NURS 452: Exam 1

Term
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One of the primary focuses of improving the health of the American people in the twenty-first century is to address:

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
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Terms in this set (355)
One of the primary focuses of improving the health of the American people in the twenty-first century is to address:

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
ANSWER: 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.
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 cause the health care system to collapse

c. This threat of bioterrorism may divert funds from other public safety health care programs.

d. Fear of bioterrorism will increase the need for shelters
ANSWER: 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 of these things would happen because of the diversion of funds.
Which of the following describes the consequence of the successful implementation of the Affordable Care Act?

a. Americans will pay closer attention to their health status.

b. The majority of the population will be covered by insurance.

c. Public health departments will need to increase the number of nursing positions.

d. The prevalence of obesity will decrease.
ANSWER: B
One consequence of successful implementation of the Affordable Care Act might actually 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.
The public health nurse (PHN) must participate in the essential services of public health. Which of the following most accurately describes one of the essential services of public health?

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
ANSWER: 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.
A public health department is using the mission of public health as described by the Institute of Medicine when planning its health programming. Which of the following activities will 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 anti-venom at the Centers for Disease Control and Prevention in Atlanta
ANSWER: 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 anti-venom is aimed at disease care for an individual, not health promotion or disease prevention.
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.
The purpose of public health core functions is to:

a. clarify the role of the government in fulfilling the mission of public health.

b. ensure the safety of populations in receiving quality health care.

c. provide community-based individualized care to every person in the United States.

d. unite public and private providers of care in a comprehensive approach to providing health care.
ANSWER: 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 purpose of clarifying the government's role.
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 personal behavior.

d. Reform of the medical insurance system is the single change needed to improve the health of Americans.
ANSWER: 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.
A PHN collects data and monitors the health status of the population. Which of the following core public health functions is being implemented?
a. Assessment
b. Prevention
c. Assurance
d. Policy development
ANSWER: 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.
The PHN compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is being implemented?
a. Assurance
b. Assessment
c. Prevention
d. Policy development
ANSWER: 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 available, and policy development is needed to provide leadership in developing policies.
A 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 being used? a. Assessment b. Prevention c. Assurance d. Policy developmentANSWER: 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.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 being used? a. Assessment b. Prevention c. Assurance d. Policy developmentANSWER: 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.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 developmentANSWER: 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 development refers to the need to provide leadership in developing health policies.A nurse performs activities to meet the primary goals of public health. Which of the following is the nurse most likely to complete? 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 womanANSWER: 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.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 of the following best describes this data? a. Sociodemographic characteristics b. Health status data c. Health risk factors d. Health care resource consumption informationANSWER: 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.The 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 statusANSWER: 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 of people is a sociodemographic characteristic. Health status includes birth and death rates. Functional status refers to reports of good health status by members of the population.A nurse is implementing quality performance standards in a public health department. Which of the following 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.ANSWER: 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.To better address emerging public health issues, a PHN plans to complete continuing education in this area. Which of the following content areas should be included in the course that is chosen? a. Leadership b. Ethics c. Communication d. FinanceANSWER: 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.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 d. Curriculum developmentANSWER: 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.Public health nursing is a specialty because: a. it has a distinct focus and scope of practice. b. it must be done by a registered nurse with a master's degree. c. it is focused on disadvantaged citizens. d. it performs interventions at the acute care level.ANSWER: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty.The necessary basic preparation for public health nursing is a(n) _____ in nursing. a. associate's degree b. baccalaureate degree c. master's degree d. Doctor of Nursing Practice degreeANSWER: B A bachelor of science in nursing (BSN) is the necessary basic preparation to function as a beginning staff PHN. An associate's 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.A PHN has been prepared at the graduate level. Which of the following activities should the practitioner be able to complete? a. Teach public and community health nursing b. Assess and intervene successfully at the aggregate level c. Diagnose and treat disease and have prescriptive authority d. Run for political office as experts in public health policyANSWER: B According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine.A PHN provides a clinic for HIV-positive citizens in the community. Which of the following best describe this activity? a. Primary prevention b. Health education c. Tertiary prevention d. Policy makingANSWER: 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.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 coffeeANSWER: 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.A population is best defined as a: a. high-risk group. b. those interacting within a school or institutional setting. c. collection of individuals who share at least one common characteristic. d. geographical location within a community.ANSWER: 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.MULTIPLE RESPONSE Which of the following 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 fundsANSWER: 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 education in public health. The number of job opportunities continues to increase, but the amount of funding allotted to public health continues to decline.A local senator has proposed changes to the health care delivery system in the United States. Based on current trends, which of the following 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.ANSWER: 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.A nurse is working in a community health nursing practice setting. Which of the following is the nurse most likely to implement? a. Administrating 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 centerANSWER: 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 community as a whole. Administrating a flu shot to an individual is the only example that meets this criterion. Performing a client assessment focuses only on individual care and 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.PHNs are looking to improve population-focused care in the community. Which of the following 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 practiceANSWER: 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.The nurse is investigating environmental health problems caused by contaminated ground water. Which of the following types of nursing practice is being used? a. Community-oriented b. Community-based c. Policy development d. Tertiary careANSWER: 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.A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse performing? a. Community-oriented b. Public health c. Community health d. Community-basedANSWER: 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 community as a whole. Community health nursing focuses on the health status of individuals and the effect of their health status on the community as a whole.A nurse is implementing community-based nursing care. Which of the following nursing interventions 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 communityANSWER: 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.A public health staff nurse has a clear understanding of population-focused practice. Which of the following characteristics would the nurse most likely display? a. Volunteering for a local community action coalition b. Able to perform interventions with individuals in the community c. Able to improve the effectiveness of care provided d. Considered a PHN specialistANSWER: 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.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 community as a whole. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice.ANSWER: A By definition, the first option is correct. 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.Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a. individuals. b. aggregates. c. communities. d. geographical regions.ANSWER: 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.A nurse is using a population focus when providing public health nursing care. Which of the following statements 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 as a whole, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered.ANSWER: 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.In the past, population-centered nurses have been called: a. district nurses. b. almshouse nurses. c. soldier nurses. d. sisters.ANSWER: 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.A nurse is working in a public health nursing setting. Which of the following best describes why this specialty is appealing to nurses? a. Interactions with wealthy contributors to secure 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 peopleANSWER: 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.Current threats to health in the United States that community health nurses are faced include: a. diphtheria, cholera, and hepatitis. b. HIV, H1N1 influenza, and bioterrorism. c. avian flu, tuberculosis (TB), and radiation. d. polluted water and air.ANSWER: 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.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. MedicareANSWER: 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.In early colonial North America, a colonist worked in the public health sector. Which of the following would have most likely been the focus? 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 almshousesANSWER: 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.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 seamenANSWER: 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.Florence Nightingale's contributions to public health included: 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.ANSWER: 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.Lillian Wald's major contribution to public health nursing was: a. founding the American Nurses Association. b. developing the New York Training Hospital for Nurses. c. creating the Public Health Service. d. establishing the Henry Street Settlement.ANSWER: 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.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 homeANSWER: B Lillian Wald provided health care that included educating the community on health care matters. The focus of the majority 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 (as at this point in time very few women were working outside of the home).Nurses who provided care to people in their homes and provided that care to several people at a time were called _____ nurses. a. private duty b. visiting c. public health d. community healthANSWER: 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 considered to be anyone who worked outside of a hospital setting.Neighborhood centers that provided health care, education, and social welfare programs were called: a. settlement houses. b. nursing care centers. c. nurse-managed clinics. d. public health services (PHSs).ANSWER: 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.A nurse worked in a school setting during the early twentieth century. Which of the following 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 schoolANSWER: 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.A nurse is comparing the historical practices of industrial and occupational health nurses. Which of the following would the nurse most likely note when comparing these two occupations? a. Industrial nurses invented new machines to streamline production of medical goods, whereas occupational health nurses provide care to employees. b. Industrial nurses investigated industrial injuries to improve work conditions, whereas occupational health nurses demonstrated proper body mechanics. c. Industrial nurses treated work related-injuries, whereas occupational health nurses care for families in their homes. d. Industrial nurses provided care for workers in their homes, whereas occupational health nurses care for work-related injuries.ANSWER: D Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home. Contemporary occupational health nurses provide care for work-related injuries. The focus of both of these professions has been on employee care and the work environment.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.ANSWER: 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.During the time when the Rural Nursing Service was operating through the American Red Cross, a nurse needed to demonstrate resourcefulness. Which of the following tasks would the nurse most likely have done? a. Using hot bricks, salt, or sandbags to substitute for hot water bottles b. Testing well water for pollutants c. Teaching school and developing curricula for rural nursing programs d. Providing post-surgical careANSWER: 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.Local health departments were formed in urban areas in the late 1800s to: a. target environmental hazards associated with crowded living conditions. b. facilitate interdisciplinary efforts and promote "practical nursing." c. provide immunizations and health care services to all citizens. d. offer public health education to nurses who had finished basic training.ANSWER: 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.A nurse was involved in the original work of the National Organization for Public Health Nursing. Which of the following best describes the influence this has had on nursing practice today? a. Requiring that PHNs have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing nursing cooperatives d. Opening the Henry Street SettlementANSWER: 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.A nurse is considering joining the American Public Health Association (APHA). Which of the following 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.ANSWER: C APHA was formed to facilitate inter-professional 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.Which statement is true about African American nurses in public health? a. Certificate and graduate education were more difficult to obtain. b. Cities were the major areas where they practiced. c. They often belonged to the Frontier Nursing Service (FNS). d. They were recruited heavily as military nurses.ANSWER: 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.A nurse had the opportunity to work with Mary Breckinridge. Which of the following would the nurse most likely have assisted with? 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 SouthANSWER: 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.A nurse is providing care to clients through the FNS. Which of the following clients would the nurse most likely have seen? a. An injured soldier b. A homebound, elderly male c. A woman in labor d. A child with measlesANSWER: 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.A major provision of the Social Security Act of 1935 was the establishment of: a. the 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.ANSWER: 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.A student is enrolled in a nursing education program during World War II. Which of the following groups would the student most likely have joined? a. The Public Health Service of New York City b. The Marine Nurse Corps c. The FNS d. The Cadet Nurse CorpsANSWER: 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.Which of the following best describes one of the health trends that occurred in the United States between 1900 and 1955? a. There was a rise in chronic diseases such as heart disease and cancer. b. There was a rise in communicable disease. c. The crude mortality rate increased dramatically. d. The life span after diagnosis remained the same.ANSWER: 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.A 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 PracticeANSWER: 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.A neighborhood health center is researching its origins. Which of the following legislative acts 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 ActANSWER: 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.A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs? a. Medicare b. Medicaid c. Social Security d. Economic Opportunity ActANSWER: 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.A PHN became involved in health care reform. Which of the following best describes the purpose of this action? a. Promote the nursing profession b. Increase funding for public health nursing c. Address the concerns of nurses d. Improve health care access and reduce health care costsANSWER: 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.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 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.ANSWER: 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.In the United States, the majority of health care dollars are spent on: a. prescription drugs. b. hospital care. c. physician services. d. public health services (PHSs).ANSWER: 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.The number of uninsured Americans has dramatically increased because: 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 coverage was dropped from employment-based health plans.ANSWER: D Although the majority of 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.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 InnovationANSWER: 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.According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year could be attributed to: a. cardiovascular disease. b. obesity. c. medical error. d. drug overdose.ANSWER: 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.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 technologyANSWER: 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.A nurse is exploring a job opportunity at a community health center. Which of the following expectations would the nurse have about the center? a. Would be located in a large metropolitan area 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 shotsANSWER: C Community health centers serve the entire community for primary health care (PHC) services, regardless of income. They are located in a high need or medically underserved community, which can be urban or rural.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.ANSWER: 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 provide more effective care. It has been suggested that the number of minority nurses should 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 minoritiesA community health nurse is utilizing telehealth. Which of the following 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 itC Telehealth provides increased access to health care by the use of 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.One of the goals of the World Health Organization (WHO) is to: a. provide PHC services to everyone. b. prevent outbreaks of disease. c. prevent the transmittal of communicable disease among nations of the world. d. provide humanitarian support in times of disaster.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.A public health agency is considering implementing an electronic health record. Which of the following best describes one of the benefits the agency will experience? a. Facilitation of inter-professional 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) standardsA The electronic medical record facilitates inter-professional 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; 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.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. PHC d. Specialized careC By definition, 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.A client is receiving 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.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.A nurse who was working in public health care 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 providedA Primary care focuses on individuals. It is also provided by generalists, is dominated by health care professionals, and is not community focused.What initiative began as a result of a resolution adopted by the WHO in 1977? a. Declaration of Alma Ata b. Medicare c. Healthy People d. PHC movementD 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.PHC in the United States: a. has dramatically improved since the passage of the Declaration of Alma Ata. b. focuses on the use of government-funded insurance programs. c. lacks community participation and a multidisciplinary health care delivery team. d. utilizes Preferred Provider Organizations to meet needs of the citizens.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.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 citizensC 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 major goals cited in Healthy People 2020.An 80-year-old woman comes to the community health center 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 pay for these medications. I will refer you to our social worker." d. "These medications are important. Do your best to pay for them."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. The Medicare Advantage program incorporates private insurance plans into the Medicare program including HMO and PPO managed care models and private fee-for-service plans. In addition, Medicare Part D has been added to cover prescriptions. These plans receive payments from Medicare to provide Medicare benefits, including hospital, physician, and often, prescription drug benefits. Finding prescriptive coverage through an insurance plan 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.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.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.A nursing student interviews a member of the local congressional district to learn more about the health care system in the United States. Which statement made by the congressman would be accurate? a. "Managed care was short-lived because too many consumer groups endorsed the plans." b. "Under managed care, clients had unlimited access to providers of their choice." c. "Managed care failed because Americans were used to free access to providers of their choice." d. "Managed care in the United States has been replaced by the Affordable Health Care for America Act."C Managed care has not become prominent as the original concept outlined. Consumer groups were not only accustomed to freedom of choice and unlimited service, but they did not like the ideas of short-stay maternity care and denial of bone marrow transplantation for breast cancer patients, thus managed care failed in the United States. The Affordable Care Act has not replaced managed care.The federal agency of the public health system that is most involved with the health and welfare of United States citizens is the: 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.B The U. S. Department of Health and Human Services is charged with regulating health care and overseeing the health status of Americans. The Centers for Medicare and Medicaid 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.A nurse works to promote the passage of a public health law to protect the health of the community. Which of the following 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 plantsC 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.A nurse is working in a state health department. Which of the following programs would the nurse most likely be working with? a. Senior health b. Dental services c. HIV/AIDS service d. Mental healthC Typical programs in a state health department include: communicable disease service, HIV/AIDS service, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department.A nurse is employed by the Department of Homeland Security. Which of the following actions would be expected by this department? a. Prevention and protection against terrorist attacks b. Regulation of licensure of medical personnel c. Inspection of the safety of food and cosmetics d. Regulation of managed care organizationsA 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.MULTIPLE RESPONSE 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 e. Poor staffing patternsA, 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.A nurse is entering the health care workforce. Which of the following expectations 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 2016 there are expected to be 527,000 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.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.Official agencies are financed primarily by: 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 REF: p. 891Medicare-certified home health agencies place emphasis on _____ care. a. chronic b. distributive c. intermittent d. primaryANS: 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 REF: p. 888A nurse is implementing a population-focused model of home care delivery. Which of the following actions would most likely be taken by the nurse? a. Use an assessment protocol when conducting visits b. Collaborate with other disciplines c. Provide care for a specific population d. Apply high-intensity interventionsANS: A Population-focused home care models of care usually include structured approaches to regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching. DIF: Cognitive level: Applying REF: p. 889A home care nurse is employed by a proprietary agency. What does this mean? a. The agency is exempt from federal income taxes. b. The agency is governed by a board of directors. c. The agency is a profit-making agency. d. The agency 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 REF: p. 891A 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 teamANS: 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 REF: p. 893 (How To box)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 monthsANS: A The focus of hospice care is comfort, peace, and a sense of dignity at a very difficult time. Comprehensive services emphasize continuity of 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: Analyzing REF: p. 892The 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. AssessmentANS: 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 REF: p. 887A 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 dayANS: 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 REF: p. 891A 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 careANS: 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 REF: p. 891Which 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 AssociationANS: 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. DIF: Cognitive level: Understanding REF: pp. 893-894A 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. ImplementationANS: 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 REF: pp. 893-894Which 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 ModifiersANS: B The Omaha System Problem Rating Scale for Outcomes uses the concepts of Knowledge, Behavior, and Status. DIF: Cognitive level: Understanding REF: p. 897After 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 behaviorsANS: 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. DIF: Cognitive level: Analyzing REF: p. 896A 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 assessmentANS: 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 REF: p. 895A 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 communicationANS: 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.A nurse is trying to facilitate interprofessional collaboration. Which of the following actions should be taken by the nurse? a. Understand who is in charge of 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 skillsANS: 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. DIF: Cognitive level: Analyzing REF: p. 902A 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 visitsANS: 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 REF: p. 901A nurse is using the first stage of the Outcomes and Assessment Information Set (OASIS) outcomes analysis. Which of the following best describes what the nurse is doing? a. Comparing an agency's performance to a national sample b. Reporting data on patient care to a national registry c. Stabilizing a client's condition to continue to receive funding d. Documenting client assessment data and findingsANS: A The first stage, outcomes analysis, enables an agency to compare its performance to a national sample, identify factors that may affect outcomes, and identify final outcomes that show improvement in or stabilization of a client's condition. The second stage, outcomes enhancement, enables the agency to select specific client outcomes and determine strategies to improve care. DIF: Cognitive level: Analyzing REF: p. 901Which 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 AdministrationANS: A Medicare introduced regulations for home care practice as well as for reimbursement mechanisms. DIF: Cognitive level: Understanding REF: p. 888A 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 ActANS: 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 REF: p. 906home health nursingfocus is on empowerment for highest possible levels of function and healthhome health careProvides nursing, therapy, personal care, or housekeeping services in patient's own homeWhich 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 ActB 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.The National Association of School Nurses (NASN) recommends which educational preparation for school nurses? a. Licensed practical nursing 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 nursingB 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.A school nurse reviews the standards of professional practice published by the NASN. Which professional standard will the school nurse rely upon when providing care? a. Interact with interdisciplinary health team members b. Communicate with teachers to effectively manage classrooms c. Teach cardiopulmonary resuscitation to every member of the school staff d. Do research on students at the schoolA Interacting with interdisciplinary health team members is one of the criteria for school nurses developed by the NASN. The professional standards rely on nurses to give care based on 11 criteria: (1) develop school health policies and procedures; (2) evaluate their own nursing practice; (3) keep up with nursing knowledge; (4) interact with the interprofessional health care team; (5) ensure confidentiality in providing health care; (6) consult with others to give complete care; (7) use research findings in practice; (8) ensure the safety of children, including when delegating care to other school personnel; (9) have good communication skills; (10) manage a school health program effectively; and (11) teach others about wellness.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 fairD 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.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. CounselorB 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.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. CounselorC 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.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 c. Facilitate school attendance for students with communicable diseases d. Schedule appointments to specialists for students with chronic diseaseB The school nurse's role is comprehensive and often involves coordinating activities, such as coordinating the school health program. A common misperception 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.A site that provides primary health care services to children and youths by nurse practitioners in the school setting is a: a. primary care clinic. b. school-based health center. c. school health service. d. child health improvement plan.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 not a setting for health care services to be delivered.The leading cause of death in children and teenagers is: a. leukemia. b. injuries. c. suicide. d. diabetes.B The leading cause of death in children and teenagers is injuries.Which statement about head lice is true? a. Prevalence of head lice in U.S. schools is nearly 50%. b. Most cases of head lice are found in white, middle-class children. c. Having head lice is associated with living in an unclean home. d. Most incidents of head lice occur in those with dirty hair.B Lice are mostly found in white, middle-class children as a result of the oval shape of the hair shaft. Prevalence of head lice in U.S. schools ranges from 10% to 40%, being found most commonly in school-aged children, typically in late summer and autumn. Lice are more often seen in clean hair. The suggestion that lice are associated with unclean homes in poverty areas is incorrect.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 d. EcstasyD A very high body temperature can lead to death when taking ecstasy. GHB, Rohypnol, and Ecstasy are known as "club drugs."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.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.A nurse is providing education to prevent health problems in children. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. AssessmentA 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.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 d. Health promotionB 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.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 promotionC 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.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 occurredC 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.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? a. A copy of the prescription label on bottle b. A small container for the medication c. Signed consent parental consent form d. A signed order from the physicianC 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.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 in order 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 immunizationsC 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 immunization exemption.Which school health practice may occur in the future? a. Teaching health education using telehealth and telecounseling b. Using robotic nurses in schools c. Fulfilling the role of both classroom teacher and nurse by nurses d. Developing private practices for treatment of the entire familyA Using telehealth and telecounseling to provide health education is useful for homebound students and their parents. It is unlikely that there will be robotic nurses, that nurses will serve the role of both nurse and classroom teacher, and that private practices will be developed to treat the entire family.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 safetyB, 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.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 schoolA, 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.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 schoolA, 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.The key to achieving the goals of Health for All in the 21st Century (HEALTH21) is the worldwide: a.cure of communicable disease. b.technological development of all nations. c.availability of health care insurance. d.implementation of primary health care.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 HEALTH21. 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 HEALTH21.Which health problem is in need of control in developed countries? a.Hepatitis b.Malaria c.Polio d.SmallpoxA 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.Which is a disease that was once isolated and rare but is now widespread throughout the world? a.Acquired immunodeficiency syndrome (AIDS) b.Smallpox c.Malaria d.MeaslesA 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.Which is referred to as a lesser-developed country? a.France b.Japan c.Indonesia d.SwedenC 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.The health priorities in HEALTH21 are based on the concept of: 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).B HEALTH21 is not a single, finite goal but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity with an emphasis on individual, family, and community responsibility 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.A nurse is working with colonias. Which of the following considerations should be made by the nurse? a.They have developed roads, transportation, and electrical services. b.They are frequently driven off, only to return to the same area. c.Their settlements have led to an increase in several disease conditions. d.Their contributions have improved the local economy.C Many immigrants have settled on unincorporated land, known as colonias, outside the major metropolitan areas in California, Arizona, New Mexico, and Texas. These colonies may not have developed roads, transportation, water, or electrical services. Conditions in these settlements have led to an increase in disease conditions such as amebiasis, respiratory, and diarrheal diseases. Environmental health hazards in the colonias are associated with poverty, poor sanitation, and overcrowded conditions.Population health is an approach and perspective that focuses on: a. control of 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.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.A nurse is examining the income levels and social networks of individuals in a community. Which of the following is the nurse investigating? a. Culture b. Development c. Community d. DeterminantsD 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.Multilateral organizations: a. receive funding from multiple sources. b. control the spread of disease. c. feed the people of the world. d. use nurses as their main source of information.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 of the organizations.A nurse plans to contact a multilateral organization. Which of the following would the nurse most likely contact? a. United Nations (UN) b. United States Agency for International Development (USAID) c. Project Hope d. Catholic Relief ServicesA 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.A nurse is caring for a client who has been diagnosed with tuberculosis (TB). Which of the following medications would the nurse most likely administer? a. Isoniazid b. Nevirapine c. Amodiaquine d. Bacille Calmette-Guérin (BCG)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.A nurse is working in a lesser-developed country and is caring for the women in the local community. Which of the following 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.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 reproductive health services, as well as cultural belief systems that increase the lifetime risk of maternal death.The intergovernmental organization that focuses its efforts on assisting countries in Latin America is the: a. Pan American Health Organization. b. World Bank. c. World Health Organization (WHO). d. United Nations Children's Fund.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.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. SmallpoxD Smallpox was virtually eliminated throughout the world as a result of immunization. Tetanus, measles, and pertussis all continue to exist throughout the world.A nurse is advocating for increased funding for an international agency. Which of the following 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 organizationsB 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 actually provide for less than 5% of needed costs. Recent reports indicate that the majority of funds raised by international organizations are used for food relief, worker training, and disaster relief.A nurse has promoted the introduction of health care technology into lesser-developed countries, but this has led to less-than-satisfactory results. Which of the following 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.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.A nurse is working with a religious organization to provide food to starving people in a lesser-developed country. Which of the following organizations is the nurse most likely working with? a. International Red Cross b. Church World Service c. Maryknoll Missionaries d. Catholic Relief ServicesD 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.A government agency is planning a project in hopes of receiving funding from the World Bank. Which of the following projects 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 hurricaneA 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 encouraging family planning and childhood immunizations. 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 usedA nurse is organizing a fundraiser for a philanthropic organization. Which of the following organizations is the nurse most likely working with? a. International Red Cross b. Carnegie Foundation c. Nestlé d. Johnson & JohnsonB 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.A nurse is working to improve the health status of a population in a lesser-developed country. Which of the following interventions would the nurse most likely support? a. Decrease the number of people who need outside resources b. Increase the number of children who can attend school c. Increase the monetary resources that can be used to treat disease and illness d. Improve the ability to pay debt to more developed countriesB 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.A community health nurse is utilizing the health care system in the United Kingdom. Which of the following expectations should the nurse have? a. An equal employer-citizen share in cost of health care b. Ownership and operation of the system by the government c. Nurse practitioners as the primary providers of care in the system d. Primary care provided in hospitalsB 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 and used. Services are made available through hospitals, private physicians and allied health professional clinics, health outreach programs such as hospice, boroughs, and environmental health services.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 nationsB 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.A nurse is analyzing one of the components of a unit of DALYs. From which of the following individuals would the nurse be able to calculate this measurement? a. A woman who lives to be 100 years old b. A woman who contracts 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 infantC 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. In order to calculate this statistic, the nurse must know the client's age and the potential limit for life.Which of these statements is true about the DALYs in lesser-developed countries? a. Children are at great risk for an early death. b. Diarrheal disease and respiratory infections are rampant despite technology. c. Injuries account for most disability. d. Birth control methods are often lacking.A Approximately 2.5 million neonatal deaths occurred in 2011 and over 20 million children under age 5 died during the same year in lesser-developed countries. Children are at great risk for an early death in these lesser-developed nations. If these children could face the same risks as those in developed nations, the deaths would decrease by 90%. Noncommunicable diseases such as respiratory, cardiac, musculoskeletal, and other conditions are problems in all countries.Which of the following diseases is the leading killer of people with HIV? a. AIDS b. Malaria c. Hepatitis d. TBD TB is the leading killer of people with HIV, and up to 80% of TB clients are HIV positive in countries with a high prevalence of HIV. AIDS, malaria, and hepatitis are not the leading killer of people with HIV.A nurse is caring for a client with TB. Which of the following statements 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.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.A nurse is providing education for a client who is living in an area of the world where malaria is endemic. Which of the following interventions would be appropriate to include? a. Receive a dose of intravenous (IV) quinine b. Avoid direct contact with individuals who have malaria c. Use insecticide-treated bed nets d. Apply dichlorodiphenyltrichloroethane (DDT) sprayC 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.The government is preparing for a bioterrorism event. Which of the following would be the best strategy to use? a. Threaten lesser-developed countries so they don't develop biological weapons b. Ban biological weapons worldwide c. Effectively detect pathogens and manage services d. Develop antidotes for biological agentsC 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.A nurse is concerned about an event of bioterrorism. Which of the following would the nurse most likely be referring to? a. Outbreak of smallpox b. Bombed historic buildings c. Explosion of land mines d. Threats of warA 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.A nurse is assessing a refugee who fled the genocide in Darfur. Which of the following disease/disorder should the nurse anticipate finding? a. TB b. Post-traumatic stress disorder (PTSD) c. Chronic obstructive pulmonary disorder (COPD) d. MalnutritionB 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.Which of the following 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 physiciansA, 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 partnership for development. 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.A nurse is employed by an agency that addresses global health needs. Which of the following roles is the nurse most likely to provide? (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 communityB, 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.A nurse is working to manage the public health aspects of a bioterrorist event. Which of the following 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 publicA, 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.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.A In 2012, 48 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.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 called: a. economics. b. health economics. c. public health economics. d. microeconomic theory.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.Public health economics focuses on the: 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.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.A nurse discusses services with a federal congressman. Which of the following services would the nurse most likely be discussing? a. Family planning b. Counseling c. Policy making d. Prevention of communicable diseasesC 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.A business offers wellness incentives to its employees and then notices a decrease in the frequency of physician visits among employees. Which of the following terms best describes what has happened? a. Macroeconomic theory b. Efficiency c. Supply and demand d. Microeconomic theoryD 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."A nurse is using the principles of supply and demand in daily practice. Which of the following best describes this phenomenon? a. The demand for nurses in public health is low, but the supply is high. b. Few goods or services are available, the price tends to rise. c. Supplies are low, nurses must find alternate resources. d. Lesser-developed countries receive supplies from other countries.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.A nurse is faced with a macroeconomics issue. Which of the following best 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 servicesB Macroeconomics focuses on the "big picture," such as a program, whereas microeconomics focuses on the individual or organization.A public health nurse applies the principles of the macroeconomics theory when working with a community. Which of the following 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.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.A nurse implements a teen pregnancy prevention program in a high school that has been shown to decrease the rate of teen pregnancy. Which of the following best describes the nurse's action? a. Effectiveness b. Efficiency c. Microeconomics d. ProductionA 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.A nurse conducts a class at a public health clinic on breast self-examination for a group of 50 women. Which of the following best describes the nurse's action? a. Supply and demand b. Macroeconomics theory c. Efficiency d. EffectivenessC 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 tends to rise. 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.A nurse is promoting efficiency within the public health department. Which of the following 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 clientsC 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.A nurse enrolls in a microeconomics course at a local college. Which of the following 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.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.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 of the following best describes the action of the nurse? a. Cost-effectiveness analysis b. Cost-benefit analysis c. Supply and demand d. Microeconomic theoryB Cost-benefit analysis involves the listing of all costs and benefits that are expected to occur from an intervention during a prescribed time. Cost-effectiveness 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.A nurse is working with members of the community to assist them with acquiring health insurance. Which of the following individuals 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 businessman who works for a large corporation d. A 32-year-old man who works part-time at a small businessD 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 man who works at the large corporation probably has health insurance, since most large businesses provide it.A nurse is examining the characteristics that affect one's health. Which of the following would be of greatest concern to the nurse? a. Obesity b. Marital status c. Health insurance d. AgeA 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).A community health nurse is assisting clients to access health care. Which of the following individuals would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English b. A 25-year-old female with health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployedD 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 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.A nurse plans to implement a primary prevention strategy in the community. Which of the following would the nurse most likely complete? a. Development of a smoking prevention program b. Development of a support group for widows c. Development of a hypertension screening program d. Development of a hospice care programA 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.The first phase of development of the health care system was characterized by: 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.B Phase one was concerned with epidemics and infectious disease control. Technology is characteristic of phase four, and physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the expansion of hospital clinics and long-term care facilities.A characterization of the fourth developmental phase of the health services delivery framework is: 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.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 phase. The discovery and development of pharmacological advances is only one way that technology has increased during the fourth phase. Phase one was concerned with epidemics and infectious disease control. Physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the expansion of hospital clinics and long-term care facilities.Which 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. MedicaidB 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.An employee is able to receive health insurance from a former employer after changing jobs. Which of the following best describes the legislation that 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 1935A 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.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.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.Medicare and Medicaid are: a. available to any citizen who wishes to enroll. b. two federal programs that provide insurance to special groups. c. private insurance providers. d. funded by the state government.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 by definition.A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses, such as laboratory services and equipment. Which of the following parts of Medicare is being described? a. Part A b. Part B c. Part C d. Part DB 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.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 of the following? a. Medicaid b. Blue Cross c. Medicare d. HMOC 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.A nurse is discussing the services that are covered under Medicare Part A with a client who has recently become eligible for Medicare. Which of the following services is the nurse most likely to mention? a. Blood draw to assess prothrombin time (PT)/International Normalized Ratio (INR) b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulanceC 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.A nurse is providing care to an individual who has Medicaid. Which of the following would most likely describe this individual? 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 impairedC 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.When a health care organization's fees for delivery of services are not decided until after they are provided, it is called: a. retrospective reimbursement. b. prospective reimbursement. c. fee-for-service. d. capitation.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.A nurse is working with a client who receives health insurance through a managed care organization. Which of the following best describes this insurance? a. Medicare b. Medicaid c. MSAs d. Health maintenance organizationsD 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.When a third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the service to the client, it is called: a. retrospective reimbursement. b. prospective reimbursement. c. fee-for-service. d. capitation.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.A physician receives a set amount of money to provide care to a given group of clients for a set period of time. Which of the following terms is being described? a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. CapitationD 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.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.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.MULTIPLE RESPONSE 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 insuranceA, 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.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. 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.Environmental health is important to nurses because chemical, biological, and radiological materials are: a. A major cause of global warming b. Often found in the air, water, and products we use c. Frequently linked to the development of chronic illnesses d. Products that nurses work with on a daily basisANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use.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 clientsANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. The first two options are modern methods.The basic science applied to understanding the health effects associated with chemical exposures is: a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiologyANS: A Toxicology is the study of the health effects associated with chemical exposures.Epidemiology: a. Is a science that studies the poisonous effects of chemicals b. Explains the association between learning disabilities and exposure to lead-based paint at the cellular level c. Helps nurses understand the strength of the association between exposure and health effects d. Is a method for tracking the prevalence of a diseaseANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects.A public health nurse is working with a migrant farm worker who has experienced an exposure to a pesticide. 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 toxicityANS: B Chemicals are grouped so its possible to understand the actions and risks associated with each group.A public health nurse is organizing a multidisciplinary team to address the issue of water pollution in the community. The most likely members that would be invited to address this issue would be: a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemistsANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists.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, temperatureANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil,An example of a point source of air pollution is: a. A smoke stack b. The number of cars and trucks c. How much fossil fuel is consumed in a community d. Ground ozone levelsANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack.Which is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant waterANS: B Point source means a single place from which the pollutant is released into the environment, whereas nonpoint source implies a more diffuse source of pollution.If a nurse wanted more information on indoor air quality, which website would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. Right to Know d. The Occupational Safety and Health Administration (OSHA)ANS: B Sources of information about air quality include the Environmental Protection Agency (EPA) and the American Lung Association.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. Problems with healthANS: A Present work is the first P.A nurse fulfills the environmental health competency of assessment and referral when: 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 healthANS: C Assessment is always an important element of the nursing process. The third option is an example of the assessment phase of the nursing process.The greatest single source of air pollution in the United States is from: a. Waste incineration b. Power plants c. Motor vehicles d. MoldsANS: C Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.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 ActANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters.Employees working with hazardous chemicals have the right to know about the chemicals they are working with through the creation of the: a. Material Safety Data Sheet b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection AgencyANS: C This standard requires employers to maintain a list of all hazardous chemicals that are used on site.A nurse is addressing the problem of air pollution in the community. The first step in the process of controlling the pollution would be: a. Setting standards b. Monitoring c. Permitting d. ComplianceANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water.An acceptable level of emissions or a maximum contaminant level allowed is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standardANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed.An inspection of a facility after a permit is obtained for the purpose of observing whether the plans submitted in the permit application are being implemented as approved is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoringANS: 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.Which question would a nurse ask during the first phase of a risk assessment? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans).What action can a nurse take on an individual level to reduce pollution in the environment? a. Provide a tax incentive to factories that do not pollute. b. Make laws related to allowed levels of pollution in the area. c. Choose a less-polluting car. d. Move to an area with less pollution.ANS: C Citizens can reduce air pollution by doing their part, which can include choosing less-polluting cars.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. Determining neighborhoods that have an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the communityANS: B The use of a Geographic Information System (GIS) allows the public health nurse 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.Which approach(s) can a nurse use when assessing environmental health risks? Select all that apply. a. Ask legislators to provide a list of environmental pollutants in the area. b. Develop a list of exposures associated with urban, rural, or suburban settings. c. Assess the risk by medium such as air, water, soil, or food. d. Divide the environment into functional locations: home, school, workplace, and community.ANS: B, C, D The 2nd, 3rd, and 4th options are ways a nurse can assess the environment.A public health nurse working with a family living in poverty recognizes that they are more likely to be exposed to environmental hazards because they have (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 educationANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Sub-standard 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.A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: a. epidemiologist, pediatric specialist, and sanitarian. b. laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. c. public health sanitarian, pediatric generalist, and plumbing inspector. d. specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhoodANS: D Environmental health-risk identification and risk-reduction intervention require a multidisciplinary team. The team members needed to address an elevated lead level in a child include a specially trained housing inspector, a sanitarian familiar with lead health risks, a nurse practitioner and/or physician trained to intervene in cases of pediatric lead exposure, and housing specialists trained to reduce lead-based paint risk in the home.An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: a. contact factory senior management, educate workers about their exposure, and clean the area. b. contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. c. immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. d. treat the client and obtain a comprehensive exposure history; if an on-site environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.ANS: D A careful history should be taken using the I PREPARE (Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, Educate) model. The client should be appropriately treated. If an on-site environmental exposure is suspected, other at-risk workers should be screened and treated as needed. The environmental cause should be resolved, either by removing the offending chemical or reducing it to safer levels. Factory safety policies should be followed, reviewed, and changed if needed. State and federal agencies should be notified as required.A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? a. Encourage the use of electric cars and scooters on campus b. Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus c. Make the entire campus a no-smoking zone d. Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78° in the summer and lowering the thermostat to 70°in the winterANS: B The burning of fossil fuels to power automobiles and buses and to generate electricity is the single greatest source of air pollution in the United States. While reducing the use of electricity on campus is helpful, the single biggest source of campus air pollution is the cars and buses used to drive to and around campus. Decreasing their use is also an application of the precautionary principle.Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: a. societal justice. b. nonmaleficence. c. compliance and enforcement of the Environmental Protection Agency Regulatory Act. d. environmental justice.ANS: D Environmental health risks notably have disproportionately affected poor people and people of color in the United States. Low-income citizens and people of color are more likely to live near a hazardous waste site, and increased incidence of childhood lead poisoning and increased rates of childhood asthma are seen in these groups. Environmental justice is the principle of assuring that no group is more at risk of harmful exposure than another.A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: a. community strengths and weaknesses. b. environment and human health/disease. c. toxicology studies conducted by the Environmental Protection Agency and the environment. d. federal and state environmental regulations.ANS: B Understanding the relationship between the environment and human health and disease has become more important over the years. The environment is now known to play a role as a determinant of health status, an explanation of disease, an influence on health risk, and a cause of human toxicity and the ever-increasing burden of potentially toxic synthetic chemicals that our bodies carry.The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: a. provided for the appointment of state emergency response commissions. b. increased focus on the human health problems related to hazardous waste sites. c. established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. d. reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.ANS: B SARA changes included an increase in the size of the trust fund; encouraged greater citizen participation in decision making on how sites should be cleaned up; increased state involvement in every phase of the Superfund program; increased focus on human health problems related to hazardous waste sites; established new enforcement authorities and settlement tools; stressed the importance of permanent remedies and innovative treatment technologies in the cleanup of hazardous waste sites; provided for Superfund actions to consider standards in other federal and state regulations; and established the federal Agency for Toxic Substances and Disease Registry. This act amended the Comprehensive Environmental Response, Compensation, and Liability Act with provisions for a broader community-level involvement and public health mission to address the effects of hazardous waste sites on people.The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: a. compliance and enforcement. b. environmental epidemiology. c. secondary prevention. d. toxicologyANS: B Epidemiologic studies enable us to understand the strength of the association between exposures and health effects, such as the relation between air pollution and asthma exacerbation.When applying the nursing process to environmental health, the nurse would: a. conduct an assessment focused on the client's presenting problem. b. coordinate interventions with the primary care provider of record. c. examine criteria that are limited to the client's immediate responses. d. include outcome measures that involve mitigation and elimination of the contributing factors.ANS: D If the nurse suspects that the client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse should include outcome measures that relate to mitigation and elimination of the environmental factors.When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: a. advocating for ethical choices. b. communicating risk. c. controlling environmental damage. d. volunteering for service on state boards.ANS: A Nurses, using sound risk communication skills as trusted communicators, advocate for environmental justice. Ethical issues likely to arise in environmental health decisions are: Who has access to information and when? How complete and accurate is the information? Who is included in the decision making and when? What and whose values and priorities are given weight in decisions? How are short-term and long-term consequences considered?The role of the nurse who wants to become more active in environmental health could include which of the following? (Select all that apply.) a. Assessing farmworkers for pesticide exposure and providing pesticide risk education b. Conducting epidemiologic investigations as a public health nurse (PHN) c. Developing corporate policy to protect workers from unsafe levels of toxic agents d. Organizing the local community to encourage landlords to remove lead-based paint e. Working as a skilled risk communicator for a local chemical manufacturerANS: A, B, C, D, E Nurses can have a vital role in reducing environmental risk, educating workers and/or the community, and helping to eliminate risks in the local community. As nurses learn more about the environment, opportunities for integration of such work into their practices, educational programs, research, advocacy, and policy work will become evident and will evolve.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 Care2. 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 incorporated into the public health curricula 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 Care3. 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. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care4. 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 Care5. 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 practice is being demonstrated? a. Individual b. Systems c. Community d. GovernmentANS: 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 Maintenance6. 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 d. Teenage parentsANS: 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 Care7. 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: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care8. 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 preventionANS: 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 Care9. 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. 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 Care10. 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 Care11. A public health nurse (PHN) is using collaboration, coalition building, and community organizing to develop a new program in the community. 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 strategiesANS: 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 Care12. 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 aggregatesANS: A 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 Care13. 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. IndividualANS: 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 Maintenance14. An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. GovernmentANS: 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 Maintenance15. 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. 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 Care16. 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 productsANS: 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 tobacco products occurs at the systems level of practice, but it is not health teaching. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance17. 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 teachingANS: 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 MSC: NCLEX: Health Promotion and Maintenance18. 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-upANS: 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 Care19. 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 b. Surveillance c. Health teaching d. ScreeningANS: 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 Maintenance20. 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 casesANS: D 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 Care21. 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 Care22. A public health nurse (PHN) is addressing the problem of obesity at the community level of 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 habitsANS: 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 CareMULTIPLE RESPONSE 1. What are the cornerstones of public health nursing practice? (Select all that apply.) a. Focus on the health of the entire population. b. Reflect community priorities and needs. c. Promote health through strategies driven by epidemiological evidence. d. Are grounded in an ethic of collaboration. e. 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 CareWhich 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. Refugees make up a large part of the nursing workforce in some areas.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. Unauthorized immigrants and refugees do not make up a part of the nursing workforce.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 procedure for refugees to 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" that would allow them to work in the United StatesB 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.A large portion of foreign-born residents of the United States: a. work in service-producing and blue-collar sectors. b. reside in rural areas. c. have a high school education. d. are refugees and nonimmigrants.A 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.A 35-year-old man from Russia comes to the United States seeking asylum because of religious persecution in his native country. Which of the following best describes this type of immigrant? a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrantC 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.A visitor from Japan comes to the United States for a 2-week vacation. Which of the following best describes this person? a. Nonimmigrant b. Refugee c. Legal immigrant d. Lawful permanent residentA A nonimmigrant 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.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 a seat c. Immigrating to the United States and seeking work d. An organizational structure of a cultural groupB Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and is transmitted inter-generationally. 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.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 illnessA Explicit behaviors are straightforward and do not leave room for misinterpretation of what the person wants to communicate, such as when using verbal communication. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness.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 populationA 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.Which of the following statements about race is true? 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.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, children of biracial parents are usually assigned the race of the mother. 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.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: a. multiculturalism. b. ethnicity. c. race. d. culture.C Race is primarily a social classification that relies on physical markers. Multiculturalism is the blending of diverse cultures. Ethnicity is the shared 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 inter-generationally.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. CultureB 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 inter-generationally.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 awarenessC 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.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 health care c. Achievement of health indicators d. Improvement in client complianceB 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.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 themselves in different cultures c. Design care for special ethnic groups d. Give explicit instructions to avoid client decision makingA 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.A nurse wants to obtain information on the alternative methods of health care her 45-year-old female client uses. 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 groupC 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.A nurse has experienced a cultural encounter. Which of the following best describes what has happened? 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 c. Telephoning the priest at a Hispanic church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian clientD 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.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 valuesC 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.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 of the following best describes this action? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural re-patterningA 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 restore health. Cultural re-patterning 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.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 re-patterning c. Culture brokering d. Cultural awarenessA 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 re-patterning 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.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 re-patterningC 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 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 re-patterning 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.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. StereotypingC 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.The nurse labels a patient an alcoholic because of his ethnicity. Which of the following best describes this action by the nurse? a. Stereotyping b. Prejudice c. Racism d. EthnocentrismA 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.A nurse advocates and intervenes between the health care system and the client's cultural beliefs on behalf of the client. Which of the following best describes the nurse's action? a. Cultural accommodation b. Culture brokering c. Cultural preservation d. Cultural repatterningB 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 re-patterning 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.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. StereotypingA 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.The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as: a. cultural conflict. b. culture shock. c. cultural blindness. d. cultural imposition.C Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. 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.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 b. Cultural relativism c. Culture shock d. Culture brokeringC 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.A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take 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 impositionD 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.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 controlC 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.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 timeD 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.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 controlD 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.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? a. Biological variations b. Personal space c. Social organization d. Perception of timeA 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.A nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse in order 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. d. Certain groups may use nontraditional healing practices. e. Introduction of the American culture will be an important part of the encounter.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.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.B, D 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.To understand the causes of health and disease, epidemiology studies: a. individuals. b. families. c. groups. d. populations.D Epidemiology monitors health of populations, understands determinants of health and disease in communities, and investigates and evaluates interventions to prevent disease and maintain health. Epidemiology does not focus on individuals, families, and groups.The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using: a. descriptive epidemiology. b. analytic epidemiology. c. distribution. d. determinants.D 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.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. DeterminantsB 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.A nurse states that she has been reading about an epidemic that has been occurring in the world. Which of the following is she most likely referring to? a. "Bird" flu in China b. Adult obesity in the United States c. An isolated case of smallpox in Africa d. The nursing shortage in the United StatesB It is estimated that 30% of the adults in the United States are obese. According to the Centers for Disease Control and Prevention, this is an epidemic. The other examples are not epidemics.John Snow is called the "father of epidemiology" because of his work with: a. cholera. b. malaria. c. polio. d. germ theory.A John Snow investigated the spread of cholera in the mid-nineteenth century. John Snow did not investigate the other examples.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. b. Single organisms that cause a disease, such as cholera, must be studied in more 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.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.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 determineD One cannot tell the degree of seriousness without a denominator, which represents the total population.The probability an event will occur within a specified period of time is called: a. rate. b. risk. c. epidemiology. d. epidemic.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.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? a. Prevalence b. Incidence c. Attack rate d. Morbidity rateA 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.Which statement is true about mortality rates? Mortality rates: a. are informative only for fatal diseases. b. provide information about existing disease in the population. c. are calculated using a population estimate at year-end. d. reveal the risk of getting a particular disease.A 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.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 restaurantD 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.The interaction between an agent, a host, and the environment is called: a. natural history of disease. b. risk. c. web of causality. d. the epidemiologic triangle.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.Public health professionals refer to three levels of prevention as tied to specific stages in the: a. epidemiologic triangle. b. web of causation. c. natural history of disease. d. surveillance process.C 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.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. ClimateB An agent includes infectious organisms, such as Salmonella, chemical agents, and physical agents. Genetic susceptibility is considered to be a characteristic of a host. Human population distribution and climate are considered to be characteristics of the environment.A PHN implements a primary prevention intervention in the community. Which of the following is most likely being implemented? a. Pap smear b. Blood pressure screening c. Diet and exercise d. Physical therapyC 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.A 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 promotionA 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.As a result 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 preventionA 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, injury, or disability. Multifactorial prevention is not possible with a disease like influenza, which has one cause.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 promotionB 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.A nurse refers a client 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 promotionC 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.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. MammogramD Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Mammograms are a screening test. Avoidance of high-risk behaviors and immunizations are examples of primary prevention. Rehabilitation is an example of tertiary prevention.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 counselingA 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.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.C Specificity refers to the test accurately identifying those without the trait. High specificity is needed when re-screening is impractical and when reduction of false positives is important. The test would have a low level of false positives.The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the: a. sensitivity. b. specificity. c. positive predictive value. d. negative predictive value.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 condition or trait. Specificity indicates how accurately the test identifies those without the condition or trait. Negative predictive value is the proportion of persons with a negative test who are actually disease free.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 dataA 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.The most important predictor of overall mortality is: a. race. b. age. c. gender. d. income.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.A nurse is investigating an outbreak of a gastrointestinal illness from a food-borne pathogen. Which of the following terms is being applied? a. Attack rate b. Point epidemic c. Secular trend d. Event-related clusterB 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 peak characteristic of such graphs indicates a concentration 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.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 is a(n): a. case-control study. b. cross-sectional study. c. cohort study. d. experimental study.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 of time 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.A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called: a. cross-sectional. b. ecological. c. case-control. d. cohort.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.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. ScreeningC 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.A nurse is considering the potential for selection bias. Which of the following best describes the situation that is the nurse has encountered? a. Determining the population to be studied b. Considering how the participants will enter the study c. Studying cause and effect relationships d. Documenting results of the studyB 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.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 equipmentB, 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.A nurse states that he has incorporated epidemiology into his 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 enforcementB, 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.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. Refugees make up a large part of the nursing workforce in some areas.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. Unauthorized immigrants and refugees do not make up a part of the nursing workforce.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 procedure for refugees to 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" that would allow them to work in the United StatesB 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.A large portion of foreign-born residents of the United States: a. work in service-producing and blue-collar sectors. b. reside in rural areas. c. have a high school education. d. are refugees and nonimmigrants.A 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.A 35-year-old man from Russia comes to the United States seeking asylum because of religious persecution in his native country. Which of the following best describes this type of immigrant? a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrantC 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.A visitor from Japan comes to the United States for a 2-week vacation. Which of the following best describes this person? a. Nonimmigrant b. Refugee c. Legal immigrant d. Lawful permanent residentA A nonimmigrant 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.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 a seat c. Immigrating to the United States and seeking work d. An organizational structure of a cultural groupB 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.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 illnessA Explicit behaviors are straightforward and do not leave room for misinterpretation of what the person wants to communicate, such as when using verbal communication. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness.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 populationA 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.Which of the following statements about race is true? 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.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, children of biracial parents are usually assigned the race of the mother. 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.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: a. multiculturalism. b. ethnicity. c. race. d. culture.C Race is primarily a social classification that relies on physical markers. Multiculturalism is the blending of diverse cultures. Ethnicity is the shared 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.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. CultureB 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.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 awarenessC 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.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 health care c. Achievement of health indicators d. Improvement in client complianceB 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.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 themselves in different cultures c. Design care for special ethnic groups d. Give explicit instructions to avoid client decision makingA 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.A nurse wants to obtain information on the alternative methods of health care her 45-year-old female client uses. 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 groupC 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.A nurse has experienced a cultural encounter. Which of the following best describes what has happened? 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 c. Telephoning the priest at a Hispanic church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian clientD 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.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 valuesC 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.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 of the following best describes this action? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterningA 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 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.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 awarenessA 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.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 repatterningC 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 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.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. StereotypingC 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.The nurse labels a patient an alcoholic because of his ethnicity. Which of the following best describes this action by the nurse? a. Stereotyping b. Prejudice c. Racism d. EthnocentrismA 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.A nurse advocates and intervenes between the health care system and the client's cultural beliefs on behalf of the client. Which of the following best describes the nurse's action? a. Cultural accommodation b. Culture brokering c. Cultural preservation d. Cultural repatterningB 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.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. StereotypingA 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.The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as: a. cultural conflict. b. culture shock. c. cultural blindness. d. cultural imposition.C Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. 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.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 b. Cultural relativism c. Culture shock d. Culture brokeringC 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.A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take 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 impositionD 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.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 controlC 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.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 timeD 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 functionsAsians 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 controlD 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.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? a. Biological variations b. Personal space c. Social organization d. Perception of timeA 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.A nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse in order 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. d. Certain groups may use nontraditional healing practices. e. Introduction of the American culture will be an important part of the encounter.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.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.B, D 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.