted by knowledge and lived experience in making expert decisions. Questioning has led to a greater understanding of what most would consider the unexplainable and unimaginable. Beneficence is an ethical principle that relates to caring.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. A forensic nurse is applying the concept of distributive justice. Which of the following questions would be most appropriate for the nurse to ask? a. How will limited funds be spent? b. Who will benefit the most from the services?

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Public Health Nursing 10th Edition Stanhope Test Bank c. How will an additional service benefit the population? d. How will the privacy of the population be respected?

ANS: A Principles of distributive justice address questions in deciding what goods will be distributed to which persons in what proportions. This is best addressed by asking “How will limited funds be spent?” The principle of beneficence is addressed through “Who will benefit the most from the services?” and “How will an additional service benefit the population?” The principle of confidentiality is addressed through the question “How will the privacy of the population be respected?”

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A forensic nurse plans to collaborate with another professional to provide care to the client.

Which of the following professionals would the nurse be most likely to collaborate with? a. Social worker b. Corrections officer c. Clinic manager d. Dietician ANS: B Forensic nurses collaborate with corrections officers and law enforcement, epidemiologists, emergency department providers, psychiatric practitioners, and public health nurses.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and ENffeR ctivI e CaGre E ironM ment: Management of Care Bn.vC MULTIPLE RESPONSE 1. How would a registered nurse become a forensic nurse? (Select all that apply.) a. No additional education is needed after obtaining an undergraduate nursing degree. b. Complete additional course work in police science. c. Enroll in a certificate program for forensic nursing. d. Select a graduate program that offers a track in forensic nursing. e. Complete a nurse practitioner program.

ANS: C, D There are three primary routes for training in forensic nursing. Additional skills and knowledge can be gained through continuing education courses or basic concepts introduced in generalist education. Certificate programs and graduate programs offer additional opportunities to specialize in forensic nursing.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse would like to obtain certification as a forensic nurse. Which specialty certifications are available for the forensic nurse? (Select all that apply.) a. Legal Nurse Consultant b. Death Investigator

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Public Health Nursing 10th Edition Stanhope Test Bank c. Adolescent and adult SANE A d. Forensic Consultant e. Forensic nurse ANS: A, B, C Certification is available as an adolescent and adult SANE A, Legal Nurse Consultant, and Death Investigator. Forensic Consultant and forensic nurse are not certifications that are available.

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which is considered a forensic environment? (Select all that apply.) a. Crime scene b. Courtroom c. Mental health nursing unit d. Prison e. Emergency department ANS: B, D Forensic environments include courtrooms, jails, prisons, and psychiatric facilities for the criminally insane.

DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 45: The Nurse in the Faith Community Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which person believed that congregations should play a key role in holistic health care and focused on implementing nurse-clergy teams to work with individuals and their families? a. Pope John Paul b. President Reagan c. Rev. Granger Westburg d. Lillian Wald ANS: C Rev. Granger Westburg explored ways to address holistic healing through the body-mind-spirit connection. He believed that congregations should have a key role in holistic health care, focusing on using the nurse-clergy team to work with individuals and their families. Lillian Wald is known as the founder of public health nursing. Pope John Paul and President Reagan were not involved in the development of faith community nursing.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Where is faith community nursing practiced? a. In all United States b. Only in North America c. In the United States and other countries d. In every country in the world ANS: C Today, there are approximately 15,000 faith community nurses serving in a variety of faith settings across the United States and in 23 countries around the world such as Canada, Australia, New Zealand, Germany, Swaziland, Ukraine, and Pakistan, to name a few. This number is a conservative estimate and is based on the number of nurses reporting taking an International Parish Nurse Resource Center (IPNRC)-affiliated foundations course in faith community nursing and does not reflect the individuals who have completed nonaffiliated IPNRC programs or who practice without additional education in the specialty area.

DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which statement about faith community nurses is true? Faith community nurses: a. create caring congregations that support the holistic health of its members. b. work with clergymen to foster deeper spiritual beliefs. c. take care of a congregation of people in case of illness. d. provide holistic care and make decisions about congregational policies.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Faith community nurses use all the knowledge and skills of this specialty to provide effective services. The outcome is a truly caring congregation that supports healthy, spiritually fulfilling lives.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is working in a congregational community who gathers in a church and has common faith traditions. Which of the following best describes this community? a. Health ministry b. Faith community nursing c. Faith community d. Holistic care center ANS: C Congregational communities that gather in churches, cathedrals, synagogues, or mosques and acknowledge common faith traditions are faith communities. A health ministry is a visible activity, program, or ritual of faith organized around the health and healing of the congregation’s membership and offered by the faith community nurse, clergy, layperson, or community resource. Faith community nursing is a recognized nursing specialty practice focusing on working with individuals, families, and faith communities to coordinate programs and services that significantly affect health, healing, and wholeness. Holistic care relates to the relationship between the body, mind, and spirit in a constantly changing environment and involves caring for the soul in a special kind of engagement. Holistic care goes beyond assessing only the physical aspects of the patient; rather, it is the care of the entire patient.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation U S N T O MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse would like to engage in the role of a faith community nurse. According to the Faith Community Nursing: Scope and Standards of Practice, which is the preferred minimum educational preparation for a nurse in this setting? a. An associate degree b. A baccalaureate degree c. A master’s degree d. Certification ANS: B The preferred educational level for faith community nurses is a baccalaureate degree.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A faith community nursing program is created in an individual community of faith. The nurse is paid by the congregation and is accountable to the congregation and its governing body. Which model of faith community nursing is being used? a. Paid congregational b. Paid institutional c. Unpaid congregational

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Public Health Nursing 10th Edition Stanhope Test Bank d. Unpaid institutional ANS: A In the paid congregational model, the development of a faith community nurse/health ministry program arises from the individual community of faith. The nurse is accountable to the faith community and its governing body. In the paid institutional model, the nurse is supported by a health care institution where nurses are paid either by the institution or shared salary with the congregation over time. In the unpaid congregational model, the nurse is governed by the congregation with no contractual support from any sponsoring health care institution. The nurse may negotiate financial support for expenses. In the unpaid institutional model, the institution provides soft support in the form of continuing education and spiritual development; however, the nurse is not paid a salary and is governed by the congregation, who budgets for some expenses.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A faith community nurse is financially supported by a health care institution. Which model of faith community nursing is being used? a. Paid congregational b. Paid institutional c. Unpaid congregational d. Unpaid institutional ANS: B In the paid institutional model, the nurse is supported by a health care institution where nurses are paid either by the institution or shared salary with the congregation over time. In N R I eve GT B.Ct ofM a faith community nurse/health ministry the paid congregational modeUl, thSe dN lopmenO program arises from the individual community of faith. The nurse is accountable to the faith community and its governing body. In the unpaid congregational model, the nurse is governed by the congregation with no contractual support from any sponsoring health care institution. The nurse may negotiate financial support for expenses. In the unpaid institutional model, the institution provides soft support in the form of continuing education and spiritual development; however, the nurse is not paid a salary and is governed by the congregation, who budgets for some expenses.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A faith community nurse is working with a health ministry. Which of the following activities would most likely be performed? a. Conducting worship services in occupational areas b. Visiting the homebound c. Providing nursing care to congregation members who are acutely ill d. Participating in mission trips ANS: B

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Public Health Nursing 10th Edition Stanhope Test Bank Health ministry services may be provided by a professional or layperson. These services include visiting the homebound, providing meals for families in crisis or when a family member returns home after hospitalization, participating in prayer circles, serving “healthy heart” meals, or holding regular grief support groups. Conducting worship services in occupational areas, providing nursing care, and participating in mission trips are not typical roles of a health ministry.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which dimension is central to the practice of parish nursing? a. Physical b. Psychological c. Spiritual d. Social ANS: C The spiritual dimension is central to the practice of parish nursing. Parish nursing includes all four dimensions shown above but focuses on intentional and compassionate care that stems from the spiritual dimension of all humankind.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is concerned with the body, mind, and spirit relationship in a constantly changing environment. Which of the following types of nursing care is being provided? a. Faith community nursinNgURSINGTB.COM b. Community health nursing c. Primary care d. Holistic care ANS: D A nurse concerned with the body, mind, and spirit relationship in a constantly changing environment is practicing holistic care. Primary care focuses on the services provided at a physician’s office. Faith community nursing is a recognized nursing specialty practice focusing on working with individuals, families, and faith communities to coordinate programs and services that significantly affect health, healing, and wholeness. Community health nursing focuses on all care provided outside of a hospital.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A faith community consults with a nurse to spearhead a committee to investigate the feasibility of starting a faith community nursing program in their church. The nurse contacts which organization for information, consultation, and reference packets about faith community nursing? a. Parish Nurse Coordinator Center b. International Parish Nurse Resource Center c. American Nurses Association d. National Center for Wellness

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B The mission of the International Parish Nurse Resource Center has been the promotion and development of quality faith community nurse programs through research, education, and consultation. The Parish Nurse Coordinator Curriculum was part of the development of faith community nursing. The American Nurses Association recognizes faith community nursing as a specialty. The National Center for Wellness has no relationship to the practice of faith community nursing.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A faith community nurse holds discussions for targeted groups in the congregation. Which of the following roles is the nurse implementing? a. Counselor b. Integrator of faith and health c. Health educator d. Developer of support groups ANS: C The faith community nurse who holds discussions for targeted groups is functioning as a health educator. As a counselor, the faith community nurse discusses health problems and recommends interventions as necessary. As an integrator of faith and health, the faith community nurse assists others to improve spiritual and physical health. As the developer of support groups, the faith community nurse establishes and facilitates support groups.

DIF: Cognitive level: Applying : Nursing process: Implementation NURSINGTB.TCOP M MSC: NCLEX: Safe and Effective Care EnviroOnment: Management of Care 13. A faith community nurse encourages participation in political activities that impact the health and well-being of the faith community. Which of the following roles is the nurse implementing? a. Counselor b. Developer of support groups c. Integrator of faith and health d. Advocate ANS: D The faith community nurse who encourages participation in political activities that impact the health and well-being of the faith community is functioning as an advocate. The faith community nurse who holds discussions for targeted groups is functioning as a health educator. As a counselor, the faith community nurse discusses health problems and recommends interventions as necessary. As an integrator of faith and health, the faith community nurse assists others to improve spiritual and physical health. As the developer of support groups, the faith community nurse establishes and facilitates support groups.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 14. A faith community nurse arranges for Meals on Wheels to serve a homebound client. Which of the following roles is the nurse implementing? a. Counselor b. Coordinator c. Integrator of faith and health d. Advocate ANS: B The faith community nurse who makes arrangements for Meals on Wheels for the homebound is functioning as a coordinator. The faith community nurse who encourages participation in political activities that impact the health and well-being of the faith community is functioning as an advocate. As a counselor, the faith community nurse discusses health problems and recommends interventions as necessary. As an integrator of faith and health, the faith community nurse assists others to improve spiritual and physical health.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is practicing in faith community nursing. Which of the following best describes the goal of this type of practice? a. Enhancing spirituality of communities b. Initiating primary prevention activities c. Developing and sustain health ministries d. Acting as a health referral source for churches ANS: C The goal of faith community nursing is to develop and sustain health ministries within faith communities. Activities are implemented at all three levels of prevention. There are multiple roles that the nurse serves and only one of these roles is a referral agent. The role of the faith community nurse is to enhance the spirituality of the population served.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse wants to know the functions of a faith community nurse. Which of the following resources would the nurse consult? a. Board of Nursing b. Scope and Standards c. Health Cabinet d. Individual faith community ANS: B A nurse wanting to know the function of a faith community nurse would look to the Scopes and Standards. The Health Cabinet assists with evaluating assets and areas of need in order to plan services that will attain outcomes congruent with goals established by the congregation and faith communities served. The Board of Nursing regulates nursing practice, larger than the scope of faith community nursing. The individual faith community may be able to provide information to the nurse about what their specific needs are, but this will not define the scope and standards of practice.

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Public Health Nursing 10th Edition Stanhope Test Bank

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is employed as a faith community nurse. Which of the following elements of practice should always be considered? a. Confidentiality b. Personal faith c. Health care needs d. Fellowship ANS: A Confidentiality is of the utmost importance in faith community nursing practice. The faith community nurse values client confidentiality, but at the same time delicately assists the client and client’s family at the appropriate time to “share” concerns with pastoral staff or fellow congregants. Personal faith, health care needs, and fellowship are addressed as the nurse maintains client confidentiality.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is working as a faith community nurse. Which of the following best describes the emphasis of the care that is being provided? a. Referral to community resources b. Health promotion c. Primary care d. Direct caregiving NURSINGTB.COM ANS: B Faith community nurses have found that health promotion services were needed for persons across the life span, particularly in underserved urban and rural areas. Nurses also found that congregants benefited from health counseling and health promotion services at all levels of prevention. Faith community nurse services emphasize health promotion and disease prevention and provided the benefits of holistic care through the supportive, caring faith community. Primary care and direct caregiving are not roles of the faith community nurse.

A faith community nurse may refer a client to community resources, but that is not the focus of the care.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 19. A faith community nurse is acting as a health advocate. Which of the following best describes the action being taken by the nurse? a. Encourage individuals to implement healthy lifestyles. b. Provide referrals to health care and social services. c. Provide opportunities for others to learn about health care issues. d. Assist clients to connect to faith-based services.

ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank As a health advocate, the faith community nurse encourages individuals to implement healthy lifestyles and provides outreach services for less-mobile members, nonmembers, and vulnerable populations. As a referral agent, the faith community nurse provides referrals to health care and social services. As an educator, the faith community nurse provides opportunities for others to learn about health care issues. As an integrator of faith and health, the faith community nurse assists clients to connect to faith-based services.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A faith community nurse is available for health counseling with teens before and after youth activities. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability—providing health counseling with teenagers (an at-risk population). Primary prevention aims to prevent disease, injury, or disability before it occurs. Tertiary prevention aims for rehabilitation and treatment. Assessment is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance plem 21. A faith community nurse isNim R Ient Ging Ba.prCima Mry prevention strategy. Which of the U S N T O following activities would the nurse most likely implement? a. Providing health assessments and counseling during a home visit for a client who just had surgery b. Writing house of worship newsletter articles about healthy food choices c. Assisting in making behavioral changes for a person who is abusing alcohol d. Doing blood pressure screenings after church one Sunday ANS: B Writing house of worship newsletter articles informing the faith community about healthy food choices would classify as primary prevention. Providing health assessments and counseling for a client who just had surgery and assisting in making behavioral changes for a person who is abusing alcohol are examples of tertiary prevention (treatment and rehabilitation). Doing blood pressure screenings after church one Sunday is an example of secondary prevention (screening).

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is practicing in a faith community. Which of the following best describes an aspect of the faith community that a nurse must be knowledgeable about? a. How clergy are trained and their areas of expertise b. The economic status of the parishioners and their ability to pay the nurse c. The policies and procedures of the religious order in which they practice

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Public Health Nursing 10th Edition Stanhope Test Bank d. Lines of authority and channels of communication in the faith community ANS: D Faith community nurses must be knowledgeable about lines of authority and channels of communication, as well as personnel decisions and how these are made in the congregation.

It is important for faith community nurses to serve in collaborative relationships with the clergy to effectively implement programs. It is typically not the responsibility of the nurse to request payment for services from parishioners. There are typically not policies and procedures as part of a religious order.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which functions are the faith community nurse most likely to perform? (Select all that apply.) a. Personal health counselor b. Facilitator c. Referral agent d. Case manager e. Direct caregiver ANS: A, B, C The seven functions of the faith community nurse include: (1) personal health counseling, (2) health education, (3) referral or liaison activities, (4) facilitating groups, (5) integrating faith and health, (6) health N adUvR ocS acIyN , aGnT dB (7. )C coO orM dinating volunteer services.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Considering the goals of Healthy People 2020, which programs would a faith community nurse most likely implement? (Select all that apply.) a. Regular blood pressure screenings b. Healthy nutrition counseling c. Lead screening program d. Grief support group e. Smoking cessation program ANS: A, B, E Specific national objectives found in Healthy People 2020 that relate to the role of the faith community nurse include implementing programs to address nutrition; physical activity; use of tobacco, alcohol, and other drugs; immunization status; environmental health; and injury and violence. Examples of appropriate programming to meet these objectives include regular blood pressure screenings, smoking cessation programs, and healthy nutrition counseling.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance

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Public Health Nursing 10th Edition Stanhope Test Bank

Chapter 46: Public Health Nursing at Local, State, and National Levels Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the goal of local public health departments? a. Monitoring communicable diseases b. Improving the health status of communities c. Offering services for the uninsured d. Enforcing environmental codes and laws ANS: B The goal of local public health departments is to safeguard the public’s health and improve the health status of communities. The federal and state levels monitor communicable diseases, offer services for the uninsured, and enforce environmental codes and laws.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which agency delegates the authority of the local health department? a. The federal government b. The state c. Local authorities d. Regional governing boards ANS: B The authority of the local health department is delegated by the state. The federal government, local authorities, and regional governing boards are not involved with delegating authority of the local health department.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working in a public health department. Which of the following would most likely be the focus of the care that is provided? a. Home visiting and hospice care b. Care of communicable diseases c. Health promotion d. Illness prevention ANS: C Public health nurses (PHNs) employed in local, state, and federal agencies work together to identify, develop, and implement interventions that will improve and maintain the nation’s health.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank 4. Which event has the potential to weaken existing public health programs? a. The shift in funding to support bioterrorism response efforts b. The outbreaks of H1N1 influenza c. The number of citizens with human immunodeficiency virus (HIV) d. The lack of PHNs ANS: A The events of the twenty-first century have shifted funding to bioterrorism programs. This shift of funding has the potential to weaken existing important public health programs.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A public health nurse (PHN) discusses with a client which services are appropriate to meet her needs. Which of the following best describes the role that the nurse is using? a. Case manager b. Advocate c. Counselor d. Role model ANS: B As an advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population. A PHN discusses with a client which services are appropriate to meet her needs. In this case, the nurse’s public health function is that of an advocate. Case managers assist clients in identifying services they need the most at the least cost. As a counselor, the nurse is a person for the client to talk with to discuss feelings and concerns. A NforRtSheIcNlien GTt B.C M nurse serves as a role model U by beO ing a person for the client to look up to.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A public health nurse (PHN) assists a client in identifying the services needed the most at the least cost. Which of the following best describes the role that the nurse is using? a. Role model b. Advocate c. Counselor d. Case manager ANS: D The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager. As an advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population. A PHN discusses with a client which services are appropriate to meet her needs. As a counselor, the nurse is a person for the client to talk with to discuss feelings and concerns. A nurse serves as a role model for the client by being a person for the client to look up to.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Public Health Nursing 10th Edition Stanhope Test Bank

7. A public health nurse (PHN) aims to change behaviors such as poor hand washing skills and unsafe sex practices. Which of the following best describes the role that the nurse is using? a. Case manager b. Advocate c. Educator d. Role model ANS: C The PHN works as an educator, teaching to the level of the client so that information received is information that can be used. The PHN who aims to change behaviors, such as poor hand washing skills and unsafe sex practices, is acting in the role of educator. The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager. As an advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population. A PHN discusses with a client which services are appropriate to meet her needs. A nurse serves as a role model for the client by being a person for the client to look up to.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is providing services for uninsured women. Which of the following best describes the role that the nurse is using? a. Role model b. Primary caregiver c. Outreach worker ANS: B d. Case manager A nurse providing services for uninsured women is acting in the role of primary caregiver.

The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager. A nurse serves as a role model for the client by being a person for the client to look up to. As an outreach worker, the nurse is able to gain acceptance with the population served.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is providing information about safe sex practices. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A

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Public Health Nursing 10th Edition Stanhope Test Bank Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability—providing information about safe sex practices. Secondary prevention focuses on early detection and screening. Tertiary prevention focuses on treatment and rehabilitation. Assessment is not a level of prevention.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 10. A nurse is implementing secondary prevention strategies in the community. Which of the following best describes what the nurse is doing? a. Screening children for lead poisoning b. Working with communities on emergency preparedness plans c. Developing social networking interventions to modify community norms d. Educating patients with strokes at rehab centers to help optimize their functioning ANS: A Screenings are secondary prevention activities. Secondary prevention focuses on early detection and screening. Tertiary prevention focuses on treatment and rehabilitation— educating patients with strokes. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability—workingwith communities on emergency preparedness plans and developing social networking interventions.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance rtiar reve 11. A nurse is implementing teN URySpI NGntio TBn.stCrate OMgies in the community. Which of the following best describes what the nurse is doing? a. Providing immunizations b. Conducting lead screening activities for children c. Providing case management services for clients with chronic illness d. Identifying and treating clients in a tuberculosis (TB) clinic ANS: C Providing case management services for clients with chronic illness demonstrates tertiary prevention, as it is focused on treatment and rehabilitation. Providing immunizations is a primary prevention, and conducting lead screening activities and identifying and treating clients in a TB clinic are at the secondary level of prevention.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 12. A public health nurse (PHN) is working with uninsured individuals. Which of the following is the most appropriate action for the nurse to take? a. Providing direct care for this population in times of acute illness b. Advocating for federal policy changes for this population c. Assisting this population to access necessary health care services d. Encouraging lifestyle changes for this population ANS: C

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Public Health Nursing 10th Edition Stanhope Test Bank PHNs serve vulnerable populations by acting as a bridge between these populations and the resource needs for this at-risk group by approaching health care providers on behalf of individuals seeking medical/health services and keeping the needs of this population on the political agenda.

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. After reviewing the objectives of Healthy People 2020, the public health nurse (PHN) determines the focus for the programming for communicable diseases in the community.

Which of the following would the nurse most likely select as the focus? a. Encouraging community members to engage in healthy behaviors b. Identifying high-risk sexual behaviors among community members c. Monitoring the sexual activity of adolescents d. Providing information about the hazards of multiple sexual partners ANS: D Healthy People 2020 lists communicable disease as an area of focus, including levels of HIV, acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections.

One method to reduce the risk of acquiring a communicable disease is by the PHN providing information on the hazards of multiple sexual partners and street drug use.

Encouraging community members to engage in healthy behaviors does not specifically address communicable diseases. Identifying behaviors and monitoring sexual activity are not appropriate focuses for programming.

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health ProNmUoR tiS onIaN nG dT MB ai. ntC enOaM nce 14. Which is a principle of good practice for community partnerships? a. Partnerships are easily formed among those working in public health. b. Partnerships use their own roles to accomplish tasks. c. Partnerships are built on identified strengths and assets. d. Partnerships are loose associations among people.

ANS: C Partnerships are built upon identified strengths and assets, including areas that need improvement. This is one of the principles of good practice. An effective partnership is formed by balanced power and understanding among the partners. Partnerships use mutual trust and respect genuineness and commitment as part of their relationship.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse considering working as a public health nurse (PHN) refers to the American Public Health Association (APHA) Public Health Nursing Section to determine what level of educational preparation has been recommended. Which of the following best describes the educational preparation? a. Associate degree b. Baccalaureate degree c. Master’s degree

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Public Health Nursing 10th Edition Stanhope Test Bank d. Certification ANS: B All PHNs should have a background in the social and behavioral sciences, epidemiology, environmental health, current treatment modalities, and health care delivery options to fully understand health policy, research, and treatment choices and to translate this knowledge into the promotion of healthy populations.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A public health nurse (PHN) is involved in disaster planning. Which of the following best describes why this is important? a. To be most effective as a disaster responder b. To anticipate the potential disasters that may occur c. To educate the public about their responsibilities if a disaster occurs d. To demonstrate the importance of community partnerships ANS: A To be most effective as a disaster responder, the PHN needs to be part of the team before an emergency occurs. PHNs can be involved in educating the public, working with community partnerships, and anticipating potential disasters; however, the nurse must be part of the team before the emergency to accomplish these things.

DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Which are examples of federal agencies? (Select all that apply.) a. The U.S. Department of Health and Human Services (USDHHS) b. The Centers for Disease Control and Prevention (CDC) c. The Health Resources and Services Administration (HRSA) d. The Pentagon e. The Congress ANS: A, B, C The USDHHS, the CDC, and the HRSA are all federal agencies. The Pentagon and the Congress are not federal agencies.

DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which principles are included in the Scope and Standards of Public Health Nursing Practice? (Select all that apply.) a. The client or “unit of care” is the population. b. Primary prevention is given priority. c. All processes must include partnering with representatives of the people. d. Government agencies mandate requirements for public health. e. The focus of many interventions should be on secondary prevention.

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Public Health Nursing 10th Edition Stanhope Test Bank

ANS: B, C The eight tenets of public health nursing distinguish public health nursing from other nursing specialties. Primary prevention is given priority and all processes must include partnering with representatives of the people as part of these established principles.

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A public health nurse (PHN) collaborates with agencies to address the problem of obesity in the community. Who would be the most appropriate people to include in this collaborative partnership? (Select all that apply.) a. Local health department staff members b. Restaurant owners c. Parks and recreation department staff members d. Church representatives e. Appliance store managers ANS: A, B, C, D PHNs practice in partnership with each other at the local, state, and federal levels and with other public health staff, other governmental agencies, and the community to safeguard the public’s health and to improve the community’s health status. All of these people would provide valuable insight into the problem of obesity in the community.

DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

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Chapter 01: Public Health Nursing and Population Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which statement best describes community-based nursing? a. A practice in which care is provided for individuals and families. b. Providing care with a focus on the group’s needs. c. Giving care with a focus on the aggregate’s needs. d. A value system in which all clients receive optimal care.

ANS: A

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

2. Which statement best describes the goal of community-oriented nursing? a. Providing care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. To preserve, protect, promote, or maintain health and prevent disease ANS: D

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

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

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

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

There has to be indisputable evidence collected over time that public health policies and programs were primarily responsible for increasing the average life span from 47 in 1900 to 78.6 years in 2017, an increase of approximately 60% in just over a century plus through improvements in (1) sanitation, (2) clean water supplies, (3) making workplaces safer, (4) improving food and drug safety, (5) immunizing children, and (6) improving nutrition, hygiene, and housing. Although people are excited when a new drug is discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant gains in the health of populations that have come largely from public health accomplishments.

5. A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions

would most likely be implemented by the nurse?

Provide free health care to all citizens To increase the number of individuals with access to effective health care benefits Lower the cost of health care to the American population To lessen the governmental burden of providing health care to Americans

a. b. c. d.

ANS: B

The central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number of people with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on the American government are serious concerns, they are not the primary focus of ACA.

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6. What is the basic assumption stated by Healthy People 2010 as it relates to public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority in government planning and funding. c. The health of individuals cannot be separated from the health of the community. d. The government is responsible for lengthening the life span of Americans.

ANS: C

The major premise of Healthy People 2010 was that the health of the individual cannot be entirely separate from the health of the larger community. Public health practice focuses on the community as a whole, and the effect of the community’s health status (resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices is the directive for lengthening life span not the role of the government.

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

needed health services Working with community groups to create policies to improve the environment

ANS: D

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

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

Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. A major challenge for the future is the need for public health nursing specialists to be more aggressive in working collaboratively with various groups in the community as well as professional colleagues in institutional settings to deal with barriers to health. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

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

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

10. Which question asked by a novice nurse would be the most reflective of an understanding of the role of a public health nurse? a. “Which groups are at the greatest risk for problems?” b. “Which patients should I see first as I begin my day?” c. “With which physicians will I be most closely collaborating?” d. “With which nursing assistants will I partner the most?”

ANS: A

Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals rather than a community-oriented perspective.

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

Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment, policy development. Scientific knowledge-based care is not a core function of public health.

Assessment is systematic data collection on the population, monitoring the population’s health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.

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12. When talking to a women’s group at the senior citizens’ center, the nurse reminded them that the only way the center would be able

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

ANS: D

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

13. The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community.

Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a. To increase the group’s self-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups ANS: D

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

14. The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use

in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals ANS: D

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

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

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

16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an

unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed ANS: A

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

MULTIPLE RESPONSE 1. Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.) a. Economic turmoil and demand for high-technology care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism ANS: B, C, D

As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a stronger commitment to population-focused services, rather it has occurred as overall health needs have become the focus of care.

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2. Which of the following actions demonstrate effective public health nursing practice in the community? (Select all that apply.) a. Epidemiologic investigations examine the environment for health hazards. b. New services are organized where particular vulnerable populations live. c. Partnerships are established with community coalitions. d. Staff members at the public health agency continue to increase in number. e. Staffing walk in clinics for low income families ANS: A, B, C

Evidence that public health nurses are practicing effectively in the community would include organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Neither increasing the number of staff nor acting as staff in the delivery of acute and/or chronic care has a relationship to the effectiveness of public health nursing practice.

3. Why are nurses increasingly providing care in clients’ homes rather than in hospitals? (Select all that apply.) a. Home care is less expensive. b. It is much more efficient to give care in the home. c. Nurses prefer to give home care with individual attention. d. People prefer to receive care in their homes rather than in hospitals.

ANS: A, D

An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

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Chapter 02: The History of Public Health and Public and Community Health Nursing Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position

would be appealing? a. Its autonomy and independence b. Its focus on acute care and immediately visible outcomes c. Its collaboration with other health care professionals d. Its flexibility and higher wages ANS: A

Public health nursing is known for its autonomy and independence. In many instances, there are limited other health care professionals and staff with whom to interact. In-patient acute care nurses focus on acute care with outcomes known fairly quickly.

Acute care nurses collaborate frequently with other health care professionals. Depending on the position there may be more flexibility, but typically public health nurses do not receive higher wages.

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

The Elizabethan Poor Law guaranteed medical care for poor, blind, and “lame” individuals. This minimal care was generally provided in almshouses supported by local government similar to Medicaid assistance. Welfare and food stamps do not provide for medical care. Medicare provides medical care to primarily the elderly population.

3. How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors,

becoming inadequate? a. Economic and political wars resulted in frequent death and injuries. b. Incredible plagues consistently and constantly swept the European continent. c. Migration and urbanization resulted in increased demand for care. d. Caregivers could easily find other employment, so they demanded to be paid.

ANS: C

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

4. A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely

been completed?

Establishing schools of nursing Developing vaccines to administer to large numbers of people Collecting vital statistics and improving sanitation Developing public housing and almshouses

a. b. c. d.

ANS: C

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

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

ANS: A

Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health.

The threat of disease was the impetus for creation of the boards of establishing boards of health. The primary interest of the boards of health was to provide public health services for the entire population and not only those who were poverty-stricken. The primary purpose of the boards of health was not to collect accurate vital statistics or receive tax dollars rather its purpose was to ensure the health of the population.

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6. A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely

have implemented?

Setting policy on quarantine legislation for immigrants Establishing hospital-based programs to care for the sick at home Identifying and improving environmental conditions Providing health care for merchant seamen

a. b. c. d.

ANS: D

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

Identifying and improving environmental conditions was a focus of the public boards of health, not necessarily specifically a role of the nurse.

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

ANS: C

It took 19 years for the first of Shattuck’s recommendations to be implemented, but his report was the first effort to create a modern public health organization. This report called for broad changes to improve the public’s health to take place; however, these changes did not happen immediately after publication. They took 19 years to be implemented in the first state of Massachusetts.

The report included establishment of a state health department and local health boards in every town, sanitary surveys, and food, drug, and communicable disease control, but none of these changes happened quickly.

8. Which nurse is famous for creating public health nursing in the United States? a. Florence Nightingale b. Frances Root c. Lillian Wald d. Mrs. Solomon Loeb ANS: C

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

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

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

10. A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which accomplishments of today

were started within this organization? a. Requiring that public health nurses have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing public health nursing competencies d. Opening the Henry Street Settlement ANS: B

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

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

clients.

ANS: D

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

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12. A nurse is considering joining the American Public Health Association (APHA). What information about this organization should

be considered when making this decision?

APHA focuses on the public health concerns of the medical profession.

APHA represents concerns of nursing specialty practices.

APHA provides a national forum for nurses to discuss their public health concerns. d. APHA focuses on providing health promotion education to the public. a. b. c.

ANS: C

APHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The Public Health Nursing Section within APHA provides nurses with a national forum to discuss their concerns and strategies within the larger context of the major public health organization. It also serves as a focus of leadership and policy development for community/public health nursing. The focus of public health concerns of the APHA is broader than only the medical profession.

The APHA focuses on concerns of public health nurses, not all nursing specialty practice. The APHA focuses on practical application of public hygiene, which is broader than only health promotion education.

13. Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health

program for policyholders?

Creating such a service was the morally correct thing to do Employing nurses directly was less expensive than paying taxes to the city for the same purpose c. Having the company’s nurses make home visits increased worker morale d. Public health nurses visits led to fewer policyholder deaths and lowers company costs a. b.

ANS: D

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

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

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

15. A public health nurse is determining what type of programming should be developed for the community. Which of the following is

the most crucial factor that will influence program development? a. Comprehensive assessment and planning done in the community b. Documented needs of the local community c. Federal funding for priority diseases or groups d. Nursing staff’s expertise and skills ANS: C

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

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

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

17. A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document

would most likely provide useful information about this topic?

The Future of Public Health Healthy People 2020 Patient Protection and Affordable Care Act Scope and Standards of Public Health Nursing Practice

a. b. c. d.

ANS: B

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

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18. A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these

efforts?

To promote the nursing profession To increase funding for public health nursing To address the concerns of nurses To help improve health care access

a. b. c. d.

ANS: D

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

MULTIPLE RESPONSE 1. How did Florence Nightingale help bring about community health nursing? (Select all that apply.) a. She convinced socially prominent wealthy women to volunteer to give care. b. She focused on all soldiers and their environment. c. She interacted with each individual person, assessing his or her needs and acting d.

to meet those needs.

She kept careful records on what was done and what were the results.

ANS: B, D

Nightingale progressively improved the soldiers’ health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes. While Nightingale was part of a wealthy family, the role of nurses during this time period was typically fulfilled by poor women. The focus of Nightingale’s care was to identify health care needs and interventions that influenced the health of the entire population, not individuals.

2. A nurse working with Mary Breckinridge would have likely assisted in what activity? (Select all that apply.) a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural c. d.

populations Blazing a nursing trail through the Rockies, providing nursing care to miners and their families Ensuring positive outcomes for pregnancies among women in the Appalachian region

ANS: B, D

Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of the Southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement. Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky, not the Rockies.

3. How did nursing education change in the 1950s? (Select all that apply.) a. Baccalaureate nursing programs typically included public health nursing b. c. d. e.

concepts.

Diploma schools of nursing continued to expand their student numbers.

Junior and community colleges began offering nursing programs.

Nurses were strongly encouraged to have a scientific basis for their practice.

Post diploma training was initiated nationwide.

ANS: A, C

In the 1950s, public health nursing became a required part of most baccalaureate nursing education programs. In 1952, nursing education programs began in junior and community colleges. Associate degree programs began to expand their enrollments, not diploma schools. The need for evidence-based practice continues to grow but was not a change in the 1950s. In 1914 Mary Adelaide Nutting, working with the Henry Street Settlement, began the first course for post-diploma school training in public health nursing at Teachers College in New York City.

4. How did health care and its delivery change during the 1980s? (Select all that apply.) a. Funding to public health increased as funding for acute hospital care decreased. b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco. c. Nurse practitioners were increasingly used to provide care. d. Public health programs suffered reduced political support, financing, and

effectiveness.

ANS: B, C, D

During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.

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Chapter 03: US and Global Health Care Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A public health agency is planning to implement the electronic health record. (Which is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards ANS: A

The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. There is no evidence that an electronic health record improves client compliance with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies.

2. Which statement best describes the cost of health care in the United States? a. Health care costs are kept low, and the indicators of health are among the best b. c. d.

worldwide.

Health care costs are low which has resulted in poor health outcomes.

Health care costs are the highest in the world, but the indicators of health are not the best worldwide.

Health care costs and indicators of health are the highest in the world.

ANS: C

Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic product, the indicators of what constitutes good health do not document that Americans are really getting their money’s worth.

Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor in comparison to other countries who spend less money on health care.

3. A nurse is explaining the health care system in the United States to a group of health care providers visiting from South America.

How would the nurse best describe the current health care system? a. “It is a logical, rational approach to meeting expressed needs while still trying to control costs.” b. “It is a centralized system that provides care in hospitals.” c. “It is divided primarily into two components: private health care and public health care.” d. “It is the best in the world with outstanding research and high-technology care available to all.”

ANS: C

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

4. Which statement best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages c. d.

self-management Focused on health promotion and disease prevention for everyone enrolled in the health center Local efforts to meet the Declaration of Alma Ata principles

ANS: B

Primary health care is generally defined as essential care made universally accessible to individuals, families, and the community.

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

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5. How does managed care (MC) attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice b. c. d.

associates By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider’s permission By moving Medicaid-eligible families onto state Medicare enrollment By refusing permission for families to use urgent care or emergency department services

ANS: B

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

6. An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no

longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. “Let’s go through these medications and see which ones we can delete.” b. “You can get these medicines at this clinic for free.” c. “Let’s see if we can get some help from Medicare to help you pay for these medications.” d. “These medications are important. Do your best to pay for them.”

ANS: C

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

7. A nurse is determining which health care services must be offered at a local public health clinic. Which factor is most important for

the nurse to consider?

Data available from the most recent community assessment Suggestions from community members about what is needed Recommendations from Healthy People 2020 Services mandated by the state government

a. b. c. d.

ANS: D

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

8. A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the

nurse make about this population?

They have difficulty accessing health care due to a shortage of primary-care providers. b. They most likely receive health insurance through Medicare. c. They are unable to access health care due to the implementation of the Affordable Care Act. d. They have access to affordable health care insurance. a.

ANS: D

Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only 2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly different in Massachusetts than in other areas of the country. Low-income populations are eligible for Medicaid services, not Medicare. The program in Massachusetts became a model for the Affordable Care Act. 9. A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the

client to in order to receive care? a. Managed care b. Community health center c. Emergency department d. Physician office ANS: B

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

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10. Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate

more closely in the last few years?

Increased administrative pressures to demonstrate outcomes Increased focus on emergency preparedness and response Increased taxpayers’ complaints and general unhappiness Increased pressure to decrease overlap in services

a. b. c. d.

ANS: B

Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response.

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

11. Minority nurses represented about 30.1 percent of the RN population. What is this an example of? a. Projection b. Disparity c. Racism d. A sentinel event ANS: B

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

MULTIPLE RESPONSE 1. A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency would

want to achieve accreditation? (Select all that apply.) a. To improve health programming and services b. To improve community relationships c. To improve performance and quality d. To improve management e. To decrease cost of health care ANS: B, C, D

The purpose of accreditation for public health departments is to assist and identify quality health department performance and quality, and it develops leadership, improve management, and improve community relationships. Neither the improvement of health care programming and services nor minimizing health care costs is a reason why a public health agency would want to achieve accreditation.

2. What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that

apply.) a. Foreign-born immigrant population is increasing. b. Hispanics are the largest minority group population. c. Leading causes of death are from infectious diseases. d. Mortality for both genders in all age groups declined. e. Unintentional injuries are among the top 10 causes of death.

ANS: A, B, D, E

The nation’s foreign-born population is growing, and it is projected that from now until 2050 the largest population growth will be due to immigrants and their children. Although African Americans used to be the largest minority group, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined. The leading causes of death have changed from infectious diseases to chronic and degenerative diseases with unintentional injuries being among the top 10.

3. Which of the following statements is accurate descriptions of current social and economic trends in the United States? (Select all

that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. People often spend a considerable amount of their own money on complementary therapies. d. The gap between the richest and poorest is widening. e. The composition of families and living patterns are changing.

ANS: A, C, D, E

Several social trends that influence health care include changing lifestyles, a growing appreciation of the quality of life, the changing composition of families and living patterns, changing household incomes, and a revised definition of quality health care.

People often spend a considerable amount of their own money for these types of therapies because few are covered by insurance. It is obvious that the gap between the richest and poorest is widening because of the percent wage increase in the higher income levels. Americans spend considerable money on health care, nutrition, and fitness, because health is seen as an irreplaceable commodity. To be healthy, people must take care of themselves.

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4. Which of the following provides evidence that the US health care system is in crisis? (Select all that apply.) a. Health insurance is an expensive benefit for employers to provide. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors. e. Consumers want lower costs and high-quality health care without limits.

ANS: A, C, E

Consumers want lower costs and high-quality health care without limits and with an improved ability to choose providers and services of their choice while employers are typically the purchasers of health care; they want to be able to obtain basic health care plans at reasonable costs for their employees. Many employers have seen their profits diminish as they put more money into providing adequate health care coverage for employees. Nurses working long hours pose a serious threat to patient safety because fatigue slows reaction time, saps energy, and diminishes attention to detail. The Institute of Medicine’s (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. The report makes it clear that the majority of medical errors today were not produced by provider negligence, lack of education, or lack of training.

5. A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting?

(Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state’s citizens c. Employing and supervising school health nurses d. Establishing and maintaining child immunization clinics e. Providing education regarding established health codes ANS: A, B, E

State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in areas such as ongoing assessment of health needs. Employing and supervising school health nurses occur at the local level, and many times within a specific school. Provision of child immunization clinics occurs at the local level.

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Chapter 04: Government, the Law, and Policy Activism Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best defines the word politics? a. The art of influencing others b. The outcome of governmental policies c. A provision of power for making decisions d. The result of legislative action ANS: A

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

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

The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws).

The judicial branch interprets laws.

3. A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following

branches of the government is the nurse working?

Constitutional branch of government Executive branch of government Legislative branch of government Judicial branch of government

a. b. c. d.

ANS: C

The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies problems and proposes and then debates, passes, and modifies laws to address those problems. There is not a constitutional branch of the government. The executive branch administers and regulates policy. The judicial branch interprets laws.

4. Which of the following statements best describes why the federal government has become involved in health care? a. The states asked the federal level to become involved. b. Because of rising costs to the states, the federal budget needed to be used to pay c. d.

for necessary services.

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

This step was necessary to standardize care on a national level.

ANS: C

One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution, that such federal governmental action was within the powers of Congress to promote the general welfare. According to Article I, Section 8 of the US Constitution Congress has multiple roles in relation to health care: provide for the general welfare, regulate commerce among the states, raise funds to support the military, and provide spending power. Thus, Congress was within its role to become involved in health care and was not asked to do so by the states or used to standardize care on the national level.

5. A client states to the nurse, “I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I

have seen no benefits from this legislation.” Which of the following statements would be the best reply by the nurse?

“Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill.” b. “It will take years to see any effects from the act because of the delays in implementation of the changes.” c. “This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits.” d. “The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact.” a.

ANS: A

It is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of this law. The goal of the Affordable Care Act was to improve the health of the nation and access care. Several changes to health care have already been made because of this legislation, and more changes will continue in the future. Multiple provisions of the act will affect individuals and families.

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6. What was the significance of the 1979 Surgeon General’s report? a. It planned the goals and priorities for the entire Veterans Administration medical b. c. d.

system.

It vastly increased funding for health promotion activities.

It identified the use of tobacco as a cause of lung cancer.

It created national goals for promoting health and preventing disease.

ANS: D

The 1979 Surgeon General’s report began a focus on preventing disease and promoting health for all Americans. It was a national effort with all levels of government, as well as other interested parties, involved. The 1979 report did not plan goals and priorities for the Veterans Administration medical system; rather it looked at health of all Americans. There was no funding associated with the report. It addressed prevention of disease and promotion of health for multiple diseases, not just lung cancer.

7. A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the

following factors should the nurse emphasize? a. Providing disease investigation training b. Providing research opportunities c. Providing leadership experiences d. Providing salaries commensurate with responsibilities ANS: D

Through the input of the Division of Nursing’s National Advisory Council for Nursing Education and Practice (NACNEP), the Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to support the public health nurse role are competitive salaries commensurate with responsibilities, experience in health promotion and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health disparities. The Division of Nursing’s National Advisory Council for Nursing Education and Practice (NACNEP) did not emphasize the importance of providing disease investigation training, research opportunities, or leadership experiences.

8. A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of

law will the nurse refer?

Common law Constitutional law Legislation and regulation Judicial law

a. b. c. d.

ANS: B

Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry.

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

Judicial law, based on court and jury decisions, and the principles of common law (precedent, justice, fairness, respect for an individual’s autonomy, and self-determination) are both used by court’s as the basis to make a decision and do not relate to having the right to isolate a patient. Legislation is law that comes from the legislative branches of the government and regulations are specific statements of law related to defining or implanting individual pieces of legislation. Neither are as important in this case as the constitutional law of the police power of the states in regards to isolation of a patient.

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

Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse practice act is governed by legislators in each state. The American Nurses Association, US Department of Health and Human Services, and federal government do not determine the scope of practice for nurses; this responsibility is the role of state governments. The US Department of Health and Human Services is the agency most heavily involved with the health and welfare of US citizens.

10. Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for

professional negligence?

“Because the health care workers didn’t turn my mother every 2 hours, she developed bedsores.” b. “I received permanent nerve damage because they would not remove a cast that was too tight.” c. “My daughter wasn’t given a call light, and for a whole shift no one checked on her condition.” d. “They amputated the wrong leg during surgery.” a.

ANS: C

Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an injury, except for “My daughter wasn’t given a call light, and for a whole shift no one checked on her condition,” in which case the care was substandard but no injury resulted. The incorrect responses all specify an injury whereas professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury.

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

their instructor.

Students have a scope of practice determined by the nurse practice act.

ANS: B

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

12. A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which

of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a. When the bill is first assigned to a committee. b. When the bill is discussed and debated within the committee. c. When the bill moves out of committee to be heard by the entire Senate. d. When the bill passes the Senate and moves to the House of Representatives.

ANS: C

Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this senator, who will then be in a position to act on it. To contact the senator when the bill is first assigned to the committee or is being discussed and debated within the committee is too early to effectively influence the individual senators. The nurse would not want to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.

13. The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and

requires. Which of the following effects will this change have on nurses in this state? a. None, because they are just helpful guidelines for maximum safety. b. None, because they just give specifics that may change over time. c. Major, because prudent nurses would follow such regulations. d. Major, because these rules and regulations have the effect of law and must be obeyed.

ANS: D

When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations.

Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They are laws that must be followed, not guidelines.

14. A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse

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

ANS: B

Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying against a bill because it shapes the final implementation of the law. Health care agencies do not have the ability to veto a bill. After a bill has been passed, it is too late to contact members of congress. Calling the hospital will not change the implications of the bill.

Contact must be made with the regulatory agency in order to influence how the law is regulated.

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

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

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16. Which of the following laws established programs for provision of health services for women and children and supported

community-oriented nursing practice?

Early Periodic Screening and Developmental Testing (EPSDT) Initiative Healthy People 2000 Initiative Sheppard-Towner Act State Child Health Improvement Act (SCHIP)

a. b. c. d.

ANS: C

The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children and made nurses available to provide these services in the community setting. Within the Sheppard-Towner Act was a provision to start the EPSDT initiative. SCHIP provides insurance for children and families who cannot otherwise afford health insurance.

Healthy People 2000 focuses on promoting health and preventing disease for all Americans.

MULTIPLE RESPONSE 1. Which of the following describes the significance of the passage of The Public Health Threats and Emergencies Act? (Select all

that apply.) a. It funded ongoing activities of the public health system. b. It led to improved water quality and food safety guidelines. c. It included funding for public health activities. d. It validated that the public health system was prepared for terrorism. e. Expanded the role of Secretary of HHS to include aspects of public health emergencies.

ANS: B, C

The Public Health Threats and Emergencies Act was the first federal law to comprehensively address the public health system’s preparedness for bioterrorism and other infectious disease outbreaks and signaled the beginning of renewed interest in public health as the protector for entire communities. The focus of this law was to address emerging threats to the public’s health and authorize the Secretary of HHS to take appropriate response actions during a public health emergency, including investigations, treatment, and prevention. A focus was the improvement of water quality and food safety. It did not support the ongoing activities of public health. It did not validate the public health system was prepared for terrorism.

2. Which of the following best describes the importance of the World Health Organization (WHO) to the United States? (Select all

that apply.) a. Provides daily information on disease occurrences. b. Establishes international standards for antibiotics and vaccines. c. Creates international legislation regarding international cooperation. d. Supports national programs to fight disease when asked to do so. e. Monitors for adverse drug reactions.

ANS: A, B, D, E

Some WHO services that benefit all countries (including the United States) are providing day-to-day information service on the occurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoring adverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can request assistance with strengthening the delivery of health services, supporting national programs to fight disease, and training health workers—which the United States does not. WHO can suggest but cannot legislate to individual countries.

3. Which of the following activities is the responsibilities of the Centers for Disease Control and Prevention (CDC)? (Select all that

apply.)

Conduct research to enhance disease prevention.

Detect and investigate infectious disease problems.

Develop public health policies.

Publish national goals for promoting health and preventing disease.

Serves as an advocate of public health polices

a. b. c. d. e.

ANS: A, B, C, E

The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. To monitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, and develop and advocate sound public health policies and other prevention strategies. The safety and health of the workplace is the specific responsibility of OSHA. The CDC cannot write or pass legislation. The USDHHS published national health goals in Healthy People 2020.

4. A nurse is visiting a state legislator to encourage the legislator to vote for a particular health bill that the state nurses association has

endorsed. Which of the following actions would be most important for the nurse to complete? (Select all that apply.) a. Encourage the legislator or staff to ask relevant questions. b. Be friendly and engage in small talk so that rapport can be established. c. Be aware that legislators are well informed; don’t insult the legislator by stating information that is obvious. d. Have a handout that summarizes all the major points in support of the bill.

ANS: A, D

Legislators might not be well informed about every issue, so they need and want important information. The nurse should allow time for questions or clarifications of information shared and have the material on a handout for the legislator’s convenience. It is also helpful to invite the legislator to attend nursing conferences or meetings where health issues will be discussed. The nurse should not waste time with small talk but briefly present his or her stand, emphasizing other nurses who support the bill, because numbers count. Legislators might not be well informed about every issue, so they need and want important information that the nurse can provide.

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5. A nurse would like to become involved in political action. Which of the following actions would be most appropriate for the nurse

to accomplish this goal? (Select all that apply.)

Become a member of the state nurses association.

Be friendly with everyone, whether supportive or not of your ideas.

Focus on being appointed to the state level committees.

Focus all your efforts on your specialty practice area and your employment site.

Volunteer to serve on relevant committees.

a. b. c. d. e.

ANS: A, B

A nurse wishing to become politically involved should begin by joining the state nurses association, networking with others involved, and volunteering to serve on committees or in offices. Be friendly and network to increase your knowledge beyond your own workplace or specialty and seek opportunities to share expertise with others. Becoming involved locally is a good opportunity to start becoming involved in political action and allows for networking at the local level. Seeking opportunities beyond one’s workplace or specialty area allows the nurse to gain additional knowledge and share expertise in specialty area with others.

6. A nurse is testifying at a committee meeting about a health bill. Which of the following actions should be taken by the nurse?

(Select all that apply.) a. Briefly describe professional education. b. Discuss how the bill affects more than just nurses. c. Include factual data and, if possible, statistical information in visual form. d. Provide written proof of personal and professional qualifications e. Provide information about relevant expertise and related experience.

ANS: A, B, C, E

Language must be simple and carefully chosen to convey information to listeners and to avoid professional jargon. The nurse must share a bit of personal education, experience, and expertise to be seen as a credible source, but written proof of credentials is not necessary unless specifically requested. The testimony must go beyond just nursing’s interest and include accurate, credible data.

The data must be accurate and credible which may not be the case when getting names from the media.

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Chapter 05: Economics of US Health Care Delivery Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed

as the criterion that is used to ration health care? a. Clinic operating hours b. Ability to pay for services c. Availability of local provider services d. Transportation availability ANS: B

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

2. Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate

health care resources? a. Insurance resources b. Health care rationing c. Health economics d. Medical technology ANS: C

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

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

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

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

Young adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes.

The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it.

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

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

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6. A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which

of the following statements would be most appropriate for the nurse to make?

“Don’t drop out of school.”

“Sign up for childbirth classes.”

“Sign up for the WIC program.”

“Take your prenatal vitamins daily.”

a. b. c. d.

ANS: A

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

7. A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the

financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department c. Medicaid d. Medicare ANS: C

Medicaid provides coverage for adults with low income and their children. Managed care is a type of private insurance while Medicare is available to persons aged 65 and older. The emergency department would charge a co-pay for care given to both the child and the parents.

8. Which of the following best explains how the government unintentionally encourages low-income persons to use emergency

departments as their primary care provider?

A huge amount of paperwork is required when Medicaid clients go to a physician’s office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. c. Legally, emergency departments must see clients even if clients can’t pay. d. Physicians’ limited office hours make them unavailable during evenings and weekends. a.

ANS: C

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

9. Which of the four main factors that affect health, is the most important? a. Environment b. Human biology c. Lifestyle choices d. Health care system ANS: C

Personal biology and behavior (or lifestyle), environmental factors and policies (including physical, social, health, cultural, and economic environments), social networks, living and working conditions, and the health care system—medical services are said to have the least effect. Behavior and lifestyle have been shown to have the greatest effect on longevity, with the environment and biology accounting for the greatest effect on the development of all illnesses.

10. A nurse is trying to maximize the quality of life of clients while reducing health care costs. Which of the following actions would

most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition d. Teaching a high school boy about sexually transmitted infections and proper condom application ANS: D

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

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11. Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the

United States?

Education of health care providers moved into universities.

People finally had enough money to pay for medical care.

The improved outcomes of hospital care were recognized.

Advances were made in sewage disposal, and water and milk quality.

a. b. c. d.

ANS: D

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

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

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

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

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

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

Combined state and federal governments paid the most for health care in 2018. Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers. From 1960 to 2018, the percentage of third-party public insurance payments increased and the percent of out-of-pocket payments declined.

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

Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers “medically necessary” services, such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services and physiotherapy.

16. A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as durable medical

equipment. Which of the following best describes this part of Medicare? a. Part A b. Part B c. Part C d. Part D ANS: B

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

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

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

18. Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of

reducing the need for professional health care intervention and therefore also lowering cost? a. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement ANS: A

The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion.

Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on the same criteria, but managed care integrates the financing and the delivery of health care.

19. Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients

regardless of the services needed and provided? a. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement ANS: A

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

20. A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following

would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment d. Neglecting to order certain tests or treatment to minimize cost to the provider ANS: D

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

21. When did medicine in the United States make a shift away from the treatment of acute infection to care of chronic illnesses? a. Between 1890 and 1920 b. Between1920 and 1940 c. Between 1940 and 1960 d. Between 1945 and 1984 ANS: D

The later part of the 20th Century (1945-1984) ushered in a shift away from acute infectious health problems of previous stages toward chronic health problems such as heart disease, cancer, and stroke.

22. A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following

interventions is the nurse most likely completing? a. Applying for a grant to establish a daycare center to serve dependent older adult clients living with working families b. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare ANS: B

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

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MULTIPLE RESPONSE 1. In which of the following situations would the federal government provide money through tax relief for private enterprise? (Select

all that apply.) a. A business pays for part of health insurance premiums for its employees. b. A business purchases gifts for its employees to award them for their service. c. An employer provides health screenings. d. An employer requests reimbursement for employee transportation costs. e. An employer offers immunizations to all eligible employees.

ANS: A, C, E

Businesses can pay for disease prevention and health promotion services for employees (and sometimes their families) in the form of immunizations, health screenings, and counseling. The business can then deduct these costs as a business expense, which reduces the amount the business owes the government in taxes on their profits. Similarly, when businesses subsidize health insurance for their employees—and families—this is also a business expense, which decreases the amount the business would otherwise pay in taxes. Thus, the government indirectly provides the money, but the business, a part of the private sector, decides how it is used. A business purchasing gifts for its employees and an employer requesting reimbursement for employee transportation costs do not result in tax relief for the business. Rather, the business providing health insurance and health promotion/disease prevention services allows the amount of taxes that the business owes to the government to be reduced.

2. Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.) a. Clients may have preexisting conditions not covered by insurance. b. Many physicians won’t accept Medicaid clients. c. Medicaid won’t pay for certain medical interventions. d. Medicaid recipients are noncompliant with their health care providers’ e.

recommendations.

There is a general hesitancy among those eligible to seek health care.

ANS: A, B, C

The primary reasons for delay, difficulty, or failure to access care include inability to afford health care and a variety of insurance-related reasons, including the insurer not approving, covering, or paying for care; the client having preexisting conditions; and physicians refusing to accept the insurance plan. Practical problems such as lack of childcare, transportation, long waiting periods, and communication issues also interfere. Noncompliance is not a primary reason why Medicaid clients have poor outcomes. There is no research to confirm that Medicaid recipients are reluctant to seek medical care. Rather there are usually other compounding factors that interfere with the client following the regimen or accessing other needed health care services which result in the poor health outcomes.

3. A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of the

following interventions should be implemented by the nurse? (Select all that apply.) a. Publicize data on success of health promotion efforts. b. Lobby for decreased reimbursement for secondary and tertiary care services. c. Establish standards for appropriate screenings at specific intervals. d. Encourage members of the military service to engage in appropriate healthy lifestyle behaviors. e. Provide transparency to the public regarding service costs and savings.

ANS: A, E

Reasons given for the lack of emphasis on prevention in clinical practice and lack of financial investment in prevention include provider uncertainty about which clients should receive services and at what intervals, lack of information about preventive services, negative attitudes about the importance of preventive care, lack of time for delivery of preventive services, delayed or absent feedback regarding success of preventive measures, less reimbursement for these services than for curative services, lack of organization to deliver preventive services, and lack of use of services by the poor and elderly. Considering how health care dollars are spent in the United States, it would not be reasonable to lobby for decreased funding for secondary and tertiary services, as this would result in less care available for individuals. Requiring people to change their lifestyle would be illegal.

4. Which of the following are some major differences in health care today, as compared with the first half of the 20th century? (Select

all that apply.) a. Consumers are influenced by advertising for specific health care agents or procedures. b. The emphasis is on the continued expansion of health care facilities, especially acute care hospitals. c. Education and specialization of personnel have increased. d. The need to create new ways to pay for health care is a central focus. e. Hospital stays are much shorter.

ANS: A, C, E

Since the 1980s, the United States has been in a period of limited resources, with an emphasis on containing costs, restricting growth in the health care industry, and reorganizing care delivery. Results have included shorter hospital stays and sub stitution of one set of personnel (such as nurse practitioners) for another set (physicians). Such trends are made more challenging by increased direct marketing to consumers. Also with increased knowledge has come increased education and specialization. Shorter hospital stays continue to occur so there is a focus on expanding care in the community, not in acute care hospitals. Containment of costs is a major focus; however, creation of new payment methods has not been part of this conversation.

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Chapter 06: Ethics in Public and Community Health Nursing Practice Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following is generally considered to be nursing’s first code of ethics? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses d. Principles of the Ethical Practice of Public Health ANS: A

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

2. A nurse didn’t know what to do when faced with a particular ethical dilemma because an option that would have a good outcome

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

ANS: C

Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. The supervisor is not responsible for the nurse’s choices, the nurse must maintain responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have similar knowledge as the supervisor.

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

ANS: C

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

4. A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the

wife’s diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse’s most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family’s current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family’s well-being ANS: D

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

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5. The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care

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

ANS: A

According to Callahan, although the nurse may attempt moral persuasion to change the family’s values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family’s values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family’s decision. Thus, the other answers are not an appropriate action for the nurse to take.

6. Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other

family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It is a wife’s responsibility to care for an ill husband.” Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism ANS: C

The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Based upon this understanding, none of the other options correctly describes the nurse’s statement.

7. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and

the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “The whole family is being affected and will fall apart if they don’t focus on their family’s needs first before anything else.”

Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism ANS: D

By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision- making.

Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

8. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and

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

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

9. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and

the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It’s not up to us; it’s the family’s decision. They know what is best for them.” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism ANS: C

The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values and goals. Therefore, the nurse is using Principlism—that is, basic principles are the basis of the nurse’s actions.

Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

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10. Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute

health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principles ANS: D

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

11. The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following

approaches should the nurse use in personally deciding what is right? a. Do whatever will not get the nurse in trouble with employer. b. Do whatever is supported by an ethical expert, such as the hospital chaplain. c. Do whatever the nurse would recommend to anyone in a similar situation. d. Do whatever the nurse supervisor would feel comfortable reporting to administration.

ANS: C

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

12. A man entered the emergency department bleeding profusely and screaming, “I’ve got to see a doctor right now! I’ve got a right to

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

ANS: C

The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society—and that the government’s role is to ensure this happens, at least on a basic level. Therefore, the man has a right to emergency care. Hospital funding and use of taxpayer money does not demonstrate the use of an ethical principle. Saving an individual’s life may or may not improve society. There is not an ethical principle that states that the man has a property right to his own body.

13. From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should

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

ANS: A

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

14. A health care provider refuses to order pain medication for a drug addict who has been severely injured in a car accident. When

reminded by nurses that pain medication has not been ordered, the provider merely replies that the patient’s suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is being using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics ANS: D

Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is paternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn from his experience and possibly develop into a drug-free person. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. When decisions are based on outcomes or consequences, it is known as consequentialism. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

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

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

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

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

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

ANS: C

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

18. A new nurse states to a nursing colleague, “But why do I have to be involved in politics? I just want to be the very best clinical

nurse I can.” Which of the following would be the best response from the nursing colleague?

“As long as you pay your membership fee to the American Nurses Association, you have participated in the profession’s political endeavors.” b. “Political action is the way you try to fulfill your ethical responsibilities to clients.” c. “You’re absolutely right; if you are good clinically, you have fulfilled your obligation.” d. “When you’ve completed your clinical orientation, then you’ll have time to be involved in politics.” a.

ANS: B

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

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

ANS: D

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

20. How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate

interventions? a. Ask community leaders for their opinion of the interventions. b. Examine the morbidity and mortality rate of the community. c. Reassess the community to determine whether obvious needs have been met. d. Systematically survey community residents regarding their perception.

ANS: B

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

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

important in practice.

ANS: C

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

MULTIPLE RESPONSE 1. Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nurse

believes that deciding on care rather than cure is the woman’s decision and no one else can decide for her. The second nurse says that it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility of cure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn’t fair for the family members to expend all their resources on the woman, who is probably going to die anyway. Which of the following conclusions can be drawn from this dispute? (Select all that apply.) a. Ethical principles can conflict with one another. b. The nurses are each using different ethical approaches. c. The first nurse is correct because autonomy demands that the woman decide for herself. d. There is no single accepted approach for resolving such disagreements.

ANS: A, B, D

One of the criticisms of using ethical principles is that they can conflict with one another in any given situation. No rule exists for helping resolve such conflicts. Each nurse can apply different ethical principles to reach their own ethical decision. Because there is no one rule to assist with solving an ethical conflict, and ultimately no one right answer, there is not a correct decision that can be made.

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Chapter 07: Culture of Populations in Communities Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes most Americans’ attitude toward immigrants? a. Ambivalence, because there are no clear solutions about how to address their b. c. d.

needs.

Strongly negative, because immigrants take jobs that native-born Americans could have instead.

Strongly positive, because immigrants bring useful job skills and often join previous family members already in the United States.

Strong opposition to further immigration, because of the increasing population in the United States.

ANS: A

Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions. Because Americans are ambivalent, there is neither a strong negative nor a positive attitude toward immigrants. However, many times immigrants do enter the United States because they have useful job skills or family ties. They are more likely to be low-income workers who work in low-wage, blue-collar jobs and industries.

2. Earlier in the week, a nurse carefully taught a patient from a different culture exactly how much medication to take and emphasized

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

ANS: B

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

3. A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurse’s b. c. d.

community.

Consider how the nurse’s own personal beliefs and decisions are reflective of his or her culture.

Invite a family from another culture to join the nurse for an event.

Study the beliefs and traditions of persons living in other cultures.

ANS: B

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

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

other client.

ANS: A

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

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5. A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client’s

history. He stopped doing this around specific clients after being told that they were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a. Cultural accommodation b. Cultural imposition c. Cultural re-patterning d. Cultural skill ANS: D

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

6. The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is “hot”

and he believes that penicillin, a “hot” medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the client’s prescription is changed to a different yet equally effective antibiotic? a. Cultural awareness b. Cultural brokering c. Cultural knowledge d. Cultural skill ANS: C

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

7. An immigrant who takes metamizole (banned in the United States) for pain may experience life-threatening agranulocytosis. Which

of the following actions would be taken by a nurse who employs cultural re-patterning?

Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b. Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. d. Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition. a.

ANS: C

Cultural re-patterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them. Completing a cultural assessment involves learning more about the client’s culture but does not address the need to consider changing or modifying cultural practices. In order to complete cultural re-patterning, the nurse has to take an action to resolve this potential problem.

8. A health care worker tells a nurse, “It does no good to try to teach those Medicaid clients about nutrition because they will just eat

what they want to no matter how much we teach them.” Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping ANS: D

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

9. An American nurse says, “I’m not going to change the way I practice nursing based on where the client is from because research

shows that Western health care technology and research is best.” Which of the following is being demonstrated by the nurse’s statement? a. Ethnocentrism b. Prejudice c. Racism d. Stereotyping ANS: A

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

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10. A nurse states, “The best way to treat a client from another country is to care for them the same way we would want to be cared for.

After all, we are all humans with the same wants and needs.” What does this statement reflect in relation to culture?

Awareness Blindness Knowledge Preservation

a. b. c. d.

ANS: B

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

11. A Spanish-speaking family comes to the public health department. No one in the family speaks English, and nobody at the health

department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English–Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, “No hablo Español” (I don’t speak Spanish). d. Obtain an interpreter to translate.

ANS: D

Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client’s language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client.

The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for the client—attempting communication using a book, stating that he or she does not speak English, and arranging for a referral do not address the priority action of finding an interpreter.

12. A nurse who is explaining to an immigrant client why it is important to take medication states, “The medication takes a couple of

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

ANS: A

If we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important.

When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time should be the immediate concern of the nurse. It is possible that the client did not have the necessary resource or did not understand the importance of the medication, but the nurse should first investigate the potential cultural disconnect.

13. A client is crying softly and saying, “What did I do to deserve this punishment, Lord?” Which of the following responses by the

nurse would be the most appropriate? a. “God doesn’t punish people. You’re sick just because of bad luck.” b. “I can call the hospital chaplain to help you talk about these feelings.” c. “What can I do to be helpful to you right now?” d. “Would you like to confess your sins and repent so this illness will go away?”

ANS: C

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

14. A patient who identifies as Buddhist enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give

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

ANS: B

Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don’t eat meat. The nurse should be aware of the cultural considerations that should be made for Buddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that these considerations can be made. The nature of the test determines the fasting requirements; no order is needed. Whether the client is diabetic or allergic to some foods should be determined upon admission.

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15. At a local hospital, the postpartum care policy requires that nurses observe the mother during infant care to assess the mother’s

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

ANS: A

Culturally competent nursing care focuses on the specific patient, reflects the patient’s individual beliefs and values, and is provided with sensitivity. The nurse should accept the cultural norms and behaviors of this client and her family. Thus, the nurse should provide culturally competent care and comply with the client’s desire. This should take priority over any judgments the nurse could make about this client or hospital documentation related to infant care by the mother. This respect of culture makes the other options incorrect.

16. For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patient’s

daily prayers. Which of the following is the nurse demonstrating through these actions?

Accommodation Awareness Brokering Imposition

a. b. c. d.

ANS: A

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

17. A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia

about 10 years ago. The nurse’s next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a. Covert intentional prejudice b. Covert unintentional prejudice c. Overt intentional prejudice d. Overt unintentional prejudice ANS: C

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

18. A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She

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

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

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19. When teaching a nutrition class to a student group with a large Latino population, the school nurse incorporates foods such as salsa

and other healthy dishes familiar to students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary preventions ANS: A

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

MULTIPLE RESPONSE 1. An undocumented immigrant comes to a primary care provider’s office to receive care. Which of the following services can the

client receive? (Select all that apply.)

Treatment for tuberculosis Treatment for type 2 diabetes Immunization for polio Physical examination Sutures for a laceration

a. b. c. d. e.

ANS: A, C, E

Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. They are eligible only for emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches. Undocumented immigrants are not eligible to receive treatment for chronic diseases such as type 2 diabetes or physical examinations.

2. A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar.

Therefore, a cultural assessment should be attempted. Which of the following questions should the nurse ask? (Select all that apply.) a. “Can you tell me where your family is from?” b. “Do you practice a particular religious faith?” c. “What other countries have you lived in?” d. “Is there anything special we need to know about your food preferences?” e. “What do you think is causing your health problem?”

ANS: A, B, D, E

In a general cultural assessment, nurses ask clients about their ethnic background, language, education, religious affiliation, dietary practices, family relationships, hospital experiences, occupation and socioeconomic status, cultural beliefs, and language. Nurses want to also ask about the client’s perception of the health issue and what caused it and how it should be treated as well as the results they expect from the care they get. Such basic data help nurses understand the client from the client’s point of view and recognize what is unique about the person, thus avoiding stereotyping. Knowing the other countries that the client has lived in may be helpful; however, necessary information about the client’s culture should be able to be collected through broad questions about the client’s culture.

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Chapter 08: Environmental Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals

would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacist d. Toxicologist ANS: D

Toxicology is the basic science that studies the health effects associated with chemical exposures. A chemist, epidemiologist, or pharmacist would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes.

2. A nurse wants to find information about environmental threats that are present in the community. Which of the following would be

the best source of data for the nurse? a. Cumulative Index of Nursing and Allied Health (CINAHL) database b. National Library of Medicine c. State health department d. Closest local library ANS: B

Technology helps us understand environmental threats. The National Library of Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms. The CINAHL database provides access to literature related to nursing and allied health journals and would not be as comprehensive as the National Library of Medicine. It would be difficult to access information easily through the health department. The information that is available at the local library would be dependent on the community in which one lived.

3. A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the

nurse should take?

Conduct health risk assessments of randomly selected individuals.

Perform a windshield survey.

Review facility permits and consumer confidence reports.

Survey community members.

a. b. c. d.

ANS: B

Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides firsthand information about the community and areas of concern that must be investigated. Conducting health risk assessments of randomly selected individuals or surveying community members does not give the nurse a good assessment of potential environmental health risks of the entire community. Reviewing facility permits and consumer confidence reports would not provide enough information to assess the environment of a community.

4. A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past

few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center.

ANS: A

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

5. A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and

sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. “Ask the staff in employee health if there have been any other complaints.” b. “Call the local health department about any recent problems at the hospital.” c. “Check the material safety data sheet on any chemicals you have used recently.” d. “See the nurse’s health care provider for a complete work-up.”

ANS: C

Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling. After checking the material safety data sheets, the next steps would be to connect with a health care provider which could include staff in employee health, a local health department, or one’s own health care provider. The first step should be to determine what exposure occurred.

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6. Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental b. c. d.

toxins.

Children are more susceptible to environmental toxins because of their smaller size.

The incidence of asthma among children has been decreasing.

Children are more susceptible to cancer if they have a family history of the disease.

ANS: B

Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink.

Infants and young children drink more fluids per body weight than adults, and this increases the dose of contaminants in their drinking water, milk (hormones and antibiotics), and juices (particularly pesticides). Only a small percentage of childhood cancers are associated with heredity. However, exposure to ionizing radiation increases the risk of childhood leukemia and possibly other cancers. All of the causes of autism spectrum disorder are not currently known. Environmental factors are thought to be a possible cause, as are biologic and genetic factors. Asthma is common among children, and the strongest risk factors are genetic factors and inhaled substances and particles that provoke an allergic reaction or irritate the airways. Indoor air quality is a growing concern because of the alarming rise in the incidence of asthma in the United States, particularly among children.

7. Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a c. d.

hazardous vacant lot Referring a child with toxic lead levels to a neurologist Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

ANS: A

Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages. Meeting with local government officials to request that the city clean up a hazardous vacant lot and referring child with toxic lead levels to a neurologist are examples of tertiary prevention as the problem already exists. Education to avoid exposure is part of primary prevention which relates to teaching parents about the dangers of lead-based paint in older homes.

8. An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks

among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators ANS: C

Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention. Checking radiatio n detectors and using spirometry are both examples of screening for potential exposure which is part of secondary prevention. Irrigating the eyes of an employee who had a chemical splash to the face addresses tertiary prevention as a problem has already occurred.

9. A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to

take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his or her appliances with new energy-efficient ones.

ANS: C

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

10. Which of the following best describes the purpose of local health departments making unannounced inspections of local

restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide oversight to potential exposure d. To monitor employee safety ANS: B

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

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11. A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens.

Which of the following principles would the nurse be using when vocalizing opposition for this plan?

Environmental justice Environmental epidemiology Tertiary prevention Risk communication

a. b. c. d.

ANS: A

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

Environmental epidemiology is concerned with the discovery of environmental exposures that contribute or protect against disease or illness which is not accomplished by the nurse vocalizing opposition to the plan. Vocalizing opposition to the plan would not be a tertiary prevention strategy as the nurse is addressing a problem that does not yet exist. Risk communication includes general principles of good communication (right information, to the right people, at the right time). In this scenario, the nurse is vocalizing opposition, not communicating risks.

12. A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware

nurse?

“Is anyone else in your family having these symptoms?”

“How many people live in your home?”

“What jobs have you held the longest?”

“Where did you live 10 years ago?”

a. b. c. d.

ANS: C

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

The other questions do not address the topics identified in the “I PREPARE” mnemonic (investigate potential exposures, present work, residence, environmental concerns, past work, activities, referrals, and resources, and educate).

13. A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues.

Which of the following acts would the nurse most likely discuss with the student?

Chemical Safety Information, Site Security, and Fuels Regulatory Act Comprehensive Environmental Response, Compensation, and Liability Act Food Quality Protection Act Occupational Safety and Health Act

a. b. c. d.

ANS: D

The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. The Chemical Safety Information, Site Security, and Fuels Regulatory Act, Comprehensive Environmental Response, Compensation, and Liability Act, and Food Quality Protection Act may contribute to safety but do not have the full oversight of OSHA. 14. The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of

the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation ANS: D

In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. Assessment would have been done earlier in the process because this was needed to determine that a problem existed and that interventions were needed. Diagnosis occurs when the disease and environmental factors are related to the diagnosis. When intervention is used, the nurse coordinates medical, nursing, and public health actions to meet the client’s needs.

15. A nurse practitioner has established a mobile clinic to vaccinate adults against influenza. Which of the following phases of the

nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation ANS: C

Giving immunizations is an intervention that will increase the number of people who will be vaccinated. Intervention includes coordinating medical, nursing, and public health actions to meet the client’s needs. Assessment would have been done earlier in the process because this was needed to determine that a problem existed and that interventions were needed. Planning occurs when the nurse looks at community policy and laws as methods to facilitate the care needs for the client. When criteria that includes the immediate and long-term responses of the client as well as the recidivism of the problem for the client are examined, it is part of the evaluation phase.

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MULTIPLE RESPONSE 1. A public health nurse is assisting the community in dealing with the effects of lead paint poisoning. Which of the following

activities would the nurse most likely complete? (Select all that apply.) a. Administering medications to those with signs of lead poisoning b. Assessing community members for any health problems c. Setting up a blood screening program with the local health department d. Encouraging local landlords to improve the condition of their housing e. Educating the public on the dangers of lead paint ANS: C, D, E

The nurse’s role is to understand the roles of each respective agency and organization, know the public health laws, and work with the community to coordinate services to address the community’s needs. Other needed interventions include organizing a blood-lead screening program through the local health department, educating local health providers to encourage them to systematically test children for lead poisoning, and working with local landlords to improve the condition of their housing stock.

Educating the community of the hazards of lead paint falls within the roles of the public health nurse. Administering medications to those with signs of lead poisoning is not a typical role of the nurse when dealing with lead poisoning. Assessing community members for any health problems is too broad of an intervention and does not address the specific need of the nurse working with lead poisoning in the community.

2. Which of the following are the major sources of air pollution in the United States? (Select all that apply.) a. Burning of fossil fuels b. Waste incineration c. Wood burning fireplaces d. Motor vehicles e. Coal-fired power plants ANS: A, B, D, E

Motor vehicles are the greatest single source of air pollution in the United States. The burning of fossil fuels (diesel, industrial boilers, and power plants) and waste incineration are two other major contributors. Wood burning fireplaces are not one of the major sources of air pollution that has been identified.

3. A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this,

which of the following actions would be taken by the nurse? (Select all that apply.)

Advertise in the media throughout the entire surrounding area.

Communicate the correct information in a timely fashion.

Share all the data found on the community assessment.

Talk to those affected or those worried about the situation.

Conduct a community-based survey to identify risks.

a. b. c. d. e.

ANS: B, D

The correct information must be given in a language the audience—namely those at risk or worried about the risk—can understand.

Use the communication channels the neighborhood residents use and meet at a common meeting place of the community. A survive is appropriate, but the question is focused on distribution of the found information. It is wasteful of resources to advertise in media throughout a wider region or to meet at a central regional facility when only community residents will be interested or involved.

Sharing all the data would be overwhelming, and much of the data might not be relevant. Using epidemiological statistics would not be meaningful to those without the education or experience to be able to draw an appropriate conclusion.

4. Which of the following strategies would a nurse expect to be implemented by a typical state environmental agency? (Select all that

apply.)

Acting, through unannounced inspections, to ensure compliance Completing a community assessment Monitoring hazardous substances to uphold established standards Obtaining and analyzing samples to confirm compliance Involvement in the permitting process established by the state

a. b. c. d. e.

ANS: A, C, D, E

The organization and approach to environmental protection vary somewhat among states, but the common essential strategies of prevention and control via the permitting process, establishment of environmental standards, and monitoring, as well as compliance and enforcement, are found in every state. Completing a community assessment is not a strategy that is typically implemented by a state environmental agency, rather that typically occurs at the local level.

5. Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) a. Asking questions related to health implications at policy meetings b. Calling the local health department to report problems at the hospital c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees e. Conducting a health-related screening at a day care center ANS: A, C, D

Advocacy roles of the community-oriented nurse include attending policy meetings to obtain health-related information, holding public meetings (or serving on panels at meetings) to provide health-related information, serving on health-related committees, and informing local media about environmental hazards in the community. Calling the local health department to report problems at the hospital and conducting a screening at a local day care center do not demonstrate the nurse advocating for the community as the hospital and the day care do not represent the entire community.

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Chapter 09: Evidence-Based Practice Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse executive is implementing evidence-based practice at a community nursing center that serves a large Cuban immigrant

population. Which of the following actions would be the most helpful for the nurse? a. Review clinical policies with cultural competency experts from the local university. b. Conduct weekly staff meetings to discuss which methods work best when helping immigrants. c. Invite Cuban immigrants from the community to serve on the center’s advisory board. d. Send personnel to conferences and seminars that focus on treating Hispanic immigrants.

ANS: C

To determine whether practice is serving the needs of the population, the nurse will need to consult the population served. This means that evidence should be applied with input from the community. For example, decisions related to the services to be offered in a nurse-managed clinic should be made with input from the clinic’s advisory board, which should include community leaders and consumers of the clinic’s services. Information about the population needs to come from the population itself, not from cultural competency experts within the community or from the staff members. Cuban immigrant needs may not be the same as those of Hispanic immigrants from other places such as Mexico or Spain.

2. A community health nurse is determining the best way to address an outbreak of a new infectious disease using evidence-based

practice (EBP). Which of the following actions would the nurse most likely take?

Review policies and procedures.

Review outcomes of clinical trials.

Review several nursing textbooks.

Review reputable sites on the Internet.

a. b. c. d.

ANS: B

Research findings, knowledge from basic science, clinical knowledge, and expert opinion should be considered sources of evidence for EBP. The use of policies and procedures is only helpful if they have been written using EBP, and depending on when they were written, there may be evidence that supports the use of a different practice. The problem with nursing textbooks is that many are not grounded in evidence-based practice, because the concept is relatively new to the United States. Scanning the Intern et for ideas is helpful only if evidence-based practice sites are accessed, and most internet sites are not EBP sites.

3. A nursing administrator wants to develop a work environment conducive to the implementation of evidence-based practice (EBP).

Which of the following actions would best achieve this goal?

Conducting market research to determine customer satisfaction with EBP Eliciting opinions from nurses on how EBP will affect workload Purchasing computers and Internet access for use by employees Sending staff to conferences related to incorporation of EBP into practice

a. b. c. d.

ANS: C

A lack of computers and Internet access can create a barrier to implementation of EBP in community-based nursing agencies. If these are provided, nurses can quickly access current evidence-based findings and recommendations. Conducting market research will not change the work environment to make it more conductive to implementing EBP. Learning about nurses’ opinions about how it will affect workload would not impact the work environment and make it more conducive to implementing EBP. Rather the administrator would need to discuss the benefits of the use of EBP with the staff. Sending staff to a conference, although it may change staff attitudes, would not necessarily change the work environment.

4. A busy school health nurse concerned over the rising incidence of obesity wants to implement evidence-based practice (EBP) but

faces barriers because of time constraints. Which of the following actions should the nurse take first? a. Identify students who are obese so that they may be closely monitored for weight control success or failure. b. Evaluate best practices to determine those that have the highest success rates for weight control in children. c. Schedule physician appointments for obese children. d. Develop an obesity management program for children whose body mass index exceeds normal.

ANS: B

The first step of the seven-step EBP process is step zero, which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors. Step one requires asking questions in a “PICOT” format; this is not described in any of the topic descriptors. Step two involves searching for the best evidence to answer the question. This is done through evaluating best practices. The first step of the seven-step EBP process is step zero, which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors. Step one requires asking questions in a “PICOT” format; this is not described in any of the topic descriptors. Step two involves searching for the best evidence to answer the question. This is done through evaluating best practices.

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5. The nurse has been reading extensively on a particular clinical problem, using both the closest medical library and the Internet.

Which of the following would be the most helpful source?

A journal with a whole issue devoted to research on that clinical problem A randomized controlled clinical trial related to that clinical problem A researcher who has built a career on studying that clinical problem A systematic review related to the clinical problem

a. b. c. d.

ANS: D

A systematic review is an approach to identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research that is relevant to a particular research question. Systematic reviews can be accessed from most databases.

Systematic reviews require more rigor and contain less opinion of the author than typical reviews of the literature. An entire journal devoted to research on a clinical problem may be helpful, but it is unknown what type of research is being published in that journal.

A well-designed systematic review can provide stronger evidence than a single randomized controlled trial. A researcher alone does not provide the best evidence, rather one would need to look at the information that has been published by the researcher in peer-reviewed journals.

6. A school health nurse plans to use evidence-based practice (EBP) to guide the development of health education programs most

likely to increase retention of learning in elementary schoolchildren. Which of the following would be the best way to use EBP in this situation? a. Ask other school health nurses what they included in their own education programs. b. Compare and contrast randomized controlled trials related to learning in elementary schoolchildren. c. Develop a series of games to accompany the programs developed to promote health. d. Seek out and examine health education programs for elementary schoolchildren on the Internet.

ANS: B

Randomized controlled trials are generally ranked as the highest level of evidence. EBP is not collected by word of mouth; rather the nurse must look in the literature to obtain the best information. There is no evidence that a series of games will assist with the retention of learning based on what is stated in this question. This may be an appropriate activity, but this information must be gathered from the literature. Searching the Internet for ideas is helpful only if evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

7. After finding several studies related to the clinical problem, a nurse knows the studies must be evaluated. Which of the following

characteristics should be present in the literature? a. Federally supported multiagency clinical studies b. Multiple high-quality studies with large sample sizes and consistent findings c. Research studies done by multidisciplinary teams in multiple settings d. Controlled clinical trials ANS: B

The Agency for Healthcare Research and Quality (AHRQ) reviewed 40 systems used to evaluate the quality of studies and strength of evidence. The report identified three domains for evaluating systems that grade the strength of evidence: quality, quantity, and consistency. The quality of a study refers to the extent to which bias is minimized. Quantity refers to the number of studies, the magnitude of the effect, and the sample size. Consistency refers to studies that have similar findings, using similar and different study designs. Federally supported multiagency clinical studies, research studies completed by multidisciplinary teams in multiple settings, and controlled clinical trials do not necessarily meet the three domains for evaluating systems to grade the strength of the evidence: quality, quantity, and consistency. These are the criteria that should be used to evaluate the literature, so additional information is needed about these studies in order to evaluate them.

8. A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the care of clients. Which of the following

would present the biggest challenge? a. Assessing one’s current practice and accessing evidence-based resources b. Convincing administration that EBP is beneficial c. Distinguishing EBP from practice based on old standards d. Showing clients that EBP will improve their health outcomes ANS: A

The first step toward implementing evidence-based practice in nursing is recognizing the current status of one’s own practice and believing that care based on the best evidence will lead to improved client outcomes. After the nurse has assessed his or her own practice and accessed EBP resources, the next steps would be to talk with administration and implement EBP into practice. Without self-reflection first, the nurse would be ineffective in implementing EBP. The challenge for the clinician is how to access the evidence and integrate it into practice, thus moving beyond practice based solely on experience, tradition, or ritual.

9. Which of the following groups is pressuring clinicians the most to use evidence-based practice (EBP)? a. Administrators b. Insurance companies c. Nurses d. Physicians ANS: B

Much of the pressure to use evidence-based practice comes from third-party payers and is a response to the need to contain costs and reduce legal liability. Nurses, physicians, and administrators are not pressuring the use of EBP as much as insurance companies as these are not the payers of health care.

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10. A nurse implements an education program that incorporates computer games to reinforce learning for a group of older adults.

Although the research demonstrates evidence of improved retention of this information, the nurse experiences exactly the opposite with this group. Which of the following is the most likely cause of such poor outcomes? a. Failure to consider client and setting differences b. Inadequate incorporation of evidence into practice c. Inferior quality of the available research evidence d. Lack of skills when evaluating the evidence ANS: A

EBP cannot be applied as a universal remedy without attention to client differences. When EBP is applied at the community level, the best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to the community. For example, computer games may be excellent for younger groups but are often poorly suited for older Americans who may face challenges with learning new technology. Because the nurse did not consider the client differences, the intervention was unsuccessful. This does not mean that the research had poor quality, was not evaluated correctly, or was not correctly incorporated into practice. The nurse should not assume that an EBP intervention will work in a different setting or with a different population than what it has been intended.

11. A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control.

What would be the best reference for the provider to implement evidence-based practice (EBP) in the management of this problem? a. Published protocols b. Current research findings c. Opinions of colleagues d. Nursing journals ANS: B

EBP in community-oriented nursing challenges nurses to integrate outcomes of the best evidence into their clinical practice.

Current research findings will explicate evidence of the most successful interventions. (Randomized controlled trials are the gold standard of research for EBP). Protocols and opinions often reflect tradition rather than the most current scientific evidence.

Although many nursing journals are peer reviewed, many are not and, even if peer reviewed, many are not research based or focused on scientific evidence.

12. Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature.

The group has selected the interventions that seem the easiest to implement. Which of the following actions would the staff take next? a. Assess the quality of the evidence in the literature. b. Decide how best to orient the staff and community to the proposed changes. c. Eliminate all nursing interventions that are not evidence based. d. Choose another specific problem for the next literature search.

ANS: A

After the group has chosen the topic and evaluated the literature for approaches that seem feasible, specific interventions are chosen. The quality of the evidence must be assessed before recommending specific changes or writing a protocol to resolve the problem. Grading the strength of evidence or determining the quality, quantity, and consistency of research studies must be done before making recommendations for practice. Deciding how to orient staff and the community to the change would occur at the end of the process after the findings have been summarized, and written recommendations or protocols have been developed.

Elimination of nursing interventions that are not evidence based would be part of the written recommendations and proposal that happen at the end of the process. The nurse should not plan another literature search or topic to explore until after completing the process with the current issue.

13. A school nurse is developing a primary prevention strategy for school-aged children. Which of the following interventions would

the nurse most likely implement?

Developing individualized exercise programs for overweight children Drafting policy for increases in noncompetitive physical activity programs Monitoring body mass index (BMI) in children to identify elevations before they become difficult to manage d. Notifying parents and/or guardians of their child’s height–weight scale in comparison with national norms a. b. c.

ANS: B

At the primary prevention level, campaigns to support regular exercise, greater emphasis on school-based physical education programs, and environmental policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children. Exercise programs are an example of tertiary prevention.

Monitoring BMI in children is an example of secondary prevention. Notifying parents of their children’s height–weight scale increases family awareness but does not meet the definition of a preventive measure.

14. Which of the following is the best way to increase the number of persons who come to their screening test appointments? a. Reminding clients via telephone, e-mail, or mail b. Emphasizing long life and happy family when conditions are caught early and c. d.

treated successfully Pointing out how inexpensive and convenient screening tests are Stressing the dangerousness of the condition if not caught early

ANS: A

Client reminders and recalls via telephone, e-mail, or mail—or a combination of these strategies—are effective in increasing compliance with screening activities such as those for colorectal and breast cancer. Emphasizing the importance of screening, how it is inexpensive, and the dangers of the condition if it is not diagnosed early can all occur as clients are reminded of the screening via telephone, e-mail, or mail. Without the reminder, clients are likely to lose sight of the benefits of receiving the screening.

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15. A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the clinical setting. Which of the following

would be the best strategy to accomplish this goal?

Eliminate all protocols and standards that are not evidence based.

Encourage group reflection on the ideals and expectations of nursing care.

Refer agency nurses to Internet sources of research findings.

Support nurses using practice-oriented research findings in decision-making.

a. b. c. d.

ANS: D

EBP demands changes. It requires incorporating more practice-oriented research and more collaboration between clinicians and researchers. Emphasis should be on decision- making using the varied sources of evidence. The environment and climate must be supportive in order to implement EBP. Rather than eliminating protocols and standards that are not evidence based, the nurse manager should make it a priority to begin to update these practices based on EBP. Self-reflection on one’s own nursing practice and how EBP can be implemented would be more important than group reflection on the large ideals of nursing practice. Referring the nurses to the Internet for ideas is helpful only if evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

MULTIPLE RESPONSE 1. A nurse has decided to increase the evidence base of current nursing practice in an agency. Which of the following describes a

barrier that could be encountered by the nurse? (Select all that apply.) a. Colleagues who do not know how to search the literature or critique research b. Dedication to the history and tradition of the agency c. Little or no research published in the clinical area of concern d. Several meta-analyses in the literature with inconsistent results e. The agency is unable to provide sufficient funds to support the plan ANS: A, B, C

Barriers to evidence-based practice exist when the following are limited or lacking: time, access to journal articles, search skills, critical appraisal skills, and an understanding of research terminology. Other barriers include miscommunication about the process; inferior or unavailable research or other evidence; unwillingness of organizations to fund research or make decisions based on evidence; and concern that evidence-based practice will decrease emphasis on individual client needs or the nurse’s clinical decisions. Dedication to the history and tradition of the agency may pose a barrier as this may influence the philosophy of the practice environment and the willingness to embrace EBP. The numbers of meta-analyses in the literature, regardless if the results are consistent or not, would not be a barrier to the practice environment when implementation is considered.

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Chapter 10: Epidemiological Applications Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most

likely completing? a. Reviewing communicable disease statistics b. Determining factors contributing to childhood obesity c. Analyzing locations where family violence is increasing d. Documenting population characteristics for healthy older citizens ANS: B

Epidemiology refers not only to infectious epidemics but also to other health-related events. The goal of analytic epidemiology is to discover the determinants of outcomes—the how and the why. Analytic epidemiology looks at the etiology (origins or causes) of disease. It discusses the disease in terms of how and why. Descriptive epidemiology considers health outcomes in terms of what, who, where, and when. It discusses a disease in terms of person, place, and time.

2. A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a. Eliciting the health history of a client presenting with an illness b. Evaluating the number of clients presenting with similar diseases c. Performing a physical examination of an ill client d. Providing treatment and health education to a client with a disease ANS: B

Epidemiology monitors the health of the population by examining measures of morbidity, especially incidence proportions, incidence rates, and prevalence proportions and learning about the risk for disease, the rate of disease development, and the levels of existing disease in a population, respectively. Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals.

3. Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a. She convinced other women to join her in giving nursing care to all the soldiers. b. She demonstrated that a safer environment resulted in decreased mortality rate. c. She obtained safe water and better food supplies and fought the lice and rats. d. She met with each soldier each evening to say goodnight, thereby giving

psychological support.

ANS: B

Nightingale examined the relationship between the environment and the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers. Nightingale used statistics to document decreased mortality rates when the environmental factors were improved.

Asking other women to assist with providing nursing care, obtaining safe water, and meeting with each soldier are not interventions that demonstrate the use of epidemiology (the relationship between the health events and the determinants or factors that influence those patterns).

4. Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care

setting? a. There is limited access to information useful to the nurse in giving care in the community. b. More paperwork and forms are required when giving care in the home. c. It is more challenging to control the environment in the community. d. Specialization isn’t possible in the community setting.

ANS: C

In the community, nurses often use epidemiology, since the factors that affect the individual, family, and population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community. Nurses working in the community have multiple resources that can be used to access information about the community. There may be additional paperwork and forms to complete in the home environment, but the lack of control of the environment is a larger challenge than the completion of paperwork. Community health nursing is recognized as a specialty within nursing.

5. Several small communities have applied for grant funding from the state department of health to help decrease their teenage

pregnancy rate. Which of the following communities should the nurse suggest receive funding first?

Community A—with 23 single teenage pregnancies in a city of 500 Community B—with 45 single teenage pregnancies in a city of 1000 Community C—with 90 single teenage pregnancies in a city of 2000 Community D—with 90 single teenage pregnancies in a city of 1500

a. b. c. d.

ANS: D

The pregnancy rates of A, B, and C are 45–46:1000, whereas the rate in Community D is 60:1000. Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion.

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6. Between 2010 and 2015, 1000 of 10,000 young women age 17 to 20 years at a university tested positive for a sexually transmitted

infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a. The proportion of cases of gonorrhea to all STIs was 300:1300. b. The proportion of cases of gonorrhea to chlamydia was 300:500. c. The proportion of cases of gonorrhea to all STIs was 50%. d. The proportion of STIs to the total population was 100:1000.

ANS: D

A proportion is a ratio in which the denominator includes the numerator. If the proportion is small, we can express the number per 1000. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem. The answer of 300:1300 adds the total of the numerator to the denominator, which is unnecessary because the gonorrhea cases were already included in the denominator. In the answer of 300:500, the ratio comparing gonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e., the denominator must contain the numerator). Although proportions may be expressed as percentages, in the answer of 50%, the percentage reflects the number of gonorrhea cases to all STIs, which doesn’t summarize the total STI problem.

7. The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the

following would provide immediate verification of the success of the nursing staff’s efforts? a. An epidemic of diabetes will be recognized. b. The incidence of diabetes will increase in the community. c. The prevalence of diabetes will decrease in the community. d. The risk for diabetes in the community will increase.

ANS: B

If the screening has been successful, more diabetes will be diagnosed and, hopefully, treated. Thus, the incidence of new cases will increase. Overall, prevalence will also increase, but that is not one of the answer options. An epidemic occurs when the rate of disease, injury, or other conditions exceeds the usual level of that condition. The prevalence (measure of existing disease in a population at a particular time) of diabetes would also increase. The risk for diabetes would not increase rather it would be more likely that the disease would be detected.

8. In a particular community, several high school students were diagnosed with diabetes mellitus type 2 during the annual high school

health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus type 2 and proper nutrition. Which of the following would be the most useful for the nurses to use to determine if they are having any impact? a. The epidemic of diabetes in the high school is gradually ending. b. The incidence of diabetes is slowly decreasing during screening events. c. The prevalence of diabetes is slowly decreasing during screening events. d. The risk for diabetes is slowly increasing over time.

ANS: B

Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs. In order for an epidemic to have occurred, the rate of the illness would have had to exceed the usual level of that condition. There is no evidence in this question to support that the disease was at an epidemic level in this population. If the educational programs are effective, the risk for diabetes should be slowly decreasing over time.

9. This year 600 of 8000 young women age 17 to 20 years at a university health center tested positive for a sexually transmitted

infection (STI). Which of the following terms best describes this data?

An epidemic Incidence Prevalence Risk

a. b. c. d.

ANS: C

Prevalence is the measure of existing disease in a population at a particular time. Because we do not have baseline data, we have no way to conclude that this is an epidemic with higher-than-normal results from the screening. Incidence refers to new cases, whereas prevalence means all cases. We don’t know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem. Therefore, we can’t say whether these are new cases (incidence), but the results do represent all cases (prevalence). Risk is the probability of developing an STI, but no risk factors are discussed.

10. A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health

board to increase funding for diabetic clinics in this community? a. An epidemic of diabetes is now recognized and must be addressed. b. The incidence of diabetes is now higher than previously recognized in the community. c. The prevalence of diabetes is now higher than previously recognized in the community. d. The risk for diabetes in the community could decrease if funding is received.

ANS: C

Prevalence is a fairly stable number. Prevalence proportions reflect duration in addition to the risk for getting the disease.

Prevalence is useful in planning health care services because it is an indication of the level of disease existing in the population and therefore the size of the population in need of services. An epidemic occurs when the rate of disease, injury, or other conditions exceeds the usual level of that condition. Incidence is affected only by factors related to the risk for developing the disease and not survival or cure. The nurse is proposing to increase funding for diabetic clinics, and having more diabetic clinics would assist those who already have the disease, so it would have limited impact on decreasing the risk of developing the disease among members of the community.

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11. A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food

poisoning. Which of the following best describes the attack rate? a. 63% b. 70% c. 90% d. 100% ANS: C

The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%. Sixty-three (63) is the number of clients who developed symptoms of food poisoning. Seventy (70) is the total number of people who ate the potato salad at the school picnic. These numbers need to be used as part of the formula to calculate the attack rate. One hundred (100) does not represent any part of the formula that would be used to calculate the attack rate.

12. A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks,

“What are the chances I’ll survive this thing?”

Attack rate Case fatality rate Cause-specific morbidity rate Crude mortality rate

a. b. c. d.

ANS: B

The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease.

Persons diagnosed with a particular disease often want to know the probability of surviving. The CFR provides that information.

The attack rate is the proportion of persons exposed to an agent who develop the disease. The cause-specific mortality rate is an estimate of the risk for death from some specific disease in a population. The crude mortality rate is an estimate of the risk for death for a person in a given population.

13. Which of the following statistics is used by countries to compare the success of their health care systems? a. Attack rate b. Infant mortality rate c. Proportionate mortality ratio d. Cause-specific mortality rate ANS: B

Infant mortality is used around the world as an indicator of overall health and availability of health care services. The attack rate is the proportion of persons exposed to an agent who develop the disease. The cause-specific mortality rate is an estimate of the risk for death from some specific diseases in a population. The proportionate mortality ratio is the proportion of all deaths resulting from a specific cause.

14. A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most

likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Natural history of disease ANS: A

The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement, not the risk for disease.

15. A nurse is examining the various factors that lead to disease and suggesting several areas where nurses could intervene to reduce

future incidence of disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Web of causality ANS: D

The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease. Causal relationships (one thing or event causing another) are often more complex than the epidemiologic triangle conveys. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement not identification of where nurses could intervene to reduce future incidence of disease.

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16. Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a. Introduction of a heart-healthy curriculum beginning in the first grade,

b. c.

d.

presentations on diet and exercise for the community at large, and special education sessions for high-risk populations Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

ANS: C

Distributing handouts includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole.

Education in schools, the community, and high-risk populations focuses only on primary prevention activities. Online activities focus only on primary and secondary preventions. Efforts focused only on those who already have CAD are not primary prevention.

17. A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a

secondary prevention intervention that the nurse could implement? a. Giving a presentation on the importance of exercise and physical fitness b. Designing a game in which students select healthy food choices c. Weighing students to identify those who are overweight d. Putting students on a diet if they weigh greater than 20% of their ideal weight ANS: C

Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided. Giving a presentation and designing a game are both examples of primary prevention. Placing overweight students on a diet is an example of tertiary prevention.

18. A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of

prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Treatment, but not prevention ANS: C

Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis. Primary prevention would focus on interventions that reduce the risk of one getting the disease.

Secondary prevention addresses screening tests to detect the disease at the earliest stage possible. Treatment is not a level of prevention.

19. A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which

of the following may be lacking when obtaining blood pressure readings? a. Reliability b. Sensitivity c. Specificity d. Validity ANS: D

Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff and a pediatric cuff would allow the nurse to obtain accurate—that is, valid—measurements. Reliability refers to the consistency or repeatability of the measure. If the wrong size blood pressure cuff is used, it is likely that the same wrong blood pressure would be repeatedly obtained. Sensitivity and specificity are the two ways that validity can be described. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Specificity indicates how accurately the test identifies those without the condition or trait. With the wrong size blood pressure cuff, the sensitivity and specificity of the screening would be in question.

20. A nurse is administering a tuberculosis (TB) skin test to a client who has acquired immune deficiency syndrome (AIDS). Which of

the following results should the nurse anticipate when using this screening test? a. Decreased positive predictive value b. Decreased reliability c. Decreased sensitivity d. Decreased specificity ANS: C

Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected. Sensitivity is the extent to which a test identifies those individuals who have the condition being examined. AIDS is an acquired immune deficiency; thus, clients with AIDS may have a false-negative response to TB skin tests; that is, they have the disease but the test is not sensitive enough to detect infection in these individuals. Therefore, there is decreased sensitivity with those clients. A positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease. In this case, it is likely that if the individual has the disease, it will not be detected. Reliability relates to the consistency or repeatability of the measure. Because of the client’s altered immune status, it is likely that the same results would be obtained if the test was to be repeated. Specificity indicates how accurately the test identifies those without the condition or trait. In this case, it is likely that a false-negative reading would be obtained, so the specificity may not be accurate.

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21. Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate

treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a. The negative predictive value b. The positive predictive value c. The sensitivity of the test d. The specificity of the test ANS: C

Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important and when the identification of every case is important. A negative predictive value is the proportion of persons with a negative test who are actually disease free. A positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disea se. Specificity indicates how accurately the test identifies those without the condition or trait.

22. A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, “What’s wrong? Can I help?” The

woman responds, “They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know I’m going to die of cancer. How can I tell my family?” Which of the following information does the nurse need to know in order to help the woman cope with this finding? a. The negative predictive value of mammography b. The positive predictive value of mammography c. The reliability of mammography d. The validity of mammography ANS: B

The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease. A negative predictive value is the proportion of pe rsons with a negative test who are actually disease free. Reliability relates to the consistency or repeatability of the measure. Val idity in a screening test is typically measured by sensitivity (how accurately it identifies those with the condition) and specific ity (how accurately the test identifies those without the condition).

23. The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing

and space allocation. Which of the following sources of information would be most helpful?

Local data drawn from a professional survey in the city The National Health Interview Survey The National Hospital Discharge Survey The state’s vital statistics

a. b. c. d.

ANS: A

For many studies, however, the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question. Both the National Health Interview Survey and the National Hospital Discharge Survey provide information on the health status and behaviors of the national population. A state’s vital statistics are the birth and death certificates within the state which would not give the administration the information that they are looking for in this community.

24. Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest

of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a. A cultural or ethnic concentration in the neighborhood b. The geographic location of the neighborhood within the city c. A statistical fluke without meaning d. The time of year the different statistics were collected throughout the city ANS: A

The most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern, resulting in different health outcomes. The assumption is made that all things in the city are the same, thus the geographical location would not be a likely explanation for the difference. However, location may play a role at times with increased incidence of disease depending on exposure to certain environmental factors which could place the population at risk. A statistical fluke does not provide a likely explanation for the difference. There are times when there are cyclical patterns of disease.

However, the question states that the assumption should be made that all else is the same, so one can assume that the data were collected within the city at the same time.

25. Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal.

Which of the following best explains this similarity in the two women? a. They are both members of the same birth cohort. b. They are close friends. c. They attended the same school. d. They both go to the same church.

ANS: A

Being born at about the same time would mean both women have lived through similar social events and media occurrences and therefore would have much in common. Being close friends is probably the result of the similarity rather than the cause. Going to the same school or the same church, depending on the size of the institutions, might not result in any personal interaction whatsoever.

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26. A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have

0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school’s neighborhood? a. Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b. Don’t say anything about Cub Scouts, because it isn’t relevant to nursing care. c. Encourage the parents to enroll their sons in Cub Scouts. d. Share the finding and let the parents draw whatever conclusions they feel appropriate.

ANS: C

Relative risk is an estimation of the risk of acquiring a problem for those who are exposed compared with those who are unexposed. As the risk for obesity is less for those that are members of Cub Scouts, joining the group is protective and reduces the incidence among members. Parents should be encouraged to enroll their sons in Cub Scouts as joining the group is protective and reduces the risk for becoming obese. The finding should be interpreted for the parents, and the protective aspect of joining the group should be explained.

27. A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there

were before the school was remodeled a couple of years ago. The nurse investigates the principal’s observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? a. Descriptive epidemiological study b. Ecological study c. Prospective cohort study d. Retrospective cohort study ANS: D

Retrospective cohort studies rely on existing records to define a cohort that is classified as having been exposed or unexposed at some time in the past. In this case, the issue is whether there is some health risk in the new building addition that is increasing frequency of visits to the school nurse because of asthma. In a descriptive epidemiological study, the disease is investigated in terms of person, place, and time. An ecological study is a bridge between descriptive and analytic epidemiology, looking at variations in disease rates by person, place, or time and trying to determine if there is a relation of disease rates to variations in rates for possible risk factors. A prospective cohort study, or subjects who do not have the outcome under investigation, are classified on the basis of the exposure of interest at the beginning of the follow-up period.

28. Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks

of a particular nursing intervention for senior citizens living in the community? a. Cross-sectional study b. Ecological study c. Clinical trial d. Retrospective analysis ANS: C

The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical trials are generally the best way to show causality. A cross-sectional study provides a snapshot of a population or group. An ecological study is a bridge between descriptive and analytic epidemiology, looking at variations in disease rates by person, place, or time and trying to determine if there is a relation of disease rates to variations in rates for possible risk factors. A retrospective analysis relies on existing records to define a cohort that has been exposed or unexposed at some point in the past.

29. A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school

organizations. Which of the following best describes why the nurse would reject this suggestion?

This method of data collection would result in classification bias.

This method of data collection would result in confounding bias.

This method of data collection would result in personal bias.

This method of data collection would result in selection bias.

a. b. c. d.

ANS: D

Any study is subject to bias resulting from selective choice. There may be a difference between students who choose to belong to an organization and students who choose not to join an organization. Selection bias occurs when selection procedures are not representative of the population as a whole. In this instance, the goal is to determine drug use of all students at the school. If only students who join school organizations are selected, those who do not join organizations will not be represented. Classification bias occurs once subjects are enrolled in the study and relates to how information is collected. Confounding bias results from the relationship between the outcome and the study factor and some third factor that was not accounted for. Personal bias deals with personal opinions and attitudes of the researcher which may interfere with the proper selection of the participants.

30. A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to

the bacteria have become ill. Which of the following factors best explains why this would have happened?

Chemical agent factors Environmental factors Host factors Physical agent factors

a. b. c. d.

ANS: C

The epidemiologic triangle includes the agent, host, and environment. Only differences in host factors can explain why some became ill and some were able to fight off the bacterial infestation. The epidemiologic triangle includes the agent, host, and environment. The bacteria were the agent, so chemical and physical agents are not relevant. The environment was apparently the same for everyone, since all were exposed to the bacteria.

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MULTIPLE RESPONSE 1. Which of the following explains why contagious infections are becoming a central focus of public health? (Select all that apply.) a. Americans are fearful of terrorists using biological agents. b. Awareness of human susceptibility to animal diseases has been publicized. c. Drug-resistant strains of old diseases have evolved. d. Media coverage exaggerates the dangers of exposure to crowds. e. The American population has become more health conscious in the last 20 years.

ANS: A, C

New infectious diseases and new forms of old diseases, such as drug-resistant strains of TB, have emphasized the dangers of infectious diseases. Potential threats from terrorist use of infectious agents have also emphasized infectious diseases. There has not been any increased awareness of human susceptibility to animal diseases that has caused contagious infections to become a central focus of public health. Also, media coverage has not exaggerated the danger of exposure to crowds when it comes to contagious infections. While health and wellness is a higher priority for many Americans, the interest is not a factor in focus on contagious infections.

2. A nurse is concerned about the high incidence of sexually transmitted infection (STIs) in the community college population and

sets up a special STI screening. Which of the following groups of students would be encouraged to attend? (Select all that apply.) a. Sexually active students currently receiving treatment for an STI b. Sexually active students who had been screened the previous year c. Students who are not sexually active and do not plan to become sexually active d. Students who are sexually active but never “go all the way” e. Students who are freshmen or new transfers ANS: B, D

Those who are at risk to develop the problem should be encouraged to attend the screening. This should be anyone who is or plans to be sexually active to any degree. Those already diagnosed with the problem are not at risk, because they already have the condition and are no longer at risk for developing it. Thus, it would not be beneficial for this population to attend the screening as they have already been diagnosed. Students who are not sexually active do not need to attend the screening as they are not at risk for contracting an STI because they are not having sex.

3. A nurse is planning to host a health screening at a large urban mall. Which of the following variables will help the nurse determine

which screenings should be included? (Select all that apply.) a. Adequate space for persons to lie down after testing until side effects are reduced b. Health problems for which the specific population is at risk c. Whether adequate privacy can be obtained for the invasive or embarrassing procedures d. Whether health care providers are available to follow up on any positive screening results e. Ability to provide the individual health screenings free to the public ANS: B, D

The screening tests should be reliable, valid, fast, and inexpensive. Results should be known immediately. Ethically, nurses should not screen for any problem unless they can refer those with positive results to a source for follow-up testing and treatment. The screening tests should have few side effects, be minimally invasive, and be capable of detecting enough new cases to warrant the effort and expense. No tests should be used that have negative side effects, are invasive, or cause embarrassment.

4. A nurse believes a new mouth care procedure (MCP) is exacerbating a client oral tissue problems. Which of the following must be

present for the nurse to go to administration with confidence that the MCP is causing problems? (Select all that apply.)

A plausible explanation of how the new MCP could cause harm A strong feeling that the MCP is the cause Consistently seeing mouth inflammation in many of the patients who have received the MCP d. Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented e. A less expensive option for appropriate oral care a. b. c.

ANS: A, C, D

Strength of association is suggested by the fact that patients who did not receive the MCP and patients seen on the floor before the new MCP did not have problems, whereas patients who received the new MCP are having problems. Seeing the problems in many of the patients suggests a consistency. The fact that those who had the procedure more often have worse problems suggests a dose–response relationship. A plausible explanation of how the new procedure could cause harm enhances the biological risk.

Although one would hope that previous testing would have been done before the product was released to market, the product could be safe for healthy persons but a risky process for those with compromised immunity or those who are under stress. Feelings alone are not convincing. A study should be set up to confirm or dispute the nurse’s hypothesis. Cost of the initial procedure is not a relevant factor.

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Chapter 11: Infectious Disease Prevention and Control Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism ANS: B

Infectious diseases, however, are still the number one cause of death worldwide. In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Injuries and ter rorism are not the number one cause of death worldwide.

2. Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and

methicillin-resistant S. aureus (MRSA) is currently rising?

Areas where people share dressing or bathing facilities Daycare centers and schools Long-term care facilities Senior citizen centers

a. b. c. d.

ANS: A

Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas. Daycare centers, schools, long-term care facilities, and senior citizen centers are not places where the incidence of VRSA and MRSA is rising. These are not places where people are closely sharing dressing and bathing facilities.

3. During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons.

Which of the following best describes the type of immunity that will follow the administration of these injections?

Active immunity Acquired immunity Natural immunity Passive immunity

a. b. c. d.

ANS: D

Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual, such as the transfer of antibody by the administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination. Active immunity occurs as antibodies develop due to exposure to the antigen. Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent. Natural immunity refers to a species-determined, innate resistance to an infectious agent.

4. A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds.

“Why,” he asks, “should my tax dollars be used to pay for their children to be immunized?” Which of the following would be the best response by the nurse? a. “Immunizations are required by law, and if their parents can’t afford it, you and I will have to pay for it.” b. “It’s just the right thing to do.” c. “Only by making sure most kids are immunized can we stop epidemics that might hurt all of us.” d. “We’re a religious God-fearing community, and we take care of each other.”

ANS: C

Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease. The purpose of immunization laws is to promote herd immunity.

Receiving immunizations helps to block the further spread of the disease as more members of the community become resistant to the infection.

5. Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection

caused by fungi after successful treatment of her strep throat with antibiotics?

Agent Environment Host Agent and host

a. b. c. d.

ANS: B

The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman’s body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection. The agent is the factor that is causing the disease or illness. The host is the human or animal that becomes infected.

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6. Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda ANS: A

Vectors include mosquitoes, which can transmit the infectious agent by biting the host. Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance.

7. Which statement made by the nurse best describes the effect vaccines have had on tuberculosis (TB)? a. Tuberculosis is no longer a threat in most of the world. b. Tuberculosis has developed resistance to the all antibiotics. c. The treatment has helped greatly reduce the incidence of TB in the United States. d. The incidence of TB has remained constant since the 20th century.

ANS: C

In 1900, communicable diseases were the leading causes of death in the United States. Since that time, improved sanitation and nutrition, the discovery of antibiotics, and the development of vaccines has ended some epidemics such as diphtheria and typhoid fever and greatly reduced the incidence of others such as tuberculosis (TB).

8. Which population is best protected against pertussis by the DTaP vaccine? a. Young children b. The pre-teen c. The teen d. Adult ANS: A

More than 200,000 children previously got pertussis each year. Two vaccines protect again this disease: DTaP protects young children from diphtheria, tetanus, and pertussis; and Tdap protects preteens, teens, and adults.

9. Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered ANS: C

Syndromic surveillance systems use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks. These systems incorporate factors such as the previously mentioned temporal and geographic clustering and unusual age distributions with groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs, skin rashes, gastrointestinal symptoms) with the goal of detecting early signs of diseases that could result from a bioterrorism-related attack. Syndromic surveillance systems may include tracking emergency department visits sorted by syndrome symptoms as well as other indicators of illness including school absenteeism and sales of selected over-the-counter medications. In recent years, the tracking of cold medicines used to make crystal methamphetamine has received considerable attention. Syndromic surveillance systems use existing health data—the number of air travelers is not existing health data. It is the intention of syndromic surveillance systems to detect early signs of diseases that could result from a bioterrorism-related attack; thus, the system is not measuring the incidence of bioterrorism attacks. Administration of influenza vaccines should decrease the prevalence of this disease. Therefore it is unlikely that the administration of vaccines would be data that is collected; the incidence of the influenza would be more likely to be examined.

10. The nurse is trying to determine if a disease occurrence needs to be reported to the state health department. Which of the following

resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Nationally notifiable infectious diseases on the CDC website d. State health department website ANS: D

Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The CDC updates these conditions annually, and the list can be found under the heading of Nationally notifiable infectious diseases on the CDC website. The weekly reports may provide information about the current incidence or prevalence of certain diseases, but it will not provide the nurse with information about what is required to be reported.

11. There is great concern in the nurse’s community over three local cases of West Nile virus. Which of the following actions should

the nurse take to get the community involved in addressing this problem?

Ask the state department of health for assistance.

Demand that everyone over age 65 become immunized immediately.

Encourage immunization of all children under 12.

Have an educational campaign to remove any containers of standing water.

a. b. c. d.

ANS: D

Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather— especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites. Currently, there is not a vaccine available for humans; an equine vaccine does exist, and work is under way to develop a vaccine for both birds and humans. The state health department would most likely not become involved in this local health problem, rather this may be the role of a local health department.

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12. Which of the following is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population ANS: A

Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is. The environmental changes around the world are causing new infectious agents to emerge, not evolve. The environmental changes that occur because of overcrowding is the issue, not the population itself.

13. Which of the following best describes the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases ANS: B

The goal of prevention and control programs is to reduce the prevalence of a disease to a level at which it no longer poses a major public health problem. In some cases, diseases may even be eliminated or eradicated. The goal of elimination is to remove a disease from a large geographical area (e.g., a country or region of the world), such as has been done with polio in the Americas.

Eradication is the irreversible termination of all transmission of infection by extermination of the infectious agents worldwide, as has been done with smallpox. Because of the large amount of international travel, it is impossible to prevent the spread of diseases from occurring worldwide. The expansion of health care facilities would not improve the treatment of infectious diseases, rather improved sanitation could assist in this. The goal for the spread of communicable diseases is eradication, not control of new cases.

14. Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia ANS: A

Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat.

Botulism, smallpox, and tularemia do not have the ability to be transmitted through a resistant aerosol that is highly fatal.

15. Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the

United States?

Answering parents’ questions about the safety and importance of vaccines today Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. “No shots, no school” legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge a. b.

ANS: C

Vaccines are one of the most effective methods of preventing and controlling communicable diseases. One of the most effective programs has been the “no shots, no school” legislation, which has resulted in the immunization of most children by the time they enter school. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. These interventions have not been particularly instrumental in reducing childhood infections.

16. A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes

small white spots on the inside of the student’s cheeks. Which of the following actions should be taken by the college health nurse? a. Inform all students, staff, and faculty of a possible rubella epidemic. b. Inform all students, staff, and faculty of a possible measles epidemic. c. Reassure the student that it is just a bad cold and will soon pass. d. Tell the student to take two acetaminophen and drink lots of fluids.

ANS: B

Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the United States in adolescents and young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), and a red, blotchy rash beginning several days after the respiratory signs. Measles is serious. Around 10% of measles cases require hospital admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who may have been exposed should be informed that anyone under 18 who has not received both immunization doses should receive measles vaccine.

The student is displaying symptoms of measles, not rubella. Symptoms of rubella include a low-grade fever, runny nose, headache, and a rash that starts on the face and spreads to the rest of the body. The white spots (Koplik spots) should make the nurse suspect that the client has measles, not just a bad cold in which case the nurse would recommend the acetominophen and fluids.

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17. An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs

further review on how Salmonella is spread?

“Certain pets and farm animals may be Salmonella carriers.”

“It is possible to transmit Salmonella by person-to-person contact.”

“Salmonella may be spread by spores that form once contaminated blood is exposed to the air.” d. “Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs.” a. b. c.

ANS: C

Anthrax (not Salmonella) forms spores when infected blood is exposed to air. Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings.

18. Which of the following is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever ANS: C

Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States. Babesiosis, Ehrlichiosis, and Rocky Mountain spotted fever are all diseases borne by ticks as the vectors. These are not the most common vector-borne diseases.

19. A student reports to the college health nurse that her academic work has been going downhill because of lack of sleep. “My

3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn’t been sleeping well and keeps scratching her bottom. Hopefully, she’ll adapt to daycare soon.” Which of the following information should the nurse provide to the student? a. “Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime.” b. “Your daughter may have pinworms; let me teach you how to check for this.” c. “Perhaps your child is not developmentally ready for group play.” d. “Try to arrange more one-on-one time with your 3-year-old.”

ANS: B

Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year.

This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver. The nurse should suspect that the underlying problem is pinworms, not dry skin. These symptoms do not demonstrate a developmental delay or the need for additional one-on-one time.

20. Which of the following is the most common vector-borne disease is a result of travelers introducing the disease to the United

States? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever ANS: B

Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. About 2000 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia. Dengue is rarely transmitted in the United States. Onchocerciasis and Yellow fever are not reported as common vector-borne diseases.

21. At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is

meant by the phrase “a virulent organism.” The nurse explains that this means the organism causing the disease is able to do which of the following? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions ANS: D

Virulence is the ability to produce a severe pathological reaction. Bypassing the normal immunological response mechanisms, invading major organ systems, and producing toxins and poisons that weaken the body are not correct definitions of virulence.

22. A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely

taking? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

ANS: A

Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is secondary prevention. Because the client has the condition, treatment is aimed at prevention of further injury.

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23. Which of the following infectious disease interventions best represents the use of secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual b. c. d.

partners.

Clients with HIV infection are given medications to improve immunological response.

Health care workers are encouraged to receive annual vaccinations for influenza.

Health care workers are required to have a tuberculosis skin test or chest X-ray.

ANS: D

Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest X-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection.

MULTIPLE RESPONSE 1. Five students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that

apply.)

The first student asks for a salad with chicken strips and dressing on the side.

The second student asks for a hamburger, very rare.

The third student orders a tuna salad sandwich with extra mayonnaise.

The fourth student orders a breakfast meal with two very soft-poached eggs and toast. e. The fifth student asks for a vegetable platter and a side of hummus. a. b. c. d.

ANS: B, D, E

Escherichia coli O157:H7 can produce a strong cytotoxin that can cause a potentially fatal hemorrhagic colitis. Hamburger is often involved in outbreaks, since the grinding process exposes pathogens on the surface of the whole meat to the interior of the ground meat, effectively mixing the once-exterior bacteria thoroughly throughout the hamburger so that searing the surface no longer suffices to kill all bacteria. Also, hamburger is often made of meat ground from several sources. The best protection against foodborne pathogens is to thoroughly cook food before eating it. Salmonella is also transmitted by undercooked foods such as eggs, poultry, dairy products, vegetables and seafood. Consequently, students eating very rare hamburger and undercooked eggs are at high risk. The food items requested by the first (salad with chicken strips and dressing) and third (tuna salad sandwich with extra mayonnaise) students are at the lowest risk for illness. These foods have been thoroughly cooked which helps to assure that potential bacteria have been destroyed.

2. Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox?

(Select all that apply.) a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever. e. Vesicles do not collapse when punctured.

ANS: C, D, E

Symptoms of smallpox include rash lesions on face and extremities (“centripetal”), rash that occurs 2 to 4 days after onset of fever, and vesicles that are deep seated and do not collapse on puncture. Symptoms of chickenpox include a sudden onset with slight fever and mild constitutional symptoms, rash that is present at onset, rash progression is maclopapular for a few hours, vesicular for 3 to 4 days, followed by granular scabs, rash is “centifugal” with lesions most abundant on the trunk or areas of the body usually covered by clothing, lesions appear in “crops” and can be at various stages in the same area of the body, and vesicles are superficial and collapse on puncture.

3. The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that

might make the client more comfortable. Which of the following best describes why the nurse doesn’t just prescribe antibiotics as the client repeatedly requests? (Select all that apply.) a. Antibiotics are expensive, whereas the support measures would be almost free of cost. b. Viral diseases are not affected by antibiotics. c. Clinics cannot afford to continually give antibiotics to anyone who asks for them. d. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs. e. Antibiotics are not particularly effective against coughs and nasal congestion.

ANS: B, D

Antibiotics are not effective against viral diseases, a fact found unacceptable to many clients looking for relief from the misery of a cold or flu. The inappropriate prescribing of antibiotics contributes to the growing problem of infectious agents that have developed resistance to once-powerful antibiotics. There are many broad-spectrum antibiotics that are inexpensive. Typically, insurance providers or clients are paying for the cost of prescription antibiotics, not the clinic. So, although the health care system is impacted by these increased costs it is most likely not impacting the clinic itself.

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Chapter 12: Communicable and Infection Disease Risks Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Genital Herpes Simplex ANS: C

Hepatitis B infection can be prevented by immunization; vaccines for the remaining options are not yet available. There are not yet vaccines for chlamydia, gonorrhea, or genital herpes simplex.

2. Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first

become ill with HIV? a. They are afraid to get tested for fear that the results will be positive. b. They avoid the problem (maybe it will go away). c. They don’t recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

ANS: C

When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain.

An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV. Thus, it is not worthwhile to be tested during this stage of the illness. This information supports the incorrectness of the other options.

3. A client was clearly very relieved when an HIV test came back negative. “Thank goodness. I’ve had sex several times without a

condom, and when one of my friends said he was sick, I think I panicked.” Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D

The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks; thus, this test could be negative now, but positive in 3 months. All persons who have an STD test should be counseled about risk reduction activities before and after the test is done. This information supports the incorrectness of the other options.

4. A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best

response by the nurse? a. “A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test.” b. “A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure.” c. “A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood.” d. “A diagnosis of AIDS is made when CD4 T-lymphocytes drop to less than 22 cells/mm.”

ANS: D

AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 22 cells/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

5. The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following

diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis ANS: D

HIV-infected persons, who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB. Hepatitis B and hepatitis C are both transmitted through blood and body fluids which are not as highly contagious as tuberculosis which is transmitted through airborne droplets. Herpes zoster (shingles) is spread by direct contact with fluid from the rash blisters. None of the other options are as directly related to HIV as an opportunistic disease.

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6. A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need

for additional teaching?

“I wouldn’t sit next to someone with HIV.” “Having unprotected sex with someone who is infected spreads HIV.” “Sharing needles when shooting up drugs spreads HIV.” “Transfusions of blood products that are contaminated can spread HIV.”

a. b. c. d.

ANS: A

HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. Worldwide, the largest number of HIV infections result from heterosexual transmission.

7. In the United States, which group is most affected by a new HIV diagnosis? a. Women having heterosexual relationships b. White IV drug abusers c. Young Black gay and bisexual men d. Men who have sex with other men ANS: C

Although new HIV diagnosis in general has declined, young Black gay and bisexual men are the most affected, with an 94% increase in diagnosis. The largest number of new infections in 2018 was in men who had sex with other men, and this was followed by heterosexual transmission. HIV infections in women are primarily due to heterosexual contact or IV drug use. This information supports the incorrectness of the other options.

8. Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the

client’s name, address, or contact information? a. Client doesn’t actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test, and collection agencies will not be able to harass them. d. Client wants to be sure care providers don’t share results with their family.

ANS: B

An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination. If testing is anonymous, the client is given an identification code number that is attached to all records of the test results and is not linked to the person’s name and address. Demographic data such as the person’s sex, age, and race may be collected, but there is no record of the client’s name and associated identifying information. Thus, the client is able to know the results of the test while staying anonymous. It would be a violation of HIPAA for the providers to share the results of this test or any other medical information with family members. The follow-up related to payment is not a main concern for the population who is requesting anonymous testing.

9. A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part

of this teaching?

“Side effects of PrEP include extreme lethargy and joint pain.”

“PrEP has been shown to be effective in preventing transmission of the disease from sharing needles.” c. “The effectiveness of PrEP will depend on your adherence to the medication regimen.” d. “PrEP will prevent you from contracting HIV and hepatitis B.” a. b.

ANS: C

Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b). It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available.

Extreme lethargy and joint pain are not common side effects of PrEP. PrEp provides protection against HIV, not against hepatitis B. 10. A male client visits the clinic office reporting a yellow-green discharge from his penis. Which of the following STIs has the client

most likely contracted?

Gonorrhea Syphilis Herpes simplex virus 2 Human papillomavirus

a. b. c. d.

ANS: A

The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility. Symptoms of syphilis may not appear for several years after contracting the disease. The first stage of syphilis is called primary syphilis when a chancre, a firm, round, small and painless lesion, develops. Signs and symptoms of HSV-2 infection range from no symptoms to painful lesions or blisters around the genitals, rectum, or mouth. Most people with HPV are asymptomatic.

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11. A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client

would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching ANS: D

Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. A chancre at the site of entry is a symptom of primary syphilis.

Difficulty coordinating movements is a sign of tertiary syphilis. Jaundice is a sign of congenital syphilis.

12. Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs. b. It can cause problems in infants born to infected mothers. c. It is not frequently seen in the United States. d. It is so difficult and expensive to treat.

ANS: B

Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers. It is treated rather easily with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

13. Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further

outbreaks.

ANS: A

Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease. Recurrence with HSV-2 is common. The treatment for HSV-2 may be episodic or suppressive for frequent recurrence, which is not expensive to treat. HSV-2 may be asymptomatic but does appear as vesicles, painful ulceration of penis, vagina, labia, perineum, and anus with lesions lasting 5 to 6 weeks.

14. When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been

tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. “Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs.” b. “Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs.” c. “The presence of an STD in women with cervical cancer may lead to congenital defects in offspring.” d. “The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.”

ANS: B

The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information. There is no evidence that the presence of an STD in women with cervical cancer will lead to congenital defects in offspring. The presence of an STD increases the risk for another STD. There is no evidence of relapse of cervical cancer when there is presence of an STD. 15. Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a “cauliflower” appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days ANS: B

HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance.

The warts are usually multiple and vary between 1 and 5 mm in diameter. The other descriptions are not characteristic of lesions of the human papillomavirus (HPV).

16. A client who is very upset says to the nurse, “But we always used a condom! How could I have genital warts?” Which of the

following would be the best response by the nurse?

“Are you positive you always used a condom?”

“Condoms don’t always work.”

“The condom might have had a tear in the latex.”

“Contact may have occurred outside the area that the condom covers.”

a. b. c. d.

ANS: D

Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur. The challenge of HPV prevention is that condoms do not necessarily prevent infection. Thus, even with correct usage and the use of undamaged condoms, transmission may still occur.

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17. Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B (HBV) than

HIV? Everyone would assume the person infected with hepatitis B is a drug user.

Having HBV would mean no further employment in health care.

The fatality rate is higher and occurs sooner with HBV. There is no treatment for HBV, which can be a very serious illness.

a. b. c. d.

ANS: D

Unlike HIV, there is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease. There are multiple populations that have a high prevalence of HBV including injection drug users, persons with STDs or multiple sex partners, immigrants, and refugees and their descendants who came from areas where there is a high endemic rate of HBV, health care workers, clients on hemodialysis, and inmates of long-term correctional institutions. Those who are infected with HBV are still able to work in health care. There is no evidence that the fatality rate is higher or sooner with HBV than with HIV. 18. A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the

hepatitis B vaccine immediately and then also an immune globulin injection. “Wait,” said the new mother. “Why is my son getting two shots?” Which of the following statements would be the best response by the nurse? a. “One injection protects your son, while the other encourages his body to build up immunity.” b. “One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him.” c. “Since you’ve already been infected with the virus, your son needs twice as much protection.” d. “The second shot is just to make sure the first one works.”

ANS: A

Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection. One of the shots provides passive immunity and the other provides active immunity. The active immunity continues to be built up by receiving two follow-up injections weeks later.

19. A client diagnosed with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day.

Which of the following statements is the best response by the nurse? a. “Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered.” b. “This therapy is recommended to make sure that you receive the treatment you need and the infection doesn’t become resistant to the drugs.” c. “This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember.” d. “Tuberculosis medications are very expensive so this method ensures that government money doesn’t get wasted on those who will not take the drugs.”

ANS: B

It is important to be respectful to clients and to consider their perspective and psychological health while also respon ding truthfully.

Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment. The risk to client and the community if the client does not follow the treatment regimen is that the TB will become resistant to these medications. It does not have to do with the possibility of noncompliance by the patient, that the patient will not remember, or related to the cost of the medications.

20. A nurse is concerned about the prevalence of tuberculosis among migrant farm workers. Which of the following activities would be

best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

ANS: B

Tertiary prevention is carried out among persons already infected with the disease. In this instance, DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems. Administering purified protein derivative (PPD) to contacts of those with tuberculosis is secondary prevention as this is an at-risk population. Providing education about the prevention of tuberculosis to members of the migrant community is a primary prevention strategy as it is aiming to prevent the disease from occurring. Using skin tests to screen migrant health workers for tuberculosis infection is secondary prevention as it is a screening aimed at early detection of the disease.

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21. A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations,

the mother was extremely upset. “Don’t you know HIV children are immunosuppressed?” she exclaimed. Which of the following would be the nurse’s best response? a. “All children have to have these immunizations before they can attend school.” b. “Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized.” c. “I’m so sorry; I forgot for a moment your child was HIV positive.” d. “The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them.”

ANS: B

Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Although this child is HIV positive, there is no medical reason why the child should not be immunized. Many states do have a “no shots, no school” law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

22. A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause

the nurse to interpret the test as positive?

15 mm of erythema in a client with HIV infection 5 mm of induration in an immigrant from a country where TB is endemic A 5-mm ruptured pustule with purulent drainage in a homeless client 10 mm of swelling and increased firmness in a client recently released from a correctional facility

a. b. c. d.

ANS: D

For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10-mm induration would be a positive finding in an immigrant from a region with high TB infection. Erythema alone does not indicate a positive finding. A 5-mm induration is not large enough to indicate a positive finding. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

23. A high school student is planning to volunteer at the hospital after school, so he or she needs to have a Mantoux test before

beginning. Which of the following information should the nurse provide to the new volunteer? a. “I will be using tiny tines to administer the TB antigen to the skin on your arm.” b. “Notify the clinic immediately if you experience any redness or itching at the test site.” c. “The areas should be kept dry until you return; cover it with plastic wrap when bathing.” d. “You will need to return in 2 to 3 days to have any reaction interpreted.”

ANS: D

The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters. The Mantoux test involves a 0.1-ml injection not tines as in the TB tine test. Slight redness or itching at the test site may occur, but that should resolve on its own and does not require the client to notify the clinic. The client can engage in normal activities; the site does not need to be kept dry.

MULTIPLE RESPONSE 1. A woman and man who have come to the health clinic begin to argue loudly. “You gave me an STI!” the man yells. The woman

screams back, “Not me. I don’t have an STI!” Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. “Actually, you’re very fortunate to have been tested, so you and your partner can begin treatment before more serious damage is done.” b. “Some STIs may not have any symptoms, so you need to be tested for other conditions and treated if necessary.” c. “Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again.” d. “You may be able to get treatment from your pharmacist so you won’t have to be embarrassed like this again.” e. “Some STIs are spread in ways that are non-sexual in nature.”

ANS: A, B, C

Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STI test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person. The pharmacist must receive an order from the primary care provider in order to dispense a prescription.

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2. The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, “I’m sorry to bother

you when you’re not feeling well, but I need to ask you a few questions.” Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. “Do you know how you got this infection?” b. “Who lives with you?” c. “Where are you employed?” d. “Where do you usually eat?” e. “Are you sexually active?”

ANS: B, C, E

The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the client’s place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others. Hepatitis A can be spread through food contaminated by an infected food-handler, contaminated produce, or contaminated water. However, this mode of transmission is not very common in the United States.

3. In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child

home from school? (Select all that apply.) a. The child develops allergies with sneezing. b. The child is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school. e. The child persists in biting behavior.

ANS: B, D, E

Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Thus, the nurse should not be fearful of providing care to this child.

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Chapter 13: Community Assessment and Evaluation Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following is the best brief definition of community? a. A geographic area or political division under common leadership b. A group sharing a common bond such as a profession or occupation c. A group working together to confront a common problem d. A social group with common goals within a geographic area ANS: D

According to WHO, a community is “A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future.” The correct answer includes aspects of people, place, and function or aims. In addition to sharing geographic boundaries and leadership, a community also has common values and interests. In addition to sharing a common bond, members within a community have to interact with one another. A group working together to confront a common problem only addresses the aspect of function; it does not address people or place.

2. A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes

the activities of this nurse? a. Providing care to an active caseload of 50 families in the neighborhood b. Inviting all the parents of asthmatic children in the school to meet together for mutual support c. Sharing assessment findings and health goals with every community group that will listen d. Writing articles for the local newspaper highlighting the various programs and services of the local health department ANS: C

Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals.

Although it is not possible to know the nurse’s goals from the nurse’s behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesn’t necessarily help eligible clients access care.

3. Persons often point out that smokers choose to light their cigarettes; alcoholics lift the glass to their mouth, and drug addicts inject

or ingest their drugs. Which of the following statements best describes why nurses don’t simply focus on helping persons who engage in poor health behaviors to behave appropriately? a. Addicts don’t have the willpower to change their behavior. b. It is too rewarding to continue the behavior for a person to be able to change. c. Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change. d. Society must offer healthy choices, offer support, and practice helpful policies.

ANS: D

Change for the benefit of the community client often must occur at several levels, ranging from the individual to society as a whole.

Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide healthy choices. Most individuals cannot change their habits alone; they require the support of family members, friends, community health care systems, and relevant social policies. Change in society is helpful for addicts to change their behavior. Many times, certain aspects of society limit an individual’s ability to make change on their own. Laws and policies within society must support individuals to make healthy lifestyle choices.

4. A nurse is focusing on the process dimension of a community’s health. Which of the following interventions will the nurse most

likely implement? a. Assessing the health care services available in a community b. Establishing screening programs to diagnose diseases as early as possible so that the treatment can begin c. Implementing health promotion activities such as education programs d. Planning for new programs to be developed based on identified needs ANS: C

When the emphasis is on the process dimension—usually the level of intervention of the nurse in community health—the best strategy is usually health promotion, such as various primary prevention strategies. The other responses represent the structure dimension of the community. Structure is defined as the services and resources within the community. This includes service use patterns, treatment data from various health agencies, and provider-to-client ratios.

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5. A nurse has invited community members to participate as full partners in creating changes to improve the health of the community.

Which of the following may be an unexpected consequence of this action?

A change in the distribution or redistribution of power and influence An increase in awareness of the importance of health Continued ongoing interest in community health activities Improved family functioning and involvement in health activities

a. b. c. d.

ANS: A

Collaborative practice models involving the community and nurses in joint decision-making and specific nursing roles are required.

Nurses must remember that collaboration means shared roles and a cooperative effort in which participants want to work together.

These participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision-making. This means sharing not only the power but also the responsibility for the outcomes of the intervention. By having the community members involved in creating the health change, it is likely they will have an increased awareness of the importance of health, an ongoing interest in the health of the community. These things should occur because the community is more educated about its health because of its involvement. Being involved will not necessarily result in improved family functioning, so this consequence will most likely not occur.

6. During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community’s

strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a. To ensure that others agree with the nurse’s plans for interventions b. To confirm the nurse’s initial findings and conclusions c. To encourage community partners to feel they “own” the data d. To generate non-statistical data such as values, beliefs, and perceived needs ANS: D

Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community’s knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation. Interviews with key informants provide data; the purpose is not to ensure agreement with the nurse’s plan or confirm findings. The key informants are formal or informal leaders within the community, and although they may have information to share about the community, it may not be important that they feel that they “own” the data.

7. A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives.

Which of the following best describes the rationale for this assignment?

To allow participant observation by the nurse To ensure that the nurse would care about her intervention outcomes To maximize convenience and minimize commuting time for the nurse To save gasoline in these difficult economic times

a. b. c. d.

ANS: A

Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations and church life and reading the newspaper give the nurse “observations” of the community’s life. The nurse should care about the interventions that are performed regardless of where the nurse lives. The priority is that the nurse is knowledgeable of and can observe the community, the assignment does not have to do with the convenience of the nurse.

8. A community health nurse drives through an assigned community before visiting the community groups scheduled for the day. The

nurse then drives through the community again that evening before going home. Which of the following best describes the nurse’s reason for driving through the community twice in the same day? a. On the second trip, the nurse can carefully confirm the results of the first assessment. b. Repeating the experience ensures that the nurse absorbed all the relevant details. c. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. d. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.

ANS: C

When doing a windshield survey as part of community assessment, the nurse should observe two times: one during the day when people are at work and children are at school and a second time in the evening after work is done and school is out. It is likely that different things are occurring in the community when the nurse drives through the community at different times. Therefore, it is likely that the nurse will learn more about the community by doing this and not necessarily confirm previous findings. If the nurse was interested in writing down the results of the findings, the nurse could use public transportation or ride in a car with another nurse driving for more efficient documentation of her findings; this would not necessarily occur by the nurse driving through the community in the evening.

9. Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including

local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity? a. To avoid confronting the community until the nurse is thoroughly oriented b. To become familiar with previous goals and priorities of the agency c. To help get a better understanding of the assigned community d. To save time and effort and perhaps have new insights ANS: D

The nurse uses previously gathered data because it saves time and effort. Many sources of data are readily available and useful for secondary analysis. Being familiar with the community before the assessment is important; however, being thoroughly oriented is not necessary. The nurse should become familiar with the community, not the goals and priorities of the agency. It is helpful for the nurse to better understand the community, but the main reason is to save time and avoid duplication of data that may already exist.

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10. A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? a. A problem that affects the most disadvantaged residents in the community b. A problem that is very easy and inexpensive to address c. A problem that is of high concern to the community d. A problem in an area in which the nurse has a great deal of expertise ANS: C

Choice of priority must depend on the community’s awareness of the problem—and their motivation to improve it. Other bases for choosing include determining which individuals would be most affected, what benefits to the community would result, what might happen if the problem is not resolved, how much it might cost to address the problem, and how much support for or opposition to the problem seem likely based on community values and priorities. Rather than examining the issues from the perspective of the most disadvantaged residents, the nurse should look at the problem which affects most individuals in the community who may or may not be disadvantaged. The cost of the problem will need to be addressed, but if the problem is not a priority to the community, the agency may be wasting money addressing a problem that the community does not care to solve. If the nurse is unfamiliar with interventions to solve the problem, the nurse should collaborate with others to solve the problem. The priority should be the needs of the community, not the needs of the nurse.

11. Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? a. All monitored patients will receive abortive therapy for lethal dysrhythmias b. c. d.

within 3 minutes of dysrhythmia recognition.

Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class.

95% of children will be immunized by 1 year of age.

There will be a 25% reduction in health disparities by 2015.

ANS: B

Objectives must be precise, behaviorally stated, and measurable. The response that describes mothers receiving nutrition counseling represents a specific, measureable behavior as an objective. Treatment in an acute care setting is not part of a community-oriented care plan. The objective that 95% of children will be immunized by 1 year does not precisely state which children (in a county? in the country?) and does not state which immunizations. (Some are not appropriate to give to children who are only 1-year-old.) A 25% reduction by 2015 is a goal, not an objective.

12. During which of the following activities is the nurse in community health acting as a partner in change? a. Administering vaccinations to preschoolers b. Analyzing community problems to determine the best interventions c. Establishing an elder-care center for older adults living with family members who d.

work Teaching anger management skills to a group of teens in a halfway house

ANS: D

Content-focused roles often are considered change agent roles, whereas process roles are called change partner roles. Change partner roles include those of enabler-catalyst, teacher of problem-solving skills, and activist agent. Teaching anger management skills to a group of teens in a halfway house demonstrates the use of a change partner role of teacher of problem-solving skills.

Change agent roles stress gathering and analyzing facts and implementing programs. The nurse establishing an elder-care center is acting as a change agent. The nurses administering vaccinations and analyzing community problems are carrying out other nursing roles.

13. A nurse is assessing a community’s openness to change. Which of the following variables indicate that the community is ready? a. Commitment to current processes and policies b. High socioeconomic status in the community as a whole c. Long history of dependence on the community health agency and its staff d. Minimal level of social participation by community members ANS: B

The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents. Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. A community that is open to change is likely to be open to changing current processes rather than focusing on tradition. Communities that are open to change typically have a high level of social participation by its residents.

14. A nurse is working toward an objective to “increase to at least 90% the proportion of all pregnant women who receive first

trimester prenatal care.” During which of the following phases of the nursing process would determination of the objective occur?

Assessment phase Planning phase Implementation phase Evaluation phase

a. b. c. d.

ANS: B

Evaluation begins in the planning phase, when goals and measurable objectives are established, and goal-attaining activities are identified. Assessment involves getting to know and understand the community as the client. Implementation involves the work and activities aimed at achieving the goals and objectives. Evaluation is the appraisal of the goals and objectives that have been created.

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15. A nurse is assessing the status of a community’s health. Which of the following will the nurse examine? a. Community awareness b. Health facilities c. Health care manpower d. Vital statistics ANS: D

The status of community health involving biological indicators is often measured by traditional morbidity and mortality rates, life-expectancy indices, and risk-factor profiles. Vital statistics are measures of community health status. Health care manpower (e.g., nurses, physicians) and health facilities (e.g., hospitals, clinics) are measures of community health structure. Community awareness is a measure of the process.

16. A nurse is assessing the structure of a community’s health. Which of the following data will the nurse examine? a. The community’s commitment to health b. Health-risk profiles of selected aggregates c. Statistics of morbidity and mortality in comparison with similar communities d. Treatment and service use patterns from local health agencies and care providers ANS: D

Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios. The community’s commitment to health is part of the process dimension of the community. Health risk profiles and vital statistics are part of the status dimension of the community.

MULTIPLE RESPONSE 1. A community health nurse encourages members of the community to partner and assist in creating health programs. Which of the

following best describes the rationale for this action? (Select all that apply.) a. Partnering results in increased effectiveness b. Involving community members results in contributions of time and money into the program c. Having many partners results in increased publicity for the program d. Participating in planning results in having a vested interest in the outcome e. Involving community partners ensures increased support by the populace ANS: A, D

The primary reason community partnership is crucial is that community members and professionals who are active participants in a collaborative decision-making process have a vested interest in the success of efforts to improve the health of their community. The significance and effectiveness of partnership in improving community health are supported by a growing body of literature.

Community partners do contribute time and money into programs and most likely will increase the publicity for the program; however, this should not be the primary reason for including them in the partnership. Increased populace support is not necessarily assured by community partnerships. Through the partnership, it is likely that the program will have increased success and better outcomes, which should be the primary objective of the nurse.

2. A community health nurse is beginning to work with a newly assigned community. Which of the following would be appropriate

actions for the nurse to take to help ensure acceptance? (Select all that apply.)

Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies) b. Attending community events such as festivals or fairs and interacting with participants c. Becoming involved in and contributing to volunteer community organizations d. Completing a comprehensive physical assessment on nearby neighbors e. Arranging to meet with the community’s governing body a.

ANS: A, B, E

Gaining entry or acceptance into the community is perhaps the biggest challenge in assessment. The nurse is usually an outsider and often represents an established health care system that is neither known nor trusted by community members, who may therefore react with indifference or even active hostility. Entry into the community is critical. Often the nurse can gain entry by taking part in community events, visiting people in formal leadership positions, and clarifying community members’ perceptions of health needs.

While an activity such as volunteering is a positive action, it is not the most efficient way to become involved in the wider community. Completing physical assessments on individuals is an individual-based, not community-based intervention and would not be anticipated to be performed by the community health nurse.

3. A nurse is deciding which alternative interventions should be implemented. Which of the following factors must be considered by

the nurse when making this decision? (Select all that apply.) a. The expected effect or outcome of each possible intervention b. How interested others are in helping in any particular intervention c. The nurse’s own interest in implementing each intervention d. The likelihood that the intervention will resolve the problem e. Change process required to achieve stated objective ANS: A, B, D, E

The nurse can list each possible intervention and then consider the resources or barriers to that particular intervention, the expected effect of each choice, the likelihood that the activity will help meet the objective and resolve the problem, whether others can be educated to implement the intervention, and the change process necessary to complete the objective. The primary interest should be the concern of the community, not the nurse’s personal interests.

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4. A nurse wants to determine whether health problems have been improved and interventions have been appropriate and successful

over a period of time. Which of the following data should the nurse examine? (Select all that apply.)

Changes in staffing patterns in the health agency Demographic data Education and school statistics Environmental factors Utilization of health services

a. b. c. d. e.

ANS: B, D, E

To see the outcomes of chosen interventions, the nurse would examine changes in demographics, socioeconomic factors, environmental factors, health status, and/or use of health services. Changing in staffing patterns and education and school statistics would not be impacted by a change in the health problems in the community. Epidemiologic data and trends would be the best sources to examine to evaluate the change.

5. Which of the following activities are considered to be part of the core competencies for public health professionals? (Select all that

apply.) a. Defining variables relevant to current public health problems b. Obtaining and interpreting information regarding risks and benefits to the community c. Implementing nursing care and subsequent evaluation outcomes d. Maintaining public health departments throughout the United States e. Focusing on health concerns of the individuals residing within the community ANS: A, B

Eleven core competencies for the nurse and other health providers working in the community have been defined by the Council on Linkages Between Academia and Public Health Practice. Defining variables relevant to current public health problems and obtaining and interpreting information regarding risks and benefits to the community are two of the eleven core competencies.

Implementing nursing care focuses on care for individuals and not the community; it is not one of the core competencies. Public health nurses have various roles within the community, they may or may not work for a public health department. It is not within the scope of public health nurses to be responsible to maintain these departments.

6. A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be

the effective key informants for the nurse? (Select all that apply.) a. Community’s immigrant group activist b. Federal senators and representatives c. Health board members d. The town mayor e. Local Clergy ANS: A, D, E

Informant interviews, which consist of directed talks with selected members of a community about community members or groups and events, are basic to effective data collection. Talking to key informants is a critical part of the community assessment. Key informants are not always those who have a formal title or position. Key informants often have an informal role within the community. Examples of informal key informants would include a member of a minority group who is listened to by other members of the group, a church leader, and a parent who is active and vocal about the school health curriculum. Key informants should be formal or informal leaders within the community. Based on the information provided, it is not known if the federal senators, representatives, and health board members fulfill these roles within the community.

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Chapter 14: Health Education in the Community Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily

exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge ANS: C

Steps in the affective domain have the learner doing the following in this sequence: knowledge, comprehension, application, analysis, synthesis, and evaluation. During evaluation, the learner adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior, and this has resulted in the ability to maintain the value of a healthy weight. Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation. None of the other options are considered in the sequence.

2. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session,

the nurse distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material ANS: C

The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned. Because breast self-examination is a psychomotor skill, the emphasis should be placed on the learner having the ability to perform the skill after the conference. The most important aspect should be the time for practice in this situation, and not on the time for questions.

The nurse would not need to explain to the audience why culturally appropriate images are acceptable, rather these should have been incorporated into the session. Having printed materials is important so that the learner has a reference after leaving the conference.

3. A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best

learning objective for this program? a. Each participant will state why TSE is important and explain how to do it. b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c. 90% of the men will correctly demonstrate testicular self-examination. d. 100% of the men will do a testicular examination correctly on a model.

ANS: C

If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.

4. A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college.

However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Ask the students why they are being so rude. b. Explain why the information is crucial to their current clinical practice. c. Nothing; let the instructor of the course handle the problem. d. Tell a joke to get the students’ attention.

ANS: B

Before learning can take place, you need to gain the learner’s attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally. Asking the students why they are being so rude would not be a professional response by the nurse. The nurse should take responsibility for gaining the attention of the audience and not expect the instructor to do so. Gaining the students can best be accomplished by telling the students why it is important rather than telling a joke.

5. Which of the following statements by the client indicates the client is experiencing a learner-related barrier to new information

about type 2 diabetes management? a. “I know about diabetes; my sister has it.” b. “I Don’t like to read’ just tell me what I need to know.” c. “It won’t change my life; it’s type 2 diabetes.” d. “It can’t be that hard to learn; I don’t have to take shots.”

ANS: B

One of the most important learner-related barriers is low literacy. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels. These individuals may be embarrassed to admit their reading deficit to health care providers, and educators and may try to appear to understand when they really do not. Denying the impact or the importance of learning about a new diagnosis is problematic but not considered a primary barrier.

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6. A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a. Evaluation b. Experience c. Participation d. Understanding ANS: C

Educators should include participation. Lack of participation is a barrier to learning. Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic. Evaluation occurs at the end of the education; evaluation is not necessarily missing when an educator uses lecture as the primary method of education. The nurse may be able to include experiences as part of the lecture when educating clients. It may be difficult to assess understanding if lecture is the primary method of education; however, the nurse should be able to use nonverbal clues to assess understanding. Also, the use of lecture does not mean that understanding is missing from the process.

7. The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the

presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlines. d. The nurse gave them too much information too fast for them to want to cope with it all.

ANS: B

Most health information is printed at a tenth-grade reading level, which is too difficult for almost half of the adult readers in the United States. If people cannot read or understand the material, they discard it. Although visual images are certainly helpful, it does not explain why the handouts were discarded. Audience’s expectations of the use of PowerPoint or video presentations or receiving too much information too fast do not explain why the handouts were thrown away. If the nurse covered information too fast, it is likely that the participants may have been more inclined to keep the handout.

8. Which of the following statements regarding the Health Belief Model is accurate? a. Cues to action are an important component of the model. b. Multiple methods of education should be used when implementing this model. c. The first stage experienced in this model is the pre-contemplation stage. d. To successfully implement this model, ongoing maintenance of the behavior must

be considered.

ANS: A

The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The Health Belief Model does not indicate the number of methods of education that should be used. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.

9. A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the

nurse to elicit feedback from program participants? a. At the beginning of the program b. At the program midpoint c. Immediately following program completion d. Throughout the program ANS: D

Not only should learners receive feedback but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified. Obtaining feedback only at one point in time during the program does not give the nurse enough feedback as to what is happening throughout the presentation. In order for the educator to modify the teaching process and better meet the learner’s needs, evaluation data should be obtained at multiple points in time.

10. When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives.

Which of the following parts of the program should be improved? a. Educator b. Content c. Learners d. Objectives ANS: A

Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge. The educator determines how content can be tailored to the learner. The educator determines the objectives.

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11. A man says, “I just can’t get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to

motivate myself.” Which of the following would be the best action for the nurse to take?

Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set up rewards, such as a nice snack after he gets back from walking. a.

ANS: C

Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior. Group support often helps people make needed changes for health that they are unable to accomplish on their own or with the help of just one individual. The role of the employer is not to dictate employee health behaviors, so having a written contract would be inappropriate. The man may already recognize that walking is one of the best health promotion activities he can choose; however, he has expressed that he is lacking motivation. Setting up rewards for himself may be helpful; however, it may not be enough to get him motivated to take action. Group support may help him to get motivated.

12. A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One

teenager states, “My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag.” Which of the following best describes the group purpose that is being served by the teenager’s statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking about food c. Task function of resolving problems about what to nibble during movies d. Task function of sharing information and resources ANS: D

A task function is anything a member does that deliberately contributes to the group’s purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenager’s statement shared information about a good resource for the group. Maintenance functions help members affirm, accept, and support one another, resolve conflicts, and create social and environmental comfort. The teenagers’ comment does not support a maintenance function of the group, rather it focuses on a task function by contributing to the group’s purpose.

13. A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in

common. One teenager replied, “I don’t know if I want to share all the problems I’m having with strangers.” Which of the following is the best nurse response? a. “Don’t share anything with anyone until you’re comfortable doing so.” b. “I can understand what you are saying.” c. “No one will require you to do anything you don’t want to do.” d. “The purpose of the group is to have a safe place to share problems with others who may be having similar problems.”

ANS: D

During the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. The response explaining that “the purpose is to have a safe place” both recognizes what was said and clarifies the purpose of the group. The statements of “Don’t share anything until you’re comfortable” and “No one will require you to do anything…” are supportive, but they do not recognize the phase of development of the group. The statement “I understand…” offers the client empathy but does not reinforce the purpose of the group.

14. The leader of an Alzheimer’s support group surveys the members of the group to determine the best time for the group to meet.

Which of the following norms is being supported through this action? a. Group norms b. Task norms c. Maintenance norms d. Reality norms ANS: C

Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times.

Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space. Group norms set the standards for the group members’ behaviors, attitudes, and perceptions. Task norms are the commitment to return to the central goals of the group. Reality norms occur when members reinforce or challenge and correct their ideas of what is real.

15. A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in

arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers’ needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a. The group became cohesive enough to share leadership tasks. b. Teenagers don’t like feeling dependent on adults with power. c. Teenagers often rebel against adult authority. d. The nurse was overwhelmed and lost control of task process.

ANS: A

In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group. As the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion, not necessarily a rebellion against adult authority. The group naturally progressed to leading itself based on normal group development. This did not occur because of the teenagers’ attitudes, behaviors, or because of the feelings of the nurse.

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16. A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during

summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict?

Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week. a.

ANS: A

Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict. If the nurse were to respond to conflict by avoiding (suggesting that they avoid further discussion), forcing with power (assuming adult authority), capitulating, or excluding some members (asking the deviant members to leave), the behavior would fail to satisfy the concerns of those involved.

MULTIPLE RESPONSE 1. The nurse is scheduled to teach carbohydrate counting to middle-aged adults newly diagnosed with diabetes. Which of the

following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning. e. Reinforce learning with handouts.

ANS: A, C

Because the nurse is working with middle-aged adults, the assumption can be made that they are members of Generation X. This generation tends to be self-directed, likes to work with teams, and may need to develop skills because they are not as likely to be as tech savvy. Members of this group can tolerate delayed gratification; they want clear information with practical value; and they are able to have fun and engage in games and activities when appropriate. Because of this, the best approach will be to use adult experiences and practical problems as learning motivators—for instance, appealing to adults’ sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions. This generation tends to be self-directed so they most likely will not depend on the instructor to set goals for learning or need the instructor to emphasize how important it is to know this information. Reinforcement with handouts are generally helpful. Members of this generation are likely to have the intrinsic motivation to accomplish these things on their own.

2. Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. The necessary ability to perform the skill b. An open mind to learn the new skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill e. Desire to learn the skill ANS: A, C, D

Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor abilities, having a sensory image of how to carry out the skill, having opportunities to practice the new skill. Having an open mind to learn a new skill and wanting to learn the skill are important. However, it is not necessary in order to master psychomotor learning.

3. Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Emphasize how to build learning from previous experiences. b. Use simple words to enhance understanding. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences. e. Use concrete examples to reinforce learning ANS: B, C, E

When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills. When working with adults, emphasis should be placed on previous experience. This is not as important when working with children as they have had more limited experiences. Children are not concerned with long-term consequences, rather they focus on consequences and activities that will occur in the near future (short-term).

4. A client tells a nurse, “I know all about this already. I read about it on the Internet” and then begins to summarizes what he has

learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a. Were you able to find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information? d. Did you enjoy reading the material on the website? e. Did the information sound correct to you?

ANS: A, B, C

To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc. Assessing if the material was enjoyable to read or sounded correct does not help the nurse to assess the quality of information that was read by the client.

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Chapter 15: Case Management Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes case management? a. A tool of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate ANS: C

Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system. Managed care is a tool of health maintenance organizations. Care management is an enduring process in which a population manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or a group.

2. Which of the following best describes why planning care for an individual is so challenging in today’s health care system? a. Because today’s clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client d.

treatment Because so many different health care providers are in the acute care setting today

ANS: B

Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client’s continuum of care. Planning care is so challenging because of the complexities of the system, not the high expectations of the population, new technology, or different providers. Coordination of all of these aspects of care, not just one of them, is what makes planning so difficult.

3. Which of the following best describes the primary problem that can result from health care today being given by many different

care providers?

Clients are not sure which provider to see first.

Health care providers have to make referrals to other providers.

Clients sometimes are not sure who their primary provider is.

Overuse, underuse, or gaps in care may result.

a. b. c. d.

ANS: D

A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication. Clients who have a primary care provider typically know who that provider is and recognize that this is the provider that should be seen first. The referral system is not a primary problem with health care being given by various providers. It is the fragmentation of services that causes the problems within the system.

4. Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 24-year-old who has a master’s degree in public health b. A 34-year-old who will be moving from a large city c. A 44-year-old who was born and raised in the community d. A 54-year-old who, until recently, was a member of the community’s school

board ANS: B

Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict resolution skills; critical thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills.

5. Which of the following best explains why every client doesn’t receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers.

ANS: A

Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses’ caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet. Health agencies continue to employ more case managers as the cost spent for the care saves the agency money in the long term. Because case management is labor intensive and costly, it is unrealistic for all clients to have a case manager although additional clients could benefit from case management. Nurses fulfill the roles of advocate, care coordinator, and referral agent which are necessary to function as case managers.

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6. The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for

continuing care to be implemented?

A primary care provider who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic a.

ANS: C

Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client’s health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phone bank location. Wireless prescriptions and plans of care are not necessary for a client who is receiving telehealth services. Home visits may not be necessary for a telehealth client. Through the use of telehealth, the need to visit clinics is decreased.

7. A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important

consideration that should be made by the nurse? a. Case management plans should be used only by nurses to manage care. b. Case management plans should be individualized for each client. c. Case management plans provide additional expense to the client and family. d. Case management plans focus on the natural progression of the disease.

ANS: B

Adaptation of the case management care plan to each client’s characteristics is a crucial skill for standardizing the process and outcome of care. It links multiple provider interventions to client responses and offers reasonable predictions to clients about health outcomes. Institutions report that sharing case management plans with clients empowers the clients to assume responsibility for monitoring and adhering to the plan of care. Case management plans should link the care that is provided together and involve multiple providers. Case management is part of the standard of care that is provided and does not provide an additional expense to the client, although it may cause an additional expense to the agency. Disease management, not case management, focuses on the natural progression of the disease.

8. A client spends a great deal of time on the Internet or reading articles related to diabetes and its long-term effects. One day, the

client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse?

“Life care plans are only for young persons who are newly diagnosed.”

“Life care plans are primarily used to determine long-term financial needs for legal reasons.” c. “You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn’t currently appropriate.” d. “I was waiting for you to express interest in having a life care plan.” a. b.

ANS: C

Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice. Others who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging. Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice, not young persons with a newly diagnosed illness. The life care plan is a customized, medical-based document that provides assessment of all present and future needs (i.e., medical, financial, psychological, vocational, spiritual, physical, and social), including services, equipment, supplies, and living arrangements for a client. These plans may be used by either a plaintiff or a defense lawyer to analyze damages. They are also used to set financial rewards, which can be used to pay for care in the future and create a lifetime care plan.

9. Which of the following Medicaid clients would most likely receive case management? a. An elderly person b. A person receiving rehabilitation following an injury c. A person who has a high-cost chronic disease d. A person with acute illness ANS: C

Some states, through their Medicaid programs, are developing disease management programs for high-cost chronic diseases among their populations, such as asthma and diabetes. An elderly person is most likely to receive Medicare services, not Medicaid services. Additionally, there is not any information that states that the elderly person has a high-cost chronic disease. A person who is receiving rehabilitation following an injury or who has an acute illness does not have a diagnosis that warrants case management, as case management is reserved for those with high-cost chronic diseases.

10. Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing b. c. d.

objectives To improve community service needs identified by research findings To integrate evidence-based practice guidelines in the provision of community nursing service To promote the client’s rights and self-determination

ANS: D

In today’s practice, the nurse advocate makes the client’s rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. Integrating evidence-based practice is part of the role of the nurse as a researcher. Gaining organizational and government support and improving community service needs identified by research are not roles of the nurse as an advocate. In the advocate role, the nurse promotes the self-determination of the group.

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11. A case manager advocates for a client by helping an insurer understand the client’s needs and desires and by helping the client

understand programs and benefits offered by the insurer. What role is the nurse? a. Arbitrator b. Systems allocator c. Mediator d. Negotiator ANS: D

Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. As a systems allocator, the nurse distributes limited health care resources according to a plan or rationale. Mediating is the process of assisting parties to understand each other’s concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome.

12. A nurse reviews with the client what can be expected during the next 3 days, as well as how the client should expect to feel each of

those days. The client laughs and says, “You’ve got my care all mapped out.” Which of the following tools is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management ANS: B

Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measureable outcomes. Care planning involves developing a plan of care for an individual. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system.

13. A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of

the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client’s recovery is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client’s family considered most important ANS: C

One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable.

To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences. Changing the goal allows other possibilities, which may or may not include long-term care, to be considered. The client outcomes in different settings are not being addressed at this time. Examining the aspects that the family feels is most important can better be considered by broadening the goal.

14. The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them.

Which of the following terms best describes this action? a. Assertiveness b. Collaboration c. Cooperation d. Compromising ANS: B

In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties. Assertiveness is the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. When compromising, an individual attempts to find a mutually acceptable solution that partially satisfies both parties.

15. A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing

process does this correspond? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase ANS: B

The diagnosis phase of the nursing process is analogous to the identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment. During the assessment phase, the nurse develops networks with the target population and disseminates written materials. In the planning phase, the nurse validates and prioritizes problems with all participants. When working through the implementation phase, the nurse contacts providers and negotiates contracts and services.

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16. A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process.

Which of the following activities would the nurse most likely use?

Asking the client what is most important Seeking appropriate referrals for the client Assuring the client that his wishes will be supported Determining the order in which actions will occur

a. b. c. d.

ANS: C

Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking the client what is most important is a way to illuminate values, which occurs in the assessment phase. Seeking appropriate referrals for the client occurs in the assessment phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase.

17. A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? a. Advocating for the client whose values conflict with those of the medical service b. c. d.

provider Collaborating between nursing and occupational health personnel Educating a group regarding community services that are available if ever needed Resolving conflict between a primary care clinic and a tertiary health care facility

ANS: C

Primary prevention involves the use of the information exchange process to increase the client’s understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed.

MULTIPLE RESPONSE 1. Which of the following are the primary goals of case management? (Select all that apply.) a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision-making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care e. To reduce institutional care as a means of achieving wellness ANS: A, B, C, E

The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision-making, guideline use, and disease management programs; and control expenses by managing care processes and outcomes. Case management involves more aspects of care than only care that occurs in the community. Thus, stressing the advantages and benefits of community-based care is not part of the primary goals of case management.

2. A case manager is concerned about exposure to possible lawsuits. Which of the following are appropriate actions to take to

minimize this risk? (Select all that apply.) a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Share client information with the other involved providers and agencies. d. Confirm credentials and capabilities of providers or agencies to give care. e. Being mindful to maintain effective lines of communication with all clients.

ANS: A, B, D, E

Elements that reduce risk exposure include clear documentation of the extent of participation in decision-making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources, which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), no nurse is allowed to share information with others without written consent of the client.

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Chapter 16: Disaster Management Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best defines a disaster? a. Any event that results in multiple deaths b. Devastation that cannot be relieved without assistance c. Devastation that covers a broad geographic area d. When the event results in multiple injuries and deaths as well as property damage ANS: B

A disaster is any human-made or natural event that causes disruption, destruction, or devastation that cannot be relieved without external assistance. A disaster does not need to involve injuries or deaths. The devastation may not cover a broad area, rather the main concept of the definition of a disaster is that it cannot be relieved without assistance.

2. Which of the following best describes countries that bear the greatest burden of disasters? a. Arid regions that are prone to drought b. Developing countries with limited resources c. Industrialized countries with much to lose d. Water-boundary regions that are prone to floods and hurricanes ANS: B

Disasters create the most devastation in developing countries. The people of low socioeconomic status suffer the most because their houses are less sturdy and have fewer resources and less means of social security. The climate and location of the country do not relate to its risk of bearing the burden of disasters. Industrialized countries have a higher socioeconomic status and can better address disasters if they occur.

3. What is the purpose of the National Response Framework? a. Create a new branch of government that deals with bioterrorism. b. Establish a way for the Red Cross to carry out its mission. c. Define roles, responsibilities, and relationships critical to effective emergency d.

preparedness.

Extend presidential power to act quickly upon weapons of mass destruction.

ANS: C

The National Response Framework, a successor to the National Response Plan, “helps define the roles, responsibilities, and relationships critical to effective emergency planning, preparedness, and response to any emergency or disaster.” The NRF serves as a guide for conducting a nationwide all-hazards response that is flexible and adaptable and that links all levels of the government with nongovernmental organizations and the private sector. The US Department of Homeland Security was developed in 2002 to develop and coordinate the implementation of a comprehensive national strategy to secure the United States from terrorist threats or attacks. Eventually, the NRF was developed within this department. The National Response Framework helps to provide a linkage for the Red Cross to other organizations but does not assist with it carrying out its mission. The NRF does not change presidential power.

4. When does disaster management begin? a. Before the disaster occurs b. During the disaster c. Immediately following the disaster d. During the recovery period ANS: A

Disaster management includes the four stages of a disaster: prevention, preparedness, response, and recovery. The first stage of prevention (or mitigation) occurs before the disaster occurs. Disaster management that occurs during the disaster is called response.

Recovery occurs following the disaster. Nothing can be done as the actual disaster is occurring.

5. A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most

likely complete? a. Provide community educational programs and training on how to prepare for disasters. b. Request donations be sent to the affected area. c. Develop a notification procedure to be used by the international disaster relief office. d. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area.

ANS: A

Mitigation refers to actions to prevent specific disasters from occurring or to reduce the severity of a disaster’s effects if it cannot be avoided. To provide community educational programs on disaster preparedness is the only intervention that addresses mitigation. Requesting donations be sent to the affected area occurs during the disaster and is known as the response. Developing a notification procedure would occur as part of the preparedness stage. Depending on the timing of the recruitment, this would be part of either the preparedness or the response stage.

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6. Which of the following should family members have readily available to best cope with a disaster? a. Gloves, mask, and other personal protective equipment b. A copy of the nurse’s professional license c. A 5-day supply of water d. Where they will meet in case of an emergency ANS: D

Families are best protected by having the skills and knowledge to cope with a disaster, including details such as where families will reunite in the event of an emergency. The nurse should have his or her own copy of the professional license. It is recommended that a 3-day supply of water (1 gallon per person per day) be part of an emergency planning kit. Gloves, mask, and other personal protective equipment are recommended for the professional nurse to have available as an emergency supply.

7. A nurse is working with a community during the preparedness stage of disaster management. Which of the following events would

the nurse anticipate occurring?

Heightened inspection and increased security in the community Incorporation of provision of pets into local disaster plans Purchase of personal protective equipment for all citizens Assembly of disaster kits for the home, workplace, and car

a. b. c. d.

ANS: D

Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security is part of the mitigation phase. Individuals should make plans for the provision of their pets through their own personal disaster planning; this would not be part of the community disaster planning. It would not be appropriate or feasible for the nurse to purchase personal protective equipment for all citizens.

8. A community health nurse has invited several agencies in the community to a meeting to discuss the disaster plan for the

community. Which of the following best describes the purpose of this meeting? a. To increase stability in the community b. To improve overall community functioning c. To manage response to disasters in the community d. To enhance communication among agencies in the community ANS: C

The level of community preparedness for a disaster is only as good as the people and organizations in the community make it.

Although natural disasters cannot be prevented, much can be done to minimize further increases in accidents, death, and destruction after impact. A concise, realistic, and well-rehearsed disaster plan is essential for managing the response to disaster. Open, clear, and ongoing communication among involved workers and organizations is critical. A disaster planning meeting among community agencies would not impact the stability or functioning of the community. The communication among the agencies that are present may be improved; however, the group is meeting for a specific purpose so the overall communication may not change, and there may be agencies that are not represented at the meeting.

9. The local hospital, health department, and university together planned and implemented a mock casualty drill, with the university’s

theater and nursing students playing the injured victims. After the drill, which of the following would the nursing students most likely complete? a. Volunteer as leaders in the next casualty drill. b. Evaluate the drill and offer recommendations for more effectiveness in the future. c. Recognize how to respond to a real disaster in the future. d. Write a report on their actions and how they felt during the drill.

ANS: B

The nursing students should be prepared to offer a critique of the drill performance and suggest improvements for the next drill—or for an actual disaster. It would be unlikely that the students would be volunteers at the next drill as typically the agencies involved with disaster management are the ones who are coordinating and leading these activities. It is unknown if the student will ever be in the same type of disaster as what they completed the drill for, so their involvement may not change their response in the future.

Writing a report and talking about feelings would not be helpful for the agencies to learn what they can do differently if an actual disaster was to occur.

10. Which of the following organizations would direct nurses’ response to a countywide disaster? a. American Red Cross b. Centers for Disease Control and Prevention c. Emergency Management Agency d. The local public health department ANS: C

The first level of disaster response occurs at the local level with the mobilization of responders such as the fire department, law enforcement, public health, and emergency services. If the disaster stretches local resources, the county or city emergency management agency (EMA) will coordinate activities through an emergency operations center (EOC). Generally, local responders within a county sign a regional or statewide mutual aid agreement to allow the sharing of needed personnel, equipment, services, and supplies. The American Red Cross may assist with disaster relief efforts, but this would not be the agency that would direct the response by nurses. The Centers for Disease Control and Prevention is a national agency and would most likely not be involved with a county-wide disaster. The local public health department may be involved in responding to the disaster, but this would not be the organization that is responsible for leading the response.

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11. A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the

most crucial aspect for the nurse to consider?

Detecting an increase in people with similar signs and symptoms Identifying typical chemical or biological agents Identifying factors that put people at risk Recognizing areas of vulnerability within an area

a. b. c. d.

ANS: A

An unannounced dissemination of a biological agent may easily go unnoticed, and the victims may have left the area of exposure long before the act of terrorism is recognized. Therefore, the first and most important aspect is recognizing that an outbreak has occurred by noting the increase in people presenting with similar signs and symptoms. After the similar signs and symptoms have been detected, the next step is striving to identify the biological or chemical agent. Then the nurse will identify factors that place people at risk, implement measures to control the outbreak, and finally, inform the medical and public communities about treatments, health consequences, and preventive measures.

12. Which of the following older adults is most in need of psychological support? a. The older adult who keeps asking if loans will be available for him to rebuild b. The older adult who keeps asking if he can go back home yet c. The older adult who keeps lamenting the loss of his family photos d. The older adult who keeps talking about how expensive his home theater was and

how he will never be able to afford to replace it ANS: C

Older adults react deeply to the loss of personal possessions because of the high sentimental value attached to the items. Family photos are a part of family history and are not replaceable. This type of a loss warrants psychological support. Homes and electronic equipment can be replaced, so the older adult may be able to eventually access loans to rebuild his home and replace his equipment. Because these things are replaceable, it is likely that the older adult will be able to better cope with these losses than with something that is irreplaceable. Depending on the loss of the older adult, he or she may have a need for relocation rather than returning home.

13. A community is experiencing the honeymoon phase following a disaster. Which of the following is most likely to occur in the

community?

First responders work tirelessly to save others.

Survivors share their stories.

Medical personnel experience exhaustion.

Community organizations rebuild the community.

a. b. c. d.

ANS: B

During the honeymoon phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the heroic phase. Medical personnel experience exhaustion during the disillusionment phase.

The community begins to rebuild during the reconstruction phase.

14. A nurse was the first on the scene of a disaster and saw people with injuries ranging from minor to serious. Some of those with

minor injuries were helping others. Which of the following injured persons would the nurse assist first? a. Those with life-threatening head and chest injuries b. Those who have life-threatening abdominal injuries c. Those who have serious injuries of limbs d. Those who are hurt but still mobile and functioning ANS: B

Triage is the process of separating casualties and allocating treatment on the basis of the victims’ potentials for survival. The nurse will determine how seriously hurt individuals are and who should get care first, with the first priority being those who have life-threatening injuries but will probably survive if treated quickly. Although the textbook does not address the issue, because of the limited resources in a disaster situation and the fact that only the nurse is currently available to give care, seri ously hurt individuals with head or chest injuries that have only a small chance of surviving are not treated. Those who do not have life-threatening injuries and are mobile and functioning are not given priority during the triage process.

15. A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse

should take?

Limit the amount of equipment and medications brought into the shelter.

Determine if the person has a psychological condition requiring special attention.

Assess if this type of facility is appropriate for the person.

Provide medical care for persons as if they were in a hospital.

a. b. c. d.

ANS: C

Any person who comes to a special needs shelter must be assessed by a nurse to determine whether this type of facility is appropriate. After it has been determined if the facility is appropriate for these people, the nurse can work with them as needed to limit equipment if there is limited space. Assessment of the physical concerns of the people, not the psychological conditions, should be the primary concern of the nurse. The nurse would not be providing medical care at the shelter, rather, the nurse would provide assessments and referrals, assist the client to meet health care needs, keep client records, ensure emergency communications, and provide a safe environment.

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16. A nurse learns about a huge disaster a few states away. Which of the following actions by the nurse would be most helpful in this

situation?

Donating to any charity that is assisting the victims Driving over to the area and volunteering to assist Sending clothes and food to the area for distribution Training to become a Red Cross disaster volunteer

a. b. c. d.

ANS: D

Disaster workers must know what kinds of populations they are attempting to assist. Thus, formal training related to disaster management and response would be important for the nurse to complete. Without having formal training and having official sponsorship, volunteers may not be able to be used. Lack of information or inaccurate information regarding the scope of the disaster and its initial effects can contribute to the misuse of resources. Often too many volunteers who lack official sponsorship convene at the site of disaster and are disappointed when their help cannot be used. Similarly, well-meaning people may send clothes and food to disaster sites. The unneeded contributions of food and clothing add to the stress of coping with the disaster, particularly if refrigeration and storage are not available. Although contributing to an organization such as the American Red Cross is to be encouraged and commended, many fraudulent scam charities may pop up claiming to collect funds for the victims.

17. On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is

feeling irritable and having difficulty focusing. Which of the following actions should the nurse take in response to the complaint of headache? a. Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later. b. Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break. c. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time. d. Suspect dehydration and encourage the worker to drink more fluids.

ANS: B

Symptoms of early stress and burnout include minor tremors, nausea, inability to concentrate, difficulty thinking, and problems with memory. Suppressing feelings of guilt, powerlessness, anger, and other signs of stress eventually will lead to symptoms such as irritability, fatigue, headaches, and distortions of bodily functions. It is normal to experience stress, but it must be addressed. The worst thing anyone can do is to deny that it exists. The American Red Cross recommends that the worker get enough sleep and take time away from the disaster (i.e., take breaks). The colleague should deal with his emotions now and not put them off to deal with later. The symptoms that are described relate to early stress and burnout, thus, multitasking or drinking more water are probably not going to help relieve his symptoms.

18. A nurse, after working 2 weeks at the site of the largest natural disaster to hit the United States, returns home. Which of the

following behaviors would suggest the nurse needs professional assistance? a. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there. b. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured. c. The nurse is moody and feels family demands are not really as important as the other members of her family think they are. d. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities.

ANS: A

The fact that the nurse needs to continue to ventilate about the disaster, even after the family has quit listening, would suggest a delayed stress reaction that is not resolving and therefore warrants professional intervention. The nurse presenting at a college about the disaster demonstrates that the nurse is able to engage in conversations about the disaster after it has occurred. It is understandable that the nurse would return exhausted and moody. Indeed, concerns of major importance to family members may seem trivial when compared with problems the disaster victims were confronting.

19. After experiencing a house fire, a 4-year-old child begins sucking his thumb and wetting his bed. Which of the following would be

the most appropriate action for the nurse to take?

Explain to the child that it is important to be strong and not act like a baby.

Explain to the family that this behavior is a normal reaction to disaster.

Recommend admission for inpatient psychological counseling.

Recommend behavior therapy as a means to overcome regression.

a. b. c. d.

ANS: B

The effects on young children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumbs, wetting their beds, crying, and clinging to parents. This regression is normal in response to the event. Regression is a normal response; thus, it is not necessary to recommend psychological counseling or behavior therapy. It would not be appropriate to explain to a 4-year old child that he or she should be “strong.”

20. Which of the following levels of prevention is being used by a nurse who is helping to develop a community-wide disaster

management plan? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. All prevention levels ANS: A

Primary prevention takes place before a condition occurs. Primary prevention occurs when one participates in developing a disaster management plan for the community. Secondary prevention occurs with at risk populations and is aimed at early diagnosis and treatment. Tertiary prevention occurs after a problem has already been detected or diagnosed. The development of a plan only addresses primary prevention, not the other levels described.

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MULTIPLE RESPONSE 1. Which of the following disasters would implement disaster medical assistance teams (DMATs)? (Select all that apply.) a. Disaster that covers a broad geographic area b. Disaster that is beyond the coping capabilities of the affected state c. Disaster that may result in substantial health and medical problems d. Disaster that may cause a large number of deaths e. Disaster that may cause a large number of injuries both physical and psychosocial ANS: B, C, D

A presidentially declared disaster is one that requires implementation of disaster medical assistance teams (DMATs) because the disaster exceeds the capabilities of the involved state(s) to provide a timely and effective response. Such a disaster has the potential to cause a substantial number of deaths or injuries; substantial health and medical problems; or significant damage to the economic and physical infrastructure. The disaster may not cover a broad geographic area. The criteria for the use of DMATs is that the disaster exceeds the capabilities of the involved state to provide a timely and effective response. This could occur in a small geographic area.

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Chapter 17: Public Health Surveillance and Outbreak Investigation Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse considered copying last month’s surveillance report and changing the date because the number of occurrences per month

had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? a. Because such data are legally required b. Because it is still part of the nurse’s responsibilities, even if on minimal value c. To determine a local baseline rate and immediately notice any change d. To determine differences among communities in need for state assistance ANS: C

Disease surveillance generates knowledge of a disease or event outbreak patterns. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks. Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and improve health. Disease surveillance is not part of a legal requirement. There are many useful purposes for surveillance including monitoring for emerging infections and disease trends. The purpose of the monthly surveillance report is not for comparison among communities, rather it is a description of what is happening within the local community.

2. A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable

about this topic? a. Because nurses are employed in public health agencies b. Because nurses are often the first to recognize and respond to a problem c. Because nurses are responsible for ensuring that action is taken when necessary d. Because nurses are typically the ones to interact with the public and the media ANS: B

Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. Nurses may work in a variety of community agencies, including public health agencies. Nurses will collaborate with others to take action as necessary; it would not be the sole responsibilit y of the nurse.

A wide variety of public health professionals interact with the public and the media, not only nurses.

3. A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this

activity? a. To ensure that local causes of death are consistent with national causes of death b. To confirm that no local health problems are beginning c. To evaluate effectiveness of health promotion programs d. To obtain mortality data for the local area ANS: D

Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports, such as death certificates, are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. It is not necessary that the local causes of death are consistent with national causes, rather it is important that the nurse be aware of the major causes of mortality in the community so that the needs of the community can be addressed. Mortality data can occasionally be used to evaluate the effectiveness of health promotion programs, but this would not be the primary purpose of reviewing death certificates. Other data can be used to detect the start of local health problems. Analyzing death certificates as the only means of examining local health problems would provide the nurse with data that is not current.

4. Which of the following types of surveillance systems is being used when case reports are routinely sent to local health departments

by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? a. Active b. Passive c. Sentinel d. Special ANS: B

In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.

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5. In which of the following situations would the nurse most likely use an active surveillance system? a. A newspaper wants to know the incidence of asthma in the community. b. A real-time ongoing communication channel is established to monitor a particular c. d.

symptom.

Several children become ill with gastrointestinal (GI) upset at one local school.

The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

ANS: C

In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. Special surveillance is developed when a particular type of data is sought.

6. Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would

continue to pursue the cause of the illness even after the children have been discharged from the hospital?

So that the children’s families know the public health department cared about them b. So that action could be taken to avoid any such future episodes c. Because the children’s parents need to know whom to sue for their medical expenses d. To confirm that the symptoms were due to an infectious disease a.

ANS: B

The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case, the nurse wanted to make sure children did not become ill again when it could be avoided. The further investigation of the illness is not to demonstrate caring on the part of the public health department, rather it assists with learning about what factors contributed to the occurrence. It is unlikely that the pa rents would sue for a hospitalization for severe vomiting and diarrhea. Also, there is no indication that there would be an individual or agency to sue for the symptoms that the child is experiencing. There is no indication as to what caused these symptoms, thus, the nurse would need to do further investigation to determine if they were related to infectious disease or some other contributing factor.

7. A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing.

Which of the following types of outbreak would the nurse suspect?

Common source Mixed Propagated Intermittent

a. b. c. d.

ANS: A

A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. A mixed outbreak is a common source outbreak followed by secondary exposures related to person-to-person contact.

Intermittent source cases may be exposed over a period of days or weeks. A propagated outbreak does not have a common source but spreads gradually from person to person over more than a single incubation period.

8. A nurse noted that of 18 children in a daycare center room, 5 became ill. Which of the following best describes a host factor that

may be associated with this illness and who became ill? a. Some of the children were from very low socioeconomic families. b. Some of the children inhaled car exhaust while playing outside. c. The bacterial cause of the illness was easily removed by handwashing. d. The daycare center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

ANS: A

Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness and exposure to pollutants are considered agent factors, and the difference in temperature in the room is an environmental factor.

9. In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their primary care

providers recently. The incidence of reports of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. b. No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses. c. Action should be taken because there must be some cause for this noted increase. d. Action should be taken because this increase may be the beginning of an epidemic and should be investigated.

ANS: A

Typically, any unusual increase in incidence should be investigated. But in the majority of cases, the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal.

Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. The nurse should recognize that depression can be seasonal and not attribute this problem to an error in the data that has been collected. Because this is being recognized as a seasonal problem, there is no need for the nurse to take action. However, the nurse should continue to monitor the data to make sure that this trend does not continue as the weather begins to warm and more hours of daylight occur.

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10. Which aspect of a biological agent is probably the most frightening to those exposed? a. Infectivity b. Invasiveness c. Pathogenicity d. Virulence ANS: D

Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease.

MULTIPLE RESPONSE 1. Which of the following describes the purpose of surveillance systems today? (Select all that apply.) a. To obtain data used to fight for increased budgets from taxpayers b. To evaluate the effectiveness of public health programs c. To monitor the incidence of chronic diseases among the local population d. To note and help prevent occupational exposure and diseases e. To help formulate interventions to reduce the incidence of chronic diseases ANS: B, C, D, E

Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. With limited budgets, surveillance systems are important. The taxpayer money should be used in the most effective and efficient ways possible. This involves monitoring the effectiveness of health programming, not asking for increased budgets from taxpayers.

2. A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of

the following has most likely occurred within the community? (Select all that apply.) a. Doctors are feeling rushed as they interact with each patient. b. Emergency departments are notably busier than usual. c. Nurses are calling in ill to the local hospital. d. Pharmacists are discussing the increase in medication purchases. e. Orders for diagnostic tests have increased over last year at this time.

ANS: B, D, E

Syndromic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to primary care facilities or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. Doctors feeling rushed and nurses calling in ill are not unusual events.

3. The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the

following actions should the public health nurse take first? (Select all that apply.) a. Analyze educational health programs offered to the public last year. b. Congratulate the public health staff on the success of their asthma awareness program. c. Determine whether there are any other data sources that might confirm the apparent increase in asthma. d. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases. e. Determine whether there are any other data sources that might dispute the apparent increase in asthma.

ANS: C, D, E

Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? Confirming the data by comparing it to other sources would be the priority. After this has been completed, the next steps would be for the nurse to look at the health programming and community awareness education that has taken place. It would be premature to look at the programming if the initial data obtained is not accurate.

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Chapter 18: Program Management Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes the steps in program management? a. Assess, plan, implement, evaluate b. Identify, initiate, implement c. Organize, operationalize, mobilize, subsidize d. Substantiate, negotiate, evaluate ANS: A

The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. The other steps mentioned in other options are not part of program management. The process of program management, such as the nursing process, consists of a rational decision-making system to help nurses determine the complete process of program development, implementation, and evaluation.

2. Which of the following best describes the ultimate goal of program planning? a. Avoid unanticipated conflicts in the program development phase. b. Provide adequate funding to meet the program’s resource requirements. c. Ensure that health care services are acceptable, equal, effective, and efficient. d. Prevent unnecessary duplication of services.

ANS: C

The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective.

The other options are aspects of program planning, but they address only limited concerns.

3. Which of the following best describes the purpose of strategic planning? a. To anticipate client needs now and in the future b. To match client needs, provider strengths, and agency resources c. To maximize effective use of agency resources d. To utilize provider strengths and competencies ANS: B

Strategic planning involves the successful matching of client needs, with specific provider strengths and competencies and agency resources. Everyone involved can anticipate what will be needed to implement the program, what will occur during implementation, and what the outcomes will be. Strategic planning addresses the client, agency, and provider. The other responses address only one of these factors not all three of them which all need to be considered during the strategic planning process.

4. Which would be an appropriate descriptor that meets all criteria for defining a client to be served by a program? a. All women ages 40 to 50 who have not had a menstrual period for three b. c. d.

consecutive months Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency Pregnant women who have received nutritional counseling but whose nutritional status did not improve Children ages 18 months to 5 years who have been treated for nutritional deficiencies at the Central County Clinic

ANS: B

The client should be defined by biological and psychosocial characteristics, by geographic location, and by the problems to be addressed. For example, in a community with a large number of preschool children who require immunizations to enter school, the client population may be described as all children between 4 and 6 years of age residing in Central County who have not had up-to-date immunizations. This example tells the reader who the client is, what the need is, how large the population is, and where they are located. In order to meet all criteria for defining a client that is to be served by the program, information about the biological and psychosocial characteristics, geographical location, and the problems addressed needs to be included. The incorrect responses do not contain all of this necessary information.

5. After completing a needs assessment, the nurse presents ideas at a community interest meeting that focuses on community needs.

Unfortunately, attendees show essentially no interest in being involved. Knowing that the health problem must be addressed, the nurse proceeds with implementation as planned. Which of the following is the most likely outcome of the program? a. Community members will become increasingly positive about the new program. b. Others will recognize the importance of the program and become involved. c. The public health agency will both publicize and expand the program. d. The program will fail because of the community’s lack of interest.

ANS: D

Perspectives on the program, or what people think about the need for a program, might differ among health providers, agency administrators, policymakers, and potential clients. These groups are considered the stakeholders in the program. Collecting data on the opinions and attitudes of all persons, whether directly or indirectly involved with the program, is necessary to determine if the program is feasible, if there is a need to redefine the problems, or if a new program should be developed or an existing program expanded or modified. If a new or changed program is to be successful, it must not only be available, but also be accessible and acceptable to the people who will use it. If community members do not accept the programming, it is unlikely that they will become increasingly positive about it or invite others to become involved. The public health agency could attempt to publicize and expand the program, but without the acceptance of the community, it will most likely fail.

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6. A nurse is assessing a community to determine the feasibility of implementing a new program on bike safety for youth in the

community. Which of the following aspects should the nurse investigate to make this determination?

Whether the community, especially agency clients, desire a program Whether local politicians support the agency’s idea for a program Whether agency professionals think a program is needed Whether all involved support the need for such a program

a. b. c. d.

ANS: D

Feasibility means the program’s viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Thus, it is important to get all who are involved to support the program.

7. A community is examining which programs are needed within the community, the populations they will target, and how they will

be funded. Which of the following would be the least risky decision for the community to make? a. Choose whichever option is the least expensive of agency resources. b. Choose to do nothing. c. Choose whatever the agency administration prefers. d. Choose whatever the majority of clients prefer.

ANS: B

A “do nothing” decision is always the decision with the least risk to the provider. The need and demand for a program are determined by working with the client. This stage of planning creates options for solving the problem and considers several solutions. Each option for program solution is examined for its uncertainties (risks) and consequences.

8. A nurse checks health department records to compare the number of new teen clients presenting for birth control counseling and

management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which of the following steps of the evaluation process is being completed by the nurse? a. Engage stakeholders b. Justify conclusions c. Gather credible evidence d. Focus on the evaluation design ANS: C

When the nurse gathers credible evidence, the following information is collected: indicators that will be used, sources of data, quality of the data, quantity of information to be gathered, and the logistics of the data gathering phase. Data gathered should provide credible evidence and should convey a well-rounded view of the program. Engaging stakeholders includes those who are involved in planning, funding, and implementing the program; those who are affected by the program; and the intended users of its services. When the nurse justifies conclusions, the conclusions of the evaluation should be validated by linking them to the evidence gathered and then appraising them against the values or standards set by the stakeholders. When focusing on the evaluation design, the nurse will describe the purpose for the evaluation, the users who will receive the report, how it will be used, the questions and methods to be used, and any necessary agreements.

9. A nurse is planning a program to teach cardiac health at the senior citizens’ center. Which of the following is an effectively written

objective for the program?

By the end of the program, each participant will report walking at least 30 minutes a day at least 5 days each week. b. By the end of the program, each participant will voice a commitment to walk at least 30 minutes a day. c. By the end of the program, each participant will understand the need for physical exercise. d. Each participant will voice a commitment to engage in physical exercise each day. a.

ANS: A

Useful program objectives must include a statement of the specific behaviors desired, using an action verb that can be seen and measured. Only “will report walking 30 minutes a day at least 5 days each week” has a specific outcome action that can be seen and measured. Voicing a commitment is not an outcome action; it is only a verbal agreement. The verb understand is not an action verb that can be seen and measured.

10. The nurse contacts participants who completed an educational program on breast self-examinations to see whether they have any

questions and to determine whether they are doing breast self-examinations. Which of the following types of evaluation is being implemented by the nurse? a. Final evaluation b. Formative evaluation c. Goal evaluation d. Summative evaluation ANS: D

Summative evaluation assesses program outcomes after the program is completed. Formative evaluation occurs on an ongoing basis while the program exists. Goal evaluation and final evaluation are not types of formal evaluation that are addressed in the textbook.

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11. A nurse is completing a summative evaluation of a program designed to decrease obesity in school-age children. Which of the

following is the most important question for the nurse to ask?

Are school-age children satisfied with the program?

Can parents and guardians support the program requirements?

Has obesity in school-age children decreased?

What is the program cost compared with the program benefit?

a. b. c. d.

ANS: C

Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. Formative evaluation serves the purpose of assessing if objectives are met or if planned activities are completed. This type of evaluation begins with an assessment of the need for a program and is ongoing as the program is implemented. The considerations of satisfaction, support, and cost are all issues that could be addressed in planning and ongoing assessment of the program.

12. Evaluation is under way for a statewide program to decrease teen injury and death associated with teens that drive while under the

influence of alcohol. Which of the following questions would best be used for the summative evaluation of the program? a. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program? b. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? c. How does the amount of alcohol intake by teens compare before and after participants enter into the program? d. What problems are identified as the program is implemented?

ANS: B

Summative evaluation is the evaluation to assess program outcomes or as a follow-up of the results of the program activities. The goal is addressed in the question about statistics. Two of the options are examples of questions used for formative evaluation (satisfaction and problems with program implementation). The goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol.

13. A committee concludes that a program’s objectives were met and that activities received positive ratings from the community; yet

the program will be discontinued because cost was triple the amount anticipated. Which of the following program evaluation measures created a problem? a. Adequacy b. Effectiveness c. Impact d. Sustainability ANS: D

The aspect of program evaluation is sustainability—enough resources (usually money) to continue the program. Other aspects of program evaluation include: adequacy—program addresses the extent of the need; effectiveness—ability to meet program objectives and the results of program efforts; impact—long-term changes in the client population.

14. Based on projected increases in the number of older US citizens, a planning committee wants to establish a day care program for

the community’s older adult population. During which stage is the need for this program being assessed? a. Inactive stage b. Interactive stage c. Preactive stage d. Reactive stage ANS: C

The preactive stage is one in which assessment is based on the projection of a future need. The stages that are not being described are: reactive—defining the problem based on past needs identified by the client or the agency; inactive—defining the problem based on the existing health status of the population to be served; and interactive—describing the problem using past and present data to project future population needs.

15. Which of the following methods would be the most interactive approach to assessing a community’s need? a. Define needs based on the current health status of the community. b. Examine past needs as identified by the agency as well as the community. c. Project future needs based on current trends. d. Use past and current data to project future needs.

ANS: D

The interactive approach to assessing the needs of the community includes describing the problem using past and present data to project future population needs. Projecting a future need describes the preactive stage. The reactive stage defines the problem based on past needs identified by the client or the agency. The inactive stage involves defining the problem based on the existing health status of the population to be served.

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16. A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to

culturally competent health care services. Which of the following persons would be most helpful as a key informant?

Hospital administrator Hispanic community leader National expert on cultural competency Politician or county official

a. b. c. d.

ANS: B

Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. The hospital administrator, national expert on cultural competency, and politician are most likely not as knowledgeable about this immigrant population as the Hispanic community leader.

17. A nurse is conducting an assessment to determine whether participants of an educational program felt the stated objectives were

met. Which of the following data sources would the nurse most likely use? a. Community forum b. Interview c. Focus group d. Attitude survey ANS: D

Attitude scales are probably used most often and are usually phrased in terms of whether a program met its objectives. The client satisfaction survey is an example of an attitude scale often used in the health care delivery system to evaluate the program objectives. Focus groups, community forums, and examination of community indicators are all time consuming and not as directed toward evacuating program goals.

18. A nurse is conducting program evaluation. Which of the following would be the first action the nurse would take? a. Choose the type of evaluation to be done. b. Determine who will be involved in the evaluation. c. Identify the goal and objectives for the evaluation. d. Obtain answers to specific questions related to the program being evaluated.

ANS: A

To do a program evaluation, first choose the type of evaluation you wish to do. After the type of evaluation to be done has been chosen, the nurse will identify the goal and objectives for evaluation, decide who will be involved in the evaluation, and finally, answer the questions related to the type of evaluation.

19. Which of the following programs demonstrates the use of tertiary prevention? a. Developing an in-school clinic that provides birth control counseling and b. c. d.

contraception Providing a diabetes management program for persons with diabetes mellitus Providing cardiovascular fitness evaluations at annual health fairs Setting up free blood pressure screenings at popular department stores and supermarkets

ANS: B

The aim of tertiary prevention programs is to reduce complications from disease. Persons with diabetes mellitus already have the disease, thus meaning that tertiary prevention would be implemented with this population. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence).

MULTIPLE RESPONSE 1. Which of the following are elements of the MAPP (Mobilizing for Action Through Planning and Partnership) Program Planning

Model? (Select all that apply.) a. Generating shared visions and common values b. Assessing priorities in health problems c. Developing a framework for long-range planning d. Choosing health priorities e. Conducting a needs assessment related to community change ANS: A, C

The elements of MAPP include mobilizing community members and organizations, generating shared visions and common values; developing a framework for long-range planning; conducting needs assessments in four areas: community strengths, local public health system, community health status, and focus of change; and implementing the plan. Assessing priorities in health problems and choosing health priorities are part of other program planning models.

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Chapter 19: Healthcare Improvement in the Community Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes one of the main problems in ensuring quality for health care in the United States? a. Consumers believe American health care is of high quality and the best in the b. c. d.

world.

Every hospital and health care agency has its own approach to data collection and documentation.

Finances are the basis of clinical decisions, not quality of care.

We all agree on what quality is but not on how best to measure it.

ANS: B

Very little is known about quality of care in this country because a variety of definitions of quality are used, and it is difficult to get comparable data from health care providers and agencies. All consumers, including private citizens, insurance companies, industry, and the federal government, are concerned about achieving the highest quality outcomes at the lowest possible cost. Consumers want more information about quality. Both consumers and providers have a vested interest in improving the quality of the health care system.

2. A wealthy factory owner says, “I don’t care about the poor. I just want the best care available for me and my family. Why should I

care if other people don’t get health care?” Which of the following would be the most appropriate response by the nurse? a. “If your employees are ill, who will do the work in your factory?” b. “You might catch a contagious disease from one of your employees.” c. “You have a moral obligation to help those less fortunate.” d. “Your personal insurance and tax costs will go up if your employees have to use community resources when they’re ill.”

ANS: D

Because the speaker’s primary concern is apparently money, an appropriate response must show that the factory owner will lose money if he doesn’t support the health of others in the community. Everyone—consumers, providers, and those who pay the health care bills—benefits if people stay healthy. The focus should be on the larger community and not only on the work needing to be done at the factory.

3. Which of the following information can be gathered by reviewing a community health report card? a. Utilization of health care services in the community b. Demographic information of the community c. Leading causes of morbidity in a community d. Frequency of malpractice claims within a community ANS: C

The term community health report card refers to different types of reports, community health profiles, needs assessments, scorecards, quality of life indicators, health status reports, and progress reports. Community health report cards can be a useful tool in efforts to help identify areas where change is needed, to set priorities for action, and to track changes in population health over time. The report card may be used for tracking leading causes of morbidity and mortality in a community and looking at trends over time to see if public health interventions have improved health care outcomes. Utilization of health care services, demographic information, and frequency of malpractice claims in the community is information that is not found on a community health report card.

4. What event led to the development of the National Health Quality Improvement Act? a. A very famous movie and television star died as a result of a medical error. b. The number of malpractice claims had increased. c. Media such as films highlighted the reality of current medical care. d. Publicity about a few unfortunate cases caused consumers to become concerned.

ANS: B

In response to a growing number of malpractice claims in the United States, the National Health Quality Improvement Act of 1986 was established, which encouraged consumers to become informed about their practitioner’s practice record and created a national clearinghouse of information on provider malpractice records. The media did not play a role in the creation of the National Health Quality Improvement Act. 5. What was the principal problem with early efforts at ensuring quality of care? a. No one knows how to measure quality care. b. Professionals resisted and sabotaged such efforts. c. Standards emphasized structure, not process. d. There were no standards as to what represented quality care.

ANS: C

Early efforts such as the National Health Quality Improvement Act of 1986 emphasized structure rather than process or outcome of care; hence, they did not really address the root issues of quality. Health care professionals are concerned with providing high quality care. Both standards and measures are in place to evaluate quality.

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6. An agency has not created a continuous quality improvement program. Which of the following actions should the agency take to

help ensure quality care within the institution?

Ensure appropriate policies and procedures are followed.

Employ highly recommended and credentialed professionals to give care.

Use administrative action to ensure that quality care is given to clients.

Write quality care plans for the most typical problems of clients.

a. b. c. d.

ANS: A

Quality assurance/quality improvement (QA/QI) programs remain the enforcers of standards of care for many agencies that have not elected to engage in a program of CQI. These activities are called assurance activities because they make certain that those policies and procedures are followed so that appropriate quality services are delivered. Without proper policies in place, it may be difficult to ensure quality care is provided by the professionals employed by the agency. Administrative action is difficult without having policies in place to support such actions. Policies and procedures provide a broader scope of quality than a written care plan.

7. A home-care nurse is encouraging the administration of the agency to increase their quality assurance efforts. Which of the

following best describes a negative outcome from this activity?

An agency deficiency may become visible.

An individual may be found at fault and then become fearful of being involved.

Some agency processes may be questioned.

Employees at the agency will have to commit extra time to complete this process.

a. b. c. d.

ANS: B

Quality assurance (QA) focuses on the care a client receives within the system and is concerned with the accountability of the provider. A major problem with quality assurance efforts, done by the quality assurance team, is that individuals may be found to be at fault and hence may be fearful of reporting problems or errors. Total quality management and continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Continuous quality improvement focuses on processes and possible deficiencies of the organization as a whole so that everyone is involved.

8. How does continuous quality improvement (CQI) differ from quality assurance? a. Quality assurance focuses on client care, whereas CQI focuses on system issues. b. Quality assurance focuses on system issues, whereas CQI focuses on individual c. d.

client care.

Quality assurance measures care at one point in time, whereas CQI is an ongoing issue.

Quality assurance focuses on families, whereas CQI focuses on agency issues.

ANS: A

Total quality management and continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Total quality management and continuous quality improvement focus on system issues, and quality assurance focuses on individual client care. Quality assurance measures care at multiple points of time. Quality assurance focuses on care of the client, not families, and CQI focuses on management of the system of care.

9. Which of the following is accomplished through the use of traditional quality assurance? a. Implementation of new techniques to improve outcomes b. Implementation of appropriate interventions for diagnosed problems c. Implementation of change when measured performance does not meet standards d. Implementation of research findings to ensure appropriate clinical treatment ANS: C

Traditional approaches to quality assurance are to focus on assessing or measuring performance, to ensure that performance conforms to standards, and to take action to bring about change when care does not meet standards. CQI involves comprehensive data analysis to detect process failures. Thus, implementation of new techniques, interventions, and research findings would require ongoing evaluation of data which is accomplished through CQI, not QA. 10. What is the primary goal of total quality management? a. To confirm the high standards desired in patient care b. To discover and correct errors in task completion c. To focus on the client and teamwork d. To enable organizations to publicize their quality approach to patient care ANS: C

Total quality management is a management philosophy that includes a focus on client, continuous quality improvement, and teamwork. Under TQM, quality is defined as customer satisfaction. Quality assurance is the promise or guarantee that certain standards of excellence are being met for the client in the delivery of care. QI is defined as a structured approach to improving performance.

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11. An agency is beginning to implement a general approach for quality improvement. Which of the following activities would the

agency most likely implement?

Customer satisfaction is assessed through the use of surveys provided to the client after each appointment. b. The health maintenance organization (HMO) provides incentives to personnel who complete in-house programs on customer service. c. The institution has received accreditation through The Joint Commission. d. The total quality improvement (TQI) team meets to examine how to make the registration process more efficient. a.

ANS: C

General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees.

Customer satisfaction may play a role in achieving one of these general approaches for quality improvement but is not one of the major approaches. Making the registration process more efficient may assist in achieving one of these general approaches but is not one of the major approaches.

12. The pharmacist sent up the wrong medication for the patient. The nurse filled out an incident report when the error was discovered.

Which of the following best describes the likely outcome when the quality improvement team reviews the incident report? a. The nurse will receive a commendation for recognition of the error. b. The pharmacist will be disciplined. c. The pharmacist will be reported to the state pharmacy board. d. The CQI team will try to determine how the error occurred.

ANS: D

In quality improvement, people are asked to help identify problems and seek ways to improve system performance. Providing additional recognition or discipline would not be appropriate steps within the quality improvement process. Ongoing quality improvement focuses on what led to the error occurring.

13. A home health care agency has major problems but does not want consumers to know about these problems while the agency

decides what should be done to improve them. Employees are not told to lie, but they are advised not to share information. Which of the following is the most likely outcome of this situation? a. As long as employees do not share what they know, the community will be uninformed. b. By law, comparative information will be available to the public via the Internet. c. Only a few informed persons will know about the problems. d. Secrecy will prevail unless the local newspaper does an investigative report.

ANS: B

In 2003, the Home Health Care Quality Initiative (HHQI) was developed by the USDHHS to provide consumers with data on the quality of home health services. Home Health Compare, posted on the Medicare website, is a home health report card available to consumers nationwide. Because the information is available to the public via the internet, the community will be able to view this data at their will.

14. The nurse admits uncertainty over how to address the needs of a group of clients. The long-term nurse in the area suggests that the

nurse review published evidence-based clinical guidelines. How can the nurse know these guidelines are reliable? a. Because the agency supports their use b. Because the guidelines have been published c. Because the long-term nurse trusts them d. Because they are based on research and expert opinion ANS: D

Evidence-based practice guidelines are protocols or statements of recommended practice developed by professional organizations and based on scientific clinical data and research as well as expert opinion from extensive clinical experience. Such guidelines help a clinician in decision-making. Scientific data is what makes these guidelines reliable, not the support of an agency, the fact that they were published, or that they are trusted by the nurse.

15. The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain

assessment were followed. Which of the following best describes this activity? a. Accreditation review b. Concurrent audit c. Retrospective audit d. Utilization review ANS: C

The retrospective audit, or outcome audit, evaluates quality of care through appraisal of the nursing process after the client’s discharge from the health care system. Accreditation is often linked to governmental regulations that encourage programs to participate in the accrediting process to be reimbursed for services. A concurrent audit is a process audit that evaluates the quality of ongoing care by examining the nursing process. Utilization review is used to ensure that care is needed and that the cost is appropriate.

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16. The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain

assessment were followed. Which of the following best describes the major drawback to the team’s approach?

The client is no longer under the agency’s care.

It is difficult to compare documentation of care to standards of care.

Records can be inaccurate or incomplete.

Team members may disagree on whether the standards of care were met.

a. b. c. d.

ANS: A

With this approach, problems are identified only after clients have been discharged. Although the hope is that better care will be given to future clients, nothing can be done about the clients who received less than optimal care. Using a retrospective audit, it is possible to compare documentation of care to appropriate standards which should be established prior to the review. Records should be complete as it is important for nurses to document the care that they are providing.

17. A nurse is invited to join the utilization review team to help the agency avoid giving unnecessary care. Which of the following

difficulties would the nurse most likely confront as client records are reviewed? a. Alternative care options rather than agency care are often encouraged. b. Not all clients fit the pattern and need more care than guidelines suggest. c. The nurse suggests the agency provide guidelines to professionals giving care. d. The agency is now accountable to its clients and their families.

ANS: B

The major disadvantage of utilization review is that not all clients fit the classic picture presented by the criteria u sed to determine approval or denial of care. Alternative care options are many times not considered as it is assumed that clients fit the criterion that has been established. Utilization review does not provide agency guidelines as to how to provide care. Utilization revie w focuses on avoiding providing unnecessary care not on accountability to clients and families.

18. The staff was informed that a Quality Improvement Organization (QIO) would be making an unannounced visit in a few hours.

Which of the following would the hospital nurse expect the QIO team to examine?

Records of hospital admissions and scheduled procedures Nursing care plans of patients with unexpected problems (infections, falls) Discharge paperwork of patients discharged in the past 30 days Documentation of adherence to nursing standards of care

a. b. c. d.

ANS: A

QIOs are directed by the federal government to reduce hospital admissions for procedures that can be performed safely and effectively in an ambulatory surgical setting on an outpatient basis and to reduce inappropriate or unnecessary admissions or invasive procedures by specific practitioners or hospitals. Therefore, the QIO team would examine records to see whether the hospital admissions and all procedures performed were medically necessary. The QIO team would not evaluate nursing care plans, discharge paperwork, or adherence to nursing care standards as that is not the focus of this type of a team. Rather, their focus is on reducing hospital admissions.

19. Which of the components of the PDCA model and Donabedian’s framework is the most crucial? a. Standard b. Outcome c. Process d. Structure ANS: B

The PDCA model and Donabedian’s framework for evaluating health care programs, using the components of structure, process, and outcome, are useful in developing a quality assurance program. Outcome is the most important ingredient of a program, because it is the key to evaluation of providers and agencies by accrediting bodies, insurance companies, and Medicare and Medicaid through PROs, report cards, and other accrediting agencies. Standard, structure, and process are important parts of the PDCA model but are not as important as the outcomes.

20. Stakeholders developing a new community-oriented clinic plan want to include a quality assurance (QA) program. Which of the

following would be the first step in measuring the structure component? a. Criteria that will be used to measure quality b. Philosophy and objectives of the organization c. Requirements of accrediting agencies d. Standards the QA program wishes to achieve ANS: B

The philosophy and objectives of an agency define the structural standards of the agency. Identification of standards and criteria for quality assurance begins with writing the philosophy and objectives of the organization. Criteria to measure quality including requirements of accreditors and standards of the QA program are not part of the structural standards of a quality assurance program.

21. Which of the following best explains why evaluation of client outcomes resulting from nursing intervention is so difficult? a. Client records may not include appropriate data. b. Few tools exist to measure client outcomes. c. Many other factors can also affect client outcomes. d. Measuring client outcomes is extremely time consuming.

ANS: C

The major problem with outcome evaluation is determining which nursing care activities are primarily responsible for causing changes in client status. In nursing, many uncontrolled factors in the field, such as environment and family relationships, have an effect on client status. Appropriate data should be included in all documentation that is recorded by the nurse. Multiple tools exist to measure client outcomes. With appropriate processes in place, it is not time consuming to measure client outcomes.

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22. The management team of the Central County Community Health Agency wants to analyze the cost of homebound client services.

Which of the following records are most likely to provide useful data?

Clinical records Financial records Morbidity and mortality records Provider service records

a. b. c. d.

ANS: D

The provider service records include information about the numbers of clinic clients seen daily, home visits made daily, transportation and mileage, the provider’s time spent with the client, and the amount and kinds of supplies used. The provider service record is completed on a daily basis by each provider and is summarized monthly and annually to indicate trends in health care activities and costs relative to personnel time, transportation, maintenance, and supplies. A clinical record is the client health record. This would contain health information for a single client, would not generally include clinic costs, and would be an inefficient source because it identifies service to only one individual. Financial records include extraneous items for the clinic as a whole. Extracting specific data will not be as easy, because they will be from the provider service record. Morbidity and mortality records would not be suitable in this instance.

23. A nurse has identified a need to increase the quality assurance efforts within the home care agency. Which of the following has

most likely occurred? a. Increased number of client complaints and injuries b. Increased costs of providing care c. Reduced number of incident reports d. Reduced government reimbursement (Medicare and Medicaid) ANS: A

The types of problems that may lead to increased quality assurance efforts include client complaints, injury, or death, poor documentation of care, with subsequent denials of reimbursement by third-party payers, lack of or inefficient service, and concerns about client or staff safety. Several factors may influence increased costs of providing care, which may or may not lead to it being a priority of increased quality assurance efforts. An increase in incidence reports, not a decrease, would lead to increased quality assurance efforts. Reduced government reimbursement may lead the agency to consider multiple aspects of care, which may or may not relate a need for increased quality assurance efforts.

24. A nurse is implementing tertiary prevention strategies as part of the quality management process. Which of the following best

describes a strategy the nurse would have used?

All new employees complete a program on fire safety that details what to do in the event of a fire. b. At the yearly employee picnic, teams compete in putting out trash can fires and in racing while carrying mock victims, using safe evacuation techniques. c. After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees. d. Mock fire drills are carried out twice a year to assess response and readiness in the event of a real fire. a.

ANS: C

Tertiary prevention involves activities that are carried out when evaluation indicates needed improvement. Thus, examining a response to an actual fire (it has already occurred) is an example of tertiary prevention. A program on fire safety is an example of primary prevention. The employee picnic activity and mock fire drills provide for evaluation of competency (screening) and are thus secondary prevention.

MULTIPLE RESPONSE 1. In which of the following ways does licensing differ from accreditation? (Select all that apply.) a. Licensing applies to the individual, whereas accreditation applies to a program. b. Licensing is required to practice, whereas accreditation is by choice. c. Licensing is required by state law, whereas accreditation is required by federal d. e.

law.

Licensing is required for all professions, whereas accreditation is only available for some.

Licensing is a cost to the individual, whereas agencies pay for accreditation.

ANS: A, B, E

Licensure controls entrance into a profession or occupation and is mandatory to practice. Accreditation is a voluntary or at least a quasi-voluntary approach used by institutions or programs. Although there are cost differences between licensure and accreditation, individuals pay for licensure, whereas agencies pay for accreditation. Licensure is based on state law, whereas accreditation is dependent upon professional standards. Licensing relates to individual practice and professions, but accreditation relat es to agencies and not individual professions.

2. A nursing committee is responsible for evaluating the process of health care agency in their quality assurance efforts. Which of the

following techniques would most likely be used by the committee members? (Select all that apply.) a. Client satisfaction survey data b. Confirmation of credentials of all health care providers employed c. Patient discharge data over the past one year d. Direct observation by individuals e. Peer review committee audit ANS: A, E

The primary approaches used for process evaluation are the peer review committee and the client satisfaction survey. The techniques used for process evaluation are direct observation, questionnaire, interview, written audit, and videotape of client and provider encounters. Once data are collected to evaluate nursing process standards, the peer review committee reviews the data to identify strengths and weaknesses in the quality of care delivered. Confirming credentials and examining patient discharge data are not typically used for process evaluation.

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Chapter 20: Family Development, Family Nursing Assessment, and Genomics Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. The following people enter the health clinic together: an unmarried man and his 1-year-old son, an unmarried woman with a

year-old daughter, and the man’s married brother, who is separated from his wife. During the assessment, it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the “family?” a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c. There is no family here, only three adults sharing resources between themselves and two biologically related children. d. The family includes whoever the adults state are family members.

ANS: D

Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A “family” may range from the traditional nuclear model with extended family to such “postmodern” family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

The incorrect answers have the nurse determining who is and who is not part of a family. This is not an appropriate action for the nurse to take, rather the nurse should let the client describe and define his or her family.

2. The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because

family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. “How many children do you have, and who is the father of each?” b. “Is there a register of families who are members of this commune?” c. “Tell me about your significant other.” d. “Who are the members of your and your child’s family?”

ANS: D

The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning. Asking who the father of each child is does not help define the family; the client needs to define the family. Knowing if there is or is not a register of families on the commune does not help the client define her own family. The client may or may not include the significant other in her definition of a family, so this may not assist in making this determination.

3. In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents

and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System ANS: C

Family structure refers to the organization of the family. This defines the roles and positions of the family members. The family functions refer to the activities and purposes of the family. The family as a system accomplishes activities that serve the individual and society. Family dynamics refers to the interactions and relationships within the family.

4. Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

ANS: A

The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the 21st century exciting and challenging. All family units have functions (activities and purposes) and structure (organization). These functions and structures may be very different among family members, but they do exist. All clients are part of a family, even if they define their family as only themselves. Nurses should be open-minded and recognize that all families are different and a “traditional” family structure may mean something different to different individuals.

5. A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be

most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the family’s strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional ANS: B

Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the family’s strengths gives the nurse assets on which to draw in planning care. The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used.

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6. The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting

their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The family’s basic needs are being met. c. The couple’s in-laws are unavailable to share their expertise about childcare. d. The married couple is excited about their first baby.

ANS: B

In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

7. A nurse focuses on the care of the individual while viewing the client’s family as a background resource or possible stressor.

Which of the following conceptualizations of family does this nurse’s view represent? a. Client b. Component of society c. Context d. System ANS: C

Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the “family as context” concept, the family serves as either a resource or a stressor to individual health and illness. When family is the client, the family is placed first, and individuals are second. The family is seen as the sum of individual family members. When family is the system, the focus is on the family as the client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts. When the family is seen as a component of society, it is seen as one of many institutions of society, along with health, education, religious, or financial institutions.

8. A nurse asks a family member, “What has changed between you and your spouse since your child’s head injury?” Which of the

following focuses of the family is the nurse assessing?

The context The client A system A component of society

a. b. c. d.

ANS: C

When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions. When family is the client, the family is placed first, and individuals are second. The family is seen as the sum of individual family members. When the family is seen as a component of society, it is seen as one of many institutions of society, along with health, education, religious, or financial institutions. When family is the context, the individual is placed first and the family second. In the “family as context” concept, the family serves as either a resource or a stressor to individual health and illness.

9. Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental b. Exosystems c. Bioecological systems d. Family systems ANS: D

The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory. In this theory, the emphasis is on the whole rather than on individuals. Families are viewed from both a subsystem and a suprasystem approach. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. The definition of exosystems is found within the bioecological systems theory; these are the external environments that have an indirect influence on the family.

10. A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the

family life cycle. Which theory is being applied? a. Family systems b. Bioecological systems c. Family developmental d. Family nursing ANS: C

The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.

In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

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11. A new mother is a full-time college student who lives with her parents, because the baby’s father has been imprisoned related to

theft and drug abuse. The infant’s grandmother, although also employed, cares for the child while the young mother attends classes.

Which of the following theoretical frameworks would be most helpful to the nurse when assessing this family’s needs? a. Developmental b. Family nursing c. Bioecological d. Systems ANS: A

Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case, the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughter’s (and grandchild’s) needs. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

12. A nurse considers how the environment outside of the family influences the development of a child when planning care for a

family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Family nursing theory ANS: A

The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

13. A nurse is in the termination phase of the nurse–family relationship. Which of the following strategies would the nurse most likely

implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family ANS: B

Making referrals when appropriate is part of the termination phase as the nurse ends the relationship with the family. It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure. If sessions with the nurse were to increase, it would be unlikely that the relationship was going to be soon terminated or ended. Formative evaluation occurs throughout the relationship and is ongoing; an evaluation that would be done at the closure of the relationship would be summative. It would be appropriate for the nurse to extend an invitation for follow-up, not refuse additional communication.

14. A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse

may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

ANS: B

It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times, late afternoon or evening appointments are necessary to accommodate the needs of the family. It is probably most important that the immediate, not necessarily the extended, family is present. If the nurse is making an appointment with a family, it would be part of the role of the nurse, and it would be within the scope of the nurse’s practice to make time to complete home visits. The nurse may need to be creative in how to best meet the needs of the family to arrange a meeting.

The larger barrier is finding a common time, not distance of the family member.

15. Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurse’s plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurse’s plan. d. Nurse has informed family how to complete the required actions.

ANS: B

Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The family must have the skills and commitment necessary and to complete the developed plan. The plan cannot be the nurse’s choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.

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16. Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy ANS: D

Government actions that have a direct or indirect effect on families are called family policy. The range of social policy decisions that affect families is vast, such as health care access and coverage, low-income housing, social security, welfare, food stamps, pension plans, affirmative action, and education. Family planning is only one example of family policy that can have a direct or indirect effect on families. Family funding may occur through programs administered by the government, but these programs are developed from family policy. Family policy is broader than only addressing legislative action.

17. A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to

take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss ANS: D

The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job. The Health Insurance Portability and Accountability Act (HIPAA) allows for families to retain health insurance after resigning from employment. HIPAA prevents family information from being shared with colleagues unless they have a need to know based on the care they are providing for the family. The provision of Medicaid is not part of the Family Medical Leave legislation.

18. A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family

with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

ANS: D

Limited communication or certain family members dominating the conversation can be suggestive of problems within the family.

Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, and expressions of a religious core or other value system, and each member being allowed some privacy.

19. The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory,

which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepares food will probably prepare meals based on the diet plan for all the family. d. The family member who prepares food will probably prepare special meals for the newly discharged member.

ANS: B

Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. However, if family members are supportive, they will want to try to help the ill member.

Therefore, the member who prepares the meals will probably compromise by trying to meet the ill member’s needs without making drastic changes in the overall eating patterns of the family. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. If the family member who prepares the meals does not attempt to make some changes, it would not be therapeutic for the family member who is ill.

20. A nurse has just met a family and is completing their family assessment. Which of the following actions should the nurse take

before engaging in self-disclosure? a. Confirm the reason for the appointment. b. Demonstrate cultural awareness. c. Take time to build trust. d. Understand the family dynamics.

ANS: C

The family assessment process is interactive. As the nurse is evaluating the family, the family is evaluating the nurse. Too much disclosure during the early contacts between the family and nurse may scare the family away. The nurse should slow the process down and take time to build trust. Components of building trust with the family would include confirming the reason for the appointment so that the family knows the nature of the visit and demonstrating cultural awareness during interactions. As the nurse completes the family assessment, the nurse will note the dynamics of the family; understanding the family dynamics is not important before engaging in self-disclosure.

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21. A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common

practice. Which of the following actions would the nurse most likely take?

Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d. Survey families in the community to determine whether they eat clay and how much clay they eat. a.

ANS: A

Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. If the family members are eating clay, it demonstrates that a problem already exists. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.

MULTIPLE RESPONSE 1. A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request?

(Select all that apply.)

The nurse can assess the family environment.

The family will feel more comfortable.

Families typically welcome others into their home.

More family members can typically be involved.

The members tend to be more relaxed.

a. b. c. d. e.

ANS: A, B, D, E

Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the family s home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.

2. In comparison with traditional norms, which family functions have become increasingly important in modern American society?

(Select all that apply.)

Conferring appropriate social status Educating the younger members Ensuring physical health and safety Fostering interpersonal relationships and support Promoting mental health and wellness

a. b. c. d. e.

ANS: C, E

Today, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health. Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, and conferring social status.

3. Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a. Why the data are needed b. How best to interview each individual in the family c. The most convenient time for you to visit the family d. The rationale or purpose of the visit e. Which family members can be available ANS: A, C, D, E

Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. The preferred time to visit is when most family members will be available. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual).

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Chapter 21: Family Health Risks Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a

drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a. “I make most of the decisions so the kids don’t notice much difference.” b. “My daughter is pretty independent; she’s active in both sports and theater.” c. “My son is old enough to get a job and help pay all these medical bills.” d. “My wife taught our daughter how to cook simple meals.”

ANS: B

Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships, equal power structure, and a high degree of autonomy by each member. Flexible role relationships are not being demonstrated if only the daughter is taught how to cook and only the son is expected to get a job. Equal power structure is not being displayed if the husband makes all the decisions.

2. Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a. “What helps you to cope with situations involving your wife’s cancer?” b. “How has your child’s illness affected the behavior of your other children?” c. “Tell me about any illnesses your other family members have.” d. “Who do you turn to for support outside your immediate family?”

ANS: C

Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman’s model include psychological health, sociocultural health, developmental health, and spiritual health. Asking about coping and support addresses psychological health, not physiological health. Inquiring about the behavior of the other children addresses developmental health.

3. A nurse is working with a family member to reduce personal health risk. Which of the following recommendations would most

likely be made by the nurse? a. “Be sure to take a 30-minute walk each day.” b. “Call our office if you have any questions or concerns at all.” c. “Come back in 2 weeks for follow-up on your surgery.” d. “Continue to take the drug until it is gone, even if you’re feeling better earlier.”

ANS: A

The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. Exercising for 30 minutes a day reduces the risk for many diseases. All the other options are treatment oriented rather than risk avoidance.

4. A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a. “Does your 4-year-old have a booster seat in the car?” b. “Have you noticed any physical problems as you go about your daily routine?” c. “What concerns do you have today?” d. “Why did you decide to come in for a checkup?”

ANS: A

Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Inquiring about why the client came in for the visit, asking about concerns, and physical problems does not address potential health risks that may need to be addressed for the client.

5. A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities ANS: D

Health risk appraisal refers to the process of assessing the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Incorrect Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

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6. A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the

nurse to ask?

“Did any of the hunters in your family kill a deer this year?”

“How do you keep your rifles safe from curious children?”

“Where do you shoot with your handguns?”

“Where do you keep your rifles locked when it is not hunting season?”

a. b. c. d.

ANS: C

Risk reduction is a complex process that requires knowledge of risks and families’ perceptions of the nature of the risk. In this situation, the nurse was asking questions to determine the family’s perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death. Asking about how guns are kept safe or locked up does not address the families’ perception of the nature of the risk. Asking if any of the hunters killed a deer this year makes the assumption that the family uses the guns for hunting. This perception by the nurse may be inaccurate; it would be more appropriate for the nurse to ask how the guns are used in the home rather than assuming that they are used for deer hunting.

7. A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe

further to determine if the family is in crisis?

“I can’t visit my husband in the hospital when I’m at work all day. How can I be sure he’s all right?” b. “My husband always handled our finances. Now that he’s gone, I’ll have to learn how to do this.” c. “I don’t know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children.” d. “What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?” a.

ANS: C

A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. Only the correct response is the person overwhelmed and unable to conceive of how to cope. In incorrect responses, the survivor is considering the problem and trying to learn how to cope or seek resources to cope.

8. A nurse has completed health risk appraisals with several different families. Which of the following families would be of most

concern to the nurse? a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c. Parents who come with their child for his prekindergarten physical examination and want to be sure all the child’s immunizations are up to date. d. A woman who is very pleased with her new position at the hospital and wants to have her preemployment examination and drug screen.

ANS: A

Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. The incorrect responses do not represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

9. Which of the following best describes a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

ANS: C

Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The incorrect responses are not normative life events.

10. A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two

individuals? a. A broken horizontal line b. An X through a circle c. A solid horizontal line d. A solid vertical line ANS: C

Marriage is indicated by a solid line on a genogram. A broken horizontal line indicates a divorce or separation. An X through a circle or square indicates a death. A solid vertical line indicates offspring and children.

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11. Which of the following best describes the use of genomic health care? a. Assists with understanding family relationships b. Assists with determining familial health risks c. Useful in learning about environmental risk factors d. Useful in detecting risk for developing cancer ANS: B

Genomic health care can give health care providers the tools that they need to use a person’s unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes and environment and lifestyle behaviors that can increase a person’s risks for the same diseases that other family members experienced. Genomic health care involves assessing for health risks based on genetic make-up, not environmental risks or risks posed by relationships or family functioning. Genomic health care is broader than detecting risk for developing cancer.

12. Which of the following families is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how b. c. d.

busy he is at his job.

A man knows that his grandfather, father, and older brother all died of cardiac disease.

A man is currently unemployed and despairs about finding a position.

A man expresses disappointment that, having been laid off as an executive, his new position pays only about two-thirds of his original salary.

ANS: C

A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care. A man who says he needs to eat better and exercise more appears to have adequate resources as he is employed. The man who has a family history of cardiac disease is not displaying any known risk factors related to income. The man who has been laid off still is receiving an income which should assist him in being able to afford the necessary goods and services he needs in the immediate future.

13. A home health nurse who is visiting a family for the first time asks, “Could we review your extended family and other persons or

groups with whom you interact each week?” Which of the following provides the best rationale for the nurse asking this question? a. To assess the family’s environment and social resources and risks b. To communicate with relevant others as needed c. To determine financial assets available to the family in case of serious need d. To understand the extended family relationships ANS: A

The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family’s connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family’s interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap. An ecomap does not assess extended family relationships or financial assets. An ecomap is not used as a communication method.

14. Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and b. c. d.

frequently walking from one interview to another The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods The client who is employed and often works 12 hours a day without moving from the computer desk The client who is employed but always leaves promptly at 5:00 to pick up the children from the daycare center

ANS: C

Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn’t move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease. The client who is currently unemployed is demonstrating positive health behaviors by actively seeking employment and walking frequently. The client who spends time at the gym and studies the benefits of organic foods is displaying positive health behaviors by being active and wanting to eat healthy. The client who leaves work to pick up the children at 5:00 is displaying healthy behaviors as he or she is balancing family and work.

15. An occupational health nurse is developing an educational program to address the importance of healthy personal health habits.

Which of the following topics would be most important for the nurse to address? a. Avoidance of alcohol b. Regular physical exercise c. Daily consumption of calcium-rich foods d. Monthly self-breast and testicular examinations ANS: B

Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

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16. A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her

car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurse’s commitment to the family and enter the home quickly. d. Drive away and notify the family from a safer location.

ANS: D

Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists.

Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit. The home health nurse should be educated about what to do in this situation before it occurs and should not need to call the agency to ask for their advice when faced with this situation. The priority would be to leave the situation before calling the family. The nurse should not place herself in a potentially violent situation by choosing to enter the home.

17. A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door.

Finally, a teenager comes out and says, “My mom said she couldn’t see you and you should go away.” Which of the following actions should be taken by the nurse? a. Demand the teen let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch with the nurse. d. Point out that legally once an appointment has been made the mother needs to be seen.

ANS: C

The contact may be terminated as requested if the nurse determines that either the situation has been resolved or the services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

18. A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a. Assess the family and the home setting for both strengths and problems. b. Determine the family’s expectations of a home visit. c. Establish rapport between the nurse and the family. d. Engage in extended social interaction as would be expected from any guest.

ANS: C

The initial home visit includes the nurse’s self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client’s expectations. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. Building rapport between the nurse and family should occur as the nurse is determining the family’s expectations, as well assessing the family and home setting.

19. A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following

actions will the nurse take before leaving? a. Determine the family’s willingness for another home visit. b. Establish the purpose of the visit. c. Review the family’s learning and other accomplishments of the visit. d. Review the family record and reason for referral.

ANS: C

During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The incorrect options listed occur during the previsit phase.

20. During which phase of the home visit does the nurse document what was accomplished? a. Previsit phase b. In-home phase c. Termination phase d. Postvisit phase ANS: D

A major task of the postvisit phase is documenting the visit and services provided. Major tasks of the pre-visit phase are to initiate contact with the family and schedule the home visit. During the in-home phase, the nurse–client relationship is established. During the termination phase, the visit is reviewed with the family and plan for future visits is made.

21. A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in

the presence of their children. Which of the following is being demonstrated through this action? a. Contracting b. Family crisis c. Empowerment d. Health risk reduction ANS: A

Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased. A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. Making a pledge through contracting is a way to cope with a family crisis. Empowerment reflects a family seeking help with access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources.

The pledge does not address the multiple components of empowerment. Health risk reduction is based on the assumption that decreasing the number or the magnitude of risks will decrease the probability of an undesired event occurring. The pledge does not address multiple health risks.

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22. A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following

actions would the nurse most likely take?

Apply for emergency financial assistance on the family’s behalf.

Arrange for community members to assist with child care.

Invite the mother to join a cancer support group.

Teach the family how to navigate the health care system.

a. b. c. d.

ANS: D

Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources.

Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

23. A nurse has been successful in creating improvement in a family’s health. Which of the following characteristics is most likely

displayed by the nurse? a. Skilled at recognizing and strengthening the family’s competencies b. Skilled at obtaining referrals and resources for the family c. Skilled at communication and interpersonal relationships d. Skilled at assessing the family’s main problems ANS: A

The nurse’s approach to the family should be positive and focused on competencies rather than on problems or deficits. The incorrect responses do not address the strengths of the family, rather they focus on obtaining necessary resources, improving relationships, and assessing for problems.

24. Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and

transgendered (LGBT) families? a. Understanding of same sex marriage laws within the state b. Understanding of personal feelings of working with members of this community c. Assessment of the family structure within the LGBT family d. Assessment of sexual orientation in a safe environment ANS: B

Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation. After understanding one’s own feelings when providing care for this population, it may be important for the nurse to investigate same sex marriage laws and family structure. It is important to provide clients a safe environment to discuss sexual orientation; however, the nurse must be aware of his or her own feelings before beginning this discussion.

25. A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the

following best describes a secondary prevention action the nurse could take? a. Conducting a sexual behavior survey with the adolescents b. Establishing in-school education related to transmission of sexual infections c. Providing free condoms at schools and universities d. Providing follow-up educational programs for those diagnosed with an STI ANS: A

Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

MULTIPLE RESPONSE 1. A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family

prefers to meet in their home? (Select all that apply.) a. The family won’t have to travel. b. It is cheaper for the family because of reimbursement requirements. c. Meeting at home is much more convenient for the family. d. The nurse won’t be distracted by other clients or responsibilities. e. It would save money for the nurse and the clinic.

ANS: A, C

Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel; it allows more individualized services; and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurse’s employer because of travel costs and the amount of time spent with just one family.

Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

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2. Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) a. Agency’s policies regarding eligibility for services b. Family’s feelings about the home visit and willingness to continue c. Nurse’s perception of the amount of time needed to complete required tasks d. Reimbursement policies of third-party payers e. Family’s perception of need ANS: A, B, D

Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the family’s willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurse’s time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible.

The nurse’s perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available. While the family’s perception of their needs is relevant, it is not the only factor considered when allotting time for visits.

3. The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with

some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) a. A reassessment of resources should be done if the plan does not work. b. Individual family members must all be willing to make the plan their first priority. c. Goals must be realistic and feasible. d. Ongoing negotiation is central to the process. e. All family members must be involved in setting the goals.

ANS: C, D

In contracting, an important aspect is obtaining the family’s view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The family’s inability to change “as easily and quickly as they had hoped” does not mean the plan is not workable—only that more time and effort may be necessary. The plan does not need to be the “first priority” for all family members for it to be effective. The plan does need to be mutually set but depending on the situation it may be difficult for this to be the priority for all members of the family. The plan may not be working for a variety of reasons; lack of resources may not be the reason.

4. A nurse enters a family’s home for the first time. Which of the following goals should the nurse have? (Select all that apply.) a. Assessing each family member in detail both physically and psychologically b. Collaborating with the family to establish goals and a plan for meeting them c. Determining the exact relationship between each member of the family d. Exploring the family’s perception of their problems and needs e. Collecting information regarding the perceived issues ANS: B, D

During the beginning phase of the nurse-family interaction, three activities occur—mutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan. Assessment of each family member and determining the exact relationship between each member of the family are not part of nurse-family interactions.

5. A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the

family? (Select all that apply.)

The reason for the visit Everything the nurse knows about the family How many visits will be planned The cost of the visit and how this may be paid How the visit’s referral was made

a. b. c. d. e.

ANS: A, D

The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the family’s situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the family’s willingness for a home visit. If the family does not have a phone, mail can be used to share information. It would be inappropriate for the nurse to share everything that she knows about the family with the family as there may be some information that the family does not need to know. Without visiting the family first, the nurse may not yet know the number of visits that may be planned.

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Chapter 22: Health Risks Across the Life Span Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be

most effective? a. Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b. Increase nutrition programs in schools that teach children to make healthy food choices. c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d. Provide after-school and summer camps that focus on diet and exercise.

ANS: C

Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant. Changes need to be made at a more direct level, such as by working with the family, to establish a change. Community-level changes may not impact what is happening within the family in regard to diet and exercise.

2. A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be

the target of this program?

Accidents and injuries AIDS Childhood obesity Vaccine-preventable diseases

a. b. c. d.

ANS: A

Injuries are the number one cause of death among children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable.

Obesity, although a significant problem, is not a common cause of death in children. AIDS and vaccine-preventable diseases are not common causes of death among children.

3. A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be

developed? a. Antialcohol program b. Antismoking program c. Careful driving program d. Safe sex program ANS: C

Motor vehicle accidents are the leading cause of death among children and teenagers. The use of tobacco is a leading cause of preventable death among adults, but not among adolescents. Alcohol use and sexually transmitted diseases are not related to common causes of death among teenagers.

4. Which of the following is of the greatest concern for the nurse who works with high-school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex ANS: B

Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality among adolescents. Thus, this would be the greatest concern for the nurse working with high-school students. Alcohol use, sports-related injuries, and unprotected sex are not related to the major causes of morbidity and mortality among adolescents. So, although these topics may impact this population, they should not be the priority for the nurse.

5. A mother says, “My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and

other activities. Do you think I should let him have a car?” Which of the following statements would be the best response by the nurse? a. “Absolutely, it will help him recognize the cost of gas and maintenance.” b. “Certainly, most young men want their own car, and peer pressure can be painful.” c. “It depends on whether you trust your son to drive safely.” d. “No, adolescent males cannot be trusted with an automobile.”

ANS: C

Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality among adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son. The incorrect responses do not take into account the individual risk factors that the nurse should encourage the mother to consider. The nurse should encourage the mother to think about the risky behaviors specific to this population and how they apply to her son.

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6. Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager ANS: A

Children in their first year of life have the highest rate of victimization at 26.7 per 1000 children. A 6-year-old, 9-year-old, and teenager are not at high risk for being abused because they are older.

7. If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death

in the United States?

Alcohol Guns Lack of exercise Unprotected sex

a. b. c. d.

ANS: C

Heart disease is the leading cause of death in the United States. Routine physical activity has been found to prevent early death and chronic diseases, including coronary artery disease, stroke, type 2 diabetes mellitus, depression, and some types of cancer. Alcohol, guns, and unprotected sex are not related to common causes of unnecessary death among adults in the United States.

8. A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following

methods is the client using to make health care decisions?

An advance directive A living will A durable power of attorney A Do-Not-Resuscitate (DNR) order

a. b. c. d.

ANS: C

Durable power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so. Advance directives is a broad category that includes both living wills and durable power of attorney. A living will allow the client to express wishes regarding the use of medical treatments in the event of a terminal illness. A DNR order is a specific order from a physician not to use cardiopulmonary resuscitation.

9. A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her

to take an extended leave from work to care for a family member? a. Patient Self-Determination Act b. Personal Responsibility and Work Opportunity Reconciliation Act c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA) ANS: D

The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member. The Patient Self-Determination Act requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. The Personal Responsibility and Work Opportunity Reconciliation Act is commonly known as “welfare reform.”

This law created the TANF program. The Temporary Assistance for Needy Families program is a work program that mandates that women heads of households find employment to retain their benefits.

10. Which of the following situations would most likely indicate elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparent’s house breaking items. c. A young man repeatedly steals money from his grandmother. d. An elderly person demands that the family come for dinner.

ANS: C

Theft or mismanagement of money or resources is an element of abuse. A daughter refusing to visit, children breaking items, and an elderly person demanding that the family come for dinner are not situations that indicate elder abuse. None of these situations should cause alarm for the nurse as they all may normally occur within a family.

11. A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most

likely use?

Life expectancy Mortality rate Morbidity rate Health status

a. b. c. d.

ANS: A

Life expectancy is a measure that is often used to gauge the overall health of a population. Health status indicators are the quantitative or qualitative measures used to describe the level of well-being or illness present in a defined population or to describe related attributes or risk factors. Morbidity rate is the frequency that a disease occurs within a population. Mortality rate is the number of deaths in a given area or period. Both morbidity and mortality rates are health status indicators.

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12. A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse

does not yet know the community, which of the following programs would be good to plan first?

Alcohol and tobacco cessation programs Cancer screening programs Cardiac health education programs Exercise for life programs

a. b. c. d.

ANS: C

Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurse’s second focus.

13. A nurse is caring for a child who has been diagnosed with a chronic health condition. Which of the following conditions would the

child most likely have? a. Heart disease b. Down syndrome c. Emphysema d. Arthritis ANS: B

Common chronic conditions seen in children are Down syndrome, spina bifida, cerebral palsy, asthma, ADHD, diabetes, congenital heart disease, cancer, hemophilia, brochopulmonary dysplagia, and AIDS. Heart disease, emphysema, and arthritis are common chronic health conditions of adults, not children.

14. A nurse has just met the parents of a 10-year-old child who has been diagnosed with a congenital heart defect. When interviewing

the parents, which of the following would be a priority question for the nurse to ask? a. What are the learning needs of your child? b. What does your child eat on a typical day? c. Does your child have a good peer support network? d. Does your child have a medical home?

ANS: D

The use of a medical home, in which one provider or clinic has all of the child’s records, is important for this population.

Communication among all providers who are working with this child is essential in order for the child to achieve optimal health and functioning. Learning needs, nutritional needs, and peer relationships are important for a 10-year-old child. However, without having the coordination and consistency of a medical home to coordinate medical care, these other things may be insignificant.

15. Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia is considered to have more medical complications than anorexia.

ANS: C

Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight; purging is associated with bulimia; and anorexia is considered to have more complications than bulimia.

16. A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this

counseling? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

ANS: B

The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of preconceptual counseling.

17. A nurse is providing preconceptual counseling to a young woman. Which of the following supplements would the nurse most likely

recommend?

Iron Calcium Folic acid Vitamin C

a. b. c. d.

ANS: C

Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects. A recommendation was made that women capable of or planning a pregnancy take 400 mcg of folic acid daily (USDHHS, 2010).

Iron, calcium, and vitamin C are not used as routine prenatal supplements.

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18. Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a. HRT does not prevent heart disease. b. Use of HRT is recommended to prevent osteoporosis. c. When used with complementary therapies, HRT is most effective. d. HRT is a contributing cause of breast cancer.

ANS: A

HRT does not prevent heart disease. To prevent heart disease, women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active. HRT is not recommended to promote osteoporosis. HRT is not a contributing cause of breast cancer. There is no evidence that HRT is most effective when used with complementary therapies.

19. Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up ANS: B

Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider. Education for women about breast cancer is not as effective as early detection programs. Screening must be completed which is accomplished through secondary, not primary prevention. Tertiary care does not occur until after diagnosis has occurred, and this is too late.

20. Which of the following behaviors results in men being less healthy than women? a. Concentration on sports, hunting, and other dangerous recreational choices b. Employment in stressful positions more so than women c. Preference to spend money on priorities other than health care d. Reluctance to visit health care providers ANS: D

A major obstacle to improving men’s health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of US men see a doctor, nurse practitioner, or physician assistant compared with 74% of women (AHRQ, 2010). Hobbies, employment, and preference on how to spend money may influence a man’s decision to seek medical care. However, these have not been identified as major obstacles in comparison to overall reluctance to seek care.

21. Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent b. Has not had a PSA test c. Has a father or brother who has had prostate cancer d. Has benign prostatic hypertrophy ANS: C

Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer.

African-American males have a mortality rate from prostate cancer that is nearly twice as high as any other group. The PSA test is not accurate in terms of sensitivity or specificity. This blood test produces many false-positive results because many factors can elevate the PSA. There is no relationship between benign prostatic hypertrophy and the development of prostate cancer.

22. Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty ANS: D

Poverty is a strong and underlying current factor that affects all special groups. Ethnicity, education level, and lifestyle choices do not have as large of an impact on health disparities than income level related to poverty.

23. A nurse is conducting a screening for type 2 diabetes for children attending a local school. In addition to an elevated BMI, which of

the following risk factors should the nurse consider? a. Caucasian descent b. Family history of type 2 diabetes c. Birthweight greater than 9 pounds d. Poverty ANS: B

Screening for type 2 diabetes mellitus is recommended for children with a BMI from the 85th to 95th percentile with two or more for the following risk factors: family history of type 2 diabetes in a first- or second-degree relative; Native American, African American, Latino, Asian American, or Pacific Islander descent; signs of insulin resistance or conditions associated with insulin resistance; or maternal history of diabetes or GDM during the child’s gestation. Native American, African American, Latino, Asian American, or Pacific Islander descent is a risk factor, not Caucasian descent. Elevated birthweight and poverty have not been identified by the American Diabetes Association as significant risk factors that indicate the need for additional screening.

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24. A nurse is providing nutrition counseling to the parents of a 4-year-old. Which of the following recommendations is the nurse most

likely to provide?

It is recommended that the child consume approximately 10 ounces of grains on a daily basis. b. It is recommended that the child consume approximately four cups of dairy on a daily basis. c. It is recommended that the child consume approximately four cups of fruits and vegetables daily. d. It is recommended that the child consume approximately 10 ounces of protein on a daily basis. a.

ANS: C

It is recommended that children of 4 to 8 years consume 1-1.5 cups of vegetables and 1-1.5 cups of fruits on a daily basis. It is recommended that children of 4 to 8 years consume 5 ounces of grains on a daily basis. It is recommended that children of 4 to 8 years consume 2-2.5 cups of dairy on a daily basis. It is recommended that children of 4 to 8 years consume 4 ounces of proteins on a daily basis.

25. A nurse is considering implementing interventions to address an increased interest in health and wellness promotion in the

community’s older adult population. What intervention should the nurse consider as the priority? Which of the following actions would the nurse most likely take? a. Educate a community group about hypertension control. b. Create a social group for those who have lost a life partner. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

ANS: A

While all options are appropriate interventions, educating the community about hypertension control is the priority since it contributes to the deterioration of health. Administering immunizations, promoting socialization, and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

26. Toward whom is the TLC model targeted? a. Caregivers of older persons with health problems b. Community organizations that offer services for the elderly c. Elderly clients with health problems d. Nurses who care for older clients ANS: A

The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management. The TLC model is not focused on community organizations, elderly clients, or nurses, rather it focuses on caregivers and relieving caregiver burden.

27. A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone

during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a. Adult day health b. Home health c. Long-term care d. Senior center ANS: A

Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision.

Typically, individuals return home to their caregivers at night. Adult day health serves as more of a medical model than the senior center. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems, and help would not be available.

28. An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice ANS: D

Hospice would be the best form of care for a person in the last stages of dying. The other options are not specifically designed for persons in the last stages of dying. Home health provides care in the home, but is not specific to meet the needs of the dying patient and his or her family. Assisted living relates to a living situation where the client receives different amenities depending on the level of care needed. This type of living arrangement is not specific to care for the dying patient. Nursing homes provide long-term care and are not specific to care needed for a dying patient.

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29. Which of the following is the best way to ensure good nutrition in newborn infants? a. Breastfeeding only b. Feed them brand-name baby foods c. Feed them only homemade cereals d. Supplement breastfeeding with brand-name formulas ANS: A

Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant.

Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity.

Feeding brand-name foods, homemade cereals, and supplementing with formula are not the best ways to ensure good nutrition in infants. Breastfeeding is the best option to ensure good nutrition.

30. A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the

following best describes the intervention being implemented by the nurse?

Developing lifestyle improvement programs for women at risk for diabetes Presenting lifestyle management presentations at women’s conferences Monitoring blood glucose levels closely and modifying diet accordingly Screening glucose levels of women at risk for development of diabetes

a. b. c. d.

ANS: C

Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes. Developing lifestyle improvement programs for women at risk for diabetes is an example of secondary prevention as this group is at risk for developing the problem. Presenting lifestyle management at women’s conferences is an example of primary prevention, preventing the disease before it occurs. Screening glucose levels is an example of secondary prevention, as all screening tests are secondary prevention.

31. A nurse advises a client diagnosed with HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is

being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: C

Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability.

Primary prevention and health promotion both address the use of interventions before the disease occurs and to reduce the risk of developing the disease. Secondary prevention is aimed at detecting the disease early through screening programs and early intervention for at-risk individuals.

32. A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary

prevention measure that the nurse would implement? a. Establish lifestyle improvement programs through local youth organizations. b. Evaluate the food intake of a group of children for a 48-hour period. c. Provide education programs to overweight expectant parents. d. Evaluate the body mass index of children at regularly scheduled well-child examinations.

ANS: A

Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.

MULTIPLE RESPONSE 1. Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all

that apply.) a. A 16-year-old who is legally emancipated b. A pregnant adolescent c. An adolescent requiring an emergency appendectomy d. An adolescent whose diagnosis of cancer has a serious prognosis e. A 15-year-old who overdosed on cocaine ANS: A, B, C, E

Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent.

These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the “mature minor doctrine.” This allows youths of 15 years and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated. If an adolescent has a diagnosis that has a serious prognosis, parental consent will be needed as this is not a situation that involves emergency care, substance abuse, pregnancy, and birth control.

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2. Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among

school-aged children? (Select all that apply.)

Assess schools and day care centers for environmental “friendliness.”

Share nutritional information with all students in the school.

Develop home and environmental assessment guides.

Teach all school personnel how to use rescue inhalers.

Work with community developing clear air policies.

a. b. c. d. e.

ANS: A, C, E

Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day care centers for lack of asthma triggers.

Sharing nutritional information is not related to the care of asthma patients. It is not necessary that all school personnel know how to use rescue inhalers, rather those who are in direct contact with the child with asthma.

3. A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best

assist the client with healing? (Select all that apply.)

Advocating for increased support for elderly persons Eliminating signs and symptoms of disease Managing any chronic diseases to prevent complications and delay deterioration Maximizing self-care capacity Focusing on achieving quality of life

a. b. c. d. e.

ANS: C, D, E

With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity. It is probably impossible to eliminate signs and symptoms of the disease with a client who has a chronic disease. Advocating for increased support for elderly persons is not related to assisting the client with healing from the chronic disease.

4. After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older

friend asks the nurse, “I’m really scared of getting cancer. What can I do to avoid that kind of cancer?” Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Avoid smoking or much alcohol. b. Choose poultry or fish as a protein source. c. Eat lots of fruits, vegetables, and fiber every day. d. Try to get at least 8 hours of sleep a night. e. Limit intake of red or processed meat.

ANS: A, B, C, E

Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer. Getting an adequate amount of sleep will not avoid any risk factors for the development of colorectal cancer.

5. A nurse’s mother leans forward and says, “My best friend fell the other day and now she’s in the hospital. I’m really worried about

getting osteoporosis. What do you think I should do?” What should the nurse recommend? (Select all that apply.) a. Ask your doctor for hormone replacement therapy. b. Continue to abstain from alcohol. c. Eat foods high in calcium such as fortified skim milk. d. Eat lots of green leafy vegetables. e. Avoid tobacco products.

ANS: B, C, E

It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limit in alcohol consumption; and avoidance of smoking. Use of hormone replacement therapy and consumption of green leafy vegetables are not related to decreasing the risk of developing osteoporosis.

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Chapter 23: Health Equity and Care of Vulnerable Populations Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation ANS: B

People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability. Breakdown of family structures, prejudice, and social isolation may all influence vulnerability to health problems but have not been identified as a primary cause.

2. Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of

limited resources?

Disadvantaged families Multi-problem families Resilient populations Vulnerable populations

a. b. c. d.

ANS: D

Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations and do not appropriately fit the definition of “aggregates.” Resilience refers to the ability to resist poor health outcomes, not to succumb to them.

3. A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of

the following actions should be taken by the nurse? a. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

ANS: A

Vulnerability can be reversed by obtaining resources to increase resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience.

4. Which of the following factors predisposes many migrant farm workers to disenfranchisement? a. Being a minority group member b. Inability to attend religious services because of work requirements c. Previous experiences of physical abuse d. Short length of time in the community ANS: D

Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds. A person’s inability to attend religious services or to have had experienced previous physical abuse are not specifically related to disenfranchisement of the population of migrant farmworkers.

5. A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local

vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. d. Strongly consider not applying, because this population will be expensive to treat.

ANS: D

Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care). Because of the major costs associated with providing care to this population and risks related to reimbursement, it would not be in the best interest of the agency to want to eagerly apply to provide care to this group.

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6. Which individual has the greatest risk for becoming a member of the vulnerable population of the local community? a. A male diagnosed with a cardiac issue who recently moved in with his adult child b. A single mother who is studying for a law degree at the local university c. A 50-year-old married female who has worked as a server in local restaurants for d.

her entire adult life A single male who has a history that includes a learning disability and a parent diagnosed with type 2 diabetes

ANS: D

The WHO, consistent with Healthy People 2030, describes three overall determinants of health to be (1) the social and economic environment, (2) the physical environment, and (3) the person’s individual characteristics and behaviors. The WHO also notes that individuals are unlikely to be able to directly control many of the determinants of health, and this is directly related to vulnerability.

The seven WHO factors are as follows (WHO, 2015, pp. 1-2): 1. Income and social status: Higher income and social status are associated with better health.

2. Education: Low education is linked with poor health, more stress, and lower self-confidence.

3. Physical environment: Safe water and clean air; healthy workplaces; safer homes, communities, and roads; and good employment and working conditions, especially when the person has more control, all contribute to good health.

4. Social support networks: Family, friends, and community as well as culture, customs, traditions, and beliefs affect health.

5. Genetics, as well as personal behavior and coping skills, affect health.

6. Health services: Access and use of services affect health.

7. Gender: Men and women suffer from different types of diseases at different ages The single male with a history of learning disabilities and a family history of type 2 diabetes has several potential risk factors including those related to his social support network (being single); learning disabilities (effecting education and pos sible low self-esteem); and a first degree family history of a chronic disease (type 2 diabetes). While the life stories in the remaining options present the individual with risks, none have multiple risks like the male depicted in the correct option.

7. A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which

of the following nursing actions would be most appropriate?

Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b. Refer the man to a urologist to address the urinary bleeding. c. Suggest that the family take him to an urgent care center immediately. d. Treat the urinary infection and give the man medication to take to prevent the recurrence of infection. a.

ANS: A

It is important to provide comprehensive, family-centered, “one-stop” services. Providing multiple services during a single clinic visit is an example of one-stop services. If social assistance and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups. If the family is referred to a different provider or agency, it is likely that this follow-up will never occur. Only addressing the urinary infection, and not the homeless status of this family, does not provide the comprehensive services that are expected from a public health clinic.

8. Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds

to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a. At the city’s homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs ANS: A

The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population, the homeless shelter would be an appropriate location. Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. Depending on the location of the community college, there may also be transportation issues.

9. Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a. A bill that establishes policies requiring all persons to pay the same cost for b. c. d.

services regardless of income A bill that promotes universal health insurance coverage A bill that requires all health care providers to give care to uninsured persons without charge A bill that requires health care workers to report undocumented immigrants who present for treatment

ANS: B

Social justice refers to providing humane care and social support to the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered, or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care. Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. A bill requiring all persons to pay the same cost for services regardless of income is not feasible. Multiple factors, including the benefits provided by individual health insurance, influence the amount of money individuals pay to receive health care services. A bill for universal health insurance could potentially influence this inequality. Health care providers are obligated to provide care to individuals in an emergency regardless of citizenship in the United States; thus, this bill would not be feasible given current standards. These options would also not support the philosophy of social justice.

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10. A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The

nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment.

Which of the following types of service does these actions represent? a. Case management b. Client advocacy c. Holistic care d. Wrap-around services ANS: A

Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved. Client advocacy refers to actions taken on behalf of another. Because of the variety of actions being taken by the nurse, the nurse is functioning in a larger role than simply advocating for the client. Holistic care addresses providing care for physical as well as emotional and spiritual needs. The nurse is not addressing all of these aspects of care through this coordination. Wrap-around services refer to when comprehensive health services are available and social and economic services are “wrapped around” these services. These services are not being necessarily all being provided by the same clinic.

11. A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of

the following levels of prevention is being used?

Primary prevention Secondary prevention Tertiary prevention Secondary and tertiary prevention

a. b. c. d.

ANS: B

Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease. Primary prevention refers to actions taken to prevent the disease from occurring. Tertiary prevention refers to actions taken after the disease has already occurred. A screening test cannot be both secondary and tertiary preventions.

12. A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following

interventions is the nurse most likely completing? a. Administration of skin tests to identify persons who have been infected with tubercle bacilli b. Assessing for signs and symptoms of active tuberculosis c. Directly observing clients with active tuberculosis as they take their antitubercular medications d. Interpretation of tuberculosis skin test findings ANS: C

Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB. Administering skin tests, assessing for signs and symptoms, and interpreting tuberculosis skin test findings are all examples of secondary prevention as these interventions are all focused on screening or the follow-up on a screening test.

13. A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following

statements indicates a need for additional staff education? a. “If a client who does not speak English comes in, you must obtain an interpreter right away.” b. “We try to take care of as many problems as possible in one visit, so when you interview the client, ask about additional concerns.” c. “You will like working with Hispanic immigrants because they all have close-knit family structures.” d. “You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules.”

ANS: C

Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence. It is important for the staff member to obtain an interpreter after learning that a client does not speak English, so this statement does not indicate the need for additional education. Addressing multiple concerns within one visit is also appropriate and does not indicate the need for additional staff education. Also, it is important for the staff member to recognize the importance of working around work schedules; thus, this action is appropriate and does not indicate the need for additional staff education.

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14. Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their

tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Readminister the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest X-rays.

ANS: B

Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results. Homeless people often do not have a way to receive telephone calls.

Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working.

15. A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when

providing care? a. Be willing to enter into a long-term relationship with families. b. Direct and control the client’s care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency.

ANS: A

Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served.

This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client’s care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

MULTIPLE RESPONSE 1. Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) a. “I always address the problem that the client believes is the most important.” b. “I avoid asking clients for income or financial information, because this is an c. d. e.

invasion of privacy.”

“I try to observe the client’s cultural traditions as I complete my assessment.”

“I make sure to do a complete assessment, since we often don’t know when the person will return to the clinic.”

“Understanding an individual’s cultural experience is an important factor in meeting their needs.”

ANS: A, C

The nurse should focus on what data are needed to help the client that day with the problem the client believes is most important. It is important to keep the client’s cultural traditions in mind when completing an assessment so that the nurse is able to provide culturally competent care. Because poverty is a primary cause of vulnerability, the nurse should include questions about the client’s financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used.

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Chapter 24: Rural Health and Migrant Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A 13-year-old resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely

provide care to this client? a. Advanced nurse practitioner b. Allergist c. Pediatrician d. Pulmonologist ANS: A

The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). Most urban adults are more likely to seek care from a medical specialist (allergist or pulmonologist). A pediatrician would provide care specific to children which may or may not be appropriate depending on the age of the resident.

2. Which of the following best describes a health professional shortage area (HPSA)? a. An area with inadequate health care facilities for residents b. An isolated area of underserved populations within an urban region c. A region with insufficient numbers of health care providers d. A rural region of the United States with a population density of less than 10,000 ANS: C

An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often, rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties. The incorrect responses do not fit the definition of a HPSA. 3. A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for

this injury?

Emergency department for immediate care Migrant Health Act clinics OSHA, because the man was injured by farm machinery Workers’ Compensation, because injury was at work

a. b. c. d.

ANS: A

The only source the nurse can count on using is sending injured workers to emergency departments for immediate care. Farming and ranching do not often fall under OSHA guidelines, because they are considered small enterprises. Therefore, safety standards are not enforceable, nor is Workers’ Compensation insurance usually available for the agricultural industry. Although there are migrant health clinics, they are not always geographically convenient.

4. A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When

questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? a. Cancer b. Memory loss c. Skin rashes d. Headaches ANS: A

Chronic exposure to pesticides and chemicals may lead to cancer. Memory loss, skin rashes, and headaches are all potential side effects of short-term exposure to pesticides and chemicals.

5. A migrant farmworker presents to the clinic reporting an acute onset dizziness, intense thirst, vomiting, fatigue, and headache with

difficulty concentrating. Which of the following conditions would cause such symptoms? a. Appendicitis b. Bacterial gastroenteritis c. Pesticide poisoning d. Viral illness ANS: C

Because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild symptoms of pesticide poisoning including headache, fatigue, dizziness, nervousness, perspiration, loss of appetite, thirst, eye irritation, and irritation of the nose and throat. Severe poisoning symptoms include fever, intense thirst, vomiting, muscle twitches, convulsions, inability to breathe, and unconsciousness. The work setting of a migrant farmer would lead the nurse to first consider pesticide poisoning as a potential underlying cause of these symptoms. However, some of these symptoms could potentially be present with appendicitis, bacterial gastroenteritis, or a viral illness.

6. In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispan ic migrant

farmworker likely to encounter? a. Absence of culturally competent care b. Availability of specialists c. Distance of health care facilities from the place of residence d. High cost of health care ANS: A

For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers. This is an additional barrier that is not faced by other rural residents. Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers, not just migrant workers.

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7. Which of the following is the most accurate description of a migrant farmworker? a. A person who does farm work as the primary means of employment, although b. c. d.

other work may be done when the seasonal work ends A person who immigrates to the United States to “follow the crops” in performing seasonal farm work A person who moves from place to place to earn money performing seasonal agricultural work A person who specializes in the development of rural land for the purpose of farming

ANS: C

The Office of Migrant Health of the US Public Health Service defines a migrant farmworker as a person “whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months and who establishes for the purpose of such employment a temporary abode.” The emphasis in the definition of migrant farmworkers is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

8. An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all

of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a. Their personal belongings may be stolen while they are at the clinic. b. Immigration officials will send them back to their home country. c. The clinic personnel will look down on them and be biased against them. d. They weren’t getting paid for that day, and continued employment is never certain.

ANS: D

Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to “take all the time they want” could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain. Most migrant farmworkers are legal residents or US citizens, not illegal immigrants. If the clinic personnel provide culturally competent care, they should not be biased or look down on this family when providing care. They should not be at any greater risk to have their belongings be stolen than on any other day when they leave their home.

9. A migrant farmworker brings his daughter to the clinic with severe heat stroke from being out in the sun. The nurse explains the

danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a. It was a rare occurrence, which probably won’t be repeated. b. The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. c. Children may work on small farms because the family may need the additional income. d. The parents were busy working and didn’t realize the child was outside so long.

ANS: C

Children 12 to 13 years of age can work on a farm with the parents’ consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family’s economic survival. This child may be at risk for this occurring again because the family needs the income that is generated by the child’s employment. The child is most likely working and not going outside to play. In order for this child to work, the parents also were working on the same farm with them but again need this child’s income for survival.

10. A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for

the nurse? a. Avoiding touching the client except when necessary as part of the physical examination b. Calling the client by name, socializing before addressing the problem, and being very respectful c. Keeping all interactions direct, to the point, and targeted on the reason for presentation d. Maintaining a nonconfrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying ANS: B

The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual’s dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior. When interacting with Mexican immigrants, as well as some other cultures, establishing general rapport through conversation is expected rather than a direct, focused approach. It would be appropriate for a nurse to develop a therapeutic relationship with the client, not a nonconfrontational one.

11. A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To

which of the following folk illnesses is the nurse referring? a. Evil eye b. Fallen fontanel c. Fright d. Indigestion ANS: A

A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye. Caida de mollera is known as fallen fontanel, empacho is known as indigestion, and susto is known as fright.

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12. Which of the following conditions of the rural environment provides increased opportunities for teaching? a. Increased interaction among residents due to neighbors visiting neighbors on the b. c. d.

family farms Involvement in rural community activities provides more contact with community residents than in urban areas Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary preventions Increased illnesses and injuries of rural residents require that they see nurses more often

ANS: B

Rural areas have fewer churches, stores, and schools. Thus, nurses may go to the same church, shop at the same stores, and/or have children in the same schools as their clients. There are also fewer organizations, so it is easier to become involved and meet everyone while participating. Visiting neighbors does not increase opportunities for teaching. The fact that nursing responsibilities include all levels of prevention is true of both urban and rural areas. The statement about increased illness and injuries in rural residents is wrong, because although illnesses and injuries are increased, rural residents often do not seek care for these conditions.

13. A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the

nurse complete? a. Observe farmworkers for evidence of unsafe handling of pesticides. b. Provide teaching on how to handle pesticides to avoid or decrease exposure. c. Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. d. Treat a client who has pesticide exposure to prevent complications.

ANS: D

Tertiary prevention involves actions taken when a person already has a condition so that complications and worsening of the condition are avoided. Thus, treating a client with exposure is tertiary prevention. Observing farmers for evidence of unsafe handling of pesticides is an example of secondary prevention as the nurse is assessing to detect a problem at the earliest stage possible. Primary prevention occurs when the nurse aims to prevent the problem from occurring which is accomplished when the nurse teaches about safe handling of pesticides and recognition of signs and symptoms of pesticide poisoning.

MULTIPLE RESPONSE 1. Which of the following best describes why health professionals would be particularly concerned about the health needs of residents

in rural areas? (Select all that apply.) a. 40% of rural children live in poverty. b. People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c. Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d. The cost of healthcare is strain on rural families. e. Accessibility to healthcare is limited.

ANS: A, D, E

Nearly 40% of all rural children are impoverished. Poverty and inaccessibility to health care is a major problem for rural communities. Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations.

2. A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to

assess? (Select all that apply.)

Tuberculosis Hepatitis High blood level of lead Malaria Diabetes

a. b. c. d. e.

ANS: B, C, E

Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB) and hepatitis, as well as exposure to high levels of lead from pesticides. Diabetes is common among this population as well. Malaria is not an illness associated with the migrant farmer population.

3. A nurse tells her nursing supervisor that her family is moving from the urban area where they both live in a rural area to be near her

spouse’s parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) a. “Community members will probably hold you in higher regard and will look up to you.” b. “Expect to have less autonomy in a small town than you have working as a nurse in a medical center.” c. “You may feel like an isolated outsider, because the community may not immediately accept you.” d. “You will have to be very sensitive about the differences in the rural lifestyle.” e. “The church and school will be the centers for socialization.”

ANS: A, C, D, E

Nurses working in rural areas usually have a prestigious status in the community and are viewed as role models. They will be experiencing a different lifestyle in the rural area and should be sensitive to these differences. Churches and schools are seen as the socialization centers for the community. Also, moving into a community does require the community to be accepting of the outsider which may or may not occur quickly. Nurses working in rural areas typically have more autonomy because of the larger geographic area that is being served.

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4. A nurse’s family has moved to a rural area to be near her spouse’s aging parents. Which of the following would the nurse most

likely notice about the family’s new environment? (Select all that apply.)

It is very difficult to obtain continuing education, except for online programs.

Neighbors seem to expect the nurse to know everything about all health care and illness conditions. c. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d. People come to the health clinic before their situation becomes relatively serious. e. Boundaries between personal and professional lives are blurred. a. b.

ANS: A, B, C, E

The boundaries between home and work blur because clients are also neighbors and friends of immediate family members. Nurses are highly regarded by the community and viewed as experts on health and illness. Residents may ask health-related questions and request recommendations whenever they see the nurse. Nurses in rural areas may also be expected to, in general, know something about everything, and this can be a demanding expectation. Some of the challenges are professional isolation, limited opportunities for continuing education, lack of other health personnel or professionals with whom the nurse can interact, heavy workloads, the need to function well in several clinical areas, lack of anonymity, and for some, a restricted social life. Rural people often develop independent and creative ways to cope because of the distance, isolation, and sparse resources they encounter. Because of the sparse resources, rural residents may seek limited preventive care and may only come to the health clinic if their situation is severe.

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Chapter 25: Poverty, Homelessness, Teen Pregnancy, and Mental Illness Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse was shocked when late one night she saw a former high school friend going through a trash bin outside a fast-food

restaurant and pulling out half-eaten food. Which of the following is the most likely explanation for a healthy young adult engaging in such behavior? a. He ate his meal but wanted more and had no more money. b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c. A friend had thrown his meal away, and he thought he could find his friend’s untouched food. d. He was doing this to fulfill an obligation of fraternity initiation at the college.

ANS: B

The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills. Thus, it is most likely that he was unable to meet his basic needs through his current employer. If he had already eaten his meal, it would be unusual to get additional food out of garbage, rather he should be able to afford to purchase additional food if he was able to purchase his meal. The young adult would most likely not be pulling out half-eaten food if he was looking specifically for a friend’s meal. There is no reason to assume that he was part of a fraternity.

2. Which of the following clients is most likely to experience a high incidence of poverty? a. A 65-year-old woman b. A 14-year-old male c. A 79-year-old male d. A 19-year-old female ANS: B

While gender is not relevant, the poverty rate for children under 18 years of age was 16.2 percent, and the poverty rate for people aged 65 and older was 9.7 percent.

3. A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the

following concerns would lead the nurse to talk to the teacher concerning the child’s academic progress?

Protentional abuse risk Possible developmental delays Food insecurity Susceptibility to infections

a. b. c. d.

ANS: B

Poverty increases the likelihood of all the options but developmental delays will impact academic progress most severely.

4. Which of the following is the most rapidly growing group experiencing poverty? a. Hispanic families b. Women older than 65 c. African-American families d. Single men of all ages ANS: B

Under the official poverty measure, in 2017, 4.7 million adults ages 65 and older lived in poverty. The rate of increase among seniors increases with age and is higher among women, African Americans, and Hispanics.

5. Which of the following statements best describes why health care of the homeless is so expensive to the community? a. Health conditions of the homeless require increased preventive services. b. Homeless clients typically make more clinic visits for multiple health problems. c. Homeless people are a major source of spread for contagious diseases. d. Most care to homeless people takes place in hospital emergency departments.

ANS: D

Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore, health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics. It is likely that most homeless people do not seek preventive care, thus, it is not that they require increased services, but they are less likely to seek these preventive services. Homeless clients are likely to not be seen in the clinic setting. Homeless people may spread contagious diseases, but this does not explain why providing health care to this population is expensive.

6. The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the

following would be the best action to take to improve client outcomes? a. Provide antibiotics to all homeless persons with chronic, nonhealing wounds. b. Offer daily access to a room with soap, water, and bandages. c. Hand out free bandaging supplies following each clinic visit. d. Perform regular monitoring of the client’s wound condition.

ANS: B

Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits. If the wound is not kept clean, it is unlikely that antibiotics will be able to prevent an infection, and the antibiotics will not promote wound healing. Handing out bandaging supplies does not address being able to wash the wound on a regular basis. Monitoring of the wound will not assist in wound healing.

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7. A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern to both mother

and fetus?

Elevated blood pressure First prenatal visit at 5 months’ gestation Homelessness Positive STD test

a. b. c. d.

ANS: C

Pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus, being homeless is the most dangerous sign of those listed. Elevated blood pressure, positive STD test, and seeking prenatal care late in the pregnancy are all concerns for the nurse. However, most concerning would be homelessness, as homelessness presents many challenges for the women during and after the pregnancy.

8. A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following

actions would the nurse most likely take?

Assist teen mothers to learn about their body changes during pregnancy.

Develop programs that allow teen mothers to complete their education.

Offer courses in proper care of babies and how to be a parent.

Monitor pregnant teens to detect early problems with pregnancy.

a. b. c. d.

ANS: B

A direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth. Teaching about body changes a proper care of babies and parenting would address short-term health outcomes. Monitoring teens to detect early problems in pregnancy addresses short-term health outcomes as well.

9. A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, which of

the following comments by a parent would cause concern? a. “I do not know if my son is sexually active; however, I have decided I’m going to talk to him about it.” b. “My daughter is too intelligent to get involved with boys, even if her friends do sleep around.” c. “My daughter and I have often discussed sexuality, and when she’s ready, I’ll pay for her birth control pills.” d. “I have spoken to my son about birth control. He says he’s not ready to be a father and support a baby. He wants to go to college.”

ANS: B

Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy. Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active.

Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care.

10. A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider

when providing care? a. All teen pregnancies are considered high risk. b. Limited self-care knowledge can lead to pregnancy complications. c. Pregnant teens are likely to receive prenatal care late in the pregnancy. d. Pregnant teens may have limited financial resources to pay for care.

ANS: A

It is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy. All of these statements are true; however, it is crucial to consider all pregnant teenagers as high-risk obstetric clients. Limited self-care, lack of prenatal care, and limited financial resources are all contributors to the potential for all teen pregnancies to be considered high risk.

11. The nurse is making a postpartum visit to a teenage mother and her month-old infant. Which of the following assessments would be

most important?

Assessing for mother’s ability to fulfill her own growth and development tasks Assessing for mother’s knowledge about normal infant growth and development Assessing how much the teenage mother’s own mother is helping her cope with childcare d. Assessing whether the baby’s father is being helpful to the mother a. b. c.

ANS: B

The primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse. Although the nurse might assess for any and all of these options, however, the primary goal of a postpartum visit would be to assess knowledge regarding normal growth and development. A teenager mother’s knowledge about her own growth and development and how much assistance she is receiving from her own mother and the baby’s father would be secondary concerns.

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12. A mother and her son are in the emergency department seeking care after the son had become so angry that he put his hand through

a glass window and had to have stitches. The emergency care provider suggested a psychiatric consult. Now the mother asks, “Do you think my son is crazy?” Which of the following is the most appropriate response by the nurse? a. “Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger.” b. “Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones.” c. “Your son is having problems coping with anger. And naturally you’re upset. Let the psychiatrist determine whether your son is crazy or not.” d. “Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way.”

ANS: D

Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. In order to respond therapeutically to the mother, the nurse should not use the words absolutely (which implies that there may not be a problem with the son at all) or crazy (which is not a positive word to describe the son’s behavior).

13. Which of the following is the leading cause of disability for adult Americans? a. Accidents b. Arthritis c. Anxiety disorders d. Workplace injuries ANS: C

Anxiety disorders are common both in the United States and elsewhere. An alarming 31.1 percent of the adult population will experience an anxiety disorder at some time in their lives (NIMH, 2018). Anxiety disorders may have an early onset and are characterized by recurrent episodes of illness and periods of disability. While the other options can contribute to disability, none are as impactful as anxiety.

14. A community mental health nurse is working within the community to help prevent youth violence. Which of the following

interventions would most likely be implemented by the nurse? a. Distributing literature that associates violence with a lack of intelligence b. Explaining to youth why youth violence is detrimental to society c. Partnering with associations to provide alternative activities that improve social skills d. Recommending increased funding to prosecute and jail teens associated with violent activity ANS: C

Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act. Distributing literature is an ineffective intervention as community members would need to read the literature that has been provided. Based on the growth and development of youth, they are unlikely to be able to truly understand the larger scope of youth violence. Recommending increased funding for prosecution and jail does not provide any measure to prevent the problem from occurring.

15. Which of the following clients is most at risk for suicide involving firearms? a. A 15-year-old female b. A 20-year-old male c. A 56-year-old female d. A 36-year-old male ANS: B

Suicide was the second leading cause of death for youth ages 10-24. Males take their lives about four times more often than do females, yet females are more likely to have suicidal thoughts than males are. Firearms are the most common method of suicide among males and poisoning among females.

16. A nurse is trying to identify the risk for mental health problems among older adults. Which of the following interventions should

the nurse implement initially?

Provide information on mental health resources in the community.

Teach the elderly to self-monitor for signs and symptoms of depression.

Organize screening programs offered at senior centers.

Teach older clients to focus on their strengths rather than their weaknesses.

a. b. c. d.

ANS: C

Early detection and intervention for mental health problems can be increased if persons seeking primary care are assessed for mental health problems. Nurses are in an ideal position to assess and detect mental health problems. They conduct comprehensive biopsychosocial assessments as part of screening programs. While the other options are not inappropriate, they do not help identify mental illness in the older adult population.

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17. A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. Which of the

following actions by the nurse demonstrates the use of secondary prevention to limit caregiver stress?

Asking caregivers how they are doing and suggesting coping strategies Encouraging caregivers to periodically leave the house for a couple of hours Establishing support groups for caregivers of older parents Referring some activities to neighbors and friends

a. b. c. d.

ANS: A

Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed.

Also, encouraging caregivers to periodically leave the house for a couple of hours could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

18. A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of

the following actions should be taken by the nurse? a. Apply for a grant to fund a mobile clinic to take health care to the clients. b. Distribute flyers to the homeless that detail the location of various types of health care services. c. Refer homeless clients to areas that provide temporary housing. d. Solicit donations for food and clothing to be distributed to the homeless.

ANS: A

Accessibility refers to the ability of clients to obtain needed health care services. Only applying for a grant for a mobile clinic can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places. All of these options lead to opportunities for improvement in health, either directly or indirectly, but distributing flyers, referring homeless clients, and soliciting donations do not address the issue of accessibility.

19. According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic

needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter, and clothing needed to preserve health)? a. $16,020 b. $26,200 c. $36,580 d. $40,890 ANS: B

As of 2020 for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $26,200.

20. A nurse is working to improve personal self-awareness in order to provide better client-centered care to clients living in poverty.

Which of the following questions should the nurse self-reflect upon? a. What would I do if I lived in poverty? b. What can be done to get poor people motivated to work? c. How have the media images of poor persons shaped my image of poverty? d. How can community resources assist those living in poverty?

ANS: C

Self-awareness is a key component of providing authentic, genuine client-centered care. To clarify their own values and perspectives about poverty, nurses should ask themselves questions about poverty and persons living in poverty. These questions should cause the nurse to reflect on how his or her ideas of poverty have been developed. The only question that relates to the nurse reflecting on how personal values and perspectives have been developed is, “How have the media images of poor persons shaped my image of poverty?” The incorrect responses address how to address the issue of poverty or concerns of the nurse but do not address increasing the nurse’s self-awareness.

MULTIPLE RESPONSE 1. A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describes

why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a. Her friends were suggesting ways to make the problem go away. b. She knew she could not be pregnant because her boyfriend said he used a condom. c. She was afraid her parents would pressure her to terminate the pregnancy. d. She kept hoping the pregnancy would just go away. e. She dreads the gynecological examination.

ANS: C, D, E

Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, because they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Having friends suggest that the pregnancy will just go away is not a common reason why pregnant teens do not seek prenatal care; it is more likely that the teen herself is thinking that the pregnancy will just go away. Being told that a condom was used doesn’t make it so. The girl should know whether a condom was used or not without relying on verbal statements.

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2. A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following

behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.)

Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. b. Cuddle the baby often. c. Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant’s face. d. Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes. e. During the assessment, smile and gaze into the baby’s eyes. a.

ANS: B, D, E

Suggestions for promoting interaction between an adult and a baby include smiling and making eye contact. Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). The mother should be taught to use a distance of 8 to 10 inches from the infant and should not blow on the infant’s face. The mother should soothe the baby and try to provide comfort before trying to let the infant “cry it out.”

3. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse’s assessment, the

child admitted that her mother was working but didn’t make much money, so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? (Select all that apply.) a. Food insecurity b. Target of peer bullying c. Increased school absences d. Vision problems e. Depression ANS: A, C, E

The health problems of homeless children, although similar to those of poor children, often have more serious consequences and are at greatest risk for poor health as a result of poor nutrition, inconsistent health care, high levels of anxiety, and an inability to practice good health behaviors. Homeless children also experience higher rates of school absenteeism, academic failure, depression, and emotional and behavioral maladjustments. It is possible that this child could be bullied; however, there are also children who do not live in poverty who experience bullying as well. Vision issues are generally no more a risk than for the general child population.

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Chapter 26: Alcohol, Tobacco, and Other Drug Problems in the Community Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education ANS: B

The harm reduction model is a public health approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. Substance abuse education is only one part of the harm reduction model. Using an approach of punishment and the criminal justice system has not been found to be effective based on research.

2. A woman has just delivered a baby and is lamenting that the baby’s father is not with her. She shares with you that he became

involved with drugs and is now in prison for theft. The new mother says, “It’s so sad. He’s clearly no good.” Which of the following would be the best response by the nurse while demonstrating empathy? a. “I’m so sorry to hear that. Is your mother able to be with you?” b. “It’s good that you and the baby are safe from him.” c. “Is there anyone to help you with the baby until the baby’s father can be released and encouraged to get treatment for his addiction?” d. “You must hate him for leaving you alone with a new baby!”

ANS: C

The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. It is inappropriate to assume that the woman wants assistance from her mother. There is no evidence to suggest that the woman or her baby were in danger before he went to prison. Saying “you must hate him” is not appropriate, as it is not the nurse’s role to tell the client how she should be feeling.

3. A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him

feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic.

Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse ANS: C

Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful.

4. A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should

the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth.

ANS: B

Research demonstrates that genes are responsible for about half of the risk for abuse of alcohol. Multiple genes play a role in a person’s risk for the development of alcoholism. Research has not shown that the family environment is the main risk factor for alcoholism. Alcoholism is more common among men than women. Persons who are born with fetal alcohol syndrome are not alcoholics from birth and are likely to have metabolic or other disturbances.

5. A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to “win” the

drinking contest when and one is unable to continue drinking?

If their alcohol consumption is the same size, they’ll both pass out about the same time. b. Whoever has food in their stomach will probably vomit and be unable to continue drinking. c. The man will likely win because of an inborn tendency to greater alcohol tolerance. d. The woman will likely win due to the tendency to have more adipose tissue. a.

ANS: C

Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men; thus men have an increased tolerance for alcohol. It is also unlikely that they will both “win” at the same time because the alcohol will likely affect the woman factor than the man. The adipose tissue ratio is not a factor in alcohol tolerance. While vomiting may occur, it will not necessarily affect the ability to continue to consume alcohol.

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6. Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor.

During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to “just say no” when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d. The fact that tobacco smoking causes more premature deaths than any other behavior ANS: D

The most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. Because the students are engaging in tobacco use, this is the most important topic to address with them at this time. If the students were not engaging in this behavior, the other topics of commonly used drugs on campus, just “saying no”, and overcoming peer pressure may have been just as appropriate.

7. A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a

cigarette while the baby sleeps in the mother’s arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home.

ANS: B

Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Fetal alcohol syndrome is a cause of newborn congenital dysfunctions. There is not known tolerance to tobacco smoke. While chewing tobacco doesn’t produce smoke, the parents would still be at a considerable health risk from the nicotine.

8. Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) d. Mixed alcoholic beverages ANS: B

Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications.

Beer, cigarettes, and mixed alcoholic beverages are not as culturally acceptable as caffeine, as there are regulations that limit the age that these products can be used.

9. A school nurse stops a student in the hall and expresses concern that, “Your eyes look rather red and dry.” The student yawns and

denies eye problems but does mention having gained 15 pounds since smoking “special cigarettes.” Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana ANS: D

Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. Side effects of crack cocaine and ice methamphetamine are similar and include increased breathing, rapid heart rate, high blood pressure, and increased body temperature. Tobacco use is associated with many chronic diseases but a person smoking tobacco would not necessarily display the student’s symptoms.

10. Which of the following is an accurate concern about the marijuana? a. Strength of most available marijuana is weaker than in the past. b. Paranoia is a known side effect of marijuana use. c. Marijuana has no effect on a fetus. d. Psychological and physiological dependence are seldom experience with

marijuana use.

ANS: B

Marijuana’s diverse reactions include anxiety, disorientation, and paranoia. The risks of marijuana are not being discus sed as much as in the past. Today’s marijuana is stronger than ever before, and people can become addicted. The Substance Abuse and Mental Health Services Administration (SAMHSA) says “approximately 1 in 10 people who use marijuana will become addicted.” The rate increases to 1 in 6 if the youth is under age 18. Marijuana use has known effects on fetal development.

11. Which client may be able to safely detoxify and manage their withdrawal symptoms with only minimal medical supervision? a. A 50-year-old who uses diazepam to “manage my anxiety” b. The 30-year-old reporting a “weekend cocaine habit” c. A 60-year-old who takes a secobarbital “most nights to help me sleep” d. A 70-year-old who usually drinks “3-4 beers in the evening” ANS: B

Stimulants, e.g., cocaine or opiates, may produce withdrawal symptoms that are uncomfortable but not life threatening.

Detoxification from these drugs does not require direct medical supervision, but medical management of the withdrawal symptoms increases the comfort level. On the other hand, drugs such as alcohol, benzodiazepines, e.g., diazepam, and barbiturates, e.g., secobarbital, can produce life-threatening withdrawal symptoms. These clients should be under close medical supervision during detoxification and should receive medical management of the withdrawal symptoms to ensure a safe withdrawal.

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12. Research as shown that vaping increases an individual’s risk of contracting what disease five-fold? a. Gingivitis b. Mouth cancer c. Oral herpes d. COVID-19 ANS: D

Vaping increases the risk of contracting COVID-19. This is due to the fact that e-cigarettes affect the lungs and immune system, and that makes the user more susceptible to the virus. The seriousness is increased when teens or other uses share the e-cigarettes.

Research has found that people who vaped and smoked were five times more likely to develop COVID-19. The other options are potential risks but have not been shown to be so directly associated with vaping.

13. Three female clients were brought to the emergency department by ambulance after a two-car accident at a busy intersection.

Which of the following tests should automatically be done under such circumstances?

Alcohol blood level Cardiac workup Pregnancy test STI tests

a. b. c. d.

ANS: A

Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. Because of the high rate of alcohol involvement in injuries seen in trauma centers, an alcohol blood level would be most important. A cardiac workup, pregnancy test, or STI test would not be the priority.

14. An IV drug abuser admits to the nurse he has no desire to stop using drugs, so rather than lecture the individual on the dangers of

drug addiction, the nurse provides information how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases ANS: D

Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. This client is already using IV drugs, thus, the nurse will be intervening at the tertiary level of prevention. Secondary and primary prevention strategies would not be appropriate when working with this client who already has a known problem.

15. In which of the following scenarios is a family member enabling an individual to continue to abuse alcohol? a. The husband asks the nurse to explain why his wife’s continued drinking is b. c. d.

dangerous.

The son threatens to leave home because he finds the father’s behavior embarrassing.

The teenage daughter of an alcoholic turns to a favorite teacher for emotional support.

The wife tells her husband’s boss that her husband is sick when he is actually inebriated.

ANS: D

Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. When someone lies for the abuser, the individual is enabling the abusing behavior to continue. The other options do not demonstrate the behavior of enabling, since none are shielding the abuser from experiencing the consequences of the addiction.

16. Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment.

ANS: B

Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long acting and effective when taken orally, it does not produce a “high,” it is inexpensive, and it has few known side effects. The main effect of this medication is that it decreases the craving for heroin; it is not a drug that clients come to prefer nor does it prevent further dependence on drugs.

17. A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? a. A combination of interventions, beginning with changing the environment b. Acupuncture to reduce the nicotine cravings c. Behavior modification through hypnosis d. Nicotine replacement products ANS: A

The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker’s environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases. Acupuncture, behavior modification, and nicotine replacement products may all assist the client in stopping smoking. However, it has been demonstrated that the most effective method involves a combination of strategies.

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18. A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client

states, “I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal.”

Which of the following would be most appropriate response from the nurse? a. “I’m so glad you’re beginning to recognize the need to control your blood sugar.” b. “Now you just have to make sure you don’t give that habit up!” c. “Sounds like you’re not ready to really plan your eating yet.” d. “That is great. You’ve started to take action and make changes.”

ANS: D

There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. The client prepares for action by learning to recognize the importance of eating and needed changes. Therefore, the nurse should encourage and recognize that the client has begun serious change. This comment by the client demonstrates readiness to take action and needs to be encouraged by the nurse. The incorrect responses are not encouraging replies that would promote the client to continue to move forward with these actions.

19. At a county board meeting, a nurse reports statistics related to the increasing problem of substance abuse in the county. The nurse

then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? a. Help prevent obesity and boredom. b. Offer alternatives to being “on the streets.” c. Prevent children from getting in trouble before their parents get home from work. d. Promote healthy lifestyles with physical activity.

ANS: D

The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors. The purpose of the nurse requesting this funding is to address the problem of substance abuse, not obesity. This program may offer an alternative to children and keep them safe and off the streets; however, the primary objective is to address the overall healthy lifestyle of these youth.

20. A school health nurse is conducting drug screening to detect drug use by students before serious problems develop. Which of the

following levels of prevention does this action represent?

Primary prevention Secondary prevention Tertiary prevention Primary and secondary prevention

a. b. c. d.

ANS: B

One means of secondary prevention is to institute early detection (screening) programs in schools, workplace, and other areas in which people gather to determine the presence of substance abuse. Primary prevention involves education before a problem occurs.

Tertiary prevention occurs after the problem has occurred and aims to assist the client to the highest level of functioning. It is not likely for a single intervention to be both primary and secondary in prevention foci.

MULTIPLE RESPONSE 1. A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following

strategies would the nurse suggest the mother implement? (Select all that apply.) a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. d. Encourage her daughter to develop new friendships. e. Encourage her to discuss her dreams for the future.

ANS: A, B, C, E

Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategie s: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic app raisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions. Based on the information provided, there is no reason to suggest the child needs to develop new friendships. Keeping consistent friendships may provide the support the child needs to avoid engaging in these behaviors.

2. A nurse is helping a client’s family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the

need for change. Which of the following instructions by the nurse to the client’s family members would be most effective? (Select all that apply.) a. “Express your belief in him and his ability to change.” b. “Point out that his behavior is his choice and his responsibility.” c. “Let him know that you understand how much he loves being with his drinking pals.” d. “Remind him that entering treatment is better than going to prison.” e. “Let him know that he is loved by his family and friends.”

ANS: A, B, E

Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person’s own personal Responsibility for any changes made, and give Advice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of self-efficacy. Having the client’s family members tell the father that they understand his behavior does not encourage him to realize the need for change. Threatening a future possibility of prison would not provide encouragement to the father and may even challenge him to continue his behavior.

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3. A nurse is developing a community-based activity aimed at preventing substance abuse in the community. Which of the following

interventions would the nurse most likely implement? (Select all that apply.)

Supporting an increase in the availability of recreational facilities Lobbying to state legislators to approve a higher cigarette tax Educating all middle school students about the long-term side effects of drugs and alcohol d. Providing general screenings for substance abuse e. Identifying community-based resources that deal with substance abuse issues a. b. c.

ANS: A, C, D, E

Supporting an increase in additional recreational facilities would engage the community members in healthy activities rather than having them potentially turn to substances for relaxation. Providing screenings for substance abuse in the community may assist community members in recognizing the problem sooner. It would be appropriate to educate middle-school students about the long-term side effects of drugs and alcohol since they would be able to understand the information. Early intervention with education is a proven deterrent to substance abuse. Lobbying state legislators for increase in a higher cigarette tax may be beneficial, but this intervention is focused on the state rather than the community where the nurse is working. Identifying local resources where assistance and addition information about substance abuse issues can be found is an appropriate community-based intervention.

4. A home health client has been prescribed acetaminophen with codeine every 4 hours for pain following a hip arthroplasty. Which

of the following statements made by a nurse to the client’s primary health care provider indicates a need for further education on narcotics related to the goals of safe pain management? (Select all that apply.) a. “Please consider decreasing the time interval between doses to every 3 hours so that my client will maintain pain relief.” b. “I’m really concerned my client will become addicted to the codeine.” c. “Consider prescribing a different medication so that my client will achieve adequate pain relief.” d. “My client needs a prescription for PRN medication for ‘breakthrough’ pain.” e. “This medication is expensive; please prescribe something less costly.”

ANS: A, B, D

It would not be appropriate to ask to decrease the time interval in between doses as the increased use of acetaminophen may be damaging to the client’s liver and kidneys. There is no evidence that this client is at risk for developing an addiction. Thus, demanding that this medication be discontinued may be a premature action by the nurse. However, the nurse should monitor the patient closely for signs and symptoms of potential addiction. It would be appropriate to ask the primary care provider for an additional medication in the form of a PRN prescription to possibly assist with the client achieving optimal pain relief rather than changing medications entirely. Although it is a factor, the cost of pain medication isn’t a consideration when addressing safe pain management interventions.

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Chapter 27: Violence and Human Abuse Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following statements is the best explanation as to why some countries are more violent than others? a. Civilized societies are less violent than primitive societies. b. Geographical differences are the primary factor. c. Population differences are the main determinant—for example, having more d.

males than females.

Violence is a learned behavior controlled or allowed by social norms.

ANS: D

Some societies are basically nonviolent, and for them violence is not a significant health problem. Violence is a learned behavior, and social norms can keep violence at low levels or even eliminate it. The learned culture of the society is the best indicator for violence, not the differentiation between civilized or primitive, geographic location, or population differences among males and females.

2. Which of the following statements best explains the primary reason why violence is so high among young male parents? a. Men tend to be more violent than women. b. They are young and thus lack maturity. c. Unemployment is higher in this population. d. Violent tendencies are transferred genetically along racial lines.

ANS: C

Most analyses conclude that the differential rates of violence in the United States have more to do with economic realities, such as poverty, unemployment, and overcrowding, than with race. Although violence among men may be higher than among women, this question specifically addresses “young men.” Economic realities are more indicative of this rate of violence than age and maturity.

Violence is a learned behavior; it is not transferred genetically along racial lines.

3. Which of the following is the top risk factor for intimate partner homicide? a. There is a gun in the house. b. The husband has made threats against wife before. c. The wife has previously reported being physically abused. d. The woman’s young daughter also lives with them.

ANS: C

The top risk factor for intimate partner homicide (IPH) is previous domestic violence. Other risk factors are access to guns, estrangement, threats to kill or threats with a weapon, nonfatal strangulation, and a stepchild in the home if the victim is a female; however, these are not the top risk factor.

4. Which of the following persons is most likely to be assaulted? a. A young man b. A young woman c. An older man d. An older woman ANS: A

Men are far more likely to be assaulted or killed than are women. The greatest risk factor for an individual’s victimization by violence is age; youths are at significantly higher risk.

5. Which of the following is the most likely reason for a man to rape a woman? a. Because the woman was asking for it b. For power and control c. Provoked by the woman’s dress and behavior d. Sexual pleasure and release ANS: B

The underlying issues of rape are hostility, power, and control. Sexual desire is not an underlying issue of rape, nor is provocative dress and behavior. Rape occurs because of power and control, not because the woman is asking for it.

6. A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while

being raped? a. Confusion b. Satisfaction c. Sexual release d. Victimization ANS: D

During the act of rape, survivors are often hit, kicked, stabbed, and severely beaten. It is this violence, as well as the violation of the sense of self, that most traumatizes the person because of the fear for her life and her feelings of helplessness, lack of control, victimization, and vulnerability. Because of the violence associated with rape, it is highly unlikely that the victim will report satisfaction or sexual release. The woman may be confused about what to do next, but it is more likely that the trauma will cause feelings of helplessness which could contribute to the confusion.

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7. A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most

likely displayed? a. He has threatened harm to his school peers. b. He is between the ages 15 and 19. c. He is depressed and has a history of being sexually abused. d. He has been accused of abusing an animal.

ANS: C

Leading risk factors for suicide are depression and other mental disorders or substance-abuse disorders. Other risk factors (that are not as common as the leading risk factors) include prior suicide attempt, family history of suicide, mental disorder, substance abuse or violence, firearms in the home, incarceration, and exposure to the suicidal behavior of others (family, peers, or figures in the media). Children who threaten to harm others or who abuse an animal are more likely to hurt others than themselves.

8. Which of the following is a common factor typically found in those who abuse others? a. Fear and belief that others are “out to get them” b. Poor self-esteem and unawareness of alternatives c. Previous observations of violent behaviors to manage conflict d. Difficulty keeping commitments ANS: C

People who become involved in violence typically had previous exposure to some form of violence. Abusers were often beaten when they were children, or they witnessed siblings or one of their parents being beaten. They learned that violence is a way to manage conflict. The incorrect responses are not commonly found among those who typically abuse others.

9. A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities.

Which of the following parents in attendance would be most at risk for abusing his or her own child?

A new mother who has joined a parents’ support group A father who is overwhelmed and exhausted by overtime work A depressed father who was laid off from work and is missing his work colleagues d. A mother who is missing her career challenges and friends but enjoying being home with her baby a. b. c.

ANS: C

Parents with low social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their own children. Abusive parents often have unrealistic expectations of a child’s developmental abilities. A new mother who has joined a parents’ support group is displaying positive coping behaviors. Although a mother is missing her career challenges, she is finding enjoyment in being home with her child which displays that she has a positive emotional health. A father who is overwhelmed and exhausted is at risk for abusing his children; however, he is not displaying as many risk factors and stressors as the father who is depressed, laid off from work, and missing his colleagues.

10. A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate

neglect?

Bruises in various stages of healing Failure of parent to attend parent–teacher conferences or return teacher phone calls c. Lack of weight gain and wearing dirty clothes d. Lice in the hair a. b.

ANS: C

Physical neglect refers to failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect refers to the omission of basic nurturing, acceptance, and caring essential for health development. Lice are a common problem among schoolchildren, and the presence of lice does not indicate neglect. Failure to attend parent–teacher conferences should not be construed as neglect, because various reasons, such as employment requirements, may prevent parents who care from attending.

Bruising is a sign of physical abuse rather than neglect.

11. Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline

of a child? a. “I have stopped using a switch on my child, and I am learning to count to 10 before reacting.” b. “I never spank or hit; I yell at them to stop being stupid, and if they don’t, I tell them no one is ever going to love them if they act like that.” c. “I use time-outs when my child acts out or is naughty. Sometimes my child doesn’t cope well with this, but I am persistent.” d. “When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are.”

ANS: B

Emotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. Yelling at a child and threatening loss of love are devastating. Counting to 10 before reacting, using time-outs, and distraction all display positive methods of discipline.

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12. A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe

headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse? a. The daughter’s inability to do well in school b. Intimacy problems with the daughter’s boyfriend c. The mother’s abuse of the daughter over a long period of time d. Sexual abuse by the father ANS: D

Nurses must be aware of the incidence, signs and symptoms, and psychological and physical trauma of incest. Symptoms include headaches, as well as other physiological problems. Children often try to avoid or escape the abusive behavior. Intimacy problems with her boyfriend, abuse by the mother, and the daughter’s inability to do well in school could all be potential reasons why the daughter ran away. However, the nurse’s primary concern should be the potential for sexual abuse because of the behaviors that are being displayed by the daughter.

13. The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which

of the following should be the first action that is taken by the nurse? a. Arrange for the couple to attend marital counseling. b. Develop a plan for the wife’s escape if the violence starts again. c. Teach the client how to avoid initiating her husband’s anger. d. Work with the client on development of self-esteem.

ANS: B

Unfortunately, abuse tends to escalate in frequency and severity over time, and the man’s remorse tends to lessen. A nurse encountering severe abuse needs to consider the safety of the woman and her children as the priority. The woman will need an order of protection and help in getting to a safe place. At the very least, the woman must design a carefully thought-out plan for escape and arrange for someone to call the police if another violent episode occurs. Although marital counseling may be useful at an early stage of abuse, it is generally contraindicated at all other stages because of the risk to the woman’s safety. After first developing an escape plan, it may be beneficial for the nurse to speak with the woman more about potential triggers for the husband’s abuse as well as her own self-esteem and how that may be influencing the continuation of the relationship.

14. During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client

indicates a lack of insight into his violent behavior?

“I have been taking out my frustrations with work on my girlfriend.”

“I love my girlfriend and didn’t want to hurt her; it was an accident.”

“It might be a good idea for me to temporarily leave the house when I feel myself becoming angry.” d. “When I drink alcohol, I become more abusive toward my girlfriend.” a. b. c.

ANS: B

Violence is defined as those nonaccidental acts that result in physical or psychological injury. Although this client may now be feeling remorse, at the time the violent act was committed against the girlfriend, the intent was to inflict harm and maintain control.

It was not an accident. The incorrect statements indicate an admission of a problem—at least on the surface.

15. Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder

abuse? a. “Mom is always into something and can’t seem to stay still, so I’ve been giving her half a Valium to get her to relax so I can get some rest.” b. “Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us.” c. “She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake.” d. “We have to feed Mom baby food now because she has trouble chewing and swallowing regular food.”

ANS: A

Giving medication to induce confusion or drowsiness so that the elders will be less troublesome or will need less care is considered a form of elder abuse. Such medication may also make it easier for adult children to control the elder’s assets. The incorrect responses are all examples of proper care.

16. A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the

nurse most likely taking? a. Encouraging others to interfere when they see children hit or hurt in a public place b. Referring caregivers to community respite centers if abuse is beginning to occur c. Lobbying for passage of legislation to outlaw physical punishment in schools d. Screening each pregnant woman privately for intimate partner abuse ANS: C

Primary prevention involves action before damage has occurred. The other options are all screening for abuse or reactions to abuse that has already taken place. Encouraging others to interfere when they see children hit or hurt in a public place and referring caregivers to community respite if abuse is beginning to occur are examples of tertiary prevention because the abuse is already occurring. Screening pregnant women for intimate partner abuse is secondary prevention as it is a screening aimed at early detection of the problem.

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17. A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would

most likely have a positive effect?

Being assertive and taking control of decisions because family members cannot be expected to have this ability b. Focusing attention on family weaknesses that need to be fixed before healing can begin c. Pointing out things that victims should do differently to avoid antagonizing the abuser d. Soliciting ideas from the family regarding what they feel will improve their situation a.

ANS: D

To empower the family, the nurse needs to recognize and capitalize on the violent family’s strengths and to guide the family in recognizing and dealing with its problems. The nurse must use a nurse–family partnership rather than a paternalistic or authoritarian approach. Families often can generate many of their own solutions—in fact, the family’s own solutions tend to be more culturally suitable and individualized than those the nurse generates.

18. Which of the following best describes a principle of care that the nurse should abide by when working with abusive families? a. Confront the abuser and shame him into penitence and a desire to change. b. Demonstrate respect for all family members, including the abuser. c. Exclude the abuser from family meetings because the abuser is the one creating d.

problems.

Notify the abuser’s clergyman, boss, and others who can exert pressure for change.

ANS: B

Principles of giving care to families who are experiencing violence include the following: intolerance for violence; respect and caring for all family members; safety as the first priority; absolute honesty; and empowerment. Confrontation and exclusion would not be therapeutic techniques for the nurse to implement. Notification of others would violate HIPAA laws, as the nurse should be keeping this information confidential.

19. A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She

begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? a. Abide by the mother’s wishes because this information was provided in confidence. b. Arrange for counseling for the boyfriend at the earliest possible availability. c. Encourage the mother to take the child and find alternate housing right away. d. Report the incident to child protective services or other appropriate legal authority.

ANS: D

Nurses are mandatory reporters of child abuse, even when only suspected, in all states. The incorrect options put the child’s welfare at risk, including encouraging the mother to seek alternatives, since encouraging an action will not ensure that it will happen.

MULTIPLE RESPONSE 1. Which of the following factors may lead to increased violence? (Select all that apply.) a. Minimal social support b. Feelings of powerlessness c. Violence shown in the media d. Living in a crowded environment e. A history of depression ANS: A, B, C, D

Factors that increase violence include seeing violence in daily life or in the media, living in poverty with few opportunities for employment, and feelings of powerlessness. Crowded environments can be a factor but can also lead to banding together for the common good. While social support is a positive factor, an insufficient amount may lead to increased violence. Depression is not necessarily a trigger for violence.

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Chapter 28: Nursing Practice at the Local, State, and National Levels in Public Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following is the underlying science or area of study on which public health is based? a. Biostatistics b. Epidemiology c. Medicine d. Social sciences ANS: B

It works across many disciplines and is based on the scientific core of epidemiology. Public health uses biostatistics in its practice.

It is not a branch of medicine; it is an organized community approach designed to prevent disease, promote health, and protect populations. Public health is not based on the social sciences, which is the study of society and relationships.

2. A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his or her

practice?

Decisions are made at the federal level, disseminated at the state level, and carried out at the community level. b. Health of populations is only as good as the health of individuals that live and work in the community. c. Oversight of community health departments is the most important function. d. The interaction of the local-state-federal partnership is critical to success. a.

ANS: D

In the United States, the local-state-federal partnership includes federal agencies, the state and territorial public health agencies, and the local public health agencies. Their effective interaction is critical to the effective use of both financial and personnel resources to address the health of populations. Nurses working in all of these agencies work together to identify, develop, and implement interventions that will improve and maintain the nation’s health. Decisions can be made and implemented at the federal, state, and local levels. The health of individuals and populations is influenced by the health policies that are in place. The state agency may provide some oversight of local health departments, but that is not its primary purpose.

3. The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an

applicant would most likely result in the applicant not being hired? a. “I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress.” b. “I prefer to work in teams because no single person has too much responsibility because the burden is shared.” c. “Teamwork is better than work done by individuals because teamwork incorporates different perspectives.” d. “Whether teamwork is better than work done by individuals depends on the nature of the work being performed.”

ANS: A

An applicant who does not like to work in and with teams would not be appropriate to fill this position. Teamwork is a necessary skill when working as a public health nurse. Working in collaborative partnerships is an essential role of public health nursing.

Partnerships and collaboration among groups are much more powerful in making change than the individual client and nurse working alone. Part of the reason is that multiple perspectives are examined in the process of coming to the best solution.

4. Which of the following federal agencies is most influential in public health activities? a. The Agency for Healthcare, Research, and Quality b. Centers for Disease Control and Prevention c. Department of Health and Human Services d. Food and Drug Administration ANS: C

The US Department of Health and Human Services (USDHHS) and the Environmental Protection Agency (EPA) are the federal agencies that most influence public health activities at the state and local levels. The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration are all pieces of the broader USDHHS. 5. Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and

ordinances and providing essential public health programs to a community?

Community health clinics Federal health agencies Local health agencies State health agencies

a. b. c. d.

ANS: C

Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public’s health; they do not provide essential public health programs to the community. Federal health agencies develop regulations that implement policies formulated

by Congress. Community health clinics may provide essential public health programs to the community but are not responsible for implementing and enforcing local, state, and federal public health codes and ordinances.

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6. A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which

of the following roles is the nurse preforming?

Advocate Case manager Outreach worker Primary caregiver

a. b. c. d.

ANS: A

As an advocate, the nurse collects, monitors, and analyzes data and discusses with the client which services are needed and whether the client is an individual, a family, or a group. When using the role of case manager, the nurse assists in providing equal access to health care by identifying and alerting the community to gaps in services available. As an outreach worker, the nurse addresses the multiple needs of high-risk populations. Nurses provide direct client care when using the role of primary caregiver.

7. Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years? a. Advances in hospital care and procedures b. Advances in medicine and medical research c. Advances in nursing practice d. Advances in public health ANS: D

A person born today can expect to live 30 years longer than someone born in 1900. Medical care accounts for 5 years of that increase, but public health is responsible for the additional 25 years, through prevention efforts brought about by changes in social policies, community actions, and individual and group behavior changes. Advances in medical care only accounts for 5 of the additional 30 years that longevity has increased. Hospital and nursing care are not specifically noted when discussing the increase in life span.

8. Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early 20th

century?

PHNs contributed without receiving any salary for doing so.

PHNs created new settings where health care could be given.

PHNs gave care to powerless groups.

PHNs worked outside any organized health care system.

a. b. c. d.

ANS: C

During this period, public health nurses worked with populations and in settings that were not of interest to other health care disciplines or groups. Much public health service was delivered to the poor and to women and children, who did not have political power or voice. Public health nurses were employed by agencies and received pay for the work that they did. In the early 20th century, new settings where health care could be delivered were not developed. Public health nurses worked with a variety of partners to begin to include reproductive health, chronic disease prevention, and injury prevention activities.

9. Which of the following best describes the role of nursing in community health? a. Application of nursing and public health theory in promoting, preserving, and b. c. d.

maintaining health of individuals, families, or communities Health care provision offered in primary and secondary institutions or in the client’s home Provision of health care services in institutions located in the community but outside the hospital Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement

ANS: A

Nursing practice in community health is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups.

The focus of practice is health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole. Healthy People 2020 addresses the role of multiple disciplines in improving the health of the population; thus, it does not use the nursing process or is specific for the nursing profession.

10. A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant organisms. Which of

the following actions would be most appropriate for the nurse to implement? a. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. b. Notify the Centers for Disease Control regarding any unusual signs and symptoms related to a communicable illness. c. Reinforce the importance of receiving vaccinations according to recommended schedules. d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections.

ANS: D

The widespread, often inappropriate, use of antimicrobial drugs has resulted in loss of effectiveness for some infections. Clients and health care providers are responsible for the inappropriate use of antibiotics. The nurse can influence this trend by objecting to inappropriate use of antibiotics by providers and by educating individuals, families, health care providers, and the community about the dangers of misuse and overuse of antibiotics. Lobbying for increased use of antibiotics would not assist in decreasing the number of drug-resistant organisms. Notifying the Centers for Disease Control or increasing the percentage of children who are vaccinated will not affect the increased development of drug-resistant organisms.

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11. A nurse is applying for a public health nurse position at a local health department. Which of the following minimum levels of

educational preparation should the nurse have obtained?

Associate degree in nursing Baccalaureate degree in nursing Master of science degree in nursing Training as a licensed practical nurse

a. b. c. d.

ANS: B

Educational preparation of nurses in community health should be at least a baccalaureate degree. Nurses need this level of education because of the increasing complexity of better care delivery in public health. A licensed practice nurse would need supervision for a registered nurse and would not be able to practice autonomously in this setting. Those registered nurses who have associate degrees are encouraged to seek further degrees because of the increasing complexity of better care delivery in public health. A master’s degree would be even more useful, but for many, advanced education may not be feasible.

12. Which of the following should be the focus for programming in the community related to communicable diseases proposed by

Healthy People 2030?

Encouraging community members to engage in healthy behaviors Identifying high-risk sexual behaviors among community members Monitoring the sexual activity of adolescents Providing information about the hazards of multiple sexual partners

a. b. c. d.

ANS: D

Healthy People 2030 lists communicable disease as an area of focus including levels of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the public health nurse providing information on the hazards of multiple sexual partners and street drug use. Encouraging “healthy behaviors” is not specific to the prevention of communicable diseases. Monitoring the sexual activity of adolescents only addresses one segment of the population, and monitoring does not provide an active intervention for the nurse to complete to influence the problem. Identification of high-risk behaviors is part of the assessment of the community and may assist the nurse in knowing what programs to develop, but this would not assist in decreasing the rates of communicable disease.

13. Which of the following is a core competency required of public health nurses? a. Knowledge in the use of high-technology diagnostics b. Knowledge of the implementation of electronic medical records c. Skill in the physical assessment of complex clients d. Skill in developing policy and planning programs ANS: D

The core public health competencies are divided into the following eight domains: (1) analytic assessment skills; (2) basic public health sciences skills; (3) cultural competency skills; (4) communication skills; (5) community dimensions of practice skills; (6) financial planning and management skills; (7) leadership and systems thinking skills; (8) policy development/program planning skills. The incorrect competencies are better suited for tertiary facilities such as hospitals.

14. Which of the following factors is causing nursing to change so quickly? a. Economic issues b. Increases in medical and nursing knowledge c. Legislative issues d. Technology changes ANS: A

More than any other single factor, the driving force behind nursing changes is the economy and the increase in managed care to decrease or control health care costs in the United States. Changes in technology and knowledge are not influencing the rapid change in nursing knowledge. Legislative issues are not influencing nursing practice.

15. A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following

actions is the nurse most likely taking?

Identifying and treating clients in a sexually transmitted disease clinic Partnering with schoolteachers to teach and observe handwashing techniques in elementary school children c. Providing case management services that link clients with communicable diseases to health care and community support services d. Performing directly observed therapy (DOT) for clients with active tuberculosis a. b.

ANS: B

An example of primary prevention is to educate day care centers, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases. The goal of primary prevention is to prevent the disease from occurring. Identifying and treating clients are part of secondary prevention, as screening is being completed to determine at the earliest stage possible who has the disease. Providing case management services for those with communicable disease and performing DOT therapy with clients are both examples of tertiary prevention as the populations that the nurse is working with both already have the disease. Through tertiary prevention, the nurse is working to restore their health to the highest level possible.

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16. A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the

following levels of prevention is being implemented?

Primary prevention Secondary prevention Tertiary prevention Secondary and tertiary preventions

a. b. c. d.

ANS: B

Tracing individuals exposed to a client with a sexually transmitted disease is secondary prevention because the nurse is attempting to find those exposed and screen them. Once the exposed persons have been located, screening is another secondary prevention activity. Through tertiary prevention, the nurse is working to restore their health to the highest level possible. If the nurse were to provide direct care to the clients with sexually transmitted diseases, this would be an example of tertiary prevention. The goal of primary prevention is to prevent the disease from occurring. Thus, when providing primary prevention, the nurse could provide free condoms for sexually active persons or provide education about ways to prevent the transmission of these diseases.

17. A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most

likely being completed? a. Disseminating information about mental health to community organizations b. Partnering with school health nurses for early identification of children who have evidence of mental health problems c. Providing case management services that link clients with serious mental illnesses to mental health and community support services d. Screening high-risk clients for the presence of mental disorders ANS: C

An example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services. Tertiary prevention aims to restore those with the disease to the highest level of functioning possible. Disseminating information about mental health is an example of primary prevention as the nurse is aiming to prevent a problem before it occurs. Partnering for early identification of children and screening high-risk clients are examples of secondary prevention. Secondary prevention occurs when the nurse conducts screenings and tries to identify diseases at the earliest possible stage.

18. A nurse is working at a local health department. Which of the following would most likely be completed by this agency? a. Enforcement of laws and regulations related to public health nationwide b. Provide leadership in planning community health screenings c. Providing experts in various specialties to answer questions and respond as d.

needed Surveying the state’s public health needs

ANS: B

Local public health agencies provide and disseminate health information, provide leadership in health planning, provide essential public health and environmental services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community. Enforcing laws and regulations related to public health nationwide, providing experts in various specialties, and surveying the state’s public health needs would all occur at the state level.

MULTIPLE RESPONSE 1. A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this

agency? (Select all that apply.) a. Delegating power to engage in certain activities such as quarantine b. Enforcing laws and regulations that protect public health c. Filing birth and death certificates whenever these occur within the state d. Monitoring health status of citizens within its geographic boundaries e. Fund and conduct a school eye screening ANS: A, B, D, E

State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public’s health. These agencies receive funding from federal agencies for the implementation of public health interventions such as the maternal and child health programs. State agencies distribute federal and state funds to the local public health agencies to implement programs and provide oversight and consultation for local public health agencies. State health agencies also delegate some public health powers, such as the power to quarantine, to local health officers. Local departments file birth and death certificates and often ask for volunteers to assist.

2. Which of the following activities are addressed by most public health departments on the federal, state, and local levels? (Select all

that apply.) a. Collecting and analyzing various health statistics b. Fining any facility that engages in unsafe commercial practices c. Identifying and planning for high-risk populations d. Planning for and responding to emergencies e. Providing health assessments to older adults after a hurricane ANS: A, C, D, E

The majority of local, state, and federal public health agencies engage in collecting and analyzing vital statistics, providing health education and information, receiving reports about and investigating and controlling communicable diseases, protecting the environment to reduce the risk to health, providing some health services to particular populations at risk, planning for and responding to natural and human-made disasters and emergencies, identifying public health problems for at-risk and high-risk populations, conducting community assessments to identify community assets and gaps, and partnering with other organizations to develop and implement responses to identified public health concerns. Public health departments do not regulate the practices of businesses; thus, they would not be responsible for fining or terminating businesses.

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3. What did events after September 11, 2001, clearly demonstrate? (Select all that apply.) a. A strong public health structure ready to respond effectively to a crisis b. Public health’s need for additional funding and resources c. The unrecognized importance of nurses in lowering health care costs d. Lack of adequate vaccines to meet community’s needs e. The need for public education regarding bioterrorism attacks ANS: B, C, D, E

The anthrax exposures after 9/11 alerted policymakers to the weakening public health infrastructure required to respond to bioterrorism events. Unprecedented influenza, tetanus, and childhood vaccine shortages and emerging infections competed with bioterrorism activities for resources. The general public was not informed about how immunizations by nurses improved health and lowered health care cost. For public health services to receive adequate funding, it is necessary for the public and the government to be aware of the benefits provided to a community by nurses. These events showed that the public health system needed to be strengthened in order to operate effectively to keep the public safe.

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Chapter 29: The Faith Community Nurse Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following best describes the primary difference between parish nursing and all other nursing positions? a. Affiliation with a church or congregation b. Incorporation of spiritual aspects into nursing care c. Provision of holistic nursing care d. Residence within the community of service ANS: A

In 1998, the American Nurses Association accepted parish nursing as the most recognized term for the practice of nurses working with congregations or faith communities. All nurses may choose to incorporate spiritual aspects into holistic nursing care.

2. To help congregation members better meet their nutritional needs, the parish nurse organized members to participate in activities

that focused on fellowship while providing healthy meals to homebound members and serving “healthy heart” church suppers.

Which of the following activities is being completed? a. Holistic care b. Health ministries c. Partnerships d. Pastoral care practices ANS: B

Health ministries are those activities and programs in faith communities organized around health and healing to promote wholeness in health across the life span. These services include activities such as visiting the homebound, providing meals for families in crisis or when returning home after hospitalization, organizing prayer circles, serving “healthy heart” church suppers, and holding regular grief support groups. Holistic care is concerned with the relationship of body, mind, and spirit in a constantly changing environment. Providing a healthy meal does not address these multiple components. Partnerships may be among individuals, groups, and health care professionals within the congregation. It may involve partnerships to provide these meals; however, the focus is on the overall health ministry provided by this activity, not the partnerships which may be necessary to develop the program. Pastoral care practices involve stressing the spiritual dimension of nursing, lending support during times of joy and sorrow, guiding the person through health and illness throughout life, and helping identify the spiritual strengths that assist in coping with particular events. These practices related to pastoral care are not provided through this meal.

3. Which of the following best describes why it is helpful to be a member of a faith community? a. Belief and traditions help with coping. b. Members can ask others in the group for help. c. It is a social outlet. d. Members are able to get others to contribute to the causes they support.

ANS: A

Persons who encounter assaults with physical and emotional illness and brokenness and who are able to call upon their faith beliefs and religious traditions are able to increase coping skills and realize spiritual growth even during adversity. Family communities do allow for a social outlet, asking others for help, and getting others to contribute to causes the support. However, the common connect of faith and traditions is what connects the members together and allows them to accomplish these other things.

4. Which of the following principles is central to the role of the parish nurse? a. Advanced nursing practice education and skills b. Faith consistent with the community and its leadership c. Spiritual dimension of care d. Willingness to serve anyone in need ANS: C

The spiritual dimension of health care is central to the practice of parish nursing. Advanced nursing practice education and skills, although helpful, is not necessary for a nurse to become a parish nurse. Having a faith that is consistent with those who the nurse is working with is helpful, but not essential to the role of the parish nurse. Willingness to serve others is not specific to the role of the parish nurse, but rather a role that all nurses should embrace.

5. A young woman had been away from home several years before she returned home sick and disheartened. Her mother called a

nurse to help. Which of the following behaviors would suggest that the caregiver who arrived was a parish nurse? a. Advanced nursing practice education and skills b. Compassionate, skilled, dedicated touch c. Offered a prayer with the daughter and mother d. Willingness to do whatever was needed by mother or daughter ANS: C

The spiritual dimension of health care is central to the practice of parish nursing. Both nursing functions and pastoral care functions are performed by parish nurses, whose visits often involve prayer and reference to scripture, symbols, sacraments, and liturgy of the faith community. Advanced nursing practice is not required for a parish nurse, so this would not suggest that the nurse was a parish nurse. All nurses should demonstrate compassionate, skilled, and dedicated touch; thus, this would not be specific to the role of the parish nurse. Nurses should be willing to complete tasks that are within the scope of their practice, and this does not specifically describe what that scope of practice would be for a parish nurse.

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6. Which of the following statements best describes how clients and parish nurses typically perceive spiritual health? a. It exists at the point that cure is attained. b. It has a tangential relation to well-being. c. It is part of an ongoing dynamic process. d. It is usually unchanging across the life span.

ANS: C

Health, spiritual health, and healing are considered parts of an ongoing, dynamic process. Because spiritual health is central to well-being, influences are evident in the total individual and noted in a healthy congregation. Well-being and illness may occur simultaneously; spiritual healing or well-being can exist in the absence of cure. Spiritual health and its definition is an ongoing and dynamic process; thus, it changes across the life span.

7. Which of the following statements suggests that faith community nursing is a nationally recognized specialty of nursing? a. Academic programs now offer a clinical specialty in parish nursing. b. Faith community nurses are increasingly receiving salaries for their efforts. c. Faith community nursing is being adapted in other countries and to non-Christian d.

faiths.

Scope and standards of faith community practice have been developed and revised.

ANS: D

The 2005 Faith Community Nursing: Scope and Standards of Practice revised the original 1998 document in describing the who, what, where, when, why, and how of the practice of faith community nursing. Specialty areas within professional nursing achieve a major milestone when the standards and scope common to that practice are recognized. Academic programs do not offer a clinical specialty in parish nursing; however, there may be ways to obtain specialty certification in the practice after becoming a registered nurse. Many faith community nurses work as volunteers. The majority of parish nurses are found in Protestant congregations, but they can be found around the world and in other faiths; however, there is nothing to suggest that the practice needs to be adapted when working with these other populations.

8. A group of parish nurses affiliated with a number of faith-based communities located in different regions across the state are

attending a quarterly meeting. Which of the following statements made by one of them indicates a lack of understanding of parish nursing? a. “I always make sure to have new clients sign a release of information form to obtain their health record from their previous parish nurse.” b. “Because I work for and within the church, I am immune from civil laws.” c. “The pastor and I work together for the spiritual health of the community.” d. “Yes, I am happy to pray with my clients and help them worship.”

ANS: B

A nurse stating immunity to civil laws does not understand the role of the parish nurse. Parish nurses must abide by all of the parameters of the nurse practice act of the state just as other registered nurses. The nurse must personally and professionally abide by the parameters of the nurse practice act of the jurisdiction and maintain an active license of that state.

9. A nurse is considering accepting the parish nursing position within their congregation. Which of the following educational

preparation is crucial for the nurse to have received?

Baccalaureate education including community health nursing experience Graduate education in community health nursing Passing the national certifying examination for parish health nursing Worship experiences for the process of ministry

a. b. c. d.

ANS: A

Current educational preparation for the parish nurse includes the successful completion of extensive continuing education contact hours or designated coursework in parish nurse preparation at the baccalaureate or graduate level, as well as a thorough grasp of the scope and standards of the practice. These basic programs provide an orientation to the role and functions of the parish nurse, as well as worship experiences for the process of ministry. Graduate education is not necessary to be employed as a parish nurse. A national certification examination for parish health nurses does not exist at this time. The parish nurse must be a member of the faith community and be comfortable with worship practices and traditions to function; however, the main function of the parish nurse is not ministry.

10. A family shared their concerns, including sexual issues, in strictest confidence with a faith community nurse. When the nurse

returned to the church office, the pastor asked why the family wanted to see the nurse. Which of the following statements would be the best response by the nurse? a. “Because you are my supervisor, I will summarize what was said for you.” b. “I will include that information in my report to our church’s wellness committee.” c. “They just wanted me to assess their health needs and make some suggestions.” d. “The family had some issues they wanted to discuss in confidence, which I will keep in confidence.”

ANS: D

Issues of privacy and confidentiality as well as record management should be discussed upon accepting a position. Regardless, if the nurse agreed to keep the information confidential, the nurse is morally obligated to do so. If the practice is to share all information with the pastor, then the family must be told this before they choose to share any information with the nurse. In order to keep this information confidential, the nurse should not disclose to the pastor that the nurse spoke with them about their health needs, as this may lead to further questions by the pastor. Additionally, because of confidentiality, the nurse would not share this information with the church’s wellness committee.

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11. A father confides to the parish nurse that his wife has been hurting their 3-year-old daughter. The nurse examines the daughter and

finds evidence of physical abuse. In the parish nurse role, which of the following actions should the nurse take first?

Contact the pastor for guidance in handling this situation.

Recommend that the family be removed from the faith community.

Refer the family to pastoral services for counseling.

Report the findings to child protective services.

a. b. c. d.

ANS: D

As an advocate of client and group rights, the nurse identifies and reports neglect, abuse, and illegal behaviors to the appropriate legal sources. This is necessary regardless of the feelings of the pastor or the father because the nurse is bound legally to report abuse to a child, confirmed or suspected. Referral for counseling is appropriate; however, the child’s present state of well-being is paramount. Parish nurses must obey the nurse practice act and laws of the state. The nurse should not need to contact the pastor, as it is within the scope of nursing practice to report suspected abuse.

12. A faith community nurse is partnering with a local public health department to develop programs for primary, secondary, and

tertiary prevention activities. Which of the following should be used as the primary guide for development?

Contemporary articles in nursing journals Evidence-based practice guidelines for treatment of disease Healthy People 2030 goals and objectives Preferences of partners who are funding the programs

a. b. c. d.

ANS: C

Healthy People 2030 guidelines are basic to the planning of health care. Contemporary nursing articles may be limited in scope and it may be very time consuming for the nurse to search multiple articles to find examples of these various levels of prevention.

Evidence-based practice is for treatment, not for program development. Preferences of partners should not be used as the primary guide for development, rather after reviewing Healthy People 2030, the nurse may want to decide on which community partners would be appropriate for program development.

13. A parish nurse is evaluating health programs that provide holistic care across the life span. Which of the following methods would

be the most appropriate approach?

Bringing families together to plan programs to meet the needs of individuals Establishing a wellness committee to assist in the evaluation process Matching financial resources with program objectives and goals Revisiting assessment data to be certain that planning reflects actual problems observed

a. b. c. d.

ANS: B

The nurse and members of the congregation assess, plan, implement, and evaluate programs. The process of providing holistic care is enhanced by an active wellness committee or health cabinet. These incorrect options deal with factors other than program evaluation.

14. Which of the following statements by a parish nurse exhibits a lack of understanding of the concept of pastoral care? a. “By working with my clients to help them identify their spiritual strengths, I am b. c. d.

drawing on pastoral care aspects of practice.”

“To incorporate pastoral care, I should involve the pastor in ministering to the members of the congregation.”

“I use pastoral care when I emphasize the spiritual dimension of nursing when providing care.”

“When I lend support to my clients during times of joy, as well as during their times of sorrow, it illustrates an important aspect of pastoral care.”

ANS: B

Pastoral care is a service ministry formalized by a church or faith community, not necessarily involving the pastor. The nurse fulfills the role of pastoral care through stressing the spiritual dimension of nursing, lending support during times of joy and sorrow, guiding the person through health and illness throughout life, and helping identify the spiritual strengths that assist in coping with particular events.

15. A parish nurse is using the institution-based model to plan care for a client with a chronic illness. Which of the following activities

would the nurse most likely implement?

Bringing in family members to work with the client and nurse in decision making Partnering with outlying health care centers for coordinating optimal care Pulling from the collective strengths of faith-based community members for social support for the client d. Relying on congregational prayer as a component of healing a. b. c.

ANS: B

The institution-based model includes greater collaboration and partnerships. The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions. Thus, based on the institution-based model, partnering with outlying health care centers is appropriate. The other options are better examples of the nurse implementing the congregation-based model. In this practice, the nurse usually practices autonomously and is accountable to the congregation and its governing body. There are not specific partnerships in this model.

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16. A nurse would like to maximize autonomy in their parish nursing practice. Which of the following models would most likely be

preferred by the nurse?

Congregation-based model Institution-based model Teamwork model Partnership model

a. b. c. d.

ANS: A

In the congregation-based model, the nurse is usually autonomous. The development of a parish nurse/health ministry program arises from the individual community of faith. The nurse is accountable to the congregation and its governing body. The institution-based model includes greater collaboration and partnerships. The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions. The teamwork and partnership models are not models of parish nursing.

17. A parish nurse organizes the annual health fair for the congregation, inviting community agencies to attend the event and display

the health resources that are available in the community. What function of the parish nurse is being demonstrated?

Health advocate Referral agent Health educator Coordinator of volunteers

a. b. c. d.

ANS: D

As the coordinator of volunteers, the parish nurse recruits, trains, and supervises volunteers to expand ministry and outreach; organizes a health ministry team to guide and direct faith and health initiatives; and utilizes the gifts and talents of congregation and community members. As a health advocate, the parish nurse empowers congregation members to obtain needed health care services. Using the function of referral agent, the parish nurse provides information for referrals to appropriate agencies and services. As a health educator, the parish nurse focuses on the teaching role of the nurse; organizing a health fair enables others to complete that health teaching, not the parish nurse.

18. A parish nurse is implementing a primary prevention measure related to obesity among the school-age members of the church.

Which of the following activities is most likely being used by the nurse? a. Establishing a walking program that is sufficiently challenging yet not too strenuous for those who are obese b. Partnering with youth camp cooks to ensure that food is nutritious c. Supervising height and weight measurements taken by clinic assistants d. Working with parents of obese children to implement family lifestyle changes ANS: B

An example of primary prevention is encouraging healthy snacks and meals for youth outings and at educational hour and parenting sessions. The incorrect options all deal with secondary prevention activities, which are focused on decreasing obesity.

MULTIPLE RESPONSE 1. The parish nurse is working with the wellness committee to develop health programming for the congregation. Which of the

following activities would the nurse most likely include? (Select all that apply.) a. Provide regular blood pressure screening for members of the congregation. b. Create a bulletin board to display information about the signs and symptoms of stroke. c. Implement a program to speak with adolescents about stress management. d. Research evidence-based approaches for chronic wound healing. e. Provide healthy recipes for holiday baking.

ANS: A, B, C, E

As a member of the wellness committee, the parish nurse is concerned with reducing the risk of development of disease or disorder among all of the members of the congregation. Thus, implementing strategies that are related to health promotion would be appropriate for the nurse to implement. These would include blood pressure screenings, creation of bulletin board about stroke, healthy eating-related information, and implementation of stress management program for adolescents. Researching evidence-based guidelines for chronic wound healing would not address health promotion strategies within the congregation. Also, it is unlikely that the parish nurse is providing direct care services, such as caring for chronic wounds, for members of the congregation.

2. A parish nurse has been using pastoral activities when providing care to clients. Which of the following interventions is the nurse

most likely using? (Select all that apply.)

Helping families plan healthy nutritious meals and get plenty of rest Giving health education classes to the congregation Using hymns and scripture as a source of guidance and comfort Helping identify spiritual strengths that may assist in coping Visiting home-bound parishioners

a. b. c. d. e.

ANS: C, D, E

When the nurse fulfills pastoral care, the nurse stresses the spiritual dimension, lends support during times of joy and sorrow, guides the person through health and illness, and helps identify the spiritual strengths that assist in coping with particular events.

The incorrect responses represent nursing functions, not functions of pastoral care.

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Chapter 30: The Nurse in Public Health, Home Health, Palliative Care, and Hospice Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following statements best describes the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client’s environment. c. Reimbursement for home health care varies from that of care provided in d.

institutions.

The focus of acute client care is on community health.

ANS: B

Home health differs from other areas of health care in that health care providers practice in the client’s environment. All nurses give individualized care to clients. Reimbursement for home health care is different than that provided in an acute care setting; however, this is not the most essential difference. The focus of acute client care is typically on care provided in a hospital setting, not in the community.

2. A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid

to come to the clinic to receive health care. Which of the following best describes this type of nursing? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing ANS: B

Home health nursing is provided in the client’s environment, regardless of where that may be. “Home” may be a house, apartment, trailer, boarding house, shelter, car, makeshift shelter under a bridge, or cardboard box. Community-oriented nursing refers to any care that is provided in a community setting. Hospice nursing is care that is provided to a client and his or her family who has a terminal illness. Private duty nursing is care that is primary care that is paid for by an individual who is requesting the care.

3. A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital.

Which of the following is the best explanation for this? a. Home care assessment includes not only the client but also the supplies and equipment the family may have available for use. b. The home environment is less organized and equipped for the nurse’s use. c. Family members must also be assessed for possible problems that could interfere with the primary client’s recovery. d. To be effective, the home health nurse must earn the family’s trust and work in partnership with them.

ANS: D

The primary reason that assessment may take longer for the home health nurse is because when working in a client’s home, the nurse is a guest. To be effective, the nurse must earn the trust of the family and establish a partnership with client and family. The home care assessment includes many aspects which are broader in scope than only the client, supplies, and equipment. The home environment varies and may or may not be organized for the nurses’ use. The primary focus of home care is the care of the individual, not the care of other family members.

4. Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for

extensive documentation? a. Advances in medical technology and pharmacology b. Increased number of lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s ANS: C

The combination of preventive services and illness care followed the introduction of Medicare in 1966. The Medicare program emphasized care for more acutely ill people rather than illness prevention and health promotion. Medicare was a provision of the Social Security Act that was implemented in 1965. It was not part of the original legislation of the 1930s. There have not been an increased number of lawsuits based on substandard care. Advances in medical technology have been available to the population to extend their longevity, but this has not changed the need for homecare or extensive documentation.

5. In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to

remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care ANS: B

Population-focused home care is directed toward the needs of specific groups of people, including those with high-risk health needs such as mental health problems, cardiovascular disease, or diabetes; families with infants or young children; and older adults. Such care commonly includes structured regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching. Home-based primary care emphasizes delivering primary care in the homes of people who have difficulty going to a primary care clinic because of functional or other health problems. Proprietary agencies are ones that are profit making; it does not describe the care model that is being implemented. Transitional care programs are designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another.

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6. A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident.

Which of the following types of care will the client most likely receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care ANS: D

Transitional care programs in the home are designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another. Assessing, planning, teaching, making referrals, and following up on referrals foster independence and self-care. Besides intensive teaching about self-care, telephone calls help ensure that the client understands and is able to implement instruction. Home-based primary care emphasizes delivering primary care in the homes of people who have difficulty going to a primary care clinic because of functional or other health problems. Population-focused home care is directed toward the needs of specific groups of people, including those with high-risk health needs such as mental health problems, cardiovascular disease, or diabetes; families with infants or young children; and older adults. Proprietary agencies are ones that are profit making; it does not describe the care model that is being implemented.

7. Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies ANS: C

Official or public agencies include those agencies operated by the state, county, city, or other local government units, such as health departments. Nurses employed in these settings provide well-child clinics, immunizations, health education programs, and home visits for preventive health care. Consequently, they include a focus on health promotion and illness prevention as well as giving direct care. The merging of official and voluntary home health agencies has led to the development of combination agencies. One of the main purposes of hospital-based agencies is to provide for the continuity of care from the acute to the home care setting as all care is provided by the same organization. Proprietary agencies are home care agencies that are for profit.

8. Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two b. c. d.

boards of experts.

Continuity of care is enhanced.

Health promotion and illness prevention concerns take precedence over acute care and rehabilitation.

They are eligible for tax exemptions through affiliated agencies.

ANS: B

Hospital-based agencies emerged in response to the recognized need for continuity of care from the acute care setting. Having two boards of experts relates to care that is provided by a combination agency (combining an official and voluntary agency). Health promotion and illness prevention are typically the focus of official agencies. Non-proprietary agencies are eligible for tax exemptions because they do not make a profit.

9. Which of the following is the primary focus of hospice care? a. Curing or controlling the client’s chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves ANS: C

The primary goal of hospice care is to help maintain the client’s dignity and comfort. Alleviating pain: encouraging the client, family, and friends to communicate with each other about essential sensitive issues and coordinating care to ensure a comfortable, peaceful death all contribute to palliative care. Curing the disease is not part of hospice care; patients who have begun hospice care are no longer seeking a cure for their disease or illness. Hospice care focuses on providing safe and effective care so that the client is able to maintain dignity and comfort during the dying process; it does not relate to decreasing the use of hospital resources. The purpose of hospice care is not to teach self-care.

10. Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her

family than to meet the needs of a dying adult? a. Children don’t understand what it means to die. b. A child’s death is harder for anyone to accept. c. Society does not expect death to occur in children. d. Families are not prepared to deal with death.

ANS: C

The needs of the dying child and family are unique because society does not expect death to occur to the young or to have the child die before the parent. Because society does not expect death to occur in children, death among children is not discussed. Thus, families are then unprepared to deal with the death; it becomes harder to cope with because it is a subject that is not openly discussed. It is true that children have a limited understanding of dying; however, this can be related back to society’s view on death in children as well as the growth and development stage of the child.

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11. When meeting with a client and family, the home health nurse says, “We have discussed your health problems and limitations. Now

tell me what level of health and function you hope to achieve.” In which of the following phases of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning ANS: C

By steering the conversation toward goals, the nurse is now able to work with the client to mutually identify outcomes. When discussing health problems and limitations, the nurse was gathering a history as part of the assessment phase. This allowed formulation of a nursing diagnosis. The planning would occur after the outcomes have been identified so that a plan can be established as to how the outcomes will be met.

12. A home health nurse asks a client diagnosed with arthritis to attend a demonstration in which an assistive device is used to put on

shoes. Which phase of the nursing process is the nurse’s current focus?

Outcome identification Planning Implementation Evaluation

a. b. c. d.

ANS: C

Implementation is the phase in which the home health nurse implements the interventions identified in the plan of care. When the nurse discusses the development of goals with the client, they are identifying outcomes. The planning phase occurs after outcomes have been identified, as a plan to reach those outcomes is created. If the client is able to use the device, the process can progress to evaluation, in which the nurse will assess the usefulness of the device when incorporated into the client’s activities of daily living.

13. A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the

best approach for the nurse to take? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

ANS: C

Because home health care is often intermittent, and because a reliance on others is not always possible over the long term, a primary objective for the nurse is to facilitate self-care so that clients may remain in their home. This allows clients to have some control over their life and can help prevent hopelessness and a loss of self-esteem. Although assistance may be needed, such as from a private duty nurse, the home care nurse, or family members, this assistance should come after helping clients to help themselves.

14. Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC & NOC c. Nursing Diagnosis Taxonomy d. The Omaha System ANS: D

Although all four are recognized nursing taxonomies, in community health, especially home nursing, the Omaha System is typically used. This system was developed by a visiting nurses’ association in Omaha and based on home nursing documentation needs. The Omaha System is most relevant to home health nursing and is most typically used by home health nurses. NANDA is a standardized nursing language, but it is not known for its usage specific to the home health setting. NIC & NOC are standardized languages for the development of interventions and outcomes for clients but are not well known for being used in the home care setting. The Nursing Diagnosis Taxonomy refers to the use of nursing diagnoses.

15. Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associate degree in nursing and RN licensure d. Eligibility for certification as a home health nurse ANS: B

A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting. The baccalaureate degree should be in nursing, not in a health-related field. Additional education, beyond an associate degree, is necessary for a home health nurse. Certification as a home care nurse is not available until after working in this setting, so this would not be an option.

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16. A nurse orienting to the home health role states, “I don’t understand why we have to collaborate with so many other disciplines;

this conflicts with the concept of nurses providing all direct care to the client in the home?” Which of the following would be the best response? a. The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care. b. Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible. c. Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base. d. Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration.

ANS: A

The responsibilities and functions of other health professions in home care are dictated by Medicare regulations, professional organizations, and state licensing boards. Many of these services can be provided on a consulting basis. The plan of care should be implemented and reinforced by all involved disciplines. Therefore, interdisciplinary collaboration is required in the home health setting. Interdisciplinary collaboration does not conflict with the concept of providing direct care services. Direct ca re refers to the actual physical aspects of nursing care anything requiring physical contact and face-to-face interactions. In home care, direct care activities include performing a physical assessment on the client, changing a dressing on a wound, giving medication by injection, inserting an indwelling catheter, or providing intravenous therapy. Direct care also involves teaching clients and famil y caregivers how to perform a certain procedure or task.

17. A nurse completes a self-assessment of performance as part of the home health nurse’s annual evaluation. Which of the following

terms best describes this activity? a. Collaboration b. Quality of care c. Performance appraisal d. Resource utilization ANS: C

As part of a performance appraisal, the home health nurse evaluates his or her own nursing practice in relation to professional practice standards, scientific evidence, and relevant statutes, rules, and regulations. Collaboration means working with others to achieve a common goal; completing a self-assessment does not require collaboration. Using the Standards of Care is a way that the nurse can provide quality care, but a self-assessment does not guarantee that quality care is being provided. Resource utilization refers to using a variety of resources effectively to provide safe and quality care; this is not demonstrated by completing a self-assessment.

18. Which of the following best describes when the home health nurse must document required Outcome and Assessment Information

Set (OASIS-C2) data?

Before any episode of hospitalization After each home health visit For all incidences of error or mistake in care On first admission to home health care

a. b. c. d.

ANS: D

OASIS-C2 data are measured and reported to CMS (1) on admission to home health care, (2) after an episode of hospitalization, (3) at the time of recertification, and (4) on discharge from care or death at home. Data are submitted by each agency to a national databank, and agencies receive both results and comparisons with similar agencies to determine areas needing improvement. The data reported from OASIS determine the payment received by the home health agency for the client’s total episode of care.

OASIS-C2 data are measured and reported to CMS after each episode of hospitalization, not before, and at the time of recertification, not after each home health visit. The submission of OASIS-C2 data is not required when an error or mistake is made.

19. The board of directors is examining various submitted reports concerning its home health agency. Which of the following reports

represents an example of benchmarking?

A report by the administrator regarding how the home health agency’s performance compares with that of other local and national home health agencies b. A report by the chief financial officer regarding a cost-benefit analysis related to technological advances c. A report by the chief nursing officer regarding client outcomes d. A report by the medical director regarding implementation of evidence-based practice into standards of care a.

ANS: A

Performance improvement programs are based on measurable data, including benchmarking, which means comparing oneself with national standards and guidelines and with other agencies. A cost-benefit analysis relates to the use of technology and its impact on the home care agency and is not related to benchmarking. A client outcomes report would need to be compared to other data in order for benchmarking to occur. The implementation of evidence-based practice does not demonstrate the use of benchmarking.

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20. Which of the following comments was most likely stated by a home health nurse? a. “Every time I see a client, it costs $80.” b. “Health care costs are killing our economy.” c. “I can’t believe how much clients are charged for things.” d. “Medicaid costs are such a large portion of our state’s budget.”

ANS: A

Nurses in many settings are not directly exposed to the financial aspects of health care, although as citizens they should be aware of the overall effects of high health care costs. In home health, nurses must be cost-conscious so that they can accurately explain to clients what Medicare will or will not cover and discuss other financial concerns. In addition, home care nurses must be knowledgeable about which medical supplies are covered. Health care costs are impacting the economy, but it is not only home care that is influencing these high costs. Both Medicare and Medicaid costs are a large portion of a state’s budget. The home care nurse probably not only recognizes the costs of supplies, but also realizes the need to be cost conscious to keep these costs at a minimum when possible.

21. Which of the following best describes one of the outcomes of the incentives and pressures for cost control and improved health

outcomes? a. Expansion in alternative health care agencies b. Improvements in client teaching materials c. Public pressure to improve health professionals’ education d. Development and increased use of telehealth technology ANS: D

The incentives and pressures for cost control and improved health outcomes have increased the development and use of telehealth technology in home care. Simultaneously, technologies have been simplified and their reliability increased, facilitating their safe use in the home. There has not been an expansion in alternative health care agencies, most likely because there is not adequate reimbursement available. Improved client teaching materials has not been influenced by the need to control costs. Improving health professionals’ education may improve health outcomes, but this may also drive up costs as the care is being provided by those who are more highly educated.

22. Which statement made by the nurse best confirms the achievement of goals related to the Omaha System conceptual model? a. The nurse confirms to the client that, “Your appointment can be rescheduled.” b. The occupational therapist emails the nurse confirming, “I got the client’s files.” c. The client thanks the nurse saying, “I appreciate knowing what the procedure will d.

cost.”

The pharmacist calls the client to say, “Your prescription is going to be delayed by one day.”

ANS: A

The Omaha System was intended for use by nurses and all members of the health care delivery team. The goals of the research were to develop a structured and comprehensive system that could be both understood and used by members of various disciplines in order to foster collaborative practice. The correction option best demonstrates collaboration between team members.

23. What example of information sharing is most important when managing a client’s transition from acute care to home care? a. Working directly with the client’s insurance provider b. Arranging for emotional support for both client and caregivers. c. Communication between acute care and home health agency staff d. Providing the client with information regarding available community resources ANS: C

The sharing of information from one health care setting or provider to another is critical for community-based care, especially as clients make the transition between hospital and home. While the other options are valid, the sharing of information between acute and home care providers is most directly involved in the successful transition of care for the client.

24. Which interdisciplinary service member is most important to the achievement of autonomy for a client who experienced a lumbar

located spinal cord injury? a. Occupational therapist b. Physical therapist c. Home health aide d. Social worker ANS: A

An occupational therapist will focus on upper extremities to restore muscle strength and mobility for functional skills and performance of activities of daily living supporting autonomy. While the other options are relevant, they are not as directly focused on self-care and autonomy.

25. A family member asks a home health nurse to explain the concept of hospice care. Which of the following would the nurse need to

include as the fundamental underlying philosophy of hospice? a. Enabling the client to die at home b. Ensuring that the client’s living will is upheld c. Placing experts in the position of power of attorney d. Providing comfort measures before death ANS: D

The hospice philosophy of care means providing comfort measures to an individual before death. Death may occur in the individual’s home, in a hospital setting, or in an uncontrolled setting such as the community. The philosophy of hospice does not relate to what happens with the client’s living will or power of attorney, rather it focuses on providing a dignified death.

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MULTIPLE RESPONSE 1. Which of the following aspects of a home health agency would most likely be examined during the accreditation process? (Select

all that apply.) a. Cost of each service rendered b. Credentials of each employee c. Organizational structure d. Outcomes of care e. History of clients ANS: C, D

Both The Joint Commission (TJC) and the Community Health Accreditation Program (CHAP) of the National League for Nursing (NLN) look at the organizational structure through which care is delivered, the process of care through home visits, and the outcomes of client care, focusing on improved health status. Performance improvement must be ongoing in the agency. It is assumed the credentials of each employee were confirmed before employment. Accreditors are not as concerned with client history or with the costs of the services rendered as they are with the other quality indicators.

2. A family is concerned about the medical bills of their father, age 63, who is unemployed and has almost no savings. Which of the

following statements by the nurse accurately explain how Medicaid and Medicare would work in this family’s situation? (Select all that apply.) a. “All your father’s medical bills will be paid by whichever program is appropriate.” b. “Choose any physician and just show them your Medicare or Medicaid card.” c. “Your father must be homebound to qualify for Medicare assistance but less so for Medicaid.” d. “Medicare is a federally funded program, but Medicaid is administered by your state.” e. “Your father’s age disqualifies him from both programs.”

ANS: C, D

Medicare, for those age 65 and over or disabled, is a federal insurance program administered by the Social Security Administration, whereas Medicaid, based on a client’s lack of financial resources, is a federal and state assistance program administered by the state. Medicare will only pay for home health care by skilled professionals while the client is homebound, whereas Medicaid does not necessarily require homebound status and may reimburse for home health aides and other nonskilled supportive services. Many physicians will not accept a client on Medicare or Medicaid because of the low reimbursement rates. A deduction from Social Security is made for Medicare premiums, and clients are still responsible for deductibles and copays, so it is misleading to tell the family that all their father’s medical bills will be paid.

3. What are examples of telehealth applications? (Select all that apply.) a. A cardiac client’s heart function being monitored daily b. A client calling their provider’s office to make an appointment c. A client discussing a skin reaction with a telephone triage nurse d. A surgeon accessing a client’s electronic health record when a referral was made e. A “Zoom” meeting between an advanced practice nurse and mother regarding a

well-baby visit ANS: A, C, D, E

Telehealth supports long-distance health care, client and professional health-related education, and public health and health administration using electronic information, medical devices, and telecommunication technologies. The technology used varies to include live videoconferencing, the Internet, store-and-forward imaging, streaming media, satellite, wireless communications, and plain old telephone systems. Telehealth equipment and program components include telephone triage and advice, and biometric telemonitoring equipment to measure vital signs, weight, cardiac function, and point-of-care diagnostics. The system may or may not include video technology for live interaction.

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Chapter 31: The Nurse in the Schools Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. Which of the following activities are expectations for a school health nurse? a. Ensuring that children with health problems are accepted by their peers b. Driving children home if parents can’t pick them up c. Giving emergency care in the school or during school events d. Giving medications as needed if children are ill ANS: C

School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school; keeping track of the state-required vaccinations that children have received; carrying out the required screenin g of the children based on state law; and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics. It would not be appropriate for the school nurse to provide transportation services to the students attending the school.

2. Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed

health care in the schools? a. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. b. Most nurses prefer to be employed in hospitals giving direct care. c. Most school districts are unable to afford a nurse in every school. d. School districts and taxpayers see no need for nurses in schools.

ANS: C

The Healthy People 2030 Objective AH-R08 recommends an increase in the proportion of secondary schools with a full-time registered nurse (US Department of Health and Human Services, 2020). But such a recommendation is expensive and not a possibility for all school districts presently. School districts may see that the need for nurses is important but may have insufficient funds to be able to afford to pay for their services. There is not a national requirement that school nurses must have baccalaureate preparation or school nurse certification. Preference of employers by nurses does not impact why school nurses are unable to ensure that adequate care if provided.

3. A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary

school that meets safety standards. Which of the following best describes the nurse’s role in this scenario? a. Case manager b. Consultant c. Counselor d. Health educator ANS: B

The school nurse is the person best able to provide health information to school administrators, teachers, and parent–teacher groups. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The nurse also can recommend changes in the school’s policies or ask community organizations to help make the children’s schools healthier places. As a case manager, the school nurse helps to coordinate the health care for children with complex health problems. As a counselor, the school nurse is considered a trustworthy person to whom the children can go if they are in trouble or when they need to talk. In the health educator role, the school nurse may be asked to teach children both individually and in the classroom.

4. At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand

washing. Which of the following best describes the nurse’s role in this scenario? a. Consultant b. Community outreach c. Counselor d. Researcher ANS: B

When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children.

As a counselor, the school nurse is considered a trustworthy person to whom the children can go if they are in trouble or when they need to talk. As a researcher, the nurse can study outcomes related to school nursing services which may advance the practice of school nursing.

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5. Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to

practice problem solving, communication, and other life skills?

Teacher shortages have required nurses to be increasingly involved in teaching life skills. b. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. c. States are requiring nurses to screen and to teach life skills. d. Nurses have been enlisted in this role to help reduce risk factors for future health problems in schoolchildren. a.

ANS: D

Nurses fulfilling the health educator role assist in teaching children both individually and in the classroom. This teaching should assist in helping reduce the risk factors among children in the future. Potential teacher shortages have not impacted the role of the school nurse as a health educator. Use of the role of health educator has not changed the need for school nurses in the school setting. There are not state requirements for required school screening or teaching life skills.

6. Which of the following best describes services that are offered at a school-based health center? a. Employee care at a discounted cost at the school b. Family-centered care for preK-12 grade students c. Sex education, birth control, family planning, and care throughout pregnancy d. Referral and networking with other health care services in the community ANS: B

These are family-centered, community-based clinics that are run within school, often in low-income populations. These centers provide primary care services to students of preK-12 and may offer expanded health services, including mental health and dental care. The intention of school-based health centers is to provide care specific to preK-12 grade students, not employees. These clinics provide a variety of services, depending on the clinic. Based on the size and services of the clinic, they may not provide family planning services, referral, or networking with other health care services.

7. The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an

antidrug presentation to their peers. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary ANS: A

Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol. Secondary prevention involves screening and intervening with at risk populations. Tertiary prevention aims for rehabilitation and returning to the highest functioning possible.

8. Which of the following best describes the primary reason that school health nurses spend so much time on educational programs

that teach children the importance of water and fire safety, using a seatbelt in the car and wearing a helmet when biking or skateboarding? a. Because children won’t know if someone doesn’t tell them b. Because injuries are the leading cause of death in children and most injuries are preventable c. Because it is a dangerous world and someone has to warn children about the dangers d. Because teaching is easy and more fun than passing out bandages and documenting care ANS: B

The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers. The nurse is a trustworthy person, but the children may likely have heard this information from someone else. The role of health educator is an appropriate and important role of the school nurse which is the same as the role of the direct caregiver in caring for injured children and documenting care.

9. A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers.

Which of the following actions would the nurse most likely take? a. Educate students about injury prevention measures. b. Provide free condoms to sexually active students. c. Screen for signs and symptoms of cancer. d. Invite a guest speaker to talk about living with HIV. ANS: A

Injuries are the leading cause of death in children and teenagers; therefore, preventive measures should focus on injury prevention.

Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety. Providing free condoms to sexually active students would be a secondary prevention intervention as these students are at risk to contract a sexually transmitted disease. Screening fo r signs and symptoms of cancer is an example of secondary prevention, aimed at early detection. Inviting a guest speaker to speak about HIV would address primary prevention, but it does not address the leading cause of death among children.

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10. The school nurse has arranged for volunteers to help assess each child’s hearing and vision. Any child that the volunteers feel did

not “pass” will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen.

Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary ANS: B

Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers. Primary prevention involves providing education before a problem or disease occurs. Tertiary prevention aims at rehabilitation after the disease or problem has occurred and intends to get the client to the highest possible level of functioning.

11. Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? a. Tell all staff to call 911 if the nurse is not in the building. b. Arrange to always be available, even if only by phone. c. Create and share an emergency plan with all teachers and staff. d. Wear a pager so that the nurse can come as soon as humanly possible.

ANS: C

It is recommended that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed. Depending on the emergency, it may or may not be appropriate to call 911; thus, having an emergency plan in place is a more appropriate response. It is impossible for the nurse to be available at all times. Depending on where the nurse is and what other roles the nurse is fulfilling, it may not be possible for the nurse to respond quickly to an emergency.

12. A school nurse is administering medications at the school. Which of the following guidelines should be followed? a. A current drug reference should be available in case information is needed. b. The nurse should administer medications brought in from home by the child in a c. d.

plastic bag.

Medications cannot be administered without a physician order.

Narcotics and controlled substances should be kept in a locked cabinet.

ANS: A

A current drug reference should always be available so that it can be consulted for information. The nurse should develop a series of guidelines to help with the legal administration of medications in the school. The prescribed drugs should have the original prescription label on it and be in the original container. There should be a current, signed parental consent form for giving the medication, and the nurse should have a means of contacting a pharmacist to ask questions. A primary care provider’s order is not needed to administer the medications. All medications, including narcotics, should be kept in a locked container so that they are not accessible to others.

13. An upset mother calls the school nurse and says, “How dare you say my child has lice? My child is clean and I keep a clean house!

You’ve obviously made an error.” Which of the following would be the best response by the nurse? a. “I’m sorry you’re upset, but your child cannot return to school until this problem is addressed.” b. “Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem.” c. “You may have been traveling. Lice are often found in motels.” d. “I’m sure you’re correct; one of my volunteers probably made an error. I’ll recheck.”

ANS: B

The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life threatening, and the necessary shampoo and other items to treat lice are widely available over the counter. Most school policies are more caring and less exclusionary and allow children with lice to attend school. It is more likely that the student contracted the lice from another student than from traveling to a motel. If the nurse has delegated the responsibility of assessing for lice to a volunteer, the nurse should reassess the findings of the volunteer to confirm that the child has lice before contacting the parent.

14. A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a

leather belt that leaves big marks on the student’s back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? a. Ask the student if abuse has occurred. b. Call in the named student and ask him to remove his shirt. c. Discuss the conversation with the student’s parents. d. Notify the legal authorities.

ANS: D

When the nurse identifies a child, who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school’s principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.

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15. A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also

sets up a peer counseling program for teens. Which of the following is the school nurse most likely trying to prevent?

Suicide Bullying Obesity Violence

a. b. c. d.

ANS: A

Among teenagers, more than 17 percent have considered suicide and more than 8 percent have actually attempted to take their own lives (Substance Abuse and Mental Health Services Administration). To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses. Bullying may result in adolescents feeling that suicide is the only answer. However, the strategies that the nurse is completing would not necessarily promote a decrease in bullying. The strategies suggested would not impact the prevalence of obesity or the incidence of violence.

16. A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? a. Continue activities as much as possible as if nothing had happened. b. Continue to assess for shock and stress. c. Help teachers discuss the disaster with their class. d. Maintain school routines and activities.

ANS: B

After a disaster, the school nurse has many responsibilities—for instance, continuing to assess the school community for the presence of shock and stress; encouraging parents to minimize how much their children view the disaster coverage on TV; providing grief counseling; continuing to communicate with the children, parents, and school personnel; and following up with assessment of children for anxiety, depression, regression, and posttraumatic stress disorder. It would not be appropriate for the nurse to ignore that a disaster has occurred or to assume that routines will remain the same; it is important for the nurse to assist the community to cope with the disaster. The nurse may use counselors in the community to assist the children to cope with the disaster as this may not be an appropriate role for the nurse or for the teacher to perform.

17. Which of the following is the leading cause of children being absent from school because of a chronic illness? a. Allergies b. Asthma c. Diabetes d. Upper respiratory infections ANS: B

Asthma is one of the leading causes of children being absent from school because of a chronic illness. Upper respiratory infections are an acute problem, not a chronic one. Diabetes and allergies are not leading causes of chronic disease that result in children being absent from school.

18. A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use

a rescue inhaler. Which of the following levels of prevention is being used by the nurse?

Primary Secondary Tertiary Both primary and secondary

a. b. c. d.

ANS: C

Tertiary prevention includes caring for children with long-term health needs, including asthma and disabling conditions. The nurse is teaching disease management (i.e., when to use an inhaler). Primary prevention involves providing education before a problem or disease occurs. Secondary prevention addresses screening and early detection of the disease or problem.

19. A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods

for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention ANS: C

Many teenage girls who are pregnant attend school; therefore, the school nurse may provide ongoing care to the mother. Although this may appear to be secondary prevention, it is tertiary prevention because adolescent pregnancies are considered to be high risk.

Primary prevention involves providing education before a problem or disease occurs. Secondary prevention addresses screening and early detection of the disease or problem. Because the teenager is already pregnant, the nurse is addressing how to assist the teen to achieve the highest level of functioning possible (tertiary prevention).

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20. A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services.

If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse?

Call in another nurse to care for this client.

Explain, from the nurse’s perspective, all the reasons that abortion should be made illegal. c. Offer the student a combination of oral contraceptives to induce spontaneous abortion. d. Provide information on alternatives to abortion and give the client information on adoption agencies. a. b.

ANS: A

This creates an ethical dilemma for the nurse. If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help or the student should be referred to other health providers who can provide the care the student needs. It is important that the nurse be able to keep an open mind when working with this teen, and if that is not possible, another nurse needs to be asked to care for this client. The incorrect options all address the nurse discussing his or her personal beliefs against abortion which may not be therapeutic for the teen.

21. Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? a. Complementary and alternative therapies b. Computer and technology use c. Psychoanalytical techniques d. Self-defense techniques ANS: B

In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. Complementary and alternative therapies are already being widely used; most likely the nurse will not be the one providing such care, so it would not be necessary for the nurse to master these skills. Psychoanalytical techniques would not be necessary for the nurse to master as the nurse is able to refer students who require this type of care to appropriate providers. There would not be a need for school nurses to master self-defense techniques.

22. The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger

sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? a. “I’ll get the names to you and the involved teachers immediately.” b. “Let me get the parents’ consent, and then I’ll get you the names.” c. “Rumors are often inaccurate; let me follow up and see what happened and what needs to be done.” d. “Why don’t we coordinate a school-wide program on preventing accidents instead?”

ANS: C

The school nurse is responsible for maintaining school health office policies, including privacy and safety of health records. When a rumor is involved, it is always wise to check its accuracy. If a child was indeed hurt, the nurse needs to make sure both children involved receive (or have already received) appropriate care. The nurse must follow the HIPAA privacy rules while also ensuring the safety of children at school. The question about having a school-wide program may be appropriate, but this behavior was apparently purposeful, not accidental.

23. The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned

that the student will be required to be homeschooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? a. “Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able.” b. “I realize that this will be a difficult adjustment, but homeschooling has improved over recent decades and the Internet will allow your child to connect with friends.” c. “Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue.” d. “Your child may remain in school as long as he can manage the course requirements and doesn’t flunk out.”

ANS: A

Federal legislation specifies that children cannot be excluded from schools because of a disability. The school must provide health services that each child needs. Legislation further requires the school district’s committee on the disabled to develop individualized education plans (IEPs) for children. Federal legislation will support this child continuing in the current school; thus, it would not be necessary to counsel the parents about concerns related to the child needing to be homeschooled. Depending on the diagnosis, special educational needs may need to be addressed for the child through an IEP which may assist the child in being successful in the coursework.

24. A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a day care

center being the first location. What of the following advice should be given to them by their instructor?

Base the program on the audience’s development and maturity.

Bring (borrow if necessary) a model of the heart to help explain its functioning.

Focus on entertaining the learners.

Have lots of handouts to reinforce the lesson.

a. b. c. d.

ANS: A

For younger learners, it is important to keep the lesson to no more than 20 minutes in length; to use plenty of examples, pictures, and stuffed animals in the talk; and to remember the developmental stage of the children when teaching them. It will be important for the nurse to assess the developmental level of the audience in order to determine if models or handouts are appropriate to be used. Keeping the presentation short should assist in keeping the learner’s attention.

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MULTIPLE RESPONSE 1. Which of the following activities are included in the Centers for Disease Control and Prevention’s school health program? (Select

all that apply.) a. Ensuring a healthy school environment b. Assisting teachers with education related to health c. Encouraging nutritious school meals d. Giving immunizations to students, staff, teachers, and their families e. Providing mental health counseling ANS: A, B, C, E

The federal government, through the coordination of the Centers for Disease Control and Prevention, developed a plan that school health programs should follow, including health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff, and family/community involvement.

Unfortunately, schools cannot afford to give immunizations to everyone who might want such a benefit.

2. Which of the following best explains why the federal government is beginning to fund school-based health centers? (Select all that

apply.) a. These centers help young children avoid becoming addicted to drugs while still in elementary school. b. Attendance and learning are higher in schools with health clinics. c. These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. d. Many children have no other source of health care services. e. To ensure parents are compliant with meeting the health needs of their children.

ANS: B, D

The US government began funding school-based health centers essentially because many schoolchildren may not receive health care services otherwise. These are family-centered, community-based clinics run within the schools. Certainly, avoiding pregnancy and drug addiction are among the goals of school-based health centers, but these are not reasons the government began funding them. Ensuring compliance is not a governmental responsibility in this situation since no federal laws apply.

3. A new student’s parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the

student twice. Which of the following actions should be taken by the nurse to keep the child in school? (Select all that apply.) a. Call the parents or mail another reminder. b. Report the problem to the teacher and the principal. c. Send the child home with a note saying the child cannot return until the immunization record is received. d. Determine whether the family has health care insurance. e. Offer assistance in replacing a lost immunization record.

ANS: A, D, E

There are many problems with children not being immunized or having incomplete vaccination records, especially in families who have moved many times or who may not have a regular physician. The parents may have no idea whether the child has received the required shots. Families may also be without health care insurance to pay for the immunizations, or they may have insurance that does not pay for preventive care. In these cases, they may lack the resources to pay for the immunizations themselves. Therefore, the nurse’s role is to be sure parents are aware of the problem, to help them obtain the records if they have been misplaced, and to suggest ways to obtain the injections without charge, even if there is no obvious evidence that lack of funds is the problem. Telling the teacher or principal won’t resolve the problem. Sending home a note saying the child cannot return to school does not assist the family with obtaining the immunization for the child which may be a burden for the family or a potential underlying reason why the child has not received the immunization.

4. Which of the following emergency supplies or equipment should a nurse have available in the school health office? (Select all that

apply.) a. Cervical spine collars b. Complete emergency kit that fulfills American Hospital Association requirements c. Epinephrine autoinjector kit d. Material for splints e. Supplemental oxygen ANS: A, C, D, E

The school nurse needs much equipment to deal with emergencies in the school. Basic necessary equipment includes full oxygen tanks with oxygen masks of different kinds, splints, cervical spine collars, sterile dressings, and an epinephrine autoinjector kit in case a child goes into anaphylactic shock after exposure to an allergen. A hospital-oriented emergency kit would become quickly outdated (medications) and extremely expensive.

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5. A school nurse would like to improve the safety of everyone at the school by creating policies to decrease the likelihood that

violence will occur. Which of the following actions would the nurse likely take to minimize risk of school violence? (Select all that apply.) a. Engaging parents in school activities b. Creating a zero tolerance police for weapons on school property c. Encouraging children to participate in the after-school program at a local community center d. Developing mentoring programs for at-risk youth e. Initiating a student hot line for discussing possible violence risks ANS: A, B, D, E

Interventions that are aimed at preventing violence from occurring are: engaging parents in school activities that promote connections with their children; fostering communication, problem solving, limit setting, and monitoring of children; supporting/assisting with creating policies of zero tolerance for weapons on school property, including school grounds; and developing mentoring programs for at-risk youth and families. Encouraging students to attend the after-school program at a local community center may assist with the students having additional supervision, but it does not contribute to the students having an increased loyalty or connection to the school. It is important to facilitate student connectedness to the school community.

6. A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the

child turns 16, which of the following actions is the school responsible for? (Select all that apply.) a. None, since the child is no longer eligible for school services b. Continuing to provide needed appropriate education for the child c. Excluding the child from selected extracurricular activities d. Continuing to prepare an updated individualized education plan e. Arranging for reimbursement for services provided ANS: B, D

Educational services must be offered by the schools for all disabled children from birth through age 22 years. Children cannot be excluded from activities because of a disability. The school must always develop an individualized education plan for each child and update it at appropriate intervals. Turning 16 does not make a child an adult; thus, the child is still able to rece ive services of the school and participate in extracurricular activities.

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Chapter 32: The Nurse in Occupational Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 10th Edition MULTIPLE CHOICE 1. An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the

following recommendations would the nurse most likely provide about safety in the workplace? a. Find employment in physical labor; at least your body will be in good condition. b. Professional positions are the safest choice for employment. c. White collar positions provide the least risk for injury. d. There is no “safe” occupation or profession.

ANS: D

Most adults spend about one-third of their time at work. No work is completely risk free. Every single industry grapples with serious hazards related to work.

2. A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a

communicable disease from a patient. Which of the following best describes the host factor? a. Each sick nurse b. The communicable disease c. The hospital d. The patient ANS: A

Each worker represents a host within the worker population group. The communicable disease and the patient are considered the agent, the factor associated with the illness or injury. The hospital is part of the physical environment.

3. Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up

evaluation? a. New workers employed less than 1 year b. Older workers with chronic illnesses c. Older workers with diminished hearing d. Women in their childbearing years ANS: A

The population group at greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job. Because of the inherent risks, the nurse should spend extra time with this group to decrease risk. Older workers with more experience are less likely to experience injury even if they have underlying issues of chronic disease. Women of childbearing age are not at any greater risk than the general population of employees.

4. An employee in a laboratory drops a flask, resulting in a chemical splash into the employee’s eyes, which in turn results in burns to

the eyes. Which of the following would be considered the agent? a. The chemical b. The employee c. The flask d. The laboratory ANS: A

Agents represent potential dangers or risks to the health and safety of workers. However, in the case given, the chemical itself caused the damage. If the flask had broken and glass got into the employee’s eye, then the flask would be an agent. However, in the case given, the chemical itself caused the damage. The employee is considered the host and the laboratory is considered part of the environment.

5. Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB? a. Housekeeping staff b. Medical staff c. Nursing staff d. Ward clerks ANS: A

Transmission of tuberculosis (TB) within health care settings has reemerged as a major public health problem. Outbreaks of this type of TB have been reported in hospitals, and some workers have developed active drug-resistant TB. Many workers in these settings are employed as maintenance workers, security guards, aides, or cleaning people, who tend not to be well protected from inadvertent exposures, which include contaminated bed linen in the laundry, soiled equipment, and trash containing contaminated dressings or specimens. Ward clerks have limited contact with acutely ill patients. Medical and nursing staff are more likely to have the proper equipment and education to be well-protected from inadvertent exposures.

6. Which of the following is the most common disabling condition when measured by days away from work? a. Bruises b. Cuts and lacerations c. Mental illnesses d. Sprains and strains ANS: D

In 2014, sprains, strains, and tears were by far the most frequent disabling conditions, accounting for 420,870 days-away-from-work cases and an incidence rate of 38.9 cases per 10,000 full-time workers (Bureau of Labor Statistics, 2015d).

Bruises, cuts and lacerations, and mental illness are not among the most common disabling conditions that are reported.

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7. A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than

earlier. Which of the following is the nurse attempting to prevent through this suggestion?

Anxiety, depression, and exhaustion Family turmoil Physical illnesses Sleeping disorders

a. b. c. d.

ANS: A

An estimated 10% of Americans do some form of shift work that has the potential to lead to a variety of psychological and physical problems, including exhaustion, depression, anxiety, and gastrointestinal disturbance. Strategies to minimize the adverse effects of shift work, such as rotating shifts clockwise, are beneficial. Family turmoil, physical illnesses, and sleeping disorders all have the potential to occur. However, there is evidence that anxiety, depression, and exhaustion are the more prevalent physical and psychological problems that are reported.

8. In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their

families? a. Acute care inpatient settings b. Community clinics and physicians’ offices c. Emergency departments and psychiatric units d. In homes during home health visits ANS: C

Nonfatal violence in the health care worker’s workplace is a serious problem that seems to be underreported. Much of the study of health care worker violence has been in psychiatric settings and emergency departments. Violence is not reported in as high of an incidence in acute care settings, community clinics, or in client homes in comparison to emergency departments and psychiatric units.

9. The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which

of the following factors will most likely determine how effective the PPE is in keeping employees safe? a. Comfort level of the PPE b. Effectiveness of the nurse’s teaching c. Knowledge level of the employee d. Psychosocial norms of the setting ANS: D

The employee will only be safe if the employee uses the PPE. If the employee doesn’t use the PPE or uses only part of the equipment, then the employee will be at risk. The primary determination of whether the PPE is used correctly and used all the time is the psychosocial norms of the setting. If others are careless in PPE use, then such carelessness is the norm. If everyone is extremely careful to use their PPE, then that is the norm in that setting. Through education, employees have the knowledge and skills available to correctly use PPE. The educational session should also make the employees comfortable with its use. The use of PPE does not depend on the effectiveness of the teaching, rather the employees’ choice to correctly put into practice the knowledge and skills that they have received.

10. Which of the following is the primary reason that large companies are becoming more involved in their employees’ personal health

and well-being?

It is an ethical and moral responsibility.

It improves public relations within the community.

It allows managers to better understand their employees.

It provides a cost savings to the company.

a. b. c. d.

ANS: D

A significant increase in the number of health promotion and employee assistance programs offered has occurred. Health promotion programs focus on lifestyle choices that cause risks to health such as obesity or smoking. Employee assistance programs are designed to address personal problems (e.g., marital/family issues, substance abuse, financial difficulties) that affect the employee’s productivity. Such efforts are cost effective for businesses. Becoming more involved in employees’ health and well-being would most likely not change the relationship between the manager and the employee. This also would not change the public relations in the community. Becoming more involved is the right thing for companies to do; however, the main motive behind this shift is to save the company money.

11. The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following

levels of prevention is being implemented?

Both secondary and tertiary prevention Primary prevention Secondary prevention Tertiary prevention

a. b. c. d.

ANS: B

Delivery of primary prevention services to employees is directed toward promoting health and averting a problem. Primary prevention is attempting to avoid harm through protecting measures, in this case reducing ear damage due to high noise levels and eye damage from flying particles or fluids. Secondary prevention involves screening for the disease or detecting the disease at the earliest stage possible. Tertiary prevention aims at rehabilitation and restoring the client to the highest possible level of functioning.

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12. An occupational health nurse is removing a foreign body from a patient’s eye. Which of the following levels of prevention is being

implemented?

Injury prevention Primary prevention Secondary prevention Tertiary prevention

a. b. c. d.

ANS: C

The nurse is engaging in secondary prevention when providing treatment for the injury. This does not meet the criteria for injury prevention because the injury has already occurred. Primary prevention would occur to prevent the injury from occurring, such as teaching the employee about use of protective eyewear. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the foreign body from developing.

13. An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of

the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Tertiary care prevention ANS: B

Secondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible moment in its course and elimination or modification of the hazard-producing situation. Primary prevention would occur to prevent the injury from occurring, such as teaching the employees about how to protect themselves from exposure to hazardous gases. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the exposure to the hazardous gas.

14. The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time

employment. Which of the following best describes the rationale for this suggestion? a. To provide an example to other employees to ensure future cooperation with safety measures b. To enforce an economic penalty for not obeying nurse’s instructions regarding safety measures c. To ensure that all employees keep their positions during an economic downturn d. To continue employment and income with limited duty as a rehabilitation effort after an injury ANS: D

Rehabilitation strategies such as return-to-work programs after a heart attack or limited duty programs after a cumulative trauma injury are examples of tertiary prevention. Tertiary prevention is intended to restore health as fully as possible and assist individuals to achieve their maximum level of functioning. The method described is focusing on an effective method of rehabilitation. Rehabilitation strategies are not used as a form of punishment to employees or to ensure employment for all workers.

15. An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy

metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change? a. To prevent injury b. To limit disability c. To provide primary prevention d. To provide tertiary prevention ANS: B

Interventions aimed at disability limitation are intended to prevent further harm or deterioration, and they include referral for counseling and treatment of an employee with an emotional or mental health problem whose work performance has deteriorated and removal of workers from heavy metal exposure who manifest neurological symptoms. The repetitive work with handling heavy metal may have already caused harm or previous injury to this employee. Thus, the goal is to limit disability rather than to prevent injury. Primary prevention would occur to prevent the injury from occurring, such as teaching safe lifting or operation of the equipment. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to any incident or injury.

16. A nurse is completing a health history on a client during a routine physical examination. Which of the following questions, which is

often omitted, should be asked by the nurse? a. “How is your family doing?” b. “What problems have you been having?” c. “What health concerns do you have today?” d. “Where do you work and what do you do there?”

ANS: D

The question often omitted is, “Where do you work and what do you do there?” The occupational health history is an indispensable component of the health assessment of individuals. Because work is a part of life for most people, including an occupational health history in all routine nursing assessments is essential. All of these questions are appropriate during a routine physical examination.

However, it is likely that the nurse asks about family, current problems, and current health concerns to clients on a routine basis.

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17. A nurse is interviewing a person who has stated on their entry health form that they are retired. Which of the following is the most

crucial question for the nurse to ask?

“Have you had any problems since leaving your employment?”

“How do you spend your time now?”

“What has retirement been like for you?”

“Where were you previously employed and what did you do there?”

a. b. c. d.

ANS: D

The most crucial question is, “Where were you previously employed and what did you do there?” The occupational health history is an indispensable component of the health assessment. All persons should be questioned about their employment history. To describe only a current status of “retired” may lead to the omission of needed data. Even for retired persons, the nurse must ask about employment history, because many problems take years to manifest in signs and symptoms. All of these questions are appropriate during a routine physical examination for a person who has retired because they relate to current problems, recreation, and mental health. However, they are not as crucial as asking for additional information about employment history. The client’s answer to this question may alert to potential problems that the nurse should focus on.

18. A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data

and the primary diagnoses into the computer to have a comprehensive perspective of the clinic’s clients. Which of the following best explains why the nurse is collecting this data? a. This data will be useful in a research study the nurse is conducting. b. This data will provide evidence of clinic resources being wasted on minor health problems. c. This data will help identify patterns in the risk factors associated with a particular subgroup. d. This data can be used to show trends that can be included in the next grant proposal for further funding.

ANS: C

When health data are considered collectively, the nurse may determine some patterns in risk factors associated with the occurrence of particular injuries and illnesses in a total population of clients. There is no mention of consent, so the nurse should not be collating research data. Grants for funding typically require current client data rather than trends.

19. As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are

hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse? a. To document employee efficiency and effectiveness at their jobs b. To look for evidence of personal protective equipment being torn or destroyed c. To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day d. To observe effectiveness of safety education and equipment ANS: D

The nurse may conduct an assessment of the workplace itself, which is known as a worksite walk-through or survey. Direct observation allows the nurse to learn about the work processes and the materials; the requirements of various jobs; the presence of actual or potential hazards; and the work practices of employees. Such information is directly useful in planning programs, assessing their effectiveness, and reinforcing safety with individuals who have been seen behaving in a less than safe manner. It is not within the scope of the occupational health nurse’s role to document employee efficiency and effectiveness. The nurse may observe how PPE is being used or if employees are taking care of themselves while on the job; however, this is not the main purpose of a worksite walk-through assessment.

20. Which of the following interventions regarding worker safety would be the least effective? a. Using job rotation and workplace monitoring b. Designing equipment so that employee exposure to hazards is minimized c. Having employees use safety measures and personal protective equipment d. Designing the environment to encourage employees to follow workplace

procedures ANS: C

Personal protective control is the last resort and requires the worker to actively engage in strategies for protection such as use of gloves, masks, and gowns to prevent blood/body fluid exposure. Various control strategies are used to eliminate or reduce exposure and hence risk. Engineering controls can reduce worker exposure by modifying the exposure source. Administrative controls reduce exposure through job rotation, workplace monitoring, and employee training and education. External controls—the way equipment is built or manufacturing processes are established—are controllable and much more effective than asking a great many individuals to engage in behaviors that they may not want to do (such as using personal protective equipment). Humans are much less programmable than external controls.

21. Which of the following best describes the mission of OSHA? a. To create an inspection system to avoid preventable loss of life b. To ensure safe and healthful working conditions c. To establish rules for employee safety d. To share factory illness and injury rates with the public ANS: B

The Occupational Safety and Health Act of 1970 had as its purpose to ensure “safe and healthful working conditions for working men and women.” OSHA enforces occupational health standards; its mission is not to have an inspection system. Safe and healthful working conditions are ensured because of the standards that have been enforced by OSHA. OSHA does maintain a databased of work-related injuries, illnesses, and death, but its mission is not to share this information with the public.

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22. Which of the following statements best describes how workers’ compensation legislation has changed employer behavior? a. Employers have improved safety of working conditions because safety data is b. c. d.

now public information.

Companies have improved safety of working conditions because workers’ compensation insurance premiums are now based on previous claims.

Employers were legally required to implement safety changes.

Companies have become more involved in the legislative process.

ANS: B

Workers’ compensation acts are important state laws that govern financial compensation of employees who suffer work-related health problems. Each state sets rules for the reimbursement of employees with occupational health problems for medical expenses and lost work time associated with the illness or injury. Workers’ compensation claims and the experience-based insurance premiums paid by industry have been important motivators for increasing the health and safety of the workplace. The financial incentive of having reduced claims is much more important to the employer than if the safety data may be available for the public to view. Workers’ compensation legislation did not mandate safety changes or cause companies to become more involved with the legislative process.

23. Which of the following would most likely be one of the first steps taken in employer disaster planning? a. All employees are invited to attend sessions on disaster planning. b. Employers stress the importance of disaster drills and encourage active c. d.

participation.

Exhaustive inventory of chemicals and industrial hazards is completed.

Written disaster plans are distributed to each employee and each worksite.

ANS: C

The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of company and community. The nurse is often a key person on the disaster planning team. The potential for disaster must be identified; this is best achieved by completing an exhaustive chemical and hazard inventory of the workplace. The MSDSs and plant blueprints are critical for correctly identifying substances and work areas that may be hazardous. Worksite surveys are the first step to completing this inventory. After potential hazards have been identified, it would be appropriate for the other events to occur. This would include providing employee education, circulating a written disaster plan, and encouraging participation in disaster planning drills.

MULTIPLE RESPONSE 1. Which of the following describes how occupational health nursing differs from other nursing specialties? (Select all that apply.) a. It is autonomous because the occupational nurse works independently. b. The major focus is on the environment. c. Nurses focus on health promotion and disease prevention. d. Nursing care is given in the community. e. A focus is directed toward restoration of health.

ANS: A, B, E

Occupational health specialty practice focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment. It involves the prevention of adverse health effects from occupational and environmental hazards. It provides for and delivers occupational and environmental health and safety services to workers, worker populations, and community groups. It is an autonomous specialty, and nurses make independent nursing judgments in providing health care. All nurses should engage in health promotion and disease prevention, and many specialties provide care in the community.

2. An occupational health nurse should be aware of which of the following trends in the marketplace? (Select all that apply.) a. A majority of new jobs will be in service-oriented employment. b. Employees will often have longer hours within a compressed work week. c. Jobs are shifting from service to manufacturing. d. Many employees will be older and suffer chronic health problems. e. Reduced job security is common.

ANS: A, B, D, E

Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. The workforce will become older, including many employees with chronic health problems. The US economy was once based on agriculture, then primarily on manufacturing, and now on highly technological positions. Currently, service-providing positions account for virtually all job growth; soon almost one of every two worker jobs will be in service positions.

3. Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace?

(Select all that apply.) a. All chemicals are inherently dangerous to humans. b. Chemicals are often used when natural substances are equally effective. c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown. e. It is difficult to accurately predict the reaction of chemical contact.

ANS: C, D, E

Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. A variety of chemicals are found in the body tissues of the general population. Daily, low-level doses of chemicals may be below the exposure standards but may still carry a potentially chronic and perhaps cumulative assault on workers’ health. Predicting human responses to such exposures is further complicated because several chemicals are often combined to create a new chemical agent. Human effects may be associated with the interaction of these agents rather than with a single chemical. Another concern about occupational exposure to chemicals is reproductive health effects. Not all chemicals are dangerous; however, less than 0.1% of them have been adequately studied for their effects on humans. There is no evidence to support the statement that chemicals are being used when there are other natural substances available.

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4. Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe

environment for workers? (Select all that apply.)

To fulfill their ethical and moral responsibility To avoid the cost of liability suits, workers’ compensation, etc.

To maintain good public relations To meet enacted legislated standards To avoid significant penalties for noncompliance

a. b. c. d. e.

ANS: B, D, E

Legislation at the federal and state levels has had a significant effect on efforts to provide a healthy and safe environment for all workers. OSHA employees have distributed citations to companies that do not meet minimal occupational health and safety standards. Criminal charges have been filed against business owners when preventable work-related deaths have occurred. Another important stimulus for health and safety programs is the desire to avoid the cost of liability and workers’ compensation claims and other expenses when employees are injured or killed. Having a healthy and safe environment for workers should provide the public with a positive image of the company; however, this is not a primary reason employers ensuring this type of an environment.

5. An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why

the nurse would be interested in this information? (Select all that apply.) a. To assess how others have rated the company in relation to employment there b. To compare the prospective employer’s injury rate with similar employers’ rates c. To learn more about the usual processes and products of the company as well as typical hazards d. To learn how employees feel about their employer e. To identify useful information about the employer ANS: B, C, E

All business organizations are classified within the North American Industry Classification System (NAICS) with a numerical code indicating a company’s product and, therefore, the possible types of occupational health hazards that may be associated with the processes and materials used by its employees. NAICS codes are used to collect and report data on businesses. For example, illness and injury rates of one company are compared with the rates of other companies of similar size with the same NAICS code to determine whether the company is having an excess of illness or injury. By knowing the NAICS code of a company, a health care professional can access reference books that describe the usual processes, materials, and by products of that kind of company. The NAICS code indicates a company’s product, not how others or their employees have rated them as an employer.

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