NUR 442 Exam 1 Ch 1-8

1. After teaching a group of nursing students about the similarities and differences between
public health and community health, which of the following statements by a nursing student
would indicate knowledge of the similarities and differences between public health and
community health?
A) "Community health nursing is defined as
nursing care that is provided in a community setting, rather than an institutional setting."
B) "Public health nursing is defined as nursing care that is provided in an institutional
setting."
C) "Public health nursing is focused on the
health of individuals."
D) "Community health nursing can shape the quality of community health services and
improve the health of the general public."
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1. After teaching a group of nursing students about the similarities and differences between
public health and community health, which of the following statements by a nursing student
would indicate knowledge of the similarities and differences between public health and
community health?
A) "Community health nursing is defined as
nursing care that is provided in a community setting, rather than an institutional setting."
B) "Public health nursing is defined as nursing care that is provided in an institutional
setting."
C) "Public health nursing is focused on the
health of individuals."
D) "Community health nursing can shape the quality of community health services and
improve the health of the general public."
Ans: D
Feedback:
Operating within an environment of rapid change and increasingly complex challenges,
this nursing specialty holds the potential to shape the quality of community health services and
improve the health of the general
public.
2. Which of the following statements would best
describe the difference between public health nursing and community health nursing?
A) Public health nursing is focused on the private aspects of health, and community health
nursing is focused on the public aspects of
health.
B) In our textbook, the term community health practice refers to a focus on specific,
designated communities and is a part of the
larger public health effort.
C) Public health nursing and community health nursing relate to the very same types of
services and perspectives.
D) Both public health nursing and community health nursing are practiced exclusively
within institutions.
Ans: B
Feedback: In this textbook, community health practice refers to a focus on specific, designated
communities. It is a part of the larger public health effort and recognizes the fundamental
concepts and principles of public health as its birthright and foundation for practice. Public
health nursing is focused on the public aspects of health. Public health nursing and community
health nursing have distinctive types of services and perspectives. Neither public health nursing
nor community health nursing is practiced exclusively within
institutions.
3. Which of the following is most accurate about
the concept of community?
A) A community is a collection of people who
share some important features of their lives.
B) Community members live in the same
geographic location.
C) Community members are biologically related.
D) A community is made up of people who do not necessarily interact with one another and
do not necessarily share a sense of belonging
to that group.
Ans: A
Feedback:
The broad definition of a community is a collection of people who share some important
features of their lives. Community members may not live in the same geographic location as in a
common-interest community or a community of solution. A population is made up of people
who do not necessarily interact with one another and do not necessarily share a sense of
belonging to that
group.
4. A group of students are reviewing material for a test on populations, communities, and
aggregates. Which of the following indicates
that the students understand these concepts?
A) Members of a population share a sense of
belonging.
B) Communities and populations are types of
aggregates.
C) Individuals of a community are loosely
connected.
D) Members of an aggregate share a strong bond.
Ans: B
Feedback:
An aggregate refers to a mass of grouping of distinct individuals who are considered as a
whole and who are loosely associated with one another. Communities and populations are types
of aggregates. A population is made up of people who do not necessarily interact with one
another and do not necessarily share a sense of belonging to the group. A community is a


collection of people who chose to interact with one another because of common interests,
characteristics, or goals, which form the basis for a sense of unity or
belonging.
5. Which of the following would a community health nurse identify as a community of
common interest?
A) The global community
B) Small rural town in a northern state
C) National professional organization
D) Counties addressing water pollution
Ans: C
Feedback:
A common-interest community shares a common interest or goal that binds the members
together. Membership in a national professional organization is one example. The global
community and a small rural town in a northern state would be examples of a geographic
community. Counties addressing a water pollution problem would be an example
of a community of solution.
6. The nurse is working with a community of solution. Which of the following would the
nurse expect to find?
A) A health problem affecting the group
B) Common goal binding members together
C) Sharing of a similar goal
D) Locational boundaries
Ans: A
Feedback:
A community of solution involves a group of people coming together to solve a problem
that affects them. A common-interest community involves a collection of people widely
scattered geographically who have an interest or goal that binds the members together. A
geographical community is one defined by its geographical or locational
boundaries.
7. Which one of the following statements made by a student would the nurse educator
recognize as evidence that a student
understands the health continuum?
A) The distinction between health and illness is
well demarcated.
B) Illness refers to a state of being relatively
unhealthy.
C) The term health is limited to reflect an
individual's state.
D) Treatment of acute conditions reflects the
current focus of health care.
Ans: B


Feedback:
Although society typically depicts an absolute line of difference between being either
well or ill, health is considered a relative term. Thus, illness is viewed as a state of being
relatively unhealthy. Health is typically described as a continuum that involves a range of
degrees from optimal health at one end to total disability or death at the other. The line of
demarcation is not clear. Health applies to individuals, families, and communities.
Traditionally, most health care has focused on the treatment of acute and chronic conditions at
the illness end of the continuum, but this emphasis is shifting to focus on the wellness
end.
8. When discussing the concept of the health continuum with a class, the nurse educator
would be certain to include which statement
in the description?
A) Wellness is a relative concept, not an absolute, and illness is a state of being
relatively unhealthy.
B) A client's placement on the health continuum
is static throughout time.
C) Health is best described as cyclic.
D) The health continuum can only be applied to
individuals.
Ans: A
Feedback:
Wellness is a relative concept, not an absolute, and illness is a state of being relatively
unhealthy. The continuum can change. Because health involves a range of degrees from optimal
health at one end to total disability or death at the other, it is often described as a continuum. The
health continuum applies not only to individuals but
also to families and communities.
9. After discussing the leading health indicators with a class, which condition if stated by
the class as one of these indicators suggests that
the class has understood the information?
A) Cardiac disease
B) Mental health
C) Sedentary lifestyle
D) Maternal health care
Ans: B
Feedback:
Mental health is a leading health indicator. Other leading health indicators include
physical activity, overweight and obesity, tobacco use, substance use, responsible sexual
behavior, injury and violence, environmental quality, immunization, and access to health
care.
11. A group of community health nursing students design a health education program for a
group of pregnant teens that includes teaching nutrition during pregnancy, demonstrating helpful
exercises, and discussing their concerns. This is an example
of which of the following?
A) Health promotion
B) Treatment of disorders
C) Rehabilitation
D) Evaluation
Ans: A
Feedback:
The student nurses are engaging in health promotion activities. Health promotion
incorporates all efforts that seek to move people closer to optimal well-being or to higher levels
of wellness. Treatment of disorders would include direct care for issues involving the group,
such as complications that might arise in this population.
Rehabilitation would involve activities to minimize disability or restore or preserve function.
Evaluation would involve an analysis of the effectiveness of these
activities.
10. Which of the following statements about health promotion and disease prevention is the most accurate? A) Health promotion and disease prevention include all efforts that seek to move people closer to optimal well-being or higher levels of wellness. B) Disease prevention differs from health promotion in that disease prevention is targeted toward a specific disease or diseases. C) Health promotion can be described in terms of primary, secondary, and tertiary prevention. D) The goal of disease prevention is to raise levels of wellness for individuals, families, populations, and communities.` Ans: B Feedback: Health promotion includes all efforts that seek to move people closer to optimal wellbeing or higher levels of wellness. The goal of health promotion is to raise levels of wellness for individuals, families, populations, and communities. Disease prevention is targeted toward a specific disease or diseases and consists of primary, secondary, and tertiary prevention.12. plan of primary prevention activities. Which of the following might the nurse include? Select all that apply. A) Teaching about safe-sex practices to high school students B) Encouraging older adults to install safety devices in the bathroom C) Providing regular immunization programs for communicable diseases D) Participating in cholesterol screening programs at health fairs E) Providing skin testing for tuberculosis for children over 1 year of age F) Working with a group testing water samples for contaminationAns: A, B, C Feedback: Primary prevention activities are those taken to keep illness or injuries from occurring. These include teaching about safe-sex practices, encouraging older adults to use safety devices in the bathroom, and providing regular immunization programs for communicable diseases. Cholesterol screening programs, skin tests for tuberculosis, and working with a group testing water samples for contamination are examples of secondary prevention activities.13. A community health nurse is preparing a presentation for a group of nursing students about community health nursing. Which of the following descriptions about community health nursing would the nurse most likely include in the presentation? A) Focusing on addressing continuous needs B) Working with the client as an equal partner C) Engaging in tertiary prevention as the priority D) Encouraging clients to reach out to the nurseAns: B Feedback: The community health nurse works with the client as an equal partner, encouraging autonomy. At any time, the nurse deals with continuous and episodic needs simultaneously. Primary prevention is the priority for community health nurses. The community health nurse engages in primary prevention as the priority, having the obligation to actively reach out to all who might benefit from a specific activity or service.14. A community health nurse is working with other members of a team that will be implementing a citywide immunization program. The nurse is coordinating the services and addressing the needs of the population groups to ensure which of the following? A) Involvement of the community B) Client participation C) Continuity of service D) Plan for follow-upAns: C Feedback: Working in cooperation with other team members and coordinating services and addressing the needs of population groups are essential to interprofessional collaboration. In doing so, the community health nurse is preventing fragmentation and gaps thereby ensuring continuity of service. Involvement of the community and client participation are important but these help to ensure that the clients are viewed as equal partners of the health care team. A plan for follow-up may or may not be appropriate. In addition, it is the only aspect that may be addressed with the program.15. A community health nurse works to ensure the greatest good for the greatest number of people by applying which of the following? A) Secondary prevention activities B) Autonomy C) Justice D) UtilitarianismAns: D Feedback: The ethical theory of utilitarianism promotes the greatest good for the greatest number. Primary prevention activities, not secondary prevention, are the priority. Autonomy refers to the freedom of choice. Justice involves treating people fairly.16. When working in the community, the community health nurse adopts the teaching plan to ensure that the population understands the basic information provided to address which of the following? A) Self-care B) Health disparities C) Health literacy D) Episodic needsAns: C Feedback: Consumers are often intimated by health professionals and are uninformed about health and health care affecting the quality of care. Adopting a teaching plan to ensure that the population understands the basic information addresses health literacy, the ability to read, understand, and use health care information appropriately. Doing so helps to ensure that the teaching plan will be effective. Self-care refers to the process of taking responsibility for developing one's own health potential by actively participating in promoting one's own health. Health disparities reflect differences in all aspects of health care related to vulnerable populations. Episodic needs are one-time specific negative health events that arise and are not an expected part of life.17. Which of the following would be crucial for the community health nurse to address as the priority when dealing with policy makers about the development of community health programs? A) Research-based best practices B) Population's make up C) Amount of services to be provided D) Scarcity of the available resourcesAns: A Feedback: Decisions for programs or services are often made on the basis of cost-effectiveness or cost-benefit. Therefore, community health nurses must provide policy makers with information about best practices, grounded in research. Although population make up, amount of services to be provided, and scarcity of resources are factors that may need to be considered, the community health nurse must demonstrate evidence-based practice.18. After a class that described the differences between acute care nursing and community health nursing, which statement by the class about community health nurses indicates successful teaching? A) Use a reactive approach. B) Seek out potential health problems. C) Concentrate on the illness end of the continuum. D) Emphasize curative care.Ans: B Feedback: Community health nurses, in contrast to acute care nurses, seek out potential health problems, identifying high-risk groups and instituting preventive programs; use a proactive approach; concentrate on the wellness end of the health continuum; and put less emphasis on curative care.19. Which of the following activities would be associated with a community health nurse? Select all that apply. A) Examining infants in a city well-baby clinic B) Caring for elderly stroke victims in their homes C) Providing emergency care in an acute care facility D) Carrying out epidemiologic research E) Participating in health policy analysisAns: A, B, D, E Feedback: Community health nurses work in every conceivable kind of community agency, from a state public health department to a community-based advocacy group. Their duties rang from examining infants in a well- baby clinic or teaching elderly stroke victims in their homes to carrying out epidemiologic research or engaging in health policy analysis and decision making. Providing care in an acute care facility would not be an activity associated with a community health nurse.20. The term health can be described in many different ways. A community health nurse would view health as which of the following? A) The absence of disease B) The potential to lead a productive life C) An environment free of toxins D) A holistic state of well-beingAns: D Feedback: Community health nurses view health as a holistic state of well-being, which includes soundness of mind, body, and spirit. Along with this foundational view is the emphasis on wellness, which includes the definition of health as well as the capacity to develop a person's potential to lead a fulfilling and productive life. Health is more than just the absence of disease or an environment free of toxins.21. While interviewing a client, which of the following statements would a nurse identify as reflecting an objective dimension of health? A) "I'm feeling better since I started taking that medication." B) "Life is pretty good right now, except for an occasional upset stomach." C) "I'm able to wash myself in the mornings with just a bit of help." D) "Sometimes when I wake up, I don't even want to face the day."Ans: C Feedback: The objective dimension of health involves one's ability to function in daily activities. The statement about being able to care for one's self is an example. The statements of feeling better with medication, life being pretty good, and not wanting to face the day are examples of the subjective dimension of health, which involves how people feel.22. When employing a population-oriented focus, the community health nurse would do which of the following? A) Assess the groups' relationships looking for a common need. B) Consider the members individually for similarities. C) Focus on the geographical area of the population. D) Promote the groups' dependency for improving health.Ans: A Feedback: A population-oriented focus requires the assessment of relationships, considering the groups or communities in relationship to the rest of the community to discover common needs or risks for a common health problem. The nurse does not consider the groups or communities separately but rather in context. The population may or may not be delineated by the geographical area. The community health nurse encourages individuals' participation to promote their autonomy rather than permitting dependency.23. A community health nurse is involved in a project to evaluate the health of a city. Which of the following findings would suggest that the city would most likely need additional programs? A) Citizens are actively involved in the city's department of recreation and after-school programs. B) The construction of affordable organized housing developments and communities is nearing completion. C) Approximately one third of the people are recently unemployed due to closure of the automotive factory. D) Several new recreational facilities for adults and children have been created at several locations.Ans: C Feedback: A healthy city is one in which there is continual creation and improvement the physical and social environments with expansion of community resources so that people can mutually support one another. It is characterized by the meeting of basic needs for all of the city's people. This would include food, water, shelter, income, safety, and work. Loss of employment of one third of the city's workforce would be a threat to the health of the city and necessitate intervention. Active involvement in the city's functioning, affordable housing, and recreational facilities are suggestive of a healthy city.1. A community health nurse is engaging in assurance activities. Which of the following would best explain these activities? A) Gathering and analyzing information that will affect the health of the people to be served B) Providing leadership in facilitating community groups toward meeting their needs, often involving changes in and additions to existing laws C) Being involved in activities to make certain that necessary services are being provided to the community D) Accessing relevant data that enable identification of strengths, weaknesses, and needs within the communityAns: C Feedback: Assurance activities are those activities that make certain that services are provided and include focusing on the availability of necessary health services throughout the community, maintaining the ability of public health agencies and private providers to manage day-to-day operations as well as the capacity to respond to critical situations and emergencies. Assessment involves gathering and analyzing information that will affect the health of those to be served and accessing relevant data to enable the nurse to identify strengths, weaknesses, and needs. Policy development involves providing leadership in facilitating community groups.2. When fulfilling the function of assessment, which of the following would be most important for the community health nurse to do? A) Secure the trust of the clients B) Gather appropriate information C) Interact with key community leaders D) Use a variety of assessment toolsAns: A Feedback: Although securing and maintaining the trust of others is pivotal to all nursing practice, it is even more critical when working in the community. Trust can afford a nurse access to client populations that are difficult to engage, to agencies, and to health care providers. As difficult as it may be for the nurse to gain the trust and respect of the community, if it is ever lost, these attributes can be difficult if not impossible to regain. Gathering information, interacting with key community leaders, and using a variety of assessment tools are important, but they can only occur after trust is established.3. The community health nurse is engaging in the core function of policy development. With which of the activities would the nurse most likely be involved? A) Monitoring health status to identify community health problems B) Empowering communities about important health issues C) Linking individuals to needed personal health services D) Ensuring a competent health care workforce is availableAns: B Feedback: With policy development, the community health nurse would be involved in informing, educating, and empowering people about health issues. Monitoring health status is associated with the assessment function. Linking individuals to needed personal health services and ensuring a competent public health and personal health care workforce are associated with assurance.4. A community health nurse is collaborating with local community leaders to prepare a community disaster plan. Which function is the nurse fulfilling? A) Research B) Assurance C) Policy development D) AssessmentAns: B Feedback: Community health nurses perform the assurance function at the community level when they collaborate with community leaders in the preparation of a community disaster plan. Research is demonstrated by gaining new insights and innovative solutions to health problems. Policy development would involve client information, education and empowerment, mobilization of community partnerships, and the development of plans and policies to support community health efforts. Assessment involves monitoring health status for community health problems and diagnosing and investigating health problems and hazards in the community.5. A community health nurse has collected data for several months on the birth weights of newborns to mothers who smoked throughout their pregnancy. This nurse is acting in which role? A) Collaborator B) Manager C) Researcher D) ClinicianAns: C Feedback: The nurse is assuming the role of a researcher, that is, engaging in systematic investigation that includes data collection. In the collaborator role, the nurse would work with numerous members of the health team, working jointly with others in a common endeavor. In the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations.6. A nurse in community health nursing setting works with police officers, social workers, health educators, and other nurses to promote the health of clients. The nurse is acting in which role? A) Clinician B) Educator C) Researcher D) CollaboratorAns: D Feedback: The nurse is assuming the role of collaborator. In this role, the community health nurse works jointly with many individuals to benefit client care. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations. As an educator, the nurse is the health teacher and provides information to community clients. In the researcher role, the community health nurse engages in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.7. A community health nurse is interviewing for employment. The interviewer describes some of the typical activities that the nurse would be involved in, such as making home visits to families, holding immunization clinics for infants and children, and setting up flu-shot clinics for elders. The interviewer is describing which role? A) Educator B) Advocate C) Clinician D) ManagerAns: C Feedback: The interviewer is describing direct care activities associated with the clinician role. As an educator, the nurse is the health teacher and provides information to community clients. In the advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals.8. A community health nurse is reviewing his or her schedule for the day. Included in his or her activities are planning client care, leading a staff conference, and supervising a new staff member. This nurse is fulfilling which role? A) Advocate B) Manager C) Collaborator D) ResearcherAns: B Feedback: When functioning in the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals. Overseeing client care as a case manager, supervising ancillary staff, managing caseloads, running clinics, or conducting community health needs assessment projects are examples of activities associated with the manager role. In the advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the collaborator role, the nurse would work with numerous members of the health team, working jointly with others in a common endeavor. In the researcher role, the community health nurse engages in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.9. While providing care to a family at a local center, the community health nurse contacts the local department of social services to help the family attain assistance with health insurance coverage. The nurse also gives the family a list of pharmacies where they can get their prescriptions filled. The nurse is acting in which role? A) Educator B) Leader C) Clinician D) AdvocateAns: D Feedback: The nurse is acting in the role of advocate, by pleading their cause and acting on their behalf. The nurse acts as an advocate by showing clients what services are available, the ones to which they are entitled, and how to obtain them. As an educator, the nurse is the health teacher and provides information to community clients. As a leader, the nurse directs, influences, or persuades others to effect change that will positively impact people's health and move them toward a goal. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations.10. Which of the following best exemplifies the attributes of a community health nurse in the researcher role? A) Gaining the trust and respect of the staff members B) Interpreting abstract ideas so others can understand C) Implementing a staff development program for a technique D) Evaluating the correlation between variables in specific health conditionsAns: D Feedback: Attributes of a researcher include a spirit of inquiry, careful observation, analytic skills, such as evaluating the possible cause and effect of a situation, and tenacity. Gaining the trust and respect of staff, interpreting abstract ideas, and implementing a staff development program are examples of the management skills used in the role of manager.11. Which of the following statements about the role of educator within the framework of public health nursing functions is true? A) The educator role has the potential for finding greater receptivity and providing higheryield results. B) People are unable to recognize the value of health and are not well motivated to achieve higher levels of wellness. C) It is only possible for a nurse to reach a limited number of persons. D) The public's higher level of health consciousness hinders the educator's role.Ans: A Feedback: The educator role has the potential for finding greater receptivity and providing higheryield results. People are recognizing the value of health and are increasingly motivated to achieve higher levels of wellness. With an emphasis on populations and aggregates, the educational efforts of community health nursing are appropriately targeted to reach many people. One factor that enhances the educator role is the public's higher level of health consciousness.12. Which of the following statements about the importance of the role of collaborator is true? A) Community health nurses frequently practice in isolation. B) Successful community health practice depends on multidisciplinary collegiality and leadership. C) Community health nurses must assert themselves as the most powerful person on the health care team to ensure each client receives services that are necessary. D) It is best for community health nurses to focus on what they, as nurses, can do for their clients.Ans: B Feedback: Community health nurses seldom practice in isolation. As collaborators, nurses work jointly with others in a common endeavor, cooperating as partners. Successful community health practice depends on multidisciplinary collegiality and leadership. The community health nurse's collaborator role requires skills in communicating, in interpreting the nurse's unique contribution to the team, and in acting assertively as an equal partner.13. Which of the following statements about the community health nurse's selection and practice of each role is true? A) Within a given time, a community health nurse may practice multiple roles. B) The knowledge that vulnerable populations need someone to guide them through the complexities of the health care system and the nurse can serve as an advocate for them C) The researcher role for community health nurses involves only the use of quantitative statistics. D) The leadership role consists solely of managing staff.Ans: B Feedback: Community health nurses wear many hats while conducting day-to-day practice. At any given time, however, one role is primary. They need someone to guide them through the complexities of the system and assure the satisfaction of their needs. This is particularly true for minorities and disadvantaged groups. Although research technically involves a complex set of activities conducted by persons with highly developed and specialized skills, research also means applying that technical study to real-practice situations. As leaders, community health nurses seek to initiate changes that positively affect people's health.14. A community health nurse is involved in education, screening, referral, and support for the individuals of a specific religious congregation. The nurse is practicing in which setting? A) Occupational health nursing B) Faith community nursing C) School nursing D) Residential institution nursingAns: B Feedback: In faith community nursing, the practice focal point is the faith community and the religious belief system provided by the philosophical framework. It may be called church-based health promotion, parish nursing, or primary care parish nursing practice. Occupational health nursing occurs in business and industry settings. School nursing, as the name implies, involves practicing in the school system, including from preschools to colleges and universities. Residential institution nursing occurs in any facility where the clients reside such as a halfway house or continuing care center.15. Which of the following differentiates the home setting for community health nursing from other settings? A) The nurse acts primarily as an educator. B) The client is viewed within his or her environment. C) Technologically advanced care is limited. D) The home is being used less frequently today.Ans: B Feedback: In the home, unlike most other health care settings, clients are on their own "turf," such that the client is the host, comfortable and secure in familiar surroundings, and the nurse is a guest. Although education may be a major component of care in the home, all community health nursing roles are performed to varying degrees. In addition, technologically advanced care in the home is increasing in demand, with the home being the most frequently used setting for community health nursing.16. After teaching a group of students about the various settings for community health nursing, the instructor determines that this teaching was successful when the students identify which of the following as an example of ambulatory service setting? A) Local preschool B) Halfway house C) Continuing care center D) Family planning clinicAns: D Feedback: Ambulatory service setting includes a variety of venues for community health nursing in which clients come for day or evening services that do not include overnight stays. One example is a family planning clinic. A local preschool would be an example of a school setting. A halfway house and continuing care center are examples of residential institutions.17. After teaching a group of students about the changing roles of the community health nurse in the occupational setting, the instructor determines that the students need additional teaching when they state which of the following? A) Occupational health nurses are increasing their role as employee advocates. B) Health education is a key function of the occupational health nurse. C) There is a greater emphasis on the occupational health nurse's role as a clinician. D) Collaboration with other health care providers fosters the offering of better services.` Ans: C Feedback: The clinician role was primary for many years, as nurses continued to care for sick or injured employees at work. However, recognition of the need to protect employees' safety and, later, to prevent their illness led to the inclusion of health education in the occupational health nurse role. Occupational health nurses also act as employee advocates, assuring appropriate job assignments for workers and adequate treatment for job- related illness or injury. They collaborate with other health care providers and company management to offer better services to their clients. They act as leaders and managers in developing new health services in the work setting, endorsing programs such as hypertension screening and weight control.18. A community health nurse is working as a lobbyist for health legislation for AIDS research at the state capital. This nurse is practicing in which setting? A) Faith community B) Ambulatory service C) Residential institution D) Community at largeAns: D Feedback: The community at large is not confined to a specific philosophy, location, or building. It serves as the setting for practice of a nurse who serves on health care planning committees, lobbies for health legislation at the state capital, runs for a school board position, or assists with flood relief in another state or country. Faith community nursing focuses on activities involving the faith community and religious belief system. Ambulatory service settings include a variety of venues in which clients come for day or evening services that do not include overnight stays. Residential institutions include any facility where clients reside.19. Which of the following is included in the most accurate description of school nursing? A) This is one community health setting where the role is static. B) The primary role of school nurses is clinician. C) The practice of school nurses is widening. D) School nurses rarely act as advocates.Ans: C Feedback: School nurses, whose primary role initially was that of clinician, are widening their practice to include more health education, interprofessional collaboration, and client advocacy.20. A community health nurse is assuming the role of a manager. Which function would be most important for the nurse to address first? A) Planning B) Organizing C) Leading D) ControllingAns: A Feedback: The management process incorporates a series of problem-solving activities or function: planning, organizing, leading, and controlling and evaluating. Although these activities occur simultaneously, they are sequential with planning being the first activity.21. A nursing student is interviewing a community health nurse about the various roles the nurse assumes and the skills and behaviors necessary to perform each role. Which of the following would the community health nurse identify as being essential to the role of an advocate? Select all that apply. A) Assertiveness B) Ability to plan C) Ability to negotiate D) Risk taking E) Holistic view F) Questioning attitudeAns: A, C, D Feedback: As an advocate, the community health nurse must be assertive, willing to take risks, be able to communicate and negotiate well, and be able to identify resources and obtain results. The ability to plan is associated with the manager role. A holistic view is critical to the community health nurse acting as a clinician. A questioning attitude is necessary for the role as a researcher.22. A community health nurse works in a busy community health nursing practice. Today, the nurse is devoting the day to the educator role. With which of the following activities would the nurse be involved? Select all that apply. A) Planning seven home visits today B) Working on a new curriculum for high-risk teens C) Meeting with colleagues to discuss organizational changes in the office D) Ordering pamphlets over the Internet to be used in a parenting class E) Tabulating data from surveys distributed to elders during a flu-shot clinic F) Going to social services to speak up for a family in his or her caseloadAns: B, D Feedback: In the educator role, the nurse would work on a new curriculum for high-risk teens and order pamphlets for use in a parenting class. Planning seven home visits would be part of the clinician role. Meeting with colleagues to discuss organizational changes would be part of the manager role. Tabulating data from surveys would be part of the researcher role. Speaking up for a family in the nurse's caseload would be an example of the advocate role.23. A community health nurse is devoting the day to being a manager. Which activities would the nurse expect to perform? Which of the following activities are part of this role? Select all that apply. A) Orienting three new community health nurses in the agency B) Attending a strategy meeting for a new service the community will be offering C) Working with a team to direct a smoking cessation program in public areas D) Investigating an outbreak of Salmonella in the community E) Tabulating the findings of exploring immunization practices among teens F) Reviewing the staff evaluations to assist with planning future in-servicesAns: A, B, F Feedback: As a manager, a community health nurse would be involved in orienting new nurses in the agency, attending meetings for new services to be offered, and reviewing staff evaluations. Working with a team to direct a smoking cessation program in public areas exemplifies the leadership role. Investigating an outbreak of Salmonella and tabulating the findings of immunization practices depict the researcher role.24. Of all the nursing roles assumed by community health nurses, which role must be assumed in every situation? A) Researcher B) Manager C) Leader D) ClinicianAns: B Feedback: The type and number of roles that are practiced vary with each set of clients and each specific situation, but the nurse should be able to successfully function in each of these roles as the particular situation demands. The role of manager is one that the nurse must play in every situation, because it involves assessing clients' needs, planning and organizing to meet those needs, directing and leading clients to achieve results, and controlling and evaluating the progress to ensure that the goals and clients' needs are met.25. Which of the following are core values of professional behavior that are unique to public health nursing? Select all that apply. A) Community/population as client B) Prevention C) Rehabilitation D) Partnership E) Healthy environment F) DiversityAns: A, B, D, E, F Feedback: Core values of professional behavior emphasize community/population as client, prevention, partnership, healthy environment, and diversity. Rehabilitation is not population centered.1. A group of students are reviewing the various historical events associated with the evolution of community health nursing in preparation for a test. They identify the time from 1970 to the present as the era known as community health nursing based on the understanding that which of the following influences contributed most to this change? A) The settings and the nurses delivering health care in the community B) Decisions made by the American Nurses Association C) Decisions made by physicians in a variety of community settings D) The demand to eliminate the word "public" from health servicesAns: A Feedback: The numbers, increasing variety of settings, and many nurses coming to work in the community settings since the 1970s have contributed most significantly to the change. As a result, professional associations supported the broader term of community health nursing. Physician decisions played no role in the change. The term public health nursing still remains.2. Before the mid-1800s, early home care nursing was best recognized by which of the following? A) Technical advances with the Industrial Revolution making major changes B) Care provided by family members, friends, and religious groups in the home C) Accomplishments stemming from the work of Florence Nightingale D) Formal organization of visiting nursing to provide care to the sick poorAns: B Feedback: Before the mid-1800s, early home care was characterized by care of the sick in the home by family members, friends, and religious groups. Technical advances came after 1850, as did the work of Florence Nightingale and the formal organization of visiting nurses to provide care to the sick poor.3. Community health nursing has a long history of contributing to the health of populations. Which of the following forms of service would the nurse identify as being most recent? A) Voluntary home nursing care for the sick poor via district nursing B) Care provided termed public health nursing C) Lay and religious groups providing care to the sick poor in their homes D) Focus on populations with community health nursing seen as a specialty fieldAns: D Feedback: The four stages of community health nursing followed from lay and religious groups providing care in the early years before 1850, the more specialized "health nurses" or district nursing after the mid-1800s, concern for the health of the general public from 1900s to 1970, and finally community health nursing as a specialty with a focus on populations since 1970.4. Which factor was the most significant feature associated with district nursing? A) Caring for the sick B) Teaching hygiene and cleanliness C) Preventing illness D) Gathering statistical dataAns: B Feedback: Although district nurses primarily cared for the sick, they also taught cleanliness and wholesome living to their clients. This early emphasis on prevention and health became one of the distinguishing features of district nursing and later of public health nursing. Preventing illness and gathering statistical data were key contributions of Florence Nightingale during the Crimean War of the early 1850s.5. In their early stages, district nursing was sponsored by which of the following? A) Religious organizations B) Private philanthropy C) Contributions D) Public fundingAns: A Feedback: Early district nursing services were founded by religious organizations that served as their sponsors. Later sponsorship shifted to private philanthropy. Funding came from contributions and fees charged to clients on an ability-to-pay basis. Finally, visiting nursing began to be supported by public money.6. Which of the following would characterize the public health stage of community health nursing? A) Voluntary health agencies emphasizing disease prevention B) Family considered as the primary unit of care C) Service provision to the sick poor population D) Primary health care as the key to health for allAns: B Feedback: The public health nursing stage was characterized by service to the public, with the family targeted as a primary unit of care. Official health agencies, which placed a greater emphasis on disease prevention and health promotion, provided the chief institutional base. Primary health care as the key to health for all characterizes the community health nursing stage.7. At which time did the focus of district nursing broadened to include the health and welfare of the general public? A) Beginning of 20th century B) In the late 19th century C) Prior to the 1850s D) By the early 1970sAns: A Feedback: The focus of district nursing broadened to include the health and welfare of the general public by the beginning of the 20th century or the early 1900s. In the late 19th century, district nurses were ill-prepared to cope with their clients' multiple health and social problems resulting from widespread immigration and filled tenement housing that led to inadequate sanitation, unsafe and unhealthy working condition, and barriers adding to poverty and disease. District nursing did not develop until after 1850. The early 1970s is associated with the emergence of community health nursing.8. A student is planning a presentation about the evolution of public health nursing. As part of the presentation, the student would identify which person as being the first one to use the term "public health nursing"? A) Jessie Sleet B) Lillian Wald C) Lina Rogers D) Margaret SangerAns: B Feedback: Lillian Wald, a leading figure in the expansion of district nursing, was the first to use the term "public health nursing" to describe the specialty. Jessie Sleet was credited as being the first Black public health nurse. Lina Rogers was credited with being the first school nurse. Margaret Sanger was the nurse who opened the first birth control clinic in America that eventually resulted in the formation of the International Planned Parenthood Federation.9. Which of the following are important contributions made by Lillian Wald to the profession of public health nursing? Select all that apply. A) Demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children B) Promoting the use of birth control C) Convincing the Metropolitan Life Company that nurse intervention could reduce death rates D) Providing rural "frontier nursing" to serve mountain families in Kentucky E) Founding the National Organization for Public Health Nursing (NOPHN)Ans: A, C, E Feedback: Lillian Wald contributed to the profession of public health nursing by demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children, convincing the Metropolitan Life Company that nurse intervention could reduce death rates, and Founding the National Organization for Public Health Nursing (NOPHN).10. After a class discussion about the contributions of Lillian Wald to the advancement of community health nursing, which of the following if stated by the class indicates that the discussion was effective? A) Establishment of family-centered nursing and outreach services in New York City at the turn of the 20th century B) Use of clean and safe nursing care practices to soldiers during the Crimean War in the 1850s C) Assistance to high-risk populations experiencing tropical diseases in Central America and the Caribbean in the late 1800s D) Creation of home nursing services in London, marking the beginning of district nursing in the 1860sAns: A Feedback: Lillian Wald worked with immigrant families in the Lower East Side of New York City, providing home visits, a neighborhood center, and general sanitation improvement for families and health care services to children in schools. Florence Nightingale was responsible for providing clean and safe nursing care practices to soldiers during the Crimean War. Mary Seacole helped high-risk populations who experienced tropical diseases in Central America and the Caribbean. William Rathbone was responsible for establishing a visiting nurse service for the sick in London.11. A group of nursing students are studying for an examination on influential nursing leaders involved in the advancement of community health nursing. The students demonstrate that they are prepared for the examination when they identify which person as the first community health nurse in the United States? A) Frances Root B) Mary Robinson C) Mary Seacole D) Reba ThelinAns: A Feedback: In the United States, Frances Root was the first community health nurse who was hired by the Women's Branch of the New York Mission in 1877. Mary Robinson was the nurse who cared for William Rathbone's wife and was hired by Rathbone to visit the sick poor in their homes in England. Mary Seacole, the "Black Nightingale," practiced Creole or Afro-Caribbean medicine in Jamaica and helped populations who experienced tropical diseases in Central America, Panama, and the Caribbean. Reba Thelin was a nurse hired by Johns Hopkins Hospital to visit the homes of tuberculosis clients in 1903.12. Which of the following nurses openly defied a law that she saw as unjust and eventually resulted in the formation of The International Planned Parenthood Federation? A) Lillian Wald B) Florence Nightingale C) Margaret Sanger D) Mary BrewsterAns: C Feedback: Margaret Sanger openly defied a law that she saw as unjust (the Comstock Act that prohibited the provision of any information on contraception to women). This defiance eventually resulted in the formation of The International Planned Parenthood Federation. During the same period that Lillian Wald and her contemporaries were working to alleviate the suffering caused by disease and poverty, Margaret Sanger began a different battle. Florence Nightingale wrote a series of papers on the need for "home missioners" and "health visitors" and endorsed the view that prevention was better than cure. Mary Brewster was a nurse and a friend of Lillian Wald who both together started the Henry Street Settlement.13. The community health nurse is preparing a presentation for a group of nursing students about the societal influences on the development of community health nursing. Which factors should the nurse include that have influenced the growth of community health nursing? Select all that apply. A) Advances in the technology B) The recognition that one single agent could be considered a cause of illness C) Access to education being limited to the privileged few D) Continued increase in the number of women entering nursing because it is recognized as a choice career for women and not men E) Consumer demand for quality services coupled with community health nurses provision of holistic careAns: A, E Feedback: Many factors have influenced the growth of community health nursing, including advances in technology, progress in causal thinking (relating disease or illness to its cause and recognition that many factors might contribute to a disease or health disorder), and the consumer movement with consumers demanding quality services. Education is now widely available and is considered a basic right and necessity for a vital society. Changing demographics and the role of women have influenced community health nursing; however, the number of women entering nursing has decreased.14. Which of the following actions by the community health nurse exemplifies the societal influence of causality on the practice of community health nursing? A) Using computer-based education programs for client education B) Engaging in video conferencing to share research findings C) Identifying multiple factors associated with promoting wellness D) Developing a plan to address the rapid increase in older adult populationAns: C Feedback: Causal thinking relates disease or illness to its cause and includes areas such as epidemiology; interactions among an agent, host, and environment; and recognition of multiple factors contributing to a disease, health disorder, or wellness. Using computer- based education programs and engaging in video conferencing are examples reflecting the advancement of technology. Developing a plan to address the rapid increase in the older adult population involves application of the change in demographics affecting community health nursing.15. A community health nurse who is teaching a group of nursing students about the various societal influences on community health nursing is explaining the effects of the consumer movement. Which of the following student responses would lead the community health nurse to determine that the teaching was successful? A) Individuals are considered passive members of the health care team. B) Consumers are demanding more coordinated comprehensive care. C) People are expecting community health nurses to develop new programs. D) Consumers are identifying a greater need for care by a variety of care providers.Ans: B Feedback: The consumer movement has led to changes in community health nursing. Consumers are demanding more humane, personalized health care, seeking more comprehensive coordinated care. They are viewed as active members of the health care team. The need to develop new programs is a response to the economic forces that have affected the practice of community health nursing. Consumers desire more coordinated care, not care from a variety of care providers.16. Which of the following most accurately reflects the response of community health nursing to economic forces? A) Decreased competition with other community health service providers B) Reduction in available programs and services C) Development of new services for generating revenue D) Switch to a more illness-oriented philosophy for serviceAns: C Feedback: Economic forces have led community health nursing to respond by developing new revenue-generating services to augment depleted budgets. Other responses include directly competing with other community health service providers and developing new programs and service emphases. Although some public health agencies have been drawn into more illnessoriented services, community health nursing continues to be resourceful in finding ways to foster the community's optimal health.17. A prospective nursing student is interested in working in community health nursing after graduation. Which type of education would be most appropriate for this student to choose? A) Diploma program B) Associate degree C) Baccalaureate degree D) Graduate degreeAns: C Feedback: Community health nursing is a challenging specialty in nursing. The demands of this type of nursing require additional courses in liberal arts and science, along with courses in community health nursing practice as a student. The minimum preparation for community health nurses in many states is a baccalaureate degree. The diploma and associate degree level prepares students for basic nursing practice. Students can build on this basic knowledge by entering a BSN completion program, which will prepare them to enter the specialty of community health nursing. In order to stay current and to build skills in this specialty, advanced courses or a graduate (masters) degree is needed.18. A community health nurse desires to attain a tenure-track position at a local university to teach community health nursing. Which of the following would this nurse need? A) Certification B) Master's degree C) Doctoral degree D) Nurse practitioner licenseAns: C Feedback: A doctoral degree would be the required education needed to obtain a tenure-track teaching position at a university. Certification provides additional education for specialization and may result in a promotion or higher salary accompanied by additional responsibilities and opportunities. A master's degree can lead to management positions, private community health ownership, agency teaching, or research positions. Nurse practitioners can run well-child clinics and direct a school-based clinic if a school nurse. Advanced practice can open doors into leadership positions in community health nursing.1. A nursing instructor is preparing a teaching plan for a class comparing evidence-based practice and critical thinking. Which of the following would the instructor include? A) Evidence-based practice and critical thinking are polar opposites. B) Both involve problem clarification of central concepts. C) Interpretation of accumulated evidence is unique to evidence-based practice. D) Problem exploration is unique to evidencebased practice.Ans: B Feedback: Evidence-based practice and critical thinking share commonalities including exploring a problem, addressing a purpose or goal, making assumptions, clarifying the problem around central concepts or indicators, accessing data, interpreting accumulated evidence, using reasoning, processing, defining, planning and documenting, acting on the problem, and evaluating, adjusting, generalizing, and applying to a broader problem set. In addition, critical thinking is an important component of evidence-based practice.2. According to the Institute of Medicine's landmark report, The Future of Nursing, nurses should: Select all that apply. A) work independently from other health professionals to promote the profession of nursing. B) work collaboratively with other health professionals to promote health care. C) attempt to redesign health care. D) improve practices through evidence-based means. E) The Future of Nursing report does not express the importance of evidence-based nursing.Ans: B, C, D Feedback: The Future of Nursing highlights the need for nursing to work with other health professionals in "redesigning health care" by "conducting research" and improving practices through evidence-based means.3. Which of the following statements about evidence-based practice has been identified by multiple reports over the past decade, such as To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003)? A) We must continue to cling to "the way we've always done it." B) We have spent billions of dollars each year researching new treatments and have translated that knowledge into clinical practice. C) We are not translating the knowledge that we are gaining into clinical practice. D) We have continued to spend more than a trillion dollars a year providing care and do translate that capacity into improved clinical practice.Ans: C Feedback: To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003). These reports draw attention to the fact that we spend billions of dollars each year researching new treatments, and more than a trillion dollars are spent annually on health care, but "we repeatedly fail to translate that knowledge and capacity into clinical practice."4. Which of the following statements about the steps of the EBP process is most accurate? A) One of the last steps of the EPB process is to search for and collect the most relevant best evidence. B) One of the earliest steps in the EBP process is to disseminate the outcomes of the EBP decision or change. C) It is optional to integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. D) The first step in the EBP process is to cultivate a spirit of inquiry.Ans: D Feedback: The steps of the EBP process in order are cultivating a spirit of inquiry; asking the burning question in PICOT format; searching for and collecting the most relevant best evidence; critically appraising the evidence for its validity, reliability, and applicability and then synthesizing that evidence; integrating the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluating outcomes of the practice decision or change based on evidence; and disseminating the outcomes of the EBP decision or change.5. Which one of the following statements about cultivating a spirit of inquiry is most accurate? A) It is not very important; research will be performed anyway. B) In order for effective change to occur, current practices must be continually examined, questioned, and challenged. C) It involves "asking the burning clinical question." D) The agency does not have an important role in cultivating a spirit of inquiry.Ans: B Feedback: In order for effective change to occur, current practices must be continually examined, questioned, and challenged. It is very important that the spirit of inquiry is cultivated. "Asking the burning clinical question" is part of the next step of asking the question. The agency does have a role in cultivating a spirit of inquiry. The organization must be open to a cultural shift from the status quo. The foundations of this spirit of inquiry are ongoing curiosity and a culture that supports it.6. A nurse is planning a research study to answer a clinical question. Which of the following would be most appropriate for qualitative research approach? A) Evaluating the reported cases of post vaccination complications after varicella immunization B) Determining the use of complementary and alternative health care by middle-aged adults in rural areas C) Ascertaining the effect of using calming music on older adults with dementia in extended care facilities D) Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illnessAns: D Feedback: Qualitative research is used to study those areas that need a broader focus or that do not lend themselves to objective measurement. This type of research emphasizes subjectivity and the meaning of the experiences to individuals. Thus, qualitative research would be most appropriate for assessing the emotional responses and feelings of individuals who require isolation for a communicable illness. Quantitative research would be used to evaluate the reported cases of post vaccination complications, to determine the use of complementary and alternative health care, and to ascertain the effect of calming music.7. Which of the following research studies would most likely use a quantitative research approach? A) The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized B) The experience of parents whose children have had serious complications subsequent to immunization C) The experience of parents whose children were not properly immunized and developed a vaccine-preventable illness D) Reasons that parents who practice a particular religion do not have their children properly immunizedAns: A Feedback: Quantitative research is helpful in identifying a problem or a relationship between two or more variables, such as type of treatment. A more subjective or qualitative approach is needed to study those areas that need a broader focus or that do not lend themselves to objective measurement. Qualitative research emphasizing subjectivity asks "how" or "why."8. Which of the following statements about the impact of research on community health nursing are true? Select all that apply. A) It is important to conduct research to affect public policy. B) Public policy will continue to have a negative effect on the community's health. C) Research will affect the effectiveness of community health nursing practice. D) Research will affect the status and influence of nursing as a profession. E) The impact that research has on community health nursing is negligible.Ans: A, C, D Feedback: Research has the potential to have a significant impact on community health nursing in three ways: by affecting public policy and the community's health, the effectiveness of community health nursing practice, and the status and influence of nursing as a profession. Community health nurses have been involved in research addressing all three of these dimensions.9. Application of nursing research results to community health nursing practice is essential. Which of the following must occur first before results can be applied? A) Be informed about research findings B) Demonstrate skill in examining research reports C) Assess abstracts of relevant research studies D) Check if the study was funded by a drug companyAns: A Feedback: Community health nurses have many opportunities to apply the results of other investigator's research, but a necessary prerequisite is that the nurse must be informed about research findings. Critically examining research reports and assessing abstracts are all part of evaluating relevant research studies. However, the nurse needs to know what the research findings are before he or she can evaluate the research. Checking if the study was funded by a drug company might indicate that the results of the study could be questioned due to a conflict of interest.10. After teaching a class on values, which of the following, if stated by the class, indicates the need for additional teaching? A) Some values are descriptive, while others are evaluative. B) Keeping a promise is an example of a terminal value. C) Values persist, remaining relatively stable over time. D) Certain values have more importance than others.Ans: B Feedback: Terminal values refer to end states of existence such as spiritual salvation, peace of mind, or world peace. Instrumental values refer to modes of conduct such as confidentiality, keeping promises, and honesty. Some values are descriptive or capable of being true or false, while other values are evaluative, involving judgments of good and bad. Values remain relatively stable over time and persist to provide continuity to personal and social existence. A hierarchical system of values occurs in which certain values have more weight or importance than others.11. Which of the following would the community health nurse do first when making an ethical decision? A) Engage in critical thinking B) Choose a value C) Identify isolated values D) Clarify one's valuesAns: D Feedback: Clarification of a person's values is the first step in the process of ethical decision making. Critical thinking is a strategy that can be used to help clarify values. Choosing a value is the first step in the process of valuing. Identifying isolated values are those which are organized into a hierarchical system where certain values have more weight or importance than others.12. After a class discussion on moral evaluations, which characteristic if identified by the class would lead the instructor to determine that the discussion has been effective? A) There is specificity that applies to an individual person. B) A special place is given to a person's own welfare. C) Other values cannot override the moral evaluation. D) They relate to a matter of individual taste.Ans: C Feedback: Moral evaluations have distinctive characteristics: the evaluations are ultimate, having a preemptive quality, meaning that other values or human ends cannot, as a rule, override them; they possess universality or reflect a standpoint that applies to everyone, such that everyone in principle ought to be able to make and understand, even if some individuals, in fact, do not; moral evaluations avoid giving a special place to a person's own welfare, having a focus that keeps others in view, or at least considers one's own welfare on a par with that of others. Moral evaluations are prescriptive-proscriptive beliefs that have certain characteristics separating them from other evaluations including matters of taste.13. A group of students are reviewing for an examination on values. Identification of which of the following as an instrumental value indicates the need for continued study? A) Spiritual salvation B) Confidentiality C) Honesty D) Promise keepingAns: A Feedback: Spiritual salvation is an example of a terminal value, which refers to end states of existence. An instrumental value refers to a mode of conduct, such as confidentiality, promise keeping, and honesty.14. A community health nurse obtains a client's informed consent for care demonstrating the understanding that this is derived from which value? A) Self-interest B) Well-being C) Equity D) Self-determinationAns: D Feedback: Informed consent derives from self- determination. Self-interest refers to a deterioration of self-determination in which the person focuses on fulfilling one's own desires without regard for the greater good. Well-being is a state of positive health, the intent of all therapeutic interventions. Equity refers to justice or fair and equal treatment.15. Which of the following statements about basic values that guide decision making in community health nursing is true? A) Client empowerment means that the provider must use a paternalistic approach to health care. B) Self-interest does not interfere with selfdetermination. C) When matters of well-being are considered, the client's preferences and needs should not be considered. D) Equity is not possible in times of limited resources.Ans: D Feedback: In times of limited technical, human, and financial resources, however, it may be impossible to fully respect the value of equity. Client empowerment is an approach that differs from the paternalistic approach to health care in which decisions are made for, rather than with, the client; instead, it enables patients and professionals to work in partnerships. When selfdetermination deteriorates into self-interest, it poses a major roadblock to equitable health care. Well- intended interventions sometimes fall short if they are in conflict with clients' preferences and needs.16. Situations in which self-determination should be restricted include which of the following? Select all that apply. A) When some objectives of individuals are contrary to the public interest or the interests of others in society B) When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals C) When it interferes with self-interest D) Self-determination and personal autonomy must never be restricted. E) When self-determination deteriorates into self-interest and poses a major roadblock to equitable careAns: A, B Feedback: There are two situations in which self- determination should be restricted: when some objectives of individuals are contrary to the public interest or the interests of others in society (e.g., endangering others with a communicable disease) and when a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care.17. A community health nurse is applying the value of equity in decision making with clients. Which of the following best describes this value? A) Forming, revising, and pursuing personal life plans B) Promoting clients' health and a sense of well being C) Fulfilling one's desires over those of others D) Treating similar cases in the same fair fashionAns: D Feedback: Equity is defined as the value directing like cases to be treated alike and that all individuals be treated fairly. Self- determination refers to a person's exercise of the capacity to shape and pursue personal plans for life. Well-being involves promoting clients' health and sense of well-being. Self- interest is the fulfillment of one's own desires without regard for the greater good.18. When working with clients, a community health nurse promotes the clients' self-concept and health promoting behaviors. The nurse is attempting to achieve which outcome? A) A value system B) Prescriptive-proscriptive beliefs C) Individual autonomy D) Values clarificationAns: C Feedback: Promoting clients' self-concept and health- promoting behaviors are associated with the value of self-determination that promotes individual autonomy. Value system, prescriptive- proscriptive beliefs, and values clarification are not associated with self- determination. A value system is an organized set of beliefs that guide individual behavior. Prescriptive-proscriptive beliefs are viewed as desirable or undesirable beliefs. Values clarification is a process that helps identify the personal and professional values that guide actions.19. A community health nurse discovers that a bill in the legislature would eliminate a state law that currently funds child health promotion services for low-income children. Which action at the primary level of prevention would be most appropriate? A) Advocate for amendment to the passed law to allow some funding for children to remain B) Once the bill has been passed, seek private resources to support funding of health promotion services for low-income children. C) Gather a group of health professionals to volunteer to provide the health promotion services eliminated by the passed bill D) Advocate through active lobbying against the bill and gather community supportAns: D Feedback: Appropriate activities at the primary level of prevention would include actively lobbying against the bill, garnering community support in favor of the revised bill, and advocating for the clients. Advocating for amendments would be appropriate at the secondary level. Seeking private resources and gathering volunteers to provide the health services would be appropriate at the tertiary level.20. the instructor determines that the class needs additional instruction when they identify which of the following as an ethical principle? A) Respect B) Autonomy C) Morality D) JusticeAns: C Feedback: Morality is the behavior or judgment that conforms to a standard that is right and good. When judgments involve moral values, conflicts are inevitable. There are seven fundamental ethical principles that guide decision making. These include respect, autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.21. A community health nurse is working to support programs to encourage preschool immunizations. The nurse is integrating which ethical principle in his or her practice? A) Beneficence B) Autonomy C) Nonmaleficence D) JusticeAns: A Feedback: Beneficence means doing good or benefitting others, such as supporting programs to encourage preschool immunizations. Autonomy means freedom of choice and exercise of people's rights, such as promoting individuals' and groups' rights to and involvement in decision making. Nonmaleficence means avoiding or preventing harm to others as a consequence of a person's own choice and actions, such as encouraging physicians to prescribe drugs with the fewest side effects. Justice refers to treating people fairly, such as ensuring equal access to health care.22. A community health nurse working with a group of families who come to local community health care center tells them that she is going to be setting up child care so that the families can participate in the various classes being offered by the center. Three months have passed, and the nurse still has not instituted the child care program. The nurse has violated which ethical principle? A) Veracity B) Fidelity C) Justice D) RespectAns: B Feedback: Fidelity means keeping promises or commitments to foster trust and trustworthiness. By failing to set up the child care program, the nurse has violated this fidelity. Nurses who follow through on what they have said earn their clients' respect and trust. In contrast, when a commitment is not kept, community members may lose faith and interest in participation. Veracity refers to telling the truth, giving clients accurate information in a timely manner. Veracity involves treating clients as equals. Justice refers to treating people fairly, such as by ensuring equal access to health care and not limiting the amount or quality of services due to income level. Respect involves acknowledging clients as valued participants in shaping their own and the community's health outcomes.23. A public health nurse is faced with an ethical dilemma. Which question should the nurse consider first when deciding how to resolve the dilemma? A) "What exactly is the ethical dilemma?" B) "What are the alternative courses of action?" C) "What are the consequences of each alternative courses of action?" D) "How should this dilemma be solved?"Ans: A Feedback: A framework is applied in public health ethics inquiry. Three core functions of this inquiry include (1) identifying and clarifying the ethical dilemma, (2) analyzing it in terms of alternative courses of action and their consequences, and (3) resolving the dilemma by deciding which course of action best incorporates and balances the guiding principles and values.1. After discussing the meaning of cultural diversity and its significance for community health nursing, the nursing instructor recognizes that some points need to be clarified when a student makes which of the following comments? A) "Dominant values are those held by the male head of the household in most American families." B) "The percentages of White European descent Americans are rising, while the percentages of other ethnicities are declining and this is projected to continue into the year 2050 at least." C) "Nurses maintain their original culture as they are socialized throughout the educational process." D) "America has become an amalgamation of people who have different values, ideals, and behaviors, rather than the melting pot that was once envisioned."Ans: A Feedback: The beliefs and sanctions of the dominant or majority culture are called dominant values. The proportion of the population identified as White is projected to continue to fall below other ethnicities between 2010 and 2050. Nurses will still have the same culture as they did before they were socialized in the nursing educational process, but they may be able to see things differently. America is not the ideal melting pot once described, but rather an amalgamation of people who have different values, ideals, and behaviors.2. The population that community health nurses serve in the United States is changing. Because of population shifts, nurses must become sensitive to the cultural differences and language differences among new community members. Which minority group currently represents the largest group? A) African Americans B) Hispanic Americans C) Asian Americans D) American IndiansAns: B Feedback: Significant minorities include Hispanic Americans, numbering more than 35 million in 2000 and over 42 million in 2005 and currently representing over 14% of the population; African Americans, numbering over 37 million or approximately 12.8% of the population; Asian Americans, numbering more than 12 million or approximately 4.3% of the population; and American Indians and Alaska Natives, numbering 2.8 million or 1% of the population.3. While providing care to a community group, a community health nurse provides culturally sensitive care by avoiding which of the following? A) Ethnocentrism B) Ethnorelativism C) Enculturation D) EthnicityAns: A Feedback: Ethnocentrism is the belief or feeling that one's own culture is best causing the person to believe that his or her way of doing things is right and to judge others' methods as inferior, ignorant, or irrational. It blocks effective communication by creating biases and misconceptions. Ethnorelativism is seeing all behavior in a cultural context. Enculturation refers to the process of each person learning his or her culture through socialization with the family or significant group. Ethnicity refers to the group of qualities that mark a person's association with a particular ethnic group (collection of people who have common origins and a shared culture and identity).4. As a community health nurse, you overhear a colleague say, "I don't understand why the Yang's take their young teenage daughters to the Hmong New Year celebration and have them play these match-making games. The girls meet boys every day at school and they are too young to be looking for husbands." Which of the following would be the most appropriate response? A) "The Yang's are very different from us; maybe in time we can convince them that their practices are not right." B) "Every culture has its differences; I think it is valuable that the Yang's are keeping their cultural practices alive." C) "I know what you mean, I was thinking the same thing. You wouldn't catch me doing something similar with my teens." D) "I feel sorry for those girls; they must feel funny in those cultural costumes. Let's talk to the parents and tell them how teens in America feel about such things."Ans: B Feedback: Community health nurses need to develop cultural sensitivity, becoming aware of own biases and preconceived values and beliefs. This would be evidenced by the statement about every culture having differences. The celebration is a part of the family's culture, and the nurses should not attempt to convince them that it is not right nor should they attempt to impose their views, feelings, or beliefs on the family.5. What is the most serious negative effect of a nurse maintaining ethnocentric views but not recognizing or acknowledging this? A) The nurse fails to understand the views of other cultures because of his or her ethnocentrism. B) The nurse does not communicate effectively with members of other cultures because of his or her ethnocentrism. C) The nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. D) Nurses are immune to the effects of ethnocentrism.Ans: C Feedback: The most negative effect of nurses maintaining ethnocentric views but not recognizing or acknowledging this is that the nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. The nurse who is ethnocentric and doesn't realize it will fail to understand the views of other cultures, but this is not the most serious negative effect. If the nurse is ethnocentric, he or she may not communicate effectively because of his or her ethnocentrism, and this can lead to impaired relationships and interference with the effectiveness of nursing interventions. All nurses hold ethnocentric views, but it is important for the nurse to be aware of them and acknowledge them to avoid having it damage relationships and interfere with the effectiveness of nursing interventions.6. When describing culture as shared, which of the following would be most accurate? A) It is acquired, not inherited. B) It is a product of aggregate behavior. C) It is interrelated and interdependent. D) It undergoes change.Ans: B Feedback: When describing culture as shared, it means that it is a product of aggregate behavior, not an individual habit. The customs are phenomena shared by all members of the group. Culture is learned; that is, the patterns of cultural behavior are acquired, not inherited. Culture is integrated; that is, it is a functional, integrated whole where all parts are interrelated and interdependent. Culture is dynamic; that is, it is changeable and not entirely static.7. by all cultures. Which description of culture being tacit indicates that the teaching was successful? A) Culture is mostly unexpressed. B) Cultures do not remain static. C) Culture is a functional and integrated whole. D) Patterns of cultural behavior are acquired.Ans: A Feedback: Culture is tacit, that is, mostly unexpressed and at the unconscious level. Culture is dynamic, undergoing change and never entirely static. It is integrated and learned. 8. Which of the following statements is an accurate description of the characteristic shared by all cultures, culture is integrated? A) A person's culture is an interrelated and interdependent web of ideas and practices. B) In order to describe a person's culture, it is necessary to describe each trait independently. C) Aspects of a person's culture are best described as unrelated to other aspects of the person's culture. D) A person's culture is an assortment of various customs and traits. ` Ans: A Feedback: A person's culture is an integrated web of ideas and practices. To understand culture, single traits should not be described independently. As in any system, all parts of a culture are interrelated and interdependent.9. A community health nurse is working with several Native American groups in Arizona. Which of the following would the nurse be most likely to assess? Select all that apply. A) The value of competition B) Respect for advancing age and elders C) Focus of living in the future D) Frequent dialogue and discussion E) Each tribe or nation has its own distinct language, beliefs, customs, and rituals.Ans: B, C, E Feedback: Although there are differences among Native American tribes, most have respect for advancing age and they live in the present and not the distant future (making primary prevention activities more difficult). Each tribe or nation has its own distinct language, beliefs, customs, and rituals. Competition and frequent dialogue and discussion are not values held by Native Americans.10. A community health nurse working a large metropolitan city has a large Asian American client base. Which of the following would the nurse be least likely to assess in this population? A) Belief that illness results from a body imbalance B) Reliance on Western medical practices C) Use of traditional self-care practices D) A focus on patriarchal family structuresAns: B Feedback: Asian Americans believe illness results from an imbalance of yin and yang forces. They use traditional healers and also exercise traditional self-care practices before using Western medical practices.11. While visiting an Asian American family in their home, the community health nurse inspects the skin of the 3-year-old child and notices a bruise-like lesion on the child's abdomen. The mother states that the child has been experiencing diarrhea for 2 days. Which of the following would the nurse do next? A) Report the family to the local child abuse agency B) Recognize this as a normal skin variation C) Question the family about the use of cupping D) Obtain a blood test for clotting functionAns: C Feedback: The nurse needs to gather additional information about the lesion. Practicing transcultural nursing would require the nurse to perform a cultural assessment and question the family about their use of dermabrasive techniques such as cupping that would leave a bruise-like lesion on the skin and be mistaken for physical abuse. The nurse would report the family to the local child abuse agency if further investigation provides additional information to support that decision. The lesion is not a normal skin variation. Obtaining a blood test for clotting function would be warranted only if further assessment reveals additional bruising or other signs of clotting problems.12. The community health nurse is working in the health department of a major city that has a large Hispanic/Latino population. Which of the following would the nurse need to integrate into the plan of care for this population? A) View of the female as superior to the male B) Importance of an extended, cohesive family C) Males as the binding force of the family D) Adherence to strict time schedulesAns: B Feedback: Hispanic people value extended, cohesive families. Families have been patriarchal, with male members perceived as superior and female members seen as a family-bonding life force. Many Latinos tend to be oriented to the present and are not as concerned as the mainstream culture about keeping time schedules or preparing for the future.13. A group of nursing students are studying for a test about various cultural communities. The students demonstrate that they understand the material when they identify which cultural group as believing in predestination? A) Hispanic/Latinos B) African Americans C) Muslims D) Native AmericansAns: C Feedback: Muslims believe in predestination, that life is determined beforehand, and they attribute the occurrence of disease to the will of Allah. Hispanic/Latinos believe that illness may be a form of punishment for sins. Some African Americans believe that illness is evidence of disharmony possibly due to evil spirits, punishment of God, or a hex placed on a person. Native Americans believe that health reflects living in total harmony with nature.14. A community health nurse is developing health promotion programs for a local community that consists predominantly of African Americans. Which of the following areas would be a priority for health promotion with this group? A) Cardiac health B) Respiratory care C) Mental health D) Skin careAns: A Feedback: Leading causes of death for African Americans include heart disease, cancer, and stroke. Heart disease is also a major health problem. Thus programs emphasizing cardiac health would be a priority. African Americans show a lower incidence in suicide and chronic obstructive pulmonary disease. They may experience skin problems such as keloids and melasma. However, all of these conditions would be of lesser importance than cardiac health.15. A community health nurse is providing care to a family in the community who are Muslim. Which of the following would be most important for the nurse to integrate when providing care for this family? A) Rules are stricter for boys than for girls. B) Modest dressing is key for both men and women. C) Most Arabic women work outside the home. D) Most adhere to the three tenets of Islam.Ans: B Feedback: For Muslims, modesty in dress is a core value for both men and women, although it is expressed more evidently by women. Rules are stricter for girls than for boys and most Arabic women stay at home and are not in the workplace. All practicing Muslims adhere to the five tenets of Islam.16. A community health nurse is providing care to an Asian American family who believes that a member's current illness is due to an excess of yin. The nurse integrates knowledge of this belief, expecting the family to avoid which foods? A) Rice B) Eggs C) Chicken D) FruitsAns: D Feedback: If the imbalance is an excess of yin, then "cold" foods, such as vegetables and fruits, are avoided, and "hot" foods, such as rice, chicken, eggs, and pork, are offered.17. What is the most important reason for the nurse to conduct a cultural assessment? A) Because it is often assigned by nursing faculty B) Because usually there is some culturally based reason that causes clients to engage in or avoid certain actions C) To meet the nurse's professional learning needs D) Because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing actionAns: D Feedback: The most important reason for the nurse to conduct a cultural assessment is that because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action. There is usually some culturally based reason that causes clients to engage in or avoid certain actions but that is not the most important reason for the nurse to conduct a cultural assessment. The nurse does not necessarily collect a cultural assessment to meet his or her own needs primarily.18. When developing an in-service program for a group of community health nurses about culture, which of the following would the presenter expect to include? A) All members of a cultural group are alike. B) Intraethnic variations underscore a population's cultural diversity. C) Ethnicity has a major impact on the effectiveness of health care. D) Ethnocentric attitudes are key to working with different cultures.Ans: B Feedback: Intraethnic variations, differences within microcultures, underscore the range of culturally diverse clients served by community health nurses. Subcultures and microcultures have their own distinctive characteristics even within fairly homogenous cultural groups. Culture, not ethnicity, has a major impact on the effectiveness of health care. Ethnocentric attitudes are to be avoided. All members of a cultural group are not alike. In general, individuals who are members of a specific culture are more alike than unlike but still not totally alike.19. When applying the principles of transcultural nursing, which of the following must the nurse do first? A) Cultivate cultural sensitivity B) Develop cultural awareness C) Learn the client's group culture D) Demonstrate respect for cultureAns: B Feedback: Applying the principles of transcultural nursing involves the following: (1) developing cultural self-awareness, (2) cultivating cultural sensitivity, (3) assessing the client group's culture, (4) showing respect and patience while learning about other cultures, and (5) examining culturally derived health practices.20. A community health nurse implements a plan of care that combines aromatherapy and acupuncture with medication therapy and surgery. The nurse is applying which of the following? A) Holistic health care B) Folk medicine care C) Herbalistic health care D) Integrated health careAns: D Feedback: Integrated health care is defined as the combination of complementary therapies such as aromatherapy and acupuncture with biomedical or Western health care such as medication therapy and surgery. Holistic health care vies the world as being in harmonious balance in which all facets of the individual's natures (physical, mental, emotional, and spiritual) must be in balance. Folk medicine involves treatment practices that have been handed down from generation to generation. Herbalism is the use of medicinal herbs.21. A community health nurse is providing care to several cultural groups in the community. When providing transcultural nursing, which of the following would be the priority? A) Examining one's own culture carefully and recognizing that alternative viewpoints are possible B) Recognizing that cultural values, beliefs, and practices influence people's health and lifestyles C) Obtaining health-related information about a cultural group concerning their values, beliefs, and practices D) Actively and attentively listening to demonstrate respect while learning about other culturesAns: A Feedback: The first step in providing transcultural nursing is to develop cultural self-awareness by examining one's own culture carefully and recognizing that alternative viewpoints are possible. Next, the nurse would need to cultivate cultural sensitivity by recognizing that cultural values, beliefs, and practices influence people's health and lifestyle. Then the nurse would assess the client group's culture by obtaining health-related information and actively and attentively listening to demonstrate respect.22. A community health nurse is assessing a family during a home visit. The nurse is examining the mother who is pregnant with her second child. The nurse asks the mother to raise her arms above her head. The mother replies, "I can't do this because it will cause the umbilical cord to strangle the baby." The nurse interprets this statement as reflective of which of the following? A) Home remedy B) Herbalism C) Folk medicine D) Alternative therapyAns: C Feedback: The mother's statement reflects folk medicine, a body of preserved treatment practices that has been handed down verbally from generation to generation. One example is not reaching above your head if you are pregnant, because doing so will cause the umbilical cord to strangle the baby. Home remedies are caregiving practices passed down between families, for example, ice on a cold sore, baking soda paste on a bee sting. Herbalism involves the use of medicinal herbs. Alternative therapy or complementary therapy is designed to promote comfort, health, and wellbeing and includes, for example, aromatherapy, music therapy, acupuncture, and yoga.23. When working with different cultural groups in the area of health care practices, the nurse acts as an effective advocate for the client. Which of the following must the nurse do first? A) Prepare to teach clients about the limits and benefits of cultural health practices B) Assess the client or family adequately to ascertain their belief system and choices C) Individualize caregiving for the client within his or her culture D) Be knowledgeable about health care practices and choicesAns: D Feedback: When working with different cultural groups in the area of health care practices, the community health nurse can be an effective advocate for the client. First, however, the nurse must be prepared to speak knowledgeably about health care practices and choices. The nurse also must be able to assess the client or family adequately so as to know what belief system motivates their choices. Finally, the nurse must be prepared to teach clients about the limits and benefits of cultural health care practices. The community health nurse should always individualize assessment and caregiving for the client within his or her culture and should not generalize about the client based on cultural group norms.24. When working with immigrant groups in community health care, which of the following would be least appropriate for the community health nurse to do? A) Permit ample time for interviewing to allow time to evaluate beliefs B) Develop educational programs to correct misconceptions C) Assume that the client has a basic understanding of health issues D) Ensure an appropriate interpreter for communication if neededAns: C Feedback: When working with immigrant groups in the community, do not make assumptions about a client's understanding of health care issues; permit more time for interviewing; allow time to evaluate beliefs and provide appropriate interventions; provide educational programs to correct any misconceptions about health issues; provide an appropriate interpreter to improve communication with immigrants who do not speak English well.1. After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information? A) "It influenced the speed with which healthfocused bills pass the legislature." B) "The report set up the organizational structure of the U.S. Public Health Service." C) "It emphasized sanitary progress forming the basis for current public health practice." D) "It de-emphasized the issues addressed in the Hebrew hygienic code."Ans: C Feedback: The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress addressing public health concepts and methods that form the basis of public health practice today. It had no effect on getting bills passed by the legislation nor was it involved in setting up the organizational structure of the U.S. Public Health Service. The Hebrew hygienic code, probably the first written code, was the prototype for personal and community sanitation.2. Over the past century, many health-related changes have occurred affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply. A) High levels of chronic disease B) Shortened life spans C) Increased teen pregnancies D) Abuse of multiple substances E) Increased maternal mortality F) Multidrug-resistant diseasesAns: A, C, D, F Feedback: Issues today include high levels of chronic disease, increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today. With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today did not exist.3. During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community's health care needs. Which of the following would the nurse include as a current societal event? A) Large disparity in male/female wages B) Rural to urban migration C) Rampant child labor D) Widespread violenceAns: D Feedback: Today, society is faced with widespread violence and terrorism. Populated urban areas continue to loose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago child labor laws were just forming and child labor was rampant.4. When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the understanding that these agencies are A) voluntary. B) tax supported. C) proprietary. D) privately funded.Ans: B Feedback: Official health care agencies, later called public health agencies, are tax supported; thus, they must provide services determined by the federal, state, or local government. Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for profit or nonprofit.5. After describing the Public Health Service to a group of students, which description would indicate the need for additional discussion? A) It offers consultation through national advisory health councils and special advisory committees made up of lay experts. B) The Secretary of Health and Human Services is ultimately responsible for it. C) The Secretary of Health and Human Services is an elected position. D) A major function is to administer grants and contracts with other government agencies.Ans: C Feedback: The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.6. provision of care to clients in a clinic setting at the local health department. This nurse is engaging in which core public health function? A) Clinical B) Assessment C) Policy development D) AssuranceAns: D Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community, policy development would involve helping to establish policies that will address the problems assessed, and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical is not a core public health function.7. Which of the following statements about the core public health functions are true? A) Public health nurses practice as partners with other public health professionals within these core functions. B) Assessment involves the actual provision of services. C) Policy development relates to assessment. D) Assurance means that the public health agency must directly provide the needed services.Ans: A Feedback: Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that populationbased services are provided, whether by public health agencies or private sources.8. Which one of the following groups of actions fulfills the three core public health functions in their proper order? A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school B) Identifying a source of pollution in the community, educating local residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for the pregnant adolescents D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancerAns: A Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment is data collection, the policy development would be based on the assessment, and assuring is the process of translating established policies into services. Counting the number of kindergarten students who are fully immunized would be assessment, encouraging the school officials to exclude children who are not fully immunized would be policy development, and offering immunization clinics at the school would be assurance. Identifying a source of pollution in the community would be assessment, educating local residents about precautions that should be taken when the pollution exceeds minimum standards would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance, determining how many pregnant adolescents currently attend the school would be assessment, and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance. Lobbying for a citywide ban on smoking in public would be policy development, providing smoking cessation services in the community would be assurance, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.9. A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health agencies? Select all that apply. A) American Diabetes Association B) The U.S. Public Health Service C) The National Institutes of Health D) Women, Infant, and Children Program (WIC) E) National Society for Autistic Children F) Planned Parenthood Federation of AmericaAns: A, E, F Feedback: The American Diabetes Association, National Society for Autistic Children, and Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and are nonprofit organizations. The U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies or receive federal funds to operate; thus they are not voluntary agencies.10. Which of the following most well describes a public health care agency? A) The agency most often has a very specific focus. B) The agency is responsible for promoting and protecting the health of all within their jurisdiction. C) The agency only employs nurses and environmental health practitioners. D) The agency is able to perform its work independently with complete autonomy.Ans: B Feedback: Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish a broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and interorganizational collaboration.11. Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Private sector health services are complementary and supplementary to government health agencies. B) Public sector health care agencies usually meet the needs of people with special needs. C) Private sector health agencies usually are constrained in developing innovations in health care. D) Public health sector agencies generally satisfy the health care needs of a community.Ans: B Feedback: Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private sector health care agencies usually meet the needs of people with special needs (rather than public sector health care agencies that focus on the entire population within their jurisdiction). Private sector health care agencies are less constrained than public sector health care agencies in developing innovations in health care. A part of the reason for the development of private sector health care agencies is the impatience or dissatisfaction with government (public health) programs.12. Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Public sector health care agencies are more likely to pilot or subsidize demonstration projects. B) Private sector health care agencies are more likely to promote health legislation. C) Public sector health care agencies are more likely to generate new research and innovation. D) Private sector health care agencies usually focus on needs that are met.Ans: B Feedback: Private sector health agencies are more likely to promote health legislation, whereas public sector health care agencies are more likely to be responsible for carrying out health legislation. Private sector health care agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private sector health care agencies strive to detect unmet needs rather than met needs.13. Which of the following statements about the international health organization is most accurate? A) PAHO is completely separate from the WHO. B) UNICEF promotes child and maternal health and welfare globally. C) WHO focuses primarily on developing countries. D) WHO and UNICEF are agencies of the United Nations.Ans: B Feedback: United Nations International Children's Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from WHO. WHO focuses on the promotion of health worldwide, not just developing countries. The United States Agency for International Development (USAID) focuses on developing countries. WHO and UNICEF are both agencies of the United Nations.14. An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans? A) Social Security Act B) Hill-Burton Act C) Patient Protection and Affordable Care Act D) Omnibus Budget Reconciliation ActAns: C Feedback: Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs, the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in health care planning, safety, and funding.15. A group of students are preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true? Select all that apply. A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. B) The Shepard-Towner Act provided funds to states for hospital construction. C) The Hill-Burton Act provided funds to states for administration of programs to support the health and welfare of mothers and infants. D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.Ans: A, D, E Feedback: The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill- Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for administration of programs to support the health and welfare of mothers and infants. The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the privacy of medical records.16. A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, "Why do I need to know this information? My focus is my clients." Which response by the presenter would be most appropriate? A) "You are required to know this information because your agency receives government funding." B) "You might be in management one day and have to deal with cost control and reimbursement." C) "Although it seems foreign to you, it's an important topic that you might have to deal with someday." D) "This knowledge is important to the success of your practice and for the agency's survival."Ans: D Feedback: At the local level (the community health nurse and the employing agency), health care economics is very important for survival. Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable. Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of health care economics.17. When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of the following would the nurse include? A) Quantity of services available B) Consumer's willingness to buy services C) Aggregate perspective of economic stability D) Allocation of the available resourcesAns: C Feedback: Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumptions, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer's willingness to buy services) and study how allocation and distribution affect consumer demand for goods and services.18. As part of a community wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse include in the plan? Select all that apply. A) It is a state health insurance program for elderly and the disabled. B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. C) Medicare Part D covers prescription drug costs. D) Medicare Part A is supplementary and voluntary. E) Medicare beneficiaries can make changes to their coverage at any time.Ans: B, C Feedback: Medicare is a federal health insurance program and covers citizens and some legal aliens who are over 65 years old (not a State program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing service. Prescriptions are covered under Medicare Part19. After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional teaching is necessary? A) Medicaid has a monthly fee that recipients must pay. B) Medicaid is administered individually by each state. C) Medicaid focuses on preventative services. D) It is possible to be on both Medicare and Medicaid.Ans: A Feedback: Medicaid monies come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined on the basis of financial need and residency status. Finally, some low-income Medicare eligible people also receive Medicaid.20. health nurse identify as a drawback to retrospective reimbursement? A) Spending was limited to the most necessary tests and treatments. B) Services for sickness were encouraged rather than wellness. C) Consumers had to bear the increased accountability for cost containment. D) Payments for services were based on rates calculated from predictions.Ans: B Feedback: Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illness and providing for additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatment. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.21. Which of the following statements about trends and issues influencing health care economics and community health services delivery are true? Select all that apply. A) The United States has the most cost effective health care system in the world. B) One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. C) In the United States, the health-related quality of life is lower than for most other countries. D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. E) In a survey published in 2009, most US physicians identified that their health care system worked well.Ans: B, C, D Feedback: The United States has one of the least cost effective health care systems in the world. One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than for most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system worked well.22. Which of the following statements about Health Care Rationing is most accurate? A) It will not occur in the United States because of our country's values. B) A danger of rationing is compromising quality and effectiveness. C) Rationing in health care has never been practiced. D) Advances in knowledge and technological capabilities will eliminate the need for rationing in the future.Ans: B Feedback: A danger of rationing is compromising quality and effectiveness. Rationing is already practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing decisions.23. When describing managed competition as a potential solution to resolve the health care crisis, which of the following would be included? Managed competition would A) promote cost containment and universal access to health care. B) eliminate burdensome government regulations. C) reduce state and federal control over health care delivery. D) discourage consumers from making responsible choices.Ans: A Feedback: Managed competition ideally would promote cost containment and universal access to health care. Governmental regulations and control would still be present as would insurance companies. Managed care would encourage consumers to make responsible choices.24. Which statement regarding the potential impact of health care reform on community health nursing is most accurate? A) Health care reform does not affect community health nursing. B) Community health nurses know that outcomes research is unnecessary. C) Public health nurses can lead the effort in making health care more accessible to all citizens. D) Community health nurses will only be able to work in public health agencies.Ans: C Feedback: Public health nurses can lead the effort in making health care more accessible to all citizens. Health care reform definitely affects community health nursing. Community health nurses recognize the importance of outcomes research to document the value of nursing interventions with at-risk populations. Community health nursing has important ties to both private and public health agencies.1. An instructor is discussing the worldwide distribution of AIDS. Which term would the instructor use to describe this situation? A) Epidemic B) Pandemic C) Endemic D) PathogenicityAns: B Feedback: Pandemic is the term used to describe an epidemic that is distributed worldwide. An epidemic refers to a disease occurrence that clearly exceeds the normal or expected frequency in a community or region. Endemic is used to describe the continuing presence of a disease or infectious agent in a given geographic area. Pathogenicity refers to an agent's capacity to cause disease in a host.2. After a class describing the contributions of Florence Nightingale to epidemiology, the instructor determines that the class needs additional instruction when they state which of the following is associated with Nightingale? A) Establishment of the need for a clean environment B) A sophisticated coding system for medical conditions C) Proper wound cleansing and bandaging techniques D) Separation of infected individuals from those injuredAns: B Feedback: Nightingale's colleague, William Farr, is credited for developing a more sophisticated system for coding medical conditions. Nightingale's contributions included establishing the need for a clean environment, properly cleaning wounds and bandaging them, and separating infected soldiers from those who were injured.3. When applying the epidemiologic triad model to a community's plan of care, which of the following would the community health nurse address? A) Incidence, prevalence, and case fatality B) Health, illness, and injury C) Host, agent, and environment D) Immunity, causation, and riskAns: C Feedback: The purpose of this model is to demonstrate the relationship among host, agent, and environment. Each component has to be present to a certain degree in order for any disease, illness, or injury to exist or happen. If one component is missing, illness or injury will not occur. Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are terms used in epidemiology but do not refer to the epidemiologic triad model.4. Which of the following would the community health nurse identify as a key component Of the host? A) Infectivity B) Antigenicity C) Virulence D) Inherent resistanceAns: D Feedback: The host, a susceptible human or animal, can sometimes have an ability to resist pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are characteristics of the agent.5. Which of the following statements apply to the concept of causality? Select all that apply. A) Causality is the relationship between cause and effect. B) The chain of causation is the most recent theory of causality. C) The web of causation theory is the most recent theory of causality. D) The chain of causation clearly explains causation in noninfectious disease. E) Epidemiology has changed its view of causality over time.Ans: A, C, E Feedback: Causality is the relationship between cause and effect. The web of causation theory is the most recent theory of causality. Epidemiology has changed its view of causality over time. The chain of causation was the first theory of causality. The chain of causation could not sufficiently explain causation in noninfectious disease because the chain of causation is too linear.6. A community health nurse is explaining the chain of causation to a family that includes a child who has developed Lyme disease. The nurse correctly describes the opening in the child's skin caused by the actual tick bite as the A) reservoir. B) mode of transmission. C) portal of entry. D) host.Ans: C Feedback: The opening in the child's skin caused by the actual tick bite is the portal of entry in the chain of causation. The mode of transmission would be the tick biting the child. The reservoir would refer to the tick. The host would be the child who has been bitten by the tick.7. A community health nurse is integrating the epidemiology of wellness into practice. Which of the following would the nurse include? A) Lifestyle with its self-created risks B) Communicable disease control C) The natural history of disease D) Vital statistics and reportable diseasesAns: A Feedback: Today there is an increased focus on lifestyle behaviors and how they relate to a person's state of wellness or illness. It is a basic component of a wellness model. Communicable disease control focuses on an illness state, not a wellness state, and is not part of a wellness model. The four states of the natural history of a disease or health condition is not part of the wellness model. Vital statistics and reportable diseases are not part of the wellness model.8. The nurse is examining the possibility that multiple factors are involved in the development of a disorder. The nurse is applying which of the following? A) Chain of causation B) Web of causation C) Strength of association D) TemporalityAns: B Feedback: The web of causation is being used to apply the concept of multiple causes to explain the existence of health and illness states. It was a refinement of the chain of causation, such that it looked at the combination of multiple factors as implicated in the development of poor outcomes. The chain of causation focuses on one factor in the development of a condition. The strength of association is an element of causation in noninfectious disease that refers to the ratio of disease rates in those with and without the causal factor. Temporality, also involved with the causation of noninfectious disease, is an element in which the exposure to the suspected factor must precede the onset of the disease.9. The nurse is reviewing a research article that describes the use of the bacille CalmetteGuerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to leprosy. The individuals did not develop the leprosy. The nurse interprets this as most accurately demonstrating which type of immunity? A) Herd immunity B) Passive immunity C) Cross-immunity D) Active immunityAns: C Feedback: Cross-immunity refers to a situation in which a person's immunity to one agent provides immunity to a related agent as well. This immunity can be active or passive. Herd immunity describes the immunity level present in a population group. Passive immunity refers to shortterm resistance acquired naturally or artificially. Active immunity is long-term and can be acquired naturally or artificially.10. The nurse educator knows that a nursing student understands the basics of immunity when the student nurse states A) herd immunity only pertains to cows. B) active immunity can be attained via the use of vaccines. C) passive immunity can be attained via the use of vaccines. D) cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a completely different infectious agent.Ans: B Feedback: Active immunity can be attained via the use of vaccines. Passive immunity is immunity that is given to a person, either by maternally provided protection for newborn infants or from antibody products that provide temporary resistance. Herd immunity describes the immunity level that is present in a population group. Cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a related infectious agent.11. When assessing several populations, the nurse notes each population's relative risk. Using the relative risk ratios below, which population would require a major emphasis for risk reduction intervention? A) 0.59 B) 1.13 C) 1.79 D) 2.45Ans: D Feedback: A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group. Therefore, interventions to reduce this population's risk would be most important.12. Which of the following statements about risk is true? Select all that apply. A) Risk is the probability that a disease or unfavorable health condition will develop. B) Risk means that the person who has the most negative influences will definitely develop the disease or unfavorable health condition. C) Risk refers to positive and negative influences on a person's likelihood of developing a specific disease. D) Risk can be measured using the relative risk ratio, which is based on the ratio of incidence in an exposed group to incidence rate in unexposed group. E) Risk is unimportant when determining the most effective points for community health intervention.Ans: A, C, D Feedback: Risk is the probability that a disease or unfavorable health condition will develop. Risk also refers to positive and negative influences on a person's likelihood of developing a specific disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an exposed group to incidence rate in unexposed group. Risk does not mean that the person who has the most negative influences will definitely develop the disease or unfavorable health condition, but it refers to the probability that the person will develop the disease or unfavorable health condition. The relative risk ratio assists in determining the most effective points for community health intervention in regard to particular health problems.13. While visiting a family's home, the community health nurse finds out that the two children in the home were exposed to chickenpox. Assessment of the children reveals no signs of fever or lesions. The nurse determines that the children may be in which stage of the disease? A) Susceptibility B) Subclinical disease C) Clinical disease D) ResolutionAns: B Feedback: The children have been exposed but have not yet developed the signs of chickenpox. Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is not present and individuals have not been exposed. During the clinical stage, signs and symptoms are beginning to develop. During the resolution stage, the disease causes sufficient anatomic or functional changes to produce recognizable signs and symptoms.14. communicable disease would quarantine be most effective? A) Susceptibility stage B) Subclinical disease stage C) Clinical disease stage D) Resolution stageAns: A Feedback: Quarantine is the isolation of persons who are susceptible to a communicable disease and have been exposed to that communicable disease until the incubation period of the subclinical disease stage has passed. Quarantining persons during the susceptibility stage itself is not indicated as individuals have not been exposed. The proper action for persons who are in the clinical disease stage and beyond is isolation until the danger of spreading the communicable disease has passed.15. The nurse is reviewing actual census data for information for use in an epidemiologic study. Which of the following would the nurse be least likely to find? A) Occupational status B) Housing quality C) Births recorded D) Educational levelAns: C Feedback: Vital statistic data provides information about the number of births recorded. Census data includes information about age, sex, race, ethnic background, type of occupation, income gradient, marital status, educational level, and other standards such as housing quality. If the nurse is reviewing actual census data, the nurse would be least likely to find births recorded, which is vital statistics.16. on the use of nursing home services and the common diagnoses of those using these services. Which source of information would be most appropriate for the nurse to investigate? A) National Center for Health Statistics B) Consumer Product Safety Commission C) Environmental Protection Agency D) Cancer disease registriesAns: A Feedback: The National Center for Health Statistics furnishes valuable health prevalence data from surveys of Americans. Among the information available is the National Nursing Home Survey, which provides information on those who are using these services and the diagnoses and other characteristics. The Consumer Product Safety Commission and Environmental Protection Agency would provide information about environmental issues. Cancer disease registries would provide information specific to the diagnosis of cancer.17. Which of the following is true about incidence and prevalence? Select all that apply. A) Prevalence is the number of new cases of a disease or health condition. B) Incidence is the number of new cases of a disease or health condition. C) Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. D) Incidence refers to all of the people with a particular health condition existing in a given population at a given point in time. E) When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.Ans: B, C, E Feedback: Incidence is the number of new cases of a disease or health condition. Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.18. A community health nurse is preparing to carry out an experimental epidemiologic study. Which of the following would be most important for the nurse to do? A) Focus the study on evaluating the cause of a disease B) Ensure carefully controlled conditions during the study C) Expose both groups to the same factor or condition D) Ensure that there are a substantial number of subjectsAns: B Feedback: Experimental studies are carried out under carefully controlled conditions. In human populations, experimental studies should focus on disease prevention or health promotion rather than testing the cause of disease. The investigator exposes an experimental group to some factor and simultaneously observes a control group similar in characteristics to the experimental group but without the exposure factor. An experimental study need not be elaborate to provide important data.19. A community health nurse is participating in a case-control observational study. Which of the following would most likely explain this type of study? A) Description of patterns of occurrence of illness and injury in a population B) Investigation of development of health-illness conditions over a long period of time C) Studying of a cohort with evaluation of variables associated with the disease or injury D) Comparison of persons with and without a health-illness conditionAns: D Feedback: Comparing persons with and without a certain condition is known as a case-control study. A study that describes patterns of occurrence in a population is a descriptive study. Following people over a long period of time is a longitudinal study. And cohorts are groups studied over time.20. After teaching a group of students about the various types of epidemiologic research studies that can be done, the instructor determines that the teaching was effective when the students describe a community trial as which of the following? A) A type of experimental study conducted at the community level B) An inexpensive type of analytic research study C) A study that gathers volunteers for the experimental group D) A way to locate health problems in a variety of communitiesAns: A Feedback: A community trial is conducted as an experimental study design with large populations. Some of the community receives a treatment, while the other part does not. This is probably the most expensive type of experimental study. It involves a great number of subjects, the support of the governmental forces as well as the population involved, a large number of staff over a long period of time, and the cost of the intervention itself. When a whole community is involved, individuals are not approached to be volunteers. What makes it a community study is that the entire community is part of the study. The health problem is identified prior to the implementation of the study. The introduction of an intervention in one community with no introduction in a similar community forms the study population, and the health problem being studied is then monitored between the two populations. The health problem has to be identified first in this type of study.21. When using descriptive epidemiology, which type of study would the community health nurse expect to include? A) Prevalence study B) Case-control study C) Cohort study D) Count studyAns: D Feedback: Descriptive epidemiology includes investigations that seek to observe and describe patterns of health-related conditions that occur naturally in a population. The simplest measure of a description is a count. Prevalence, case-control, and cohort studies are types of studies involved with analytical research.22. epidemiologic study from the first step to the last. A) Collect the data. B) Identify the problem. C) Analyze the findings. D) Disseminate the findings. E) Review the literature. F) Develop conclusions and applications. G) Design the study.Ans: B, E, G, A, C, F, D Feedback: The proper order of the steps in the epidemiologic study from the first step to the last is to identify the problem, review the literature, design the study, collect the data, analyze the findings, develop conclusions and applications, and disseminate the findings.23. When implementing an epidemiologic research study, which of the following would the community health nurse complete as the final step? A) Analyze the data B) Design the study C) Disseminate findings D) Review the literatureAns: C Feedback: The last step in the research process is to disseminate the findings. After identifying the problem and reviewing the literature, the researcher designs the study, collects the data, analyzes the findings, and develops conclusions and applications.1. When reporting the identification of a communicable disease and need for investigation, which of the following must be notified first? A) Centers for Disease Control (CDC) B) State health department C) Local health department D) National Reported Disease listAns: C Feedback: The local health department is the initial point of notification of a communicable disease investigation. Each local health department or agency will investigate the specific disease. The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as the guidance for State reportable diseases.2. Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that apply. A) Immunization of children and adults B) Disease investigation and case/contact finding C) Diagnosing cases of communicable diseases D) Prescribing treatment for communicable diseases E) Environmental interventions F) Community EducationAns: A, B, E, F Feedback: Appropriate interventions that may be implemented by community health nurses include immunizations of children and adults, environmental interventions, community education, screening programs, and disease investigation and case/contact finding.3. Which of the following statements accurately describes important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply. A) Review the information received from the news media reporter for completeness B) Review disease information including the reservoir, incubation period, infectious period, symptoms, and treatment C) Take all appropriate treatments to the interview site D) Investigate only laboratory confirmed communicable diseases E) Eradicate the diseaseAns: A, B Feedback: Steps to take prior to contacting an individual regarding communicable disease include reviewing the information received from the reporters for completeness (this refers to the individual reporting the communicable disease to the public health agency and not the news media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition; review the disease information (including reservoir, incubation period, infectious period, symptoms, and treatment); and identifying the specific questionnaire for the reported disease or using a generic disease investigation form and reviewing the questionnaire. It is not appropriate for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding communicable disease is one of the first steps in the process of investigation.4. Which of the following entities would the community health nurse know are required to report known or suspected cases of reportable diseases in every state in the United States? Select all that apply. A) Physicians, dentists, and nurses B) Laboratory directors C) Any individual who knows of or suspects the existence of a reportable disease D) Medical examiners E) Administrators of schools and child care centersAns: A, D, E Feedback: In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors; and any individual who knows of or suspects the existence of a reportable disease.5. A community health nurse is presenting a program about hepatitis prevention and risk reduction to a local community group. The nurse determines that the group has understood the program when they identify which method as the major mode of transmission for hepatitis B? A) Oral-fecal route B) Exposure to contaminated blood C) Airborne droplet nuclei D) Infected rodents, such as mice and ratsAns: B Feedback: Hepatitis B can occur in certain high-risk groups, including injected drug users, heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal-oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is transmitted via infected rodents.6. When reviewing the trends in communicable diseases for a county, the community health nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan for prevention and control integrating the understanding that this disease is most likely transmitted by which mode? A) Vector B) Airborne C) Vehicle-borne D) DirectAns: A Feedback: In the United States, vector-borne illnesses have received renewed attention with accumulating information about Lyme's disease, transmitted to humans by a tick vector. Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host such as through touching, biting, kissing, or sexual intercourse.7. After a community health nurse implements an educational program for a local community group about food safety, which statement indicates that the teaching was successful? A) "Handwashing is unnecessary if we use gloves." B) "After cooking the meat, we'll put it on the same platter that we used for the raw meat." C) "Our cooked foods should be cooled quickly." D) "If we peel the carrots, we don't need to wash them before eating."Ans: B Feedback: Cooked foods should be cooled quickly. Surfaces, hands, and utensils should be washed in warm soapy water (even when gloves are used as gloves do not prevent cross-contamination by themselves). Foods when cooked should not come in contact with dishes, utensils, or containers used when the foods were raw and uncooked. Foods that are to be eaten raw and uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are to be peeled that grow on the ground or come in contact with soil.8. A community health nurse is teaching a group of clients about infection control and mentions the role of vectors in transmitting diseases. Which of the following would be examples of some common vectors? Select all that apply. A) Chemicals B) Mosquitoes C) Salmonella D) Fleas E) RoachesAns: B, D, E Feedback: A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not vectors and Salmonella is an infectious agent.9. Which of the following statements about modes of transmission are true? Select all that apply. A) Direct transmission requires contact with a contaminated inanimate material. B) Indirect transmission is also known as vehicle-borne illness. C) Food- and water-related illnesses are considered to be spread by indirect transmission. D) Vector transmission requires contact with a nonhuman carrier such as an animal or insect. E) Airborne transmission commonly occurs from coughing and sneezing.Ans: B, C, D, E Feedback: Direct transmission occurs by immediate transfer of infectious agents from a reservoir to a new susceptible host. Indirect transmission requires contact with a contaminated inanimate material and is also known as vehicle-borne illness. Food- and water-related illnesses are considered to be spread by indirect transmission. Vector transmission requires contact with a nonhuman carrier such as an animal or insect. Airborne transmission commonly occurs from coughing and sneezing.10. Community health nurses practice within the three levels of prevention. Which of the following would the community health nurse engage in at the primary level of prevention for communicable disease control? Select all that apply. A) Providing TB skin test to children entering kindergarten B) Administering immunizations to senior citizens C) Teaching kindergarten students to wash their hands D) Encouraging parents to complete their children's immunizations E) Providing chest x-rays to people with positive TB skin tests F) Administering prompt treatment for the symptoms of gonorrheaAns: B, C, D Feedback: Primary prevention interventions include administering immunizations, teaching about hand washing, and encouraging adherence to the recommended schedule for childhood immunizations. Providing TB skin testing and chest x-rays, and promptly treating symptoms of gonorrhea are examples of interventions at the secondary level of prevention.11. The nurse educator has just discussed education of aggregates using mass media with targeting health messages. Which of the following statements by the nursing student would demonstrate the student's ability to analyze and apply the information? A) Television would be the most important venue of mass media to educate the aggregate as everyone has a television. B) The target audience must be assessed for educational level, salience of the issue, involvement in the issue, and access to the media channel used. C) Pamphlets should be assessed to make sure they are at a twelfth grade reading level. D) It is unnecessary to consider culture when planning the health message.Ans: B Feedback: To effectively deliver a health promotion and disease-prevention message, the message must reach the target (at-risk) population. This requires correct identification of the characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and access of the target audience to the media channels used. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease- prevention message to ethnic and racial minority groups. Television may not be the most important venue of mass media to educate the aggregate. Pamphlets may not be the best way to educate the aggregate, and the reading level of any literature must be specific for the target audience. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease- prevention message to ethnic and racial minority groups.12. A community health nurse has identified the index case. The nurse is involved in which of the following? A) Contact investigation B) Screening C) Isolation D) QuarantineAns: A Feedback: The index case (diagnosed person) results from contact investigation and partner notification. Screening describes programs that deliver a testing procedure to detect disease in groups of asymptomatic apparently health individuals. Isolation refers to the separation of the infected person from others for a period of communicability to limit transmission; quarantine refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period. Contact investigation and notification is one of two approaches to secondary prevention of communicable diseases.13. The three main approaches to the tertiary prevention of communicable disease include which of the following? A) Education, immunization, and screening B) Screening, immunization, and isolation and quarantine C) Case and contact investigation, notification, and treatment D) Care and treatment, isolation and quarantine, and safe handling and control of infectious wastesAns: D Feedback: The three main approaches to the tertiary prevention of communicable disease include care and treatment, isolation and quarantine, and safe handling and control of infectious wastes. The primary prevention techniques for communicable disease include education, immunization, and screening. The secondary prevention techniques for communicable disease include case and contact investigation, notification, and treatment.14. If an agency discards used needles and syringes in plastic milk jugs, which of the four key elements of an infectious waste management program that are applicable to community practice would the agency be violating? A) Health professionals must be able to correctly distinguish biohazardous waste from biomedical waste. B) The waste management program must have administrative support and authority to institute practice guidelines. C) Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture. D) An enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.Ans: C Feedback: Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture; they should have sufficient strength to prevent rupture or tearing under normal conditions; and they should be sealed to prevent leakage. Containers for sharps must also be puncture resistant. Other key elements of an infectious waste management program that are applicable to community practice include that health professionals must be able to correctly distinguish biohazardous waste from biomedical waste; the waste management program must have administrative support and authority to institute practice guidelines; and an enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.15. The community health nurse determines that the adult population in the community has an increased incidence of vaccine preventable disease. Which of the following are factors that may contribute to low vaccination levels among adults? Select all that apply. A) Lack of comprehensive vaccine delivery systems to the public and private sectors for adults (similar to the Vaccines for Children program for children) B) Lack of statutory requirements for vaccination of adults C) Health care providers may lack current information about recommended adult immunizations and may miss opportunities to vaccinate adults during contacts in offices, outpatient clinics, and hospitals. D) Adults fear injections for immunizations but do not worry about adverse effects after vaccination. E) A multitude of comprehensive vaccination programs exist in settings where healthy adults congregate such as workplaces and other locations.Ans: A, B, C Feedback: Low vaccination levels among adults are associated with several factors: limited comprehensive vaccine delivery systems that are available; lack of statutory requirements for vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts in offices, outpatient clinics, and hospitals. Additionally there is a lack of comprehensive vaccination programs in settings where healthy adults congregate; and clients and providers may fear adverse reactions after vaccination.16. A community health nurse would recommend pneumococcal vaccine for which group? A) 1-year-old children B) 30-year-old adults who have simple respiratory tract infections C) Adults over age 65 who have COPD D) Healthy adults in their 50sAns: C Feedback: Primary prevention includes a pneumococcal vaccine, especially for the high-risk groups, ages 2 years old and up, including those with chronic diseases, immune-suppressing health conditions, or those who are asplenic. Reimmunization is recommended only for high-risk children, or adults over 65 years old who had their first vaccination before age 65. The vaccine is not effective in children younger than 2 years of age and is not recommended for the healthy population between the ages of 2 and 65 years.17. Which of the following statements about immunization is most accurate? A) Immunization is helpful in the spread of all communicable diseases. B) Immunization cannot provide herd immunity. C) Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. D) Immunization is the process of administering antibodies to a person.Ans: C Feedback: Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. There are many communicable diseases that a vaccine is not known for. Immunization can help to promote herd immunity. Immunization does not involve the administration of antibodies to a person.18. A family member has developed tuberculosis (TB) and the remainder of the family members are undergoing tuberculosis skin testing to determine their status. The nurse assesses the indurations and determines that a family member with which size induration is positive for TB? A) 2 mm B) 3 mm C) 4 mm D) 5 mmAns: D Feedback: An induration of 5 mm or more is considered positive for individuals in close contact with others who have TB. Indurations <5 mm are not considered positive.19. The community health nurse observes an increase in the development of multidrug resistant tuberculosis. The nurse understands that a major reason for this occurrence for individual clients would most likely be A) political and social response to declining rates of TB over the past decade. B) a reduction in funding for surveillance and research. C) noncompliance with the therapy for the full, recommended period. D) a premature sense that TB has been defeated.Ans: C Feedback: On an individual case basis, the most common means by which resistant organisms are acquired is by noncompliance with therapy for the full, recommended period. Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include the political and social response to declining rates of TB over past decades, which has resulted in funding cuts for surveillance, treatment, and research, and a premature sense that TB was defeated.20. Which of the following statements about the prevention of sexually transmitted diseases Is true? Select all that apply. A) Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. B) Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. C) The proper use of condoms prevents transmission of all sexually transmitted infections. D) Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other sex partners if sexual contact is only practiced when the person does not have any visible sores.Ans: A, B, D Feedback: Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection transmission but does not eliminate the transmission of all sexually transmitted infections. It is possible for a person who has HSV-2 infection to transmit the infection to other sex partners if sexual contact is practiced even when the infected partner does not have a visible sore.21. Which one of the following statements is true about the consequences of biologic terrorism with anthrax and smallpox? A) Anthrax is not usually spread by person to person contact and so is not a good agent of biological terrorism. B) Smallpox is globally eradicated and therefore does not present a problem. C) Most adults are immune to smallpox due to routine immunization. D) As many as one in five persons who become ill with cutaneous anthrax die and inhalation anthrax can cause death in 3 to 5 days.Ans: D Feedback: The case-fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and expected death within a matter of days. Anthrax is not usually spread by person to person contact, but it has been demonstrated to be an agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist attacks. Many adults are not immune to smallpox as it has not been used for routine immunization for 40 years.22. Which of the following statements about confidentiality, privacy, and discrimination is the most accurate? A) It is permissible for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. B) It is permissible for a community health nurse to tell the contacts of a person who is infected with a communicable disease which disease they have been exposed to and the name of the source. C) It is permissible for any health care provider to report any cases of known or suspected communicable diseases to the news media. D) Only the identity of the index case of a communicable disease needs to be protected.Ans: A Feedback: It is permissible and necessary for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. It is important that the contacts of a person who is infected with a communicable disease which disease they have been exposed to but is not acceptable for the community health nurse to reveal the identity of the source. It is permissible and often helpful for a community health nurse to involve the news media in informing the public of information about the specific disease including mode of transmission, prevention, and treatment options but not the identity(ies) of the cases. It is important to assure the individual being interviewed that the information will be maintained in a confidential manner, and the goal is care and treatment.