Community CBA 1 - old textbook

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

a. Bioterrorism and global health threats
b. Delivery of individual care and hygiene
c. The need for increased hospital and acute care
d. Chronic disease and disability management
Click the card to flip 👆
1 / 394
Terms in this set (394)
One of the primary focuses of improving the health of the American people in the twenty-first century is to address:

a. Bioterrorism and global health threats
b. Delivery of individual care and hygiene
c. The need for increased hospital and acute care
d. Chronic disease and disability management
ANS: A
Rationale: There are new concerns, and one of the most serious is bioterrorism. The others are not related to public health or are concerns that have been present for many years.
The threat of bioterrorism has the potential to:

a. Dissolve community-based programs.
b. Cause the health care system to collapse.
c. Divert funds from other public safety health care programs.
d. Increase the need for shelters
ANS: C
Rationale: Bioterrorism may have an impact on the availability of resources for public safety health care programs.
Population-based preventive programs launched in the 1970s are responsible for increased:

a. Use of tobacco
b. Use of automobile safety restraints
c. Incidence of hypertension
d. Incidence of obesity
ANS: B
Rationale: One outcome of preventive programs launched in the 1970s is the increased use of automobile safety restraints. These programs also are responsible for the decreased use of tobacco and improved blood pressure control. None of these programs addressed the incidence of obesity
The public health nurse must participate in the essential services of public health. These include:

a. Monitoring health status by completing a community assessment
b. Diagnosing and investigating health problems in the world
c. Informing, educating, and empowering people about health issues
d. Working in law enforcement to regulate health and ensure safety
ANS: C
Rationale: The public health nurse monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The public health nurse would not diagnose or solve "world" problems, or work in law enforcement. Rather, the public health care nurse would participate with local regulators to protect communities and empower people to address health issues.
Which of the following is an example of the mission of public health according to the Institute of Medicine?

a. Tracking avian flu outbreaks and doing surveillance in the United States
b. Providing a flu shot for an elderly person at the health department
c. Keeping track of alternative therapies in use in the United States
d. Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta
ANS: A
Rationale: The Institute of Medicine's stated mission on public health is "to generate organized community and technical knowledge to prevent disease and promote health."
Making sure that essential community-oriented health services are available defines which of the core public health functions?

a. Policy development
b. Assessment
c. Assurance
d. Scientific knowledge-based care
ANS: C
Rationale: Public health is based on scientific knowledge, but is not a core function. The definition does not fit the terms assessment or policy development.
The number and proportion of persons aged 25 or older with less than a high school education is an example of:

a. Sociodemographic characteristics
b. Health status
c. Health risk factors
d. Health care resource consumption
ANS: A
Rationale: The number and proportion of people is a demographical characteristic
The purpose of public health core functions is to:

a. Clarify the role of the government in fulfilling the mission of public health.
b. Ensure the safety of populations in receiving quality health care.
c. Provide community-based individualized care to every person in the United States.
d. Unite public and private providers of care in a comprehensive approach to providing health care.
ANS: A
Rationale: As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government's role
Which of the following statements about public health is accurate?

a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approach
b. Expenditures and resources for public health have increased in recent years.
c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and person
d. Reform of the medical insurance system is the single change needed to improve the health of Americans.
ANS: C
Rationale: Changes, such as immunizations, tobacco use, blood pressure control, and automobile safety, have helped increase the health of communities
Collecting data and monitoring the health status of the population defines which of the core public health functions?

a. Assessment
b. Prevention
c. Assurance
d. Policy development
ANS: A
Rationale: Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies. Assessment consists of systematic data collection and monitoring health status.
The nurse who compares the rate of teenage pregnancy in various areas of the city is practicing the public health core function of: a. Assurance b. Assessment c. Prevention d. Policy developmentANS: B Rationale: Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy.Public health nurses who develop and implement local public health policies through partnerships with agencies, organizations, and consumers within the community are using which core public health function? a. Assessment b. Prevention c. Assurance d. Policy developmentANS: D Rationale: Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection. Policy development deals with developing and implementing health policies.Providing for the availability of essential personal health services for people who would otherwise not receive health care defines which public health core function? a. Assessment b. Prevention c. Assurance d. Policy developmentANS: C Rationale: Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policiesThe nurse manager who makes sure that the staff members who work in a local clinic are competent is demonstrating the public health core function of: a. Assurance b. Assessment c. Prevention d. Policy developmentANS: A Rationale: Assurance refers to making sure a competent health care workforce is availableThe public health nurse analyzes data related to the number and type of United States Environmental Protection agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional statusANS: C Rationale: Breathing air of poor quality is a risk to healthWhich is an example of the primary goal of public health? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old womanANS: C Rationale: The correct answer is concerned with the health of many people, while the other answers address individual interventionsThe public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management b. Workforce needs assessment c. Acute care services d. Curriculum developmentANS: A Rationale: Workforce needs assessment, acute care services, and curriculum development are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: analytic/assessment, policy development/program planning, communication, cultural competence, community dimensions of practice, basic public health sciences, financial planning and management, and leadership and systems thinkingPublic health nursing is a specialty because: a. It has a distinct focus and scope of practice. b. It must be done by a registered nurse with a master's degree. c. It is focused on disadvantaged citizens. d. It performs interventions at the acute care level.ANS: A Rationale: Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialtyThe necessary basic preparation for public health nursing is a(n) _____ in nursing. a. Associate's degree b. Baccalaureate degree c. Master's degree d. PhDANS: B Rationale: A BSN is the necessary basic preparation to function as a beginning staff public health nurse.Public health practitioners prepared at the graduate level should be able to: a. Teach public and community health nursing b. Assess and intervene successfully at the aggregate level c. Diagnose and treat disease and have prescriptive authority d. Run for political office as experts in public health policyANS: B Rationale: According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine.A public health nurse provides a clinic for HIV-positive citizens in the community. This is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Policy makingANS: C Rationale: This clinic is for clients who already have a disease process; therefore, it is tertiary preventionAn example of a community health nursing practice is: a. Administrating a flu shot to a client in a physician's office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation centerANS: A Rationale: Community health nursing practice focuses on providing individual interventions in the community. Administrating a flu shot to an individual is the only example that meets this criterion.Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the community as a whole. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice.ANS: A Rationale: By definition, the first option is correct. Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff public health nurse; however, this is not a requirement for public health nursing or community health nursing practices.The term community-based nursing care is applied when implementing which nursing intervention? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a communityANS: B Rationale: Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definitionThe nurse who conducts vision screenings on children in the school setting is practicing _____ nursing practice. a. Community-oriented b. Public health c. Community health d. Community-basedANS: D Rationale: This type of nursing is a setting-specific practiceWhich is an example of an aggregate or population? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who play cards together once a week at private homesANS: A Rationale: A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. They can be defined in terms of geography or a special interest. The clients in the first option share a geographical characteristicThe nurse investigating environmental health problems caused by contaminated ground water is best described as practicing: a. Community-oriented nursing b. Community-based nursing c. Policy development d. Tertiary careANS: A Rationale: Community-oriented nursing emphasizes the prevention of disease and disabilityA population is best defined as a: a. High-risk group b. School or institutional setting c. Collection of individuals who share at least one common characteristic d. Geographical location within a communityANS: C Rationale: The wrong answers are types of populations; they do not define a population.Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a. Individuals b. Aggregates c. Communities d. Geographical regionsANS: B Rationale: Aggregates are a defined population made up of individuals in communities of a specific geographical regionWhich of the following statements is true with regard to a population focus in public health nursing? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community as a whole, regardless of whether they do or do not access the he d. Only populations outside institutional settings are considered.ANS: C Rationale: Public health nurses are concerned with the health of the entire populationA public health staff nurse who has a clear understanding of population-focused practice: a. Is frustrated providing care to individuals b. Would rather perform population-focused interventions c. Is able to improve the effectiveness of care provided d. Is considered a public health nurse specialistANS: C Rationale: Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population focused specialists. Public health nurse specialists are prepared at the master's level and function in an administrative roleA key opportunity for public health nurses to improve population-focused care is by: a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practiceANS: B Rationale: Public health nurses must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused careProposed changes to the health care delivery system in the United States will: a. Provide new opportunities for public health specialists. b. Result in isolated care being provided to individuals. c. Emphasize specialty care. d. Increase the utilization of acute care services.ANS: A Rationale: Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease preventionImplementing quality performance standards in public health is important because: a. They are used to guide improvement in the public health system. b. They rigidly control public health. c. Administrators will not monitor public health at the local level, but instead at the national level. d. They can be used as hiring guidelines for nurses.ANS: A Rationale: These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services.To better address emerging public health issues, a public health nurse enrolls in a course addressing which content area? a. Leadership b. Ethics c. Communication d. FinanceANS: B Rationale: Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: informatics, genomics, cultural competence, community-based participatory research, policy, law, global health, and ethics.Which of the following are considered barriers to public health nursing? Select all that apply. a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d. The number of job opportunities in the area has been steadily declining.ANS: A, B, C Rationale: All are considered barriers to nurses specializing in public health nursing, except the number of job opportunities, which is not declining.In 1925, Mary Breckenridge established the Frontier Nursing Service (FNS) based on a system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support led to innovations in health care delivery in the twentieth century, especially for underserved populations. One of Breckenridge's innovative contributions to health care in the United States was: a. establishment of the Federal Emergency Relief Administration. b. introduction of the first nurse-midwifery training. c. introduction of the nursing process. d. introduction of occupational health nursing.ANS: B The unique pioneering spirit of the FNS influenced the development of public health programs to improve the health care of rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckenridge, the founder of the FNS, introduced the first nurse-midwives into the United States.The most important contribution made by Florence Nightingale to community-oriented nursing was: a. development of the settlement house concept as a strategy to improve urban health standards. b. expansion of the role of nursing to include health-promotion practices. c. founding of the first district nursing association in England. d. introduction of professional schools of nursing in the United States.ANS: B Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness.The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was: a. establishment of an FNS. b. provision of funding to support employment and education. c. provision of funding for research and investigation of disease. d. institution of a district nursing model.ANS: B Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses (PHNs). More than 1,000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of PHNs with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease.In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of: a. enforcing the department of health's rules and regulations. b. excluding infectious children from the school environment. c. providing and obtaining medical treatment for absent students. d. providing shoes and clothing for students.ANS: C In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide follow-up care to children absent from school.From a historical perspective, the post-Depression shift in the U.S. Congress to the practice of categorical funding that provides federal money for priority diseases or groups has to this day produced a negative effect on the delivery of health care services that can best be described as: a. adoption of 2-year associate degree nursing programs. b. exclusion of home-based care from health insurance coverage. c. national preference service model that neglects emerging problems. d. rise in hospital-based care.ANS: C The shift in the U.S. Congress to categorical funding provides federal money for priority diseases or groups rather than a comprehensive community health program. Thus local health departments designed programs to fit the funding priorities, which led to duplication of services among official health agency programs and a silo approach to program planning. When funding is directed by national preferences (silo programming), the ability of public health departments to respond to local and emerging problems is seriously impaired, because funding is earmarked for those national preferences only.During the Depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by: a. decrease in focus on the community as the unit of service. b. increase in the scope of fundamental services. c. increase in field experience. d. decrease in the need for training and supervision.ANS: A Some Depression-era federal programs, such as the Works Progress Administration, Relief Nursing Services, and Civil Works Administration (CWA), expanded the need for existing nursing services and created the need for new services in an effort to support employment of basic nurses while meeting the needs of the increasing ranks of impoverished individuals. More than 10,000 nurses were employed by the CWA and assigned to official health agencies. This facilitated rapid expansion of these programs and provided basic nurses with a taste of public health; but it also created a tremendous burden on existing public health staff to provide training and supervision. Basic nursing education focused heavily on the care of individuals, and students received very little training on working with groups and the community as a unit of service. A 1932 survey of public health agencies found that only 7% of nurses employed in public health were adequately prepared to practice in the community, which required considerable agency investment in orientation, training, and supervision.The Association of Community Health Nurse Educators has called for increased graduate programs to educate PHN leaders, educators, and researchers in such areas as: a. immigrant and migrant health. b. natural and human-made disasters. c. automobile safety for children. d. student health.ANS: B The Association of Community Health Nurse Educators calls for increased graduate programs to educate PHN leaders, educators, and researchers. Natural disasters (such as floods, hurricanes, and tornados) and human-made disasters (including explosions, building collapses, and airplane crashes) require innovative and time-consuming responses. Preparation for future disasters and potential bioterrorism demands the presence of well-prepared nurses.In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period? (Select all that apply.) a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use d. Targeting of efforts solely on environmental hazards e. Provision of supplemental food to low-income personsA, B, C The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of PHNs.The poor environmental conditions experienced by immigrants in tenement houses and sweatshops were familiar features of urban life across the northeastern United States and the upper Midwest. Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of the times? (Select all that apply.) a. Community health's focus on teaching and prevention b. Establishment of settlement houses c. Establishment of the town and country nursing services in large cities d. Lack of public interest in limiting disease e. Middle and upper class fear of diseasesA, B, E In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities.The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives? (Select all that apply.) a. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home b. Established public health nursing programs for military outposts in World War I c. Provided matching funds to establish maternal and child health divisions in state health departments d. Responded to the 1918 worldwide influenza pandemic in the United States e. Supported nurse employment through increased grants-in-aid for state programs of home medical careA, B, D The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care.Mary Lipsky has worked for the county health department in a major urban area for almost 2 years. Her nursing responsibilities include a variety of services, including consultations at a senior center, maternal/newborn home visits, and well-child clinics. As she leaves work each evening and returns to her own home, she keeps thinking about her clients. Why was it so difficult today to qualify a new mother and her baby to receive WIC (Women, Infants, and Children) nutrition services? Why must she limit the number of children screened for high lead levels, when last year the health department screened twice as many children? Several children last month seemed asymptomatic, but the laboratory found lead levels that were high enough to cause damage. One of the mothers Ms. Lipsky is acquainted with is having a difficult time emotionally. Why is it so difficult to find a behavioral health provider for her? And the health department still cannot find a new staff dentist! And families on welfare cannot find a private dentist to care for their children. A. Why might it be difficult to solve these problems at the individual level, on a case-by-case basis? B. What information would you need to build an understanding of the policy background for each of these various populations?A. It is easier to use a population-focused approach to solving these problems. If you can show through a community needs assessment that these are problems for a large number of people in the community and are putting the community at risk for increased health problems, more costly health care, and less social and economic growth, then you can convince policy makers to establish programs directed at these problems. With limited health care dollars, the emphasis is on the greatest good for the greatest number. B. A historical approach will build understanding of the public policy elements limiting care of various populations by exploring what attempts have been made in the past to innovate or reform services for these populations; determining what has limited these attempts; and identifying examples of programs or policies that have been successful.In the past, community-oriented nurses have been called: a. District nurses b. Almshouse nurses c. Soldier nurses d.SistersANS: A In the past, community-oriented nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses.Nurses have worked in the community to improve the health care status of individuals, families, populations, and vulnerable groups. Part of the appeal of this type of nursing is: 1. Working with wealthy contributors who provide the funds 2. Locating the source of disease and curing patients 3. The autonomy of practice and independence in problem solving and decision making 4.Caring for soldiers on the battlefieldANS: 3 Community health nurses have a long history of autonomous practice, problem solving, and decision making. The other three answers relate to acute care nursing or gathering funding. Community health care nurses did engage in these activities in the nineteenth century, but overall, they have been best known for autonomy of practice.Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently faced with include: 1.Diphtheria, cholera, and typhoid fever 2.HIV, AIDS, and bioterrorism 3.Avian flu, tuberculosis, and radiation 4.Polluted water and airANS:2 The newer threats to health that public health nurses are involved in are HIV, AIDS, and bioterrorism. Choice #1 lists threats of the past. Avian flu may be a threat, but radiation and tuberculosis are ongoing. Polluted water and air are generally not seen in the United States.Early colonial health efforts in the United States included: 1.Establishment of schools of nursing 2.Development of vaccines given to large numbers of people 3.Collection of vital statistics, improved sanitation, and control of communicable diseases introduced through seaports 4.Development of public housing and almshousesANS:3 The other choices are events that happened after the colonial period.Florence Nightingale's contributions to public health included: 1.Caring for the sick, poor, and neglected in institutions and at home 2.Using a population-based approach that led to improvements in environmental conditions 3.Writing the Elizabethan Poor Law to guarantee medical care for all 4.Founding of the district nursing association to provide health care to needy peopleANS:2 During the Crimean War, Nightingale progressively improved the soldiers' health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality.During America's Industrial Revolution, the number of jobs for women rapidly increased. Nightingale's successes became known across the United States, and the first nursing schools opened. Which of the following occurred related to public health nursing? 1.Community-oriented nursing began with organizations formed to meet urban health care needs. 2.Nurses were instrumental in the construction of sewers and public water systems. 3.Nurses trained in hospitals worked long hours caring for patients with communicable diseases in a humane way. 4.Nurses closed down almshouses and orphanages.ANS:1 The visiting nurse became the key to health care in urban areas. Although nurses were involved in interventions to improve sanitation and nutrition, they were not instrumental in their construction. Nurses worked in hospitals, but that was acute care. Almshouses and orphanages were not closed down at this time.Lillian Wald was the first public health nurse in the United States. Which of the following is her major contribution to public health nursing? 1. Founding the American Nurses Association 2.Establishment of the New York Training Hospital for Nurses 3.Establishment of the Public Health Service 4.Establishment of the Henry Street Settlement that later became the Visiting Nurse Service of New YorkANS:4 Lillian Wald established the Henry Street Settlement.Lillian Wald invented the term public health nursing. Which of the following classes might a person of her day attend? 1.Taking and recording blood pressures accurately 2.Safe and sanitary baby and child care 3.Environmental pollutants and their effects on lung disease 4.Time management: balancing factory work and the homeANS:2 Lillian Wald provided health care that included educating the community on health care matters.In 1909, Yssabella Waters published her survey Visiting Nurses in the United States. This document highlighted the fact that: 1.Nurses were trained by Boards of Education. 2.Trained nurses adequately covered less densely populated areas. 3.Visiting nurses services were concentrated in the northeastern quadrant of the nation. 4.Nurses were curing diseases such as tuberculosis and typhoid fever that greatly enhanced their credibility.ANS: 3 This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health.The American Red Cross, through its Rural Nursing Service, improved living conditions in villages and isolated farms. Which of the following is an example of the resourcefulness of a nurse of this era? 1.Using hot bricks, salt, or sandbags to substitute for hot water bottles 2.Testing well water for pollutants 3.Teaching school and developing curricula for rural nursing programs 4.Providing post-surgical careANS:1 In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas.Occupational health nursing began as industrial nursing. What was the purpose of this type of nursing? 1.Inventing new machines to streamline production of medical goods 2.Investigating industrial injuries to improve work conditions 3.Working at industrial sites treating work related-injuries 4.Providing care for factory workers and their familiesANS:4 Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home.Lina Rogers became the first school nurse. Early school nursing focused on: 1.Investigating causes of absenteeism such as malnourishment and lack of shoes or clothing 2.Teaching school as well as being a nurse 3.Starting the first school of public health 4.Providing medical treatment to enable children to return to schoolANS:1 Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.The National Organization for Public Health Nursing was formed in 1912. Lillian Wald was its first president. The mission was to improve the educational and services standards of the public health nurse and promote public understanding. Which of the following is a contribution of this organization? 1.Requiring that public health nurses have a baccalaureate degree in nursing 2.Standardization of public health nursing education 3.Development of nursing cooperatives 4.Opening of the Henry Street SettlementANS:2 The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.In the late 1800s, local health departments were formed in urban areas for what purpose? 1.To target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties 2.To facilitate interdisciplinary efforts and promote the "practical application of nursing" 3.To provide immunizations to all citizens 4.To provide public health education for nurses who had finished basic "training school" educationANS:1 Local health departments were formed to handle environmental issues in cities.The Frontier Nursing Service was established by Mary Breckinridge to emulate systems of care used in the Highlands of Scotland. Her biggest contribution was: 1.Establishment of the Henry Street Settlement 2.Development of health programs geared toward improving the health care of the rural and often inaccessible populations 3.Blazing a nursing trail through the Rockies, providing nursing care to miners and their families 4.Teaching birth control measures to large numbers of women in the SouthANS:2 Mary Breckenridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.Which of the following is true about African American nurses in public health? 1.Segregation existed until the 1960s, which made certificate and graduate education more difficult to obtain. 2.Cities were the major areas where they practiced 3. They often belonged to the Frontier Nursing Service. 4.They were recruited heavily as military nurses.ANS:1 The other statements listed are false.A nursing student during World War II would likely join which group? 1.The Public Health Service of New York City 2.The Marine Nurse Corps 3.The Frontier Nursing Service 4.The Cadet Nurse CorpsANS:4 The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.Between 1900 and 1955, the leading causes of mortality were pneumonia, tuberculosis, and diarrhea/enteritis. By mid-century, nurses faced new challenges as the leading causes of death became: 1. Heart disease, cancer, and cerebrovascular disease 2. Influenza 3. Tropical diseases from increased travel abroad 4. Diseases from overcrowded conditions in large citiesANS: 1 Chronic illness care, long-term illness and disability, and disease prevention became the new challenges for nurses.Ruth Freeman was a leading public health educator, administrator, consultant, author, and leader of the National Health Organization of the twentieth century. Which of the following characterize her philosophy of nursing? 1. Nursing should move from acute care to community-based care. 2. Nurse practitioners should control public health. 3. Nursing is about caring for people, and is also intellectually challenging and offers many professional opportunities. 4. All nurses should seek graduate education to increase their credibility.ANS: 3 Ruth Freeman felt that nursing was about caring for people and was also intellectually challenging and offered many professional opportunities. She did not specifically espouse the other statements.The Elizabeth Poor Law of 1601 is similar to which of the following current laws? 1. Welfare 2. Food Stamps 3. Medicaid 4. MedicareANS: 3 The Poor Law guaranteed medical care for poor, blind, and "lame" individuals, similar to Medicaid.An intervention by the United States federal government to protect the health of its citizens was the establishment of the Marine Hospital Service, presently known as the Public Health Service. Its purpose was to: 1. Set policy on quarantine legislation for immigrants 2. Establish hospital-based programs to care for the sick at home 3. Establish and promote environmental interventions such as adequate housing and sanitation for urban cities 4. Provide health care for merchant seamen to protect seacoast ports and cities from epidemicsANS: 4 Providing health care to seamen was an early effort by the federal government to improve public health. Its purpose was to secure its maritime trade and seacoast cities.Nurses who provided care to people in their homes and provided that care to several people at a time were called: 1. Private duty nurses 2. Visiting nurses 3. Public health nurses 4. Community staff nursesANS: 2 Correct by definitionNeighborhood centers that provided health care and social welfare programs were called: 1. Settlement houses 2. Nursing care centers 3. Nurse-managed clinics 4. Public health servicesANS: 1 Correct by definition. Nursing centers, nurse-managed clinics, and public health services are not necessarily in neighborhoods.An accomplishment for which the Frontier Nursing Service was noted is: 1. Improvement of the care of sick and injured soldiers 2. Establishment of a fee-for-service program for workers at Metropolitan Life Insurance Company 3. Reduction of infant and maternal mortality regardless of environmental conditions 4. Increasing funding for communicable disease treatmentANS: 3 The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.A major provision of the Social Security Act of 1935 was the establishment of: 1. The Frontier Nursing Service to provide nursing service to rural communities 2. State and local community health services and training of personnel 3. District nursing to provide home health care to sick people 4. Community-based settlement housesANS: 2 Title VI of the Social Security Act established state and local community health services and training of personnel.Which of the following trends in health issues in the United States between 1900 and 1955 is accurate? 1. There was a rise in chronic disease such as heart disease and cancer. 2. There was a rise in communicable disease. 3. The crude mortality rate increased dramatically. 4. The life span after diagnosis remained the same.ANS: 1 Leading causes of death in 1955 were heart disease and cancer, while in 1900 they were pneumonia and tuberculosis. All other answers are false.A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity ActANS: 1 The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare.Which of the following programs provided funds for neighborhood health centers, Head Start, and other community action programs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity ActANS: 4 Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act.The impact of World War I on public health nursing included which of the following? Select all that apply: 1. Many communicable diseases were eradicated. 2. The depletion of the ranks of public health nurses to the war. 3. The feeling that the greatest patriotic duty was to stay at home. 4. Inadequate funding was the major obstacle to extending nursing services in the community.ANS: 2, 3, 4 Both World Wars I and II depleted the public health nurse population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front.According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year are caused by: a. Cardiovascular disease b. Obesity c. Medical error d. Drug overdoseANS: C In 2000, it was thought that our health care system was expensive and that access and quality were not optimal, but we had not considered this important fact: many people die of preventable medical errors in the United States.In the United States, the majority of health care dollars are spent on: a. Prescription drugs b. Hospital care c. Physician services d. Public health servicesANS: B The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item. The money spent for public health services is significantly lower than the other categories and prescription drugs accounted for only 10% of expenditures in 2008.The number of uninsured Americans has dramatically increased because: a. Medicare took over payment of health care costs. b. With a declining population, the costs for health care rose. c. Nursing salaries greatly increased, causing health care costs to rise. d. Health insurance coverage was dropped from employment-based health plans.ANS: D Although the majority of Americans continue to obtain health insurance from their employer as a benefit, employment does not guarantee insurance. Employer-sponsored health insurance is sensitive to both the general economy and changes in health insurance premiums. As costs for insurance premiums rose, employers either shifted more of these costs to their employees or declined to offer employment-based health coverage at all.The primary purpose of the World Health Organization is to: a. Coordinate surveillance at the global level. b. Prevent outbreaks of disease. c. Prevent the transmittal of communicable disease among nations of the world. d. Provide humanitarian support in times of disaster.ANS: A The World Health Organization, comprised of 192 member countries, is uniquely positioned to coordinate surveillance and response at the global level.One of the benefits that a public health agency will experience by choosing to implement the electronic health record is: a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost-savings to the agency d. Compliance with JACHO standardsANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals, 24-hour availability of records with downloaded laboratory results and up-to-date assessments, incorporation of protocol reminders for prevention, screening, and management of chronic disease, improvement of quality measurement and monitoring, and increased client safety and decline in medication errors.African American females have a higher mortality rate from breast cancer than Caucasian females. This is an example of: a. Projection b. Disparity c. Racism d. A sentinel eventANS: B Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.A nursing program has initiated a recruitment campaign focusing on increasing the minority students in its program. The rationale for this campaign is that: a. The number of minority versus non-minority nurses should be equal. b. Minority health care professionals who share the same culture with the clients may provide more effective care. c. The profession should be more diverse. d. Minority nurses can mentor other nurses when providing care for diverse populations.ANS: B The Pew Commission suggests that increasing minority representation in the health workforce not only is a commitment to diversity but also will improve the health care delivery system. Minority health professionals can be expected to practice in underserved areas at a greater rate and health professionals who share the same culture and language with the clients they serve can provide more effective care.A community health nurse utilizes telehealth because it: a. Enables clients to get nursing care in their homes b. Substitutes for health department delivered care c. Improves access to care in rural areas d. Replaces face-to-face care for those who cannot afford itANS: C Telehealth provides increased access to health care by the use of a computer monitor and telephone line. It is useful for monitoring clients with chronic disease, but is not a substitute for health care.An 80-year-old woman comes to the community health center with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. Lets go through these medications and see which ones we can delete. b. You can get these medicines at this clinic for free. c. Lets see if we can get some help from Medicare to pay for these medications. I will refer you to our social worker. d. These medications are important. Do your best to pay for them.ANS: C This elderly patient probably is eligible for benefits through Part C, the Medicare Advantage program, but often a patient needs help negotiating the system. The Medicare Advantage program incorporates private insurance plans into the Medicare program including HMO and PPO managed care models and private fee-for-service plans. These plans receive payments from Medicare to provide Medicare benefits, including hospital, physician, and often, prescription drug benefits.Residents of rural communities report that they must travel for long distances to obtain health care services. As a result, they seek health care only for emergencies and severe illnesses. Which aspect of the health care system in the United States is illustrated in this situation? a. Access to care b. Cost c. Quality d. Advances in technologyANS: A Funding to clinics in rural areas has been reduced, leading many rural uninsured individuals to use emergency rooms for many illnesses.A nurse exploring a job opportunity at a community health center would expect that the center: a. Would be located in a large metropolitan area b. Provides care only to the economically disadvantaged c. Offers comprehensive primary care services and supportive services d. Is used for preventive services such as flu shotsANS: C Community health centers serve the entire community for primary health care services, regardless of income. They are located in a high need or medically underserved community, which can be urban or rural.If a 25-year-old woman visits a community health center to obtain a gynecological examination and birth control pills, these activities are termed _____ care. a. Tertiary health b. Public health c. Primary health d. Specialized careANS: C By definition, primary health care includes basic health care services with the emphasis on prevention.A client who receives primary health care services would expect that: a. The care would be provided by a physician. b. Private insurance would be necessary to receive care. c. The emphasis of care provided would be on prevention. d. A referral would be made to a specialist after receiving services.ANS: C The focus of primary health care is a broad range of services that are designed to be affordable for the recipients of the care and the governments who provide them. The emphasis of care is on prevention and the means of providing the care is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods.When compared to public health care, primary care is: a. Focused on individuals b. Provided by specialists c. Self-reliant d. Community focusedANS: A Primary care also is provided by generalists, is dominated by health care professionals, and is not community focused.What initiative began as a result of a resolution adopted by the World Health Organization (WHO) in 1977? a. Declaration of Alma Ata b. Medicare c. Healthy People d. Primary health care movementANS: A The WHO adopted a resolution accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. The name of the resolution that was adopted was the Declaration of Alma Ata.Primary health care in the United States: a. Has dramatically improved since the passage of the Declaration of Alma Ata b. Focuses on the use of government-funded insurance programs c. Lacks community participation and a multidisciplinary health care delivery team d. Utilizes Preferred Provider Organizations to meet needs of the citizensANS: C Although primary health care (PHC) has been endorsed by the United States, it faces many challenges. PHC emphasizes broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team, however, this is not the primary method of health care delivery in the United States.A community health nurse reviews Healthy People 2020 when considering the health needs that will be addressed in the community. Which goal would the nurse find in this document? a. Promote healthy behaviors for children. b. Cure cancer. c. Eliminate health disparities. d. Provide primary care to all citizens.ANS: C Elimination of preventable disease, disability, injury, premature death, achievement of health equity, elimination of health disparities, and creation of social and physical environments that will promote good health and healthy development and behavior at every stage of life are the four major goals cited in Healthy People 2020.18. When researching advanced practice nursing options, a nursing student discovers that: a. Nurse practitioners may work as independent practitioners. b. Certified nurse midwives have limited prescriptive authority. c. Clinical nurse specialists typically provide primary care services. d. The Doctorate in Nursing Practice emphasizes the importance of research.ANS: A Nurse practitioners may work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered. Certified nurse midwives have prescriptive authority in some form in all states. Clinical nurse specialists may provide primary care services, but often work in consultation, research, education, and administration. The Doctorate in Nursing Practice role is a clinical role.A nursing student interviews a member of the local congressional district to learn more about the health care system in the United States. Which statement made by the congressman would be accurate? a. Managed care was short-lived because too many consumer groups endorsed the plans. b. Under managed care, clients had unlimited access to providers of their choice. c. Managed care failed because Americans were used to free access to providers of their choice. d. Managed care in the United States has been replaced by the Affordable Health Care for America Act.ANS: C Consumer groups were not only accustomed to freedom of choice and unlimited service, but they did not like the ideas of short-stay maternity care and denial of bone marrow transplantation for breast cancer patients, thus managed care failed in the United States.20. The federal agency of the public health system that is most involved with the health and welfare of United States citizens is the: a. Centers for Medicaid and Medicare Services b. Department of Health and Human Services c. Public Health Service d. Secretary for HealthANS: B The Department of Health and Human Services is charged with regulating health care and overseeing the health status of Americans.Which program would typically be found in a state health department? a. Senior health b. Dental services c. HIV/AIDS service d. Mental healthANS: C Typical programs in a state health department include: communicable disease service, HIV/AIDS service, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department.An expected action by the Department of Homeland Security would be: a. Prevention and protection against terrorist attacks b. Regulation of licensure of medical personnel c. Inspection of the safety of food and cosmetics d. Regulation of managed care organizationsANS: A This agency was created after the terrorist attacks of September 11, 2001, to prevent and deter terrorist attacks and to protect against and respond to threats and hazards to the nation.An example of a public health law instituted to protect the health of the community is: a. Requiring all persons to have health insurance coverage b. Administering flu shots in the late fall and early winter c. Mandating immunizations for all children entering kindergarten d. Monitoring and licensing nuclear power plantsANS: C Public health laws protect the community. Required immunizations are an example.What are some of the untoward events categorized in the Institute of Medicine (IOM) report about medical errors? Select all that apply. a. Wrong-site surgery b. Adverse drug events c. Improper transfusions d. Restraint related deathsANS: A, B, C, D All of the above: wrong-site surgery, adverse drug events, improper transfusions, and restraint-related deaths are listed in the IOM report.Which statement(s) about the health care workforce are true? Select all that apply. a. There is a shortage of nurses in the United States. b. Schools of nursing turn away qualified applicants due to lack of faculty and limitations of clinical sites. c. More than one million nurses will be needed by 2012 to replace those who are retiring. d. More students are choosing laboratory science, pharmacy technology, and radiology technology over nursing.ANS: A, B, C All are true except the last option. The fields listed in it have also seen declining enrollment.1. Which statement about the nursing workforce is true? a. The nursing workforce is overwhelmingly white. b. The number of minority nurses meets the needs of the country's demographics. c. The nursing workforce is becoming increasingly diverse with increasing minorities. d. Immigrants and refugees make up a large part of the nursing workforce in some areas.a. The nursing workforce is overwhelmingly white.The Refugee Act of 1980 had what effect on refugees who were immigrating into the United States? a. Allowed specific provisions for refugees from Southern and Eastern Europe. b. Provided a uniform procedure for refugees to be admitted into the United States. c. Permitted refugees to set up communities in or around major metropolitan areas. d. Allowed refugees access to "green cards" allowing them to work in the United States.b. Provided a uniform procedure for refugees to be admitted into the United States.3. Which statement accurately describes a large portion of foreign-born residents of the United States? a. They tend to live in major metropolitan areas. b. Most reside in rural areas. c. Few have a high school education. d. They are refugees and non-immigrants.a. They tend to live in major metropolitan areas.A 35-year-old from Russia comes to the United States seeking asylum because of religious persecution in the native country. Which of the following best describes this type of immigrant? a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrantc. RefugeeA visitor from Japan comes to the United States for a 2-week vacation. Which of the following best describes this person? a. Non-immigrant b. Refugee c. Legal immigrant d. Lawful permanent resident.a. Non-immigrantA nurse is observing behaviors that may be defined by culture. Which of the following is the nurse most likely to observe? a. Speaking a dialect of a language in a local region b. Standing when an older adult gets on the bus to give him or her a seat c. Immigrating to the United States and seeking work d. An organizational structure of a cultural groupb. Standing when an older adult gets on the bus to give him or her a seatA nurse states that the client has exhibited an explicit cultural behavior. Which of the following has the nurse most likely observed? a. Verbal communication b. Body language c. Use of titles d. Perception of health and illnessa. Verbal communicationA nurse is working with an immigrant population. Which of the following should be the first action taken by the nurse? a. Be aware of one's own culture. b. Become familiar with traditional practices of the immigrants. c. Try to see things from the immigrant's point of view d. Learn to speak the language of the immigrant population.a. Be aware of one's own culture.9. Which of the following statements about race is true? a. In the United States, children of biracial parents are usually assigned the race of the father. b. Ethnicity and race are synonymous terms. c. Individuals may be of the same race but of different cultures. d. No social significance is usually placed on race.c. Individuals may be of the same race but of different cultures.A nurse is working with a population that exhibits a large amount of diversity. The nurse recognizes that skin color of individuals within this population is an example of what? a. Multiculturalism b. Ethnicity c. Race d. Culturec. RaceA client shares with the nurse that her grandparents immigrated to the United States from Germany. Which of the following best describes what she has disclosed? a. Multiculturalism b. Ethnicity c. Race d. Cultureb. Ethnicity12. A nurse implements nursing interventions considering the uniqueness of the person's culture. Which of the following best describes this action? a. Cultural diversity b. Cultural knowledge c. Cultural competence d. Cultural awarenessc. Cultural competenceA nurse is unable to provide culturally competent care to a population within the community. Which of the following is an effect of this type of care? a. Enhanced communication b. Increased cost of health care c. Achievement of health indicators d. Improvement in client complianceb. Increased cost of health careA nurse is striving to be culturally competent. Which of the following actions would most likely be taken by the nurse? a. Respect individuals from different cultures and value diversity. b. Immerse himself or herself in different cultures. c. Design care for special ethnic groups. d. Give explicit instructions to avoid client decision making.a. Respect individuals from different cultures and value diversity.A nurse wants to obtain information on the alternative methods of health care used by a 45-year-old female Hispanic client. Who would be the best person to ask about this? a. The husband of the client b. A community leader of the ethnic group c. The client herself d. The religious leader of the ethnic groupc. The client herselfWhich event best describes a cultural encounter? a. Sharing significant assessment findings with members of a racial minority b. Visiting the native land of the clients served at a community health center c. Telephoning the priest at a Hispanic church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian clientd. Learning about traditional healing practices from an American Indian clientA nurse demonstrates cultural desire to provide culturally competent care. Which of the following actions would be taken by the nurse? a. Relying on a textbook for information about an ethnic group b. Bringing a translator to the local community clinic c. Taking Spanish classes in the evening at a college d. Judging others using his or her own cultural valuesc. Taking Spanish classes in the evening at a collegeTo meet a client's needs, it is sometimes necessary to integrate into the client's care a culturally relevant practice that lacks scientific utility. Which term describes this action? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterninga. Cultural accommodationA Mexican American mother insists on using special candles to help her daughter's ear infection. The nurse asks the mother if she would also give her daughter antibiotics. Which of the following best describes the action of the nurse? a. Cultural accommodation b. Cultural repatterning c. Culture brokering d. Cultural awarenessa. Cultural accommodationA nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors. Which of the following is being demonstrated by the nurse? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterningc. Cultural preservationA city council discusses how former city laws promoted segregation in the community years ago. Which of the following was being demonstrated when segregation occurred? a. Prejudice b. Cultural imposition c. Racism d. Stereotypingc. RacismThe nurse labels a patient an alcoholic because of his or her ethnicity. Which of the following best describes this action by the nurse? a. Stereotyping b. Prejudice c. Racism d. Ethnocentrisma. StereotypingA nurse advocates and intervenes between the health care system and the client's cultural beliefs on behalf of the client. Which term best describes the nurse's action? a. Cultural accommodation b. Culture brokering c. Cultural preservation d. Cultural repatterningb. Culture brokeringA nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. Which of the following best describes what has happened? a. Ethnocentrism b. Cultural imposition c. Racism d. Stereotypinga. EthnocentrismThe tendency to ignore all differences between cultures and to act as though the differences do not exist is identified by what term? a. Cultural conflict b. Culture shock c. Cultural blindness d. Cultural impositionc. Cultural blindnessA nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. Which of the following terms best describes how the nurse is feeling? a. Cultural conflict b. Cultural relativism c. Culture shock d. Culture brokeringc. Culture shockA client comes into the clinic and reports visiting an acupuncturist for pain. The nurse suggests taking pain medication instead. Which of the following best describes the action taken by the nurse? a. Cultural conflict b. Cultural blindness c. Cultural relativism d. Cultural impositiond. Cultural impositionHispanics tend to believe that the needs of the family take priority over those of the individual. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental controlc. Social organizationIn the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Perception of timed. Perception of timeAsians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental controld. Environmental controlResearch has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. Which of the following types of cultural variations is being demonstrated? a. Biological variations b. Personal space c. Social organization d. Perception of timea. Biological variationsA nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse to provide culturally competent care? (Select all that apply.) a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care. b. Language barriers may interfere with efforts to provide assistance. c. Certain risk factors may be present for a given population. d. Certain groups may use nontraditional healing practices. e. Introduction of the American culture will be an important part of the encounter.A, B, C, DA nurse will be using an interpreter during a client encounter. Which of the following considerations should be made by the nurse? (Select all that apply.) a. It is appropriate to use family members as interpreters. b. Written materials should be available in the client's primary language. c. Observe the interpreter's gestures to assure client understanding. d. The gender, age, and educational level of the interpreter should be evaluated. e. The nurse should face the interpreter when speaking.B,DHealth policy can best be defined as a set course of action to: A. administer public health care programs at the federal level for disaster preparedness, response, and recovery. B. obtain a desired health outcome for an individual, family, group, community, or society. C. support publicly funded health care programs at the local, state, and national levels. D. support health care development and research to improve the health status of citizens.ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end.The relationship between nursing practice, health policy, and politics can best be described as nursing: A. advocacy. B. policy process. C. process. D. profession.ANS: A Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community.The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: A. federal and state. B. federal, state, and local. C. all, but primarily state and local. D. all, but primarily federal and state.ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level.Nursing practice is governed by: A. boards of nursing established by the U.S. Department of Health and Human Services. B. nurse practice acts promulgated by federal and state legislative boards. C. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. D. nurse practice acts promulgated by the states in conformity with broad federal guidelines.ANS: C State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, they would begin with the: A. Centers for Disease Control and Prevention. B. Centers for Medicaid and Medicare Services. C. Health Resources and Services Administration. D. National Institute of Nursing Research.ANS: A The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability.The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: A. apply only to underdeveloped countries. B. are guides for in-country initiatives and priorities. C. carry the weight of international law. D. provide mandates for in-country legislatures.ANS: B In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law.A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? A. Executive branch of government B. Legislative branch of government C. Local representative D. Senate hearingsANS: B Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs.A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: A. American Public Health Association's guidelines. B. website of the Centers for Disease Control and Prevention. C. Healthy People initiatives. D. Pan American Health Organization's mission statement.ANS: C The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages.A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? A. Citizen action committee B. Nursing diagnosis C. Nursing process D. Socratic methodANS: C Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem.State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) A. Documentation of client status and progress B. Documentation of services C. Living wills and advance directives D. Resident's rights in long-term care facilities E. Right to death with dignityANS: A, B, C, D, E State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of living wills and advance directives.The first major federal government action relating to health was the: a. Passage of the Social Security Act b. Creation of the National Institutes of Health (NIH) c. Creation of the Public Health Service (PHS) d. Creation of Medicare and MedicaidANS: C The PHS was created in 1798.One of the main purposes of the Patient Protection and Affordable Care Act was to: a. Create a government-funded insurance program for all Americans. b. Make health insurance affordable for the middle class and small businesses. c. Decrease the rates of chronic disease in the United States. d. Increase the funding for public health agencies.ANS: B One of the main purposes of this legislation was to make health insurance affordable for middle class families and small businesses with one of the largest tax cuts for health care in history: reducing premiums and out-of-pocket costs. This act does not create a government-funded insurance program nor does it increase funding for public health agencies.One effect of the use of block grants was a: a. Reduction of federal expenditures b. Decreased ability of states to spend money on programming c. Guaranteed continuation of programs with demonstrated effectiveness d. Shift from hospital-based to community-based nursing careANS: A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures.It is important that nurses are involved in health policy because: a. Government and policy have a large impact on nursing and health. b. Policy affects nursing values as set forth by Florence Nightingale. c. Political science is a course of study that parallels nursing. d. Nurses must interpret laws to fit their practice.ANS: A Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care.The United States Department of Health and Human Services (DHHS) is part of which branch of the government? a. Judicial b. Executive c. Legislative d. HealthANS: B The executive branch includes regulatory departments, one of which is the United States DHHS.Which branch of the government interprets the states rights to grant abortions? a. Executive branch b. Legislative branch c. Judicial branch d. Federal branchANS: C The judicial branch interprets laws and their meaning, as in its ongoing interpretation of states rights to define access to reproductive health services for citizens of the states.Action taken to protect the health, safety, and welfare of citizens, such as requiring immunizations of children before admission to school, is called what kind of power? a. Executive b. Legislative c. Judicial d. PoliceANS: D Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens.When a local health department provides a hypertension screening to all individuals, which general category of health care functions is being used? a. Direct services b. Financing c. Information d. Policy settingANS: A Direct services are actions that provide health care directly to individuals.The federal government provides for the protection of the publics health by: a. Interpreting decisions related to womens right to privacy b. Setting up immunization clinics for smallpox vaccine c. Regulating nursing at the state level d. Monitoring the influx of disease at the bordersANS: D The United States Constitution gives the federal government the authority to provide for the protection of the publics health. By monitoring the influx of disease at the borders the publics health is being protected.A goal of the Division of Nursing is to: a. Enhance nursing competence in providing high-tech skills b. Apply disease prevention, environmental health, and health promotion concepts c. Provide scholarships for advanced nursing education d. Enhance racial and ethnic diversity in the nursing workforceANS: D One of the Division of Nursing goals is to enhance racial and ethnic diversity and cultural competency in the nursing workforce. The other statements apply to other agencies or are false.The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. Unites States Department of Health and Human Services (DHHS) b. Public Health Service c. Health Resources and Services Administration d. World Health OrganizationANS: A The DHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency.The Office of Homeland Security has a mission to rebuild the crumbling public health infrastructures of each state and provide: a. Vaccines for smallpox, anthrax, and plague b. Regulation of nuclear weapons c. Surveillance of bioterrorism threats d. Regulation of foreign nurses entering the United StatesANS: C The DHHS and the new federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States.Nurses are available to provide health services for women and children due to the provisions of the: a. Sheppard-Towner Act b. Public Protection of Maternity and Infancy program c. Early Periodic Screening and Developmental Testing (EPSDT) program d. Women, Infants, and Children (WIC) programANS: A This act also offered well-child and child-development services, provided adequate hospital services and facilities for women and children, and provided grants-in-aid for establishing maternal and child welfare programs.A member of the military receives health care services through which department? a. Defense b. Labor c. Agriculture d. JusticeANS: A The Department of Defense delivers health care to members of the military, including their dependents and survivors, and to retired members and their families.An occupational health nurse maintains a log of injuries from contaminated sharps because of the: a. Bloodborne Pathogen Standard b. Occupational Safety and Health Administration (OSHA) c. Department of Labor (DOL) d. Department of Defense (DOD)ANS: A OSHA is part of the Department of Labor. The Bloodborne Pathogen Standard became effective in 2002.Needle stick legislation clarified the role of employers to: a. Use Universal Precautions when dealing with all patients. b. Select safer needle devices as they became available. c. Provide needle disposal boxes. d. Incinerate all infectious waste including needles.ANS: B Health care facilities by law have to select safer needle devices and involve employees in identifying and choosing the devices.The practices of physicians, nurses, and other health care providers are differentiated by the: a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. United States Department of Health and Human ServicesANS: C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers.A nurse is found to be negligent. Because of the doctrine of respondeat superior, the one responsible for that negligence is the: a. Administrator b. Nurses immediate supervisor c. Nurses employer d. NurseANS: C The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurses employer.When planning, delivering, and financing responsibility for programs is shifted from the federal level to the state level, it is called: a. Evolution b. Devolution c. Block granting d. State administrationANS: B The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the states is called devolution. This was a major effort during the Reagan administration.A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. This demonstrates the nurses involvement in: a. Policy b. Politics c. Law d. Health policyANS: A Politics is the art of influencing others to accept a specific course of action. Therefore political activities are used to arrive at a course of action (the policy).When a nurse is sued for malpractice and goes to court, which type of law is being used? a. Constitutional b. Common c. Judicial d. InstitutionalANS: C Judicial law is based on court or jury decisions.States have certain continuing education requirements for persons to renew a nursing license. This type of law is called: a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police powerANS: B Licensing is regulated by each states nurse practice act as a function of the board of nursing.The state orders a person newly diagnosed with tuberculosis to be quarantined. What type of law allows the state to do this? a. Constitutional b. Common c. Judicial d. StateANS: A Constitutional law provides overall guidance for selected practice situations.When a school nurse reports suspected child abuse, there is a breach of confidentiality. This breach is allowed because of: a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superiorANS: A The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position.While researching various health care services that are provided in prisons, a nursing student learns that these services: a. Are funded by the Department of Defense b. Focus on health promotion interventions c. Must be provided at an adequate level d. Are available to those diagnosed with a chronic illnessANS: C Health care services for prisoners are required at an adequate level for all incarcerated individuals. This is administered by the Department of Justice. Prisoners will receive health care services when diagnosed with chronic illnesses as well as acute illnesses.Nurses working in hospice and home care settings need to be knowledgeable of health policy to: a. Provide safe nursing care. b. Prevent elder abuse. c. Receive payment for the services provided. d. Influence future legislation.ANS: C Although nurses should be involved in influencing future legislation by contacting their legislators, the best response is that nurses need to be knowledgeable of the current health policies needed so that payment can be received for services that are providing.A nurse would like to propose legislation requiring all schools to employ a registered nurse. The first step taken in the legislative process would be: a. Introducing the bill to the legislature b. Moving the bill to the other house c. Developing the policy option into a bill d. Hearings, testimony, and lobbyingANS: C The first step in the legislative process is developing the policy option into a bill. This is then followed by introducing the bill to the legislature; hearings, testimony, and lobbying; and the bill moving to the other house.A nurse believes additional funding is necessary to support a home-delivered meal program for the elderly. The best way to share these ideas with a legislator is to: a. Send an e-mail. b. Write a formal letter. c. Attend a town hall meeting. d. Schedule a face-to-face visit.ANS: D Face-to-face visits with legislators are viewed as the most effective means of communication.A nurse is interested in census data. Which federal departments website would be a good place to start? a. Department of Labor b. United States Immunization Survey c. Commerce Department d. World Health OrganizationANS: C The Commerce Department handles the United States Census and population estimates and projections.If a nurse researcher wants to get information on the occurrence of an internationally important disease, where would be a good place to seek this information? a. The United Nations website b. The World Health Organization (WHO) website c. The World Bank website d. The World Health Assembly websiteANS: B The WHO publishes day-to-day information about international occurrence of disease, injury, and death.A doctoral prepared nurse (PhD) at a university wants to submit a grant to study the impact of a nursing activity on patient outcomes. From which federal agency could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. Department of Health and Human Services (DHHS) d. World Health Organization (WHO)ANS: B NINR funds the development of the knowledge base of nursing and promotion of nursing services in health care.Congress's legal base for actions in health care include (select all that apply): a. Providing for the general welfare b. Raising funds to support research c. Regulating commerce among the states d. Providing spending powerANS: A, B, C, D The legal base for actions in health care includes providing for the general welfare, regulating commerce among the states, providing spending power, and raising funds to support the military.The Centers for Disease Control and Prevention accomplishes its mission by (select all that apply): a. Implementing prevention strategies b. Detecting and investigating health problems c. Dictating world health policy d. Fostering safe and healthful environmentsANS: A, B, D The Centers for Disease Control and Prevention implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments.When writing to a legislator to advocate for funds to support advanced practice nursing education, a nurse should remember to (select all that apply): a. Limit the letter to one page in length. b. Identify oneself as a nurse. c. Provide only factual information. d. Share personal knowledge about the issue.ANS: B, D When writing to a legislator, the letter should be a maximum of two pages in length and opinions should be expressed. Additionally, the nurse should identify oneself as a nurse and share knowledge about the issue.1. Which statement about the Intervention Wheel is true? a. It provides a graphic illustration of population-based public health practice. b. It describes in detail the components of public health nursing. c. It demonstrates the practice of community health nurses for policy and lawmakers. d. It is a framework used by all health departments in the United States.ANS: A The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care2. Since the Intervention Wheel was first published in 1998, what related event has occurred? a. It has guided national policy. b. It has been used as a tool in deciding licensure issues for State Boards of Nursing. c. It has been incorporated into the public health curricula of many nursing programs. d. It has gained wide acceptance internationally.ANS: C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally but is not used widely at the international level. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care3. Public health interventions are implemented with: a. legislators, policy makers, and community leaders. b. individuals and families, communities, and systems. c. children, adolescents, and adults. d. health departments, public health agencies, and visiting nurses' associations.ANS: B It is important to know that public health nurses (PHNs) work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care4. Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan. c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.ANS: D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care5. A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated? a. Individual b. Systems c. Community d. GovernmentANS: C Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by "The Wheel." DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance6. A public health nurse (PHN) uses Assumption 2, "Public health nursing practice focuses on populations," to guide practice. Which of the following would be considered a population of interest? a. Healthy school children b. Homeless individuals c. A person recently diagnosed with diabetes d. Teenage parentsANS: A A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care7. A public health nurse (PHN) is conducting an assessment of the community's health. Which of the following is being accomplished through this activity? a. Define one problem that will be the focus for a year. b. Assess a social network of interacting individuals usually in a defined territory. c. Minimize the effects of health risks and hazards. d. Intervene at the population level by changing laws and regulations.ANS: B A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care8. A public health nurse (PHN) utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished? a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, systems, individuals, and families d. Utilizing primary, secondary, and tertiary preventionANS: C PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice. The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care9. Public health nurses (PHNs) across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used? a. Describe the proper order of implementation. b. Emphasize surveillance as the focus of public health practice. c. Guide practice and generate agency protocols. d. Improve the health status of communities, systems, individuals, and families.ANS: D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care10. What is the purpose of the color-coded wedges on the Intervention Wheel? a. The interventions are grouped together in related wedges. b. The wedges consist of referral information for each wedge. c. The element of health teaching is the predominant feature of each wedge. d. Coalition building must be implemented with each wedge.ANS: A Each wedge consists of related interventions. The other answers describe some of the individual wedges. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care11. A public health nurse (PHN) is using collaboration, coalition building, and community organizing to develop a new program in the community. Which of the following strategies is the nurse most likely using? a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategiesANS: B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care12. What levels of practice are encompassed by the Intervention Wheel? a. Communities, individuals and families, and systems b. Assessment, diagnosis, and evaluation c. Primary, secondary, and tertiary d. Communities, populations, and aggregatesANS: A Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care13. Public health nurses (PHNs) utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented? a. Systems b. Community c. Policy d. IndividualANS: D The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by "The Wheel." DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance14. An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. GovernmentANS: B Systems level of practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by "The Wheel." DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance15. A public health nurse (PHN) is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse? a. Involve the entire community in solving the health problem. b. Identify health problems in the community. c. Change laws, policies, and practices that influence population-based issues. d. Provide outreach services to populations at risk.ANS: C Systems level practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care16. A public health nurse (PHN) is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse? a. Participating in the "Great American Smokeout" b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco productsANS: B Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice. Participating in the "Great American Smokeout" occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual level of practice. Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not health teaching. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance17. A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied? a. Screening b. Referral and follow-up c. Surveillance d. Health teachingANS: A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and follow-up assist individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance18. A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-upANS: B One example of coalition building is promoting alliances among organizations for a common purpose. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care19. A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented? a. Collaboration b. Surveillance c. Health teaching d. ScreeningANS: C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities. Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance20. A public health nurse (PHN) is conducting a community assessment. Which of the following is the best example of this action? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse casesANS: D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care21. A public health nurse (PHN) is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse likely use? a. A 50-year-old woman receives annual mammograms. b. School absences in a community decline. c. Teachers have increased awareness of health problems. d. Those in poverty utilize the free mammogram program.ANS: A Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual level. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care22. A public health nurse (PHN) is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habitsANS: C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed. DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of CareMULTIPLE RESPONSE 1. What are the cornerstones of public health nursing practice? (Select all that apply.) a. Focus on the health of the entire population. b. Reflect community priorities and needs. c. Promote health through strategies driven by epidemiological evidence. d. Are grounded in an ethic of collaboration. e. Provide a framework for ethical decision making.ANS: A, B, C Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareThe three components of the Intervention Wheel are: a. communities, systems, and individuals/families. b. interventions, color wedges, and levels of practice. c. population base, levels of practice, and public health interventions. d. populations at risk, populations of interest, and levels of practice.ANS: C The components of the Intervention Wheel include population base, three levels of practice, and 17 public health interventions. The population-based component includes populations at risk and populations of interest. The three levels of practice include community, systems, and individual/family. The Wheel is colored coded at the intervention level, and the colors (red, blue, green, yellow, and orange) are grouped logically into wedges.Public health nursing practice is guided by the community's priorities as identified by community: a. assessment. b. diagnosis. c. interventions. d. planning.ANS: A Assessing the health status of the populations that make up a community requires ongoing collection and analysis of relevant qualitative and quantitative data. Community assessment includes a comprehensive evaluation of the determinants of health. Data analysis identifies deviations from expected or acceptable rates of disease, injury, death, or disability, as well as risk and protective factors. Community assessment generally results in a lengthy list of community problems and issues. However, communities rarely possess sufficient resources to address the entire list, and priorities must be set after assessing the community's beliefs, attitudes, and opinions, as well as the community's readiness for change.Collaboration is an intervention that would be located where in the Intervention Wheel? a. Red wedge at the individual/family level of practice b. Blue wedge at the community level of practice c. Orange wedge at the community level of practice d. Green wedge at the systems level of practiceANS: C The public health interventions are grouped with related interventions, and these wedges are color coordinated. The red wedge includes five interventions: surveillance, disease and health investigation, screening, outreach activities, and case finding. They typically occur in pairs or in sequence, although all can occur independently. The green wedge consists of three interventions: referral and follow-up, case management, and delegated functions; these are often implemented together. Similarly, the blue wedge includes three interventions—health teaching, counseling, and consultation—that are often implemented together. The orange wedge combines three interventions—collaboration, coalition building, and community organizing—which are all types of collective action that are usually carried out at the systems or community level of practice. Similarly, the three yellow wedge interventions—advocacy, social marketing, and policy development and enforcement—are often interrelated when implemented. Interventions in the orange and yellow wedges are typically used at the systems and community levels of practice, whereas those in the red, blue, and green wedges are usually carried out at the individual/family level of practice and to a lesser degree at the community and system levels of practice. Collaboration is a collective action and therefore, must be in an orange wedge.The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as: a. advocacy. b. coalition building. c. consultation. d. social marketing.ANS: D Social marketing utilizes commercial marketing principles and technologies in programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Recent examples of the use of these techniques are antismoking campaigns, campaigns for refunding of the State Children's Health Insurance Program, and campaigns to address the needs of uninsured/underinsured populations.Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of: a. community-level practice. b. family-level practice. c. individual-level practice. d. systems-level practice.ANS: D The goal of systems-level practice is to change the laws, policies, and practices that influence immunization rates, such as promoting the creation of population-based immunization registries and improving clinic and provider practices.When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses (PHNs) conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of: a. community-level practice. b. family-level practice. c. individual-level practice. d. systems-level practice.ANS: A The goal of community-level practice is to improve the knowledge and attitude of the entire community about the importance of immunization and the consequences of not being immunized. These strategies lead to an increase in the percentage of people who obtain recommended immunizations for themselves and their children.A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention. a. individual/family, secondary b. community, primary c. community, secondary d. individual/family, primaryANS: A Based on this nursing diagnosis, one could assume that the level of practice is at the individual/family level (young child who is being parented by a primary parent who is experiencing mental health problems) and at the secondary level of prevention (because the family has an existing identified risk, i.e., a mental health problem).After consulting with the health department director, a PHN collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice. a. evaluation, systems b. assessment, community c. implementation, systems d. diagnosis, communityANS: C Collaboration and advocacy are often collective actions applied at a community or systems level of practice. In this case, the identification of the community problem probably emerged out of practice, rather than from a formal community assessment. The nurse's goals were to enforce the tenant's legal rights and improve their living conditions. The nurse sought advice from a housing advocate service and connected the clients with legal counsel. The nurse also sought political support by consulting with health department officials before implementing the nursing plan.A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements. a. evaluate the effectiveness of b. assess the expansion needs of c. identify problems with d. implement the expansion ofANS: A The evaluation phase of a community-level intervention attempts to determine the effectiveness of the intervention in meeting the desired outcome (decreased social isolation for the elder community population) and in establishing new healthier practices (increased social networking and increased involvement in other community activities) while identifying any emerging barriers (problems) that may interfere with the desired outcome. Very often this can be achieved through a repeat assessment such as a survey of the population receiving the intervention to measure change in attitudes, beliefs, and behaviors.Factors related to the determinants of health identified in Healthy People 2020 include which of the following? (Select all that apply.) a. Education and literacy b. Genetic endowment c. Gender d. Culture e. Social statusANS: A, B, C, D, E The determinants of health identified in Healthy People 2020 influence health status throughout all stages of life and include such things as personal behavior, biology, physical environment, and social environment. Each of these broad areas encompasses multiple factors, and all of the factors listed above influence health status.The cognitive domain includes: a. Changes in attitudes and the development of values b. The performance of skills c. Memory, recognition, understanding, reasoning, and problem solving d. Memorization of one set of skills before moving on to the nextANS: C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving.What is the purpose of providing education across the three levels of prevention? Education: a. Enables clients to attain optimal health b. Identifies and treats health problems early to eliminate disability c. Enables populations to break into individuals d. Teaches people about Healthy People 2010ANS: A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of a disability may not be possible.A nurse is teaching a client about how to complete a dressing change of a wound. The nurse knows that what conditions must be met before learning will occur? a. Must be able to memorize the instructions, relay this information to a partner, and demonstrate the dressing change b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to practice the dressing changeANS: D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill.A health educator trying to change a clients attitudes about smoking would be using which of the following domains? a. Cognitive b. Affective c. Psychomotor d. DevelopmentalANS: B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value.Which of the following domains would be used to teach a new diabetic how to give an insulin injection? a. Developmental b. Cognitive c. Affective d. PsychomotorANS: D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills.Which format would be most appropriate for teaching a group of nursing students who are learning to give injections? a. Demonstration b. Health fair c. Lecture d. Nonnative language sessionANS: A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done.Which statement about education is true? a. It emphasizes the provider of knowledge and skills. b. It emphasizes the recipient of knowledge and skills. c. It is a process of gaining knowledge and expertise. d. It results in behavioral change.ANS: A Education is the establishment and arrangement of events to facilitate learning.Which core competency of communication is used by nurses engaged in group work? a. Soliciting input from individuals and organizations b. Using simple language when presenting information c. Asking the group to develop the program of interest d. Presenting material to lay audiences onlyANS: A Soliciting input from individuals and organizations is a communication competency.When implementing a community health education program, which educational principle will the nurse use as a guide? a. Refer to trustworthy sources b. Use an active voice c. Create the best learning environment d. Accentuate the positiveANS: C The environment must be conducive to learning for educational programs to be effective.Nurses who use Healthy People 2020 as a guide for education: a. Focus on avoiding cigarette smoking and using alcohol in moderation b. Educate clients using primary and secondary levels of prevention c. Use Blooms taxonomy when planning educational objectives d. Design health fairs aimed at individualsANS: B Healthy People 2020 focuses on primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care.A nurse is implementing an educational program about the importance of being physically active. Which step would the nurse complete first? a. Provide learning guidance b. Present the stimulus c. Gain the learners attention d. Ask learners to recall prior learningANS: C Gaining the learners attention must happen first before learning can take place.A potential barrier that a nurse may experience when in the educator role is: a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking knowledge about how to gain participationANS: D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information.After evaluating learning needs, what is the next step the nurse should take in developing an educational program? a. Consider any potential barriers to learning. b. Establish goals and objectives for the program. c. Select appropriate materials for the program. d. Assess the dynamics of the group.ANS: B Instructional objectives need to be evaluated before a teaching program is designed.Which behavior would the nurse anticipate when working with an individual with low literacy? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of motivation d. Being overly dependent on othersANS: B Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may focus on details and deal in literal or concrete concepts versus abstract concepts. They may select responses on a survey without necessarily understanding them and may be unable to understand math. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home.A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. This concept is called: a. Authoritarianism b. Learning style c. Pedagogy d. AndragogyANS: D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners.A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby. Considering the events of instruction, what should the nurse do next? a. Ask the mother about her previous experience with breastfeeding. b. Demonstrate how to position the baby for breastfeeding. c. Show the mother a video about breastfeeding. d. Have the mother demonstrate breastfeeding.ANS: A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is Tune in: listen before starting to teach; the clients needs should direct the content.A diabetic client reports to the nurse that she has been learning more about controlling her blood sugars by reading information found on the Internet. Which statement by the nurse would be most appropriate? a. Looking at the date the content was posted on the website is important. b. The Internet is an unreliable source of information and should not be used. c. The best sources of information are found on pharmaceutical websites. d. Your physician will provide you better information than the Internet.ANS: A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated.Which of the following is an example of a goal? a. Mr. Williams will look at his stoma without disgust each time his ostomy bag comes off. b. Mr. Williams will be able to independently take care of his ostomy bag within three months. c. Mr. Williams will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. Mr. Williams will successfully describe to the nurse how to care for his ostomy when he is asked.ANS: B Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time. The other choices describe objectives.A correctly written objective would be: a. Each member of the Jones family will give an insulin injection to Billy with accurate dosage 100% of the time for 10 consecutive trials. b. Ms. Smith will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.ANS: A Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms.Which group would be likely to demonstrate the most cohesion? a. A group with several leaders b. A group with diverse attitudes and values c. A group with a common goal d. A group with efficient membersANS: C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members.It is important for a nurse to recognize group norms because they: a. Allow for creativity and variety among group members b. Influence members perception of community c. Are helpful in evaluating the effectiveness of the group d. Maintain the group through various supports to membersANS: D Group norms serve to maintain the group through various supports to members.A nurse demonstrates the leadership behavior of reflecting when: a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussionANS: A Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points.A leader controls members through rewards and often keeps members in the dark about the goals and rationale behind prescribed actions. What type of leadership does this describe? a. Democratic b. Patriarchal c. Socialist d. Communication structureANS: B Patriarchal or paternal style is authoritative, winning respect and dependence through parent-like devotion.A group member who has taken on the role of the gatekeeper will: a. Seek and accept the authority or direction of others. b. Guide and direct the group activity. c. Control outsiders access to the group. d. Focus the movement toward the main work of the group.ANS: C The gatekeeper controls outsiders access to the group.An established group requests a teaching and learning session on hypertension. What can the nurse expect with this type of group? a. The group membership will change from week to week. b. The members all have the same interests. c. They prefer lectures rather than demonstrations. d. The group already has operating methods that have been successful.ANS: D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful.Which intervention can be implemented by a nurse when working with a group focused on improving the health of the community? a. Make decisions for the group to move the process along. b. Invite wealthy individuals to participate in the group process. c. Maintain members through recognition and encouragement. d. Teach topics that are of national importance.ANS: C Maintaining members is an important intervention to facilitate group process.A nurse is working with a group of clients with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. This nurse is providing effective education by: a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidanceANS: A The educator should have the learners recall previous knowledge related to the topic of interest.During a class on newborn care given at a local health department, a nursing student asks the participants to practice with baby dolls. Which step of promoting effective education is the student using? a. Eliciting performance b. Assessing performance c. Enhancing retention and transfer of knowledge d. Gaining attentionANS: A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned.The educational process of selecting appropriate educational methods is similar to which of the following steps of the nursing process? a. Assessment b. Evaluation c. Implementation d. PlanningANS: D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. Planning is similar to selecting appropriate educational methods.When a nurse is evaluating the components of an educational program, the nurse is completing a(n): a. Education evaluation b. Educational product c. Process evaluation d. Ongoing evaluationANS: C Process evaluation means looking at the components of an educational program.Evaluation of individual and group progress toward health goals is important. Which component should be included in the evaluative process? a. Type of teaching strategy used b. Recognition of accomplishments in the group c. Conflict that occurred in the group d. The type of leadership in the groupANS: B Recognition of accomplishments in the group and of the group is built into the evaluative process.When conducting an effective educational program, a nurse would use which basic principle? Select all that apply. a. Use a clear, succinct style. b. Use an active voice. c. Refer to Internet sources. d. Use aids to highlight key points.ANS: A, B, D Reliable sources must be used, and information found on the Internet is not always reliable.The goal of the Healthy Communities and Cities initiative is to: a. Promote health through community participation. b. Reorganize the current health care system. c. Maximize the cost-benefit ratio of health care. d. Improve the quality of care in communities.ANS: A This leads to addressing the health and quality of life for all through a process that includes diverse citizen participation, mobilization of all sections of the community, and community ownership.The Healthy Communities and Cities initiative supports the idea that: a. Healthy cities and communities must be both environmentally and socially sustainable. b. Health public policy is the responsibility of elected officials. c. Physical environments cannot be changed, thus strategies must be developed in order to cope with them. d. The World Health Organization is the primary source of information for cities.ANS: A Healthy cities and communities must be both environmentally and socially sustainable through a strategy of primary care.When the Healthy Communities and Cities concept was brought to the United States: a. The cities chosen for the initial work were Los Angeles and New York City. b. Canada adopted the program at the same time for continuity across borders. c. The same strict guidelines that were implemented in Europe were used. d. Smaller communities and localities were targeted instead of large cities.ANS: D The concept of Healthy Communities was used to incorporate localities that were not necessarily cities.When utilizing the Centers for Disease Control and Preventions Healthy Communities Program, a nurse recognizes that a factor that will influence the continuance of this program is: a. Time b. Community participation c. Federal involvement d. TechnologyANS: B Community participation can influence the continuance of the Healthy Communities and Cities movement.Healthy Communities and Cities is based on which of the following premises? a. When people have the opportunity to work out their own locally defined health problems, they will find sustainable solutions to those problems. b. When the health of a community is improved, the focus will be on life expectancy rather than quality of life. c. When health professionals assume a leadership role, the health of the community will improve. d. When cities recruit enough health professionals to care for those needing medical care, the cities health will improve.ANS: A Healthy Cities is based on the premise that when people have the opportunity to work out their own locally defined health problems, they will find sustainable solutions to those problems.Which approach should a nurse take when implementing interventions to improve the health of a community? a. A top-down approach with rational-empirical problem solving b. A top-down approach with community practice planned by experts c. A bottom-up approach with facilitation of communication d. A bottom-up approach with multi-sectoral planning and action for healthANS: D A bottom-up approach with multi-sectoral planning and action for health incorporates community participation. A bottom-up approach uses broad-based community problem solving that includes health professionals, local officials, service providers, and other community members, including those at risk for health problems.A nurse is leading a team responsible for evaluating the health of a community using the Community Health Promotion Model. Based on this model, which step would you expect the nurse to complete? a. Ensuring high technological access before the plan can be implemented b. Soliciting the consent of every member of the community c. Assessing the community d. Restructuring the public health policy in the communityANS: C Assessing the community is one of the steps in the nine-steps of the Community Health Promotion Model.Why would a nurse perform a community assessment as part of the Community Health Promotion Model? a. To become more acquainted with the multiple factors that influence health status b. To survey the people in the community about their wants and needs c. To allow special interest groups a say in health policy d. To provide a narrow focus for the committee workANS: A The purpose of including a community assessment in the implementation of the Community Health Promotion Model is to become more acquainted with the multiple biological, behavioral, social and physical factors that describe and influence health status of residence. The assessment provides the frame of reference for identifying the communitys strengths, needs, and resources.When implementing the Community Health Promotion Model, which underlying principle should the nurse use in order to facilitate active participation? a. Individuals should work in groups to complete necessary tasks. b. Individuals participating should represent all segments of the population. c. People will work together if they like the leadership. d. People will participate when they see the issues as worthy of their time.ANS: D People participate when they feel a sense of community and see their involvement in the issues as relevant and worthy of their time.The steps of the Community Health Promotion Model resemble the: a. Collaboration process b. WHOs Ottawa Charter c. Nursing process d. CDCs monitoring programANS: C The steps of the Community Health Promotion Model are very similar to the nursing process. The steps include assessment, planning, implementation, and evaluation.A nurse involved in the initial implementation of the Healthy Communities and Cities initiative in the United States would have likely addressed which problem? a. Reduction to the amount of pollutants released into the environment b. Provision of fire and police protection c. Creation of a coalition to address health disparities d. Elimination of crime and violence from the communityANS: C The concept of a healthy community or city is based on the belief that the health of the community is largely influenced by the environment in which people live and that health problems have multiple causes: social, economic, political, environmental, and behavioral. Creation of a coalition engages residents in addressing the problem which is impacted by multiple factors. The initial activities focused on the problems of diverse populations.Which nursing action demonstrates a nurses involvement in the Community Health Promotion Model? a. Changing public policy b. Establishing a team to conduct evaluation research c. Providing nursing diagnoses for the community d. Revising an objective for Healthy People 2020ANS: B Nurses may make a contribution to short-term impact evaluation and long-term outcome evaluation to create a knowledge base for community health promotion.A nurse who is designing interventions and evaluating results of Healthy Municipalities and Cities should consider the: a. Influence of individual actions b. Acute care hospital services in the community c. Social results and endorsement of law makers for policy changes d. Effectiveness of health services including delivery of preventive servicesANS: D The effectiveness of health services, including the delivery of preventive services, should be considered when designing interventions and evaluating the results of Healthy Municipalities and Cities.The wearing of seat belts is required in many communities. Children of a certain age must be restrained in a car seat or seat belt when riding in a car. This is an example of: a. Unilateral action of lawmakers b. Participation in health fairs c. Healthy public policy d. Media interest in protecting the publicANS: C Examples of healthy public policy are seat belt legislation, nonsmoking policies, and immunization policies for school-age children.What principle(s) were used in the creation of the Healthy Cities movement? Select all that apply. a. Primary care b. Equity in health promotion c. Community participation d. High technologic environmentsANS: A, B, C The Healthy Cities movement was based upon the principles of primary care, equity, health promotion, and community participation.According to the Ottawa Charter for Health Promotion, the areas for health promotion action include (select all that apply): a. Creating supportive environments b. Developing personal skills c. Building healthy public policy d. Reorienting health servicesANS: A, B, C, D Creating supportive environments, developing personal skills, building healthy public policy, and reorienting health services are all areas for health promotion action identified by the Ottawa Charter for Health Promotion in 1986.When using the Community Health Promotion Model to address the problem of increasing teenage pregnancy rates in the community, the nurse would use which steps? Select all that apply. a. Identifying interest by community forums b. Building the partnership c. Counseling teenagers about effective birth control methods d. Contacting other cities with similar problems and issuesANS: A, B The implementation of the Community Health Promotion Model includes identifying interest by community forums and building the partnership.A nurse is educating the community about modifiable behaviors. Which of the following is the nurse most likely to discuss? a. Smoking, poor diet, and alcohol consumption b. Cancer, emphysema, and cardiovascular disease c. Age and gender d. Genetic abnormalitiesANS: A Modifiable behaviors remain the major contributors to deaths in the United States. Tobacco use, poor diet, physical inactivity, and alcohol consumption are examples of modifiable behaviors. Cancer, emphysema, cardiovascular disease, gender, age, and genetic abnormalities are not modifiable behaviors. DIF: Cognitive level: Applying REF: p. 378 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceA nurse is utilizing a disease-oriented approach when providing care to a client. Which of the following interventions will the nurse most likely provide? a. Promotion of a greater level of positive health b. Education about common disease processes c. Acute care management of chronic disease d. Education about medication complianceANS: D A disease-oriented approach assumes that humans are composed of organ systems and cells; in this instance, health care focuses on identifying what is not working properly with a given system and repairing it. In this context, health behavior begins with patient compliance with health professionals' recommendations. This approach does not promote a greater level of positive health as this would be related to health promotion. This approach does not provide education about common disease processes or acute care management of chronic disease. DIF: Cognitive level: Applying REF: pp. 381-382 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceThe biomedical model defines health as the: a. avoidance of illness. b. absence of disease. c. promotion of healthy behaviors. d. protection from illness and disease states.ANS: B The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced. DIF: Cognitive level: Remembering REF: p. 381 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and MaintenanceThe health-oriented perspective views: a. health as the absence of disease. b. human lifestyle based on one's prescribed regime. c. humans as complex and interconnected with the environment. d. community education as the role of the registered nurse.ANS: C The health-oriented perspective includes the view that humans are complex and interconnected with others and the environment. Health behavior within this perspective involves a holistic view of lifestyle and interaction with the environment and not simply compliance with a prescribed regimen. DIF: Cognitive level: Understanding REF: p. 381 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareA nurse using the integrative model for community health promotion. Which of the following best describes how the nurse would apply the dimension of client system? a. Concentrating on individual health behaviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients d. Focusing on disease-oriented careANS: C The client system is multidimensional with nursing and health care targeting the multiple levels of clients. When the individual is the client, the environment includes the family, the broader aggregate, and the community of which the individual is a part. The nurse and health care provider are concerned with how these environments affect the individuals' health. The focus for care is on health promotion, illness prevention, and illness care. DIF: Cognitive level: Applying REF: pp. 387-388 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareA public health nurse (PHN) collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. Which of the following client systems of the integrative model does this describe? a. Community b. Aggregate c. Family d. IndividualANS: A Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people. The community is the environment for the aggregate and is the system being applied. DIF: Cognitive level: Applying REF: p. 388 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareA PHN collaborates with a physician's clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed? a. Aggregate level health promotion b. Aggregate level illness prevention c. Family level illness care d. Individual level health promotionANS: A Each succeeding level of the client system is more complex. In this situation, the PHN is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education. Illness prevention is linked to the negative view of the absence of disease. Illness care is the care provision of someone with the disease. DIF: Cognitive level: Applying REF: p. 388 & p. 390 (Table 17-1) TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareA nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation? a. Family level health promotion b. Individual level illness prevention c. Aggregate level illness prevention d. Individual level health promotionANS: B The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention. Health promotion focuses on positive measures of health. The family level and aggregate level both focus on inclusion of more than one person. DIF: Cognitive level: Applying REF: p. 390 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareWhen applying the integrative model for community health promotion, a nurse assesses the neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe? a. Individual b. Family c. Aggregate d. CommunityANS: D The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions. This is the broadest client system as the nurse is examining the neighborhood. Individual focus is looking at individuals, family focuses on families, and aggregates focuses on populations. DIF: Cognitive level: Applying REF: p. 390 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareA nurse provides a screening for school-aged children to screen for hearing deficits. Which of the following is being demonstrated by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotionANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Health promotion activities are interventions focused on improving one's health. DIF: Cognitive level: Applying REF: p. 381 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceAccording to Leavell and Clark, primary prevention consists of: a. health promotion and rehabilitation. b. health promotion and specific protection. c. early diagnosis and prompt treatment. d. health maintenance and early diagnosis.ANS: B Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. DIF: Cognitive level: Understanding REF: p. 381 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and MaintenanceA client wears a seat belt whenever riding in an automobile. Which of the following best describes the client's behavior? a. Illness prevention b. Health promotion c. Specific protection d. Health protectionANS: C Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health protection strategies include environmental measures to improve health and quality of life. DIF: Cognitive level: Applying REF: p. 381 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceA 5-feet, 6-inch, 25-year-old female who weighs 120 pounds walks 5 miles a day because she has a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protectionANS: B The woman is exercising to prevent an illness that runs in her family. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of life. DIF: Cognitive level: Applying REF: p. 381 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceA 5-feet, 6-inch, 25-year-old woman who weighs 120 pounds runs 5 miles a day because it improves her mood and energy level. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protectionANS: A The woman is exercising to improve and promote her health. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of life. DIF: Cognitive level: Applying REF: p. 379 & p. 381 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceA community is searching for additional funding so that a bike trail can be built in the community. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Specific protection d. Health protectionANS: D Health protection strategies include environmental measures to improve health and quality of life. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards. DIF: Cognitive level: Applying REF: p. 379 TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceWhich of the following statements is correct? a. Genes, biology, and health behavioral choices account for 75% of population health. b. Medical care accounts for 25% of population health. c. Physical and social environments account for 75% of population health. d. Genes, biology, and health behavioral choices account for 25% of population health.ANS: D Genes, biology, and health behavioral choices account for 25% of population health and social determinants of health, including medical care; the physical and social environment account for the remaining 75%. DIF: Cognitive level: Understanding REF: p. 380 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and MaintenanceThe National Prevention Strategy provides: a. recommendations on what can be done to improve population health. b. assistance in interpreting Healthy People 2020. c. a basis for public health nursing practice. d. health risk appraisal instruments.ANS: A The National Prevention Strategy offers recommendations on what can be done to improve population health in specified contexts and across goal areas. This document does not assist in interpreting Healthy People 2020, providing a basis for public health nursing practice, or providing health risk appraisal instruments. DIF: Cognitive level: Understanding REF: p. 382 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and MaintenanceWhich of the following describes one advantage of the Health Belief Model (HBM)? a. It is one of the most recently developed models based on evidence-based practice principles. b. It can reduce the incidence of diseases and disabilities. c. It can assist with planning programs to increase an individual's motivation to take positive health action. d. It promotes individual's participation in community-based screening programs.ANS: C It can assist with planning programs to increase an individual's motivation to take positive health action. This theory was one of the first theories of health behavior, which began in the 1950s. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. There is nothing to support that the use of this model will reduce the incidence of diseases and disabilities. It focuses on motivation of changing health behaviors, not participating in screening programs. DIF: Cognitive level: Understanding REF: p. 384 TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and MaintenanceA nurse is using the HBM when developing health programs in the community. Which of the following is the nurse most likely involved in? a. Conducting group risk appraisal and risk reduction b. Considering the factors that will motivate the participants to change their health behaviors c. Completing a community wellness inventory d. Considering legislative changes that are necessary to improve environmental living conditions and sanitationANS: B The HBM can assist with planning programs to increase an individual's motivation to take positive health action. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. Conducting a group risk appraisal and risk reduction, completing a community wellness inventory, and considering legislative changes do not address an individual's motivation to adopt a health behavior. DIF: Cognitive level: Applying REF: p. 384 TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and MaintenanceA nurse is using Anderson and McFarlane's model to complete a community health assessment. Which of the following information about the community would the nurse be collecting? a. Resources available to promote health b. Interactions among subsystems c. Physical environment d. DemographicsANS: B A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it. This model does not address the resources available to promote health, physical environment, or demographics. DIF: Cognitive level: Analyzing REF: p. 383 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareThe Framingham Heart Study was successful in: a. providing information on the effectiveness of risk-reduction interventions. b. documenting the relationship between social variables and heart disease. c. identifying factors contributing to the development of coronary heart disease (CHD). d. demonstrating the effects of mass media in modifying high-risk behavior.ANS: C The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. By collecting periodic health assessments and morbidity and mortality data, major risk factors associated with CHD mortality were identified. The investigators used health risk appraisals to relate the risk factors in well individuals to the probability of future cardiovascular disease. This study did not provide information on the effectiveness of risk-reduction interventions, document the relationship between social variables and heart disease, or identify factors contributing to the development of heart disease. DIF: Cognitive level: Understanding REF: pp. 383-384 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareA nurse is performing interventions at the individual level of care. Which of the following is the nurse most likely completing? (Select all that apply.) a. Teaching well-balanced nutrition to a mother with a malnourished child b. Providing a parent age-specific information for immunizations c. Assessing the community for other cases of malnutrition d. Assessing other families on the same street for similar problems e. Planning a social marketing campaign about seat belt safetyANS: A, B Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community. DIF: Cognitive level: Applying REF: pp. 387-388 & p. 390 (Table 17-1) TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceWhich community-based programs resulted in equally favorable health risk changes for both control and treatment groups? (Select all that apply.) a. Framingham Heart Study b. Stanford Five-City Heart Disease Prevention Program c. North Karelia Study d. Minnesota Heart Health Program e. Dutch Heart Health Community InterventionANS: B, C, D, E The Stanford Five-City Heart Disease Prevention Program, North Karelia Study, Minnesota Heart Health Program, and Dutch Heart Health Community Intervention provided beginning scientific evidence for the implementation of community-level risk reduction programs, although the results were modest and often not statistically significant. The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. DIF: Cognitive level: Understanding REF: p. 384 TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of CareChange for the community as client must often occur at several levels because: a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify.ANS: A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels.A nurse cares for the community as the client when focusing on: a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the communityANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education.A collection of individuals who have in common one or more personal or environmental characteristics is the definition of a(n): a. Community b. Group c. Family d. AggregateANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common.What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resourcesANS: C The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community.A group of nursing students forms a student nursing association to provide support while they are enrolled in a nursing program. This is known as a community of: a. Place b. Special interest c. Problem ecology d. FunctionANS: B A community of special interest brings members together with common concerns and interests.A public health nurse is collecting data about the biological aspects of community health. What data will the nurse collect? a. Race/ethnicity b. Traditional morbidity and mortality rates c. Policy making and social change d. Homicide ratesANS: B Biological community health is often measured by traditional morbidity and mortality rates, which can be found in The Morbidity and Mortality Weekly Report.A community that has residents who are very involved in its activities and encourage activities that promote the health of the community displays which condition of community competence? a. Commitment b. Participation c. Articulateness d. Effective communicationANS: B Participation is an essential condition of community competence defined by active, community-oriented involvement.Which data source provides information about the function of the community? a. Maps b. Census data c. State departments, business and labor, local library d. Civic groupsANS: C Function relates to production, distribution, and consumption of goods and services.Which characteristic is an indicator of community health process? a. Participation and community action b. Live birth rate c. Racial distribution d. Socioeconomic levelsANS: A Participation and community action are indicators of community health process.A community that demonstrates commitment would most likely support the development of a: a. Community club to facilitate community involvement b. Childrens recreation program c. Curb-side recycling program and community-based education about recycling d. Cooperative agreement with a neighboring city to share needed servicesANS: C The commitment condition of community competence defined by Cottrell refers to the affective and cognitive attachment to a community, that is worthy of substantial effort to sustain and enhance. Creating a recycling program as well as associated education enhances both the cognitive and affective domains of the community.The main characteristics of partnership are: a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utilityANS: A The main characteristics of partnership are being informed, flexibility, and negotiated distribution of power.When completing a community assessment, the nurse will: a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community.ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources.When a nurse focuses intervention strategies on the structural dimension of community health, they are directed toward: a. Health services b. Primary prevention c. Health promotion d. Secondary preventionANS: A Intervention strategies include service use patterns, treatment data from various health agencies, and provider/client ratios.Which characteristic is an indicator of community health structure? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilizationANS: D The structure of the community is defined in terms of services and resources.After identifying the boundaries of a community, what is the next step the nurse should take in completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used.ANS: A Community assessment includes gathering relevant existing data and generating missing data.What intervention would be the most appropriate for the nurse to use when trying to develop community partnerships? a. Involve only the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines.ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines.When writing a community-level diagnosis, Among refers to the: a. Specific problem or health risk faced by the community b. Characteristics of the community c. Community client experiencing the risk or problem d. Likelihood that the problem will be solvedANS: C Among identifies the specific community client with whom the nurse will be working to address the identified problem.Which nursing diagnosis is written at the community-level? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors as evidenced by client crying and stating she has no support systemANS: B There are three parts: risk of, among, and related to. The risk of identifies a specific problem or health risk faced by the community. Among identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. Related to describes characteristics of the community.A nurse surveys the school nurses in a community to determine their roles in the schools because this data is not available. The nurse is engaging in the process of data: a. Collection b. Gathering c. Generation d. InterpretationANS: C Data generation is the process of developing data that do not already exist by interacting with community members or groups. This data includes information about a communitys knowledge and beliefs, values and sentiments, goals and perceived needs, norms, problem-solving processes, power, leadership, and influence structures.A nurse schedules an appointment with a physician who has a practice in the community to learn more about the communitys beliefs regarding childhood immunizations. This is known as: a. Informant interview b. Participant observation c. Secondary analysis d. Windshield surveyANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members.When conducting informant interviews in a small community, the nurse would most likely contact: a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the areaANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants.A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. What type of data is being collected? a. Quantitative b. Qualitative c. Focus-groups d. SurveyANS: B Qualitative data is collected through interviews and observation.A nurse who reads the local community newspaper is using which method to gather data about the community? a. Informant interview b. Survey c. Participant observation d. Windshield surveyANS: C The nurse is deliberately sharing in the life of the community.Which method of data collection is being used as a nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation? a. Participant observation b. Windshield survey c. Survey d. Informant interviewsANS: B Windshield surveys are the motorized equivalent of simple observation.A nurse who uses such data as minutes from a community meeting is using: a. Secondary analysis b. Informant interviews c. A survey d. A windshield surveyANS: A The data is secondary because it is collected by someone else.A nurse plans on implementing a community-wide influenza immunization program. Which factor should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The communitys readiness to participate in the programANS: D The factors that influence implementation in the community are the nurses chosen roles, the type of health problem selected as the focus for intervention, the communitys readiness to take part in problem solving, and characteristics of the social change process.To effectively complete the evaluation phase, the nurse must have: a. Demonstrated the ability to improve the health of the participants b. Developed measureable objectives and goals before implementation c. Encouraged full participation by community members d. Improved the health of the population through the programANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed.To analyze the problem of increased adolescent alcohol use in the community, a nurse brings together several groups of people to address the issue. These groups come together at the same time to work on identifying potential causes of the problem, but do not interact during the process. Which model is the nurse applying? a. Delphi technique b. Program planning model c. Community-as-partner model d. Community empowerment modelANS: B The program planning model is known as the nominal group process. It makes the most of the contributions by various groups with diverse interests, skills, and knowledge. These groups work in the presence of one another but do not interact.A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass mediaANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people.A nurse may define a community as a(n) (select all that apply): a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concernANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions.Which data would be useful for a nurse to collect when assessing safety in a community? Select all that apply. a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurses own observationsANS: B, C, D Other nurses, social workers, and health care providers, community members, and the nurses own observations are reliable sources of information about the safety of an areaChange for the community as client must often occur at several levels because: a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify.ANS: A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels.A nurse cares for the community as the client when focusing on: a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the communityANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education.A collection of individuals who have in common one or more personal or environmental characteristics is the definition of a(n): a. Community b. Group c. Family d. AggregateANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common.What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resourcesANS: C The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community.A group of nursing students forms a student nursing association to provide support while they are enrolled in a nursing program. This is known as a community of: a. Place b. Special interest c. Problem ecology d. FunctionANS: B A community of special interest brings members together with common concerns and interests.A public health nurse is collecting data about the biological aspects of community health. What data will the nurse collect? a. Race/ethnicity b. Traditional morbidity and mortality rates c. Policy making and social change d. Homicide ratesANS: B Biological community health is often measured by traditional morbidity and mortality rates, which can be found in The Morbidity and Mortality Weekly Report.A community that has residents who are very involved in its activities and encourage activities that promote the health of the community displays which condition of community competence? a. Commitment b. Participation c. Articulateness d. Effective communicationANS: B Participation is an essential condition of community competence defined by active, community-oriented involvement.Which data source provides information about the function of the community? a. Maps b. Census data c. State departments, business and labor, local library d. Civic groupsANS: C Function relates to production, distribution, and consumption of goods and services.Which characteristic is an indicator of community health process? a. Participation and community action b. Live birth rate c. Racial distribution d. Socioeconomic levelsANS: A Participation and community action are indicators of community health process.A community that demonstrates commitment would most likely support the development of a: a. Community club to facilitate community involvement b. Childrens recreation program c. Curb-side recycling program and community-based education about recycling d. Cooperative agreement with a neighboring city to share needed servicesANS: C The commitment condition of community competence defined by Cottrell refers to the affective and cognitive attachment to a community, that is worthy of substantial effort to sustain and enhance. Creating a recycling program as well as associated education enhances both the cognitive and affective domains of the community.The main characteristics of partnership are: a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utilityANS: A The main characteristics of partnership are being informed, flexibility, and negotiated distribution of power.When completing a community assessment, the nurse will: a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community.ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources.When a nurse focuses intervention strategies on the structural dimension of community health, they are directed toward: a. Health services b. Primary prevention c. Health promotion d. Secondary preventionANS: A Intervention strategies include service use patterns, treatment data from various health agencies, and provider/client ratios.Which characteristic is an indicator of community health structure? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilizationANS: D The structure of the community is defined in terms of services and resources.After identifying the boundaries of a community, what is the next step the nurse should take in completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used.ANS: A Community assessment includes gathering relevant existing data and generating missing data.What intervention would be the most appropriate for the nurse to use when trying to develop community partnerships? a. Involve only the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines.ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines.When writing a community-level diagnosis, Among refers to the: a. Specific problem or health risk faced by the community b. Characteristics of the community c. Community client experiencing the risk or problem d. Likelihood that the problem will be solvedANS: C Among identifies the specific community client with whom the nurse will be working to address the identified problem.Which nursing diagnosis is written at the community-level? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors as evidenced by client crying and stating she has no support systemANS: B There are three parts: risk of, among, and related to. The risk of identifies a specific problem or health risk faced by the community. Among identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. Related to describes characteristics of the community.A nurse surveys the school nurses in a community to determine their roles in the schools because this data is not available. The nurse is engaging in the process of data: a. Collection b. Gathering c. Generation d. InterpretationANS: C Data generation is the process of developing data that do not already exist by interacting with community members or groups. This data includes information about a communitys knowledge and beliefs, values and sentiments, goals and perceived needs, norms, problem-solving processes, power, leadership, and influence structures.A nurse schedules an appointment with a physician who has a practice in the community to learn more about the communitys beliefs regarding childhood immunizations. This is known as: a. Informant interview b. Participant observation c. Secondary analysis d. Windshield surveyANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members.When conducting informant interviews in a small community, the nurse would most likely contact: a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the areaANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants.A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. What type of data is being collected? a. Quantitative b. Qualitative c. Focus-groups d. SurveyANS: B Qualitative data is collected through interviews and observation.A nurse who reads the local community newspaper is using which method to gather data about the community? a. Informant interview b. Survey c. Participant observation d. Windshield surveyANS: C The nurse is deliberately sharing in the life of the community.Which method of data collection is being used as a nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation? a. Participant observation b. Windshield survey c. Survey d. Informant interviewsANS: B Windshield surveys are the motorized equivalent of simple observation.A nurse who uses such data as minutes from a community meeting is using: a. Secondary analysis b. Informant interviews c. A survey d. A windshield surveyANS: A The data is secondary because it is collected by someone else.A nurse plans on implementing a community-wide influenza immunization program. Which factor should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The communitys readiness to participate in the programANS: D The factors that influence implementation in the community are the nurses chosen roles, the type of health problem selected as the focus for intervention, the communitys readiness to take part in problem solving, and characteristics of the social change process.To effectively complete the evaluation phase, the nurse must have: a. Demonstrated the ability to improve the health of the participants b. Developed measureable objectives and goals before implementation c. Encouraged full participation by community members d. Improved the health of the population through the programANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed.To analyze the problem of increased adolescent alcohol use in the community, a nurse brings together several groups of people to address the issue. These groups come together at the same time to work on identifying potential causes of the problem, but do not interact during the process. Which model is the nurse applying? a. Delphi technique b. Program planning model c. Community-as-partner model d. Community empowerment modelANS: B The program planning model is known as the nominal group process. It makes the most of the contributions by various groups with diverse interests, skills, and knowledge. These groups work in the presence of one another but do not interact.A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass mediaANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people.A nurse may define a community as a(n) (select all that apply): a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concernANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions.Which data would be useful for a nurse to collect when assessing safety in a community? Select all that apply. a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurses own observationsANS: B, C, D Other nurses, social workers, and health care providers, community members, and the nurses own observations are reliable sources of information about the safety of an areaA nurse is educating the community about modifiable behaviors. Which of the following is the nurse most likely to discuss? a. Smoking, poor diet, and alcohol consumption b. Cancer, emphysema, and cardiovascular disease c. Age and gender d. Genetic abnormalitiesa. Smoking, poor diet, and alcohol consumptionA nurse is utilizing a disease-oriented approach when providing care to a client. Which of the following interventions will the nurse most likely provide? a. Promotion of a greater level of positive health b. Education about common disease processes c. Acute care management of chronic disease d. Education about medication complianced. Education about medication complianceThe biomedical model defines health as the: a. avoidance of illness. b. absence of disease. c. promotion of healthy behaviors. d. protection from illness and disease states.b. absence of disease.The health-oriented perspective views: a. health as the absence of disease. b. human lifestyle based on one's prescribed regime. c. humans as complex and interconnected with the environment. d. community education as the role of the registered nurse.c. humans as complex and interconnected with the environment.A nurse using the integrative model for community health promotion. Which of the following best describes how the nurse would apply the dimension of client system? a. Concentrating on individual health behaviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients d. Focusing on disease-oriented carec. Providing multidimensional nursing care among various levels of clientsA public health nurse (PHN) collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. Which of the following client systems of the integrative model does this describe? a. Community b. Aggregate c. Family d. Individuala. CommunityA PHN collaborates with a physician's clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed? a. Aggregate level health promotion b. Aggregate level illness prevention c. Family level illness care d. Individual level health promotiona. Aggregate level health promotionA nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation? a. Family level health promotion b. Individual level illness prevention c. Aggregate level illness prevention d. Individual level health promotionb. Individual level illness preventionWhen applying the integrative model for community health promotion, a nurse assesses the neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe? a. Individual b. Family c. Aggregate d. Communityd. CommunityA nurse provides a screening for school-aged children to screen for hearing deficits. Which of the following is being demonstrated by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotionb. Secondary preventionAccording to Leavell and Clark, primary prevention consists of: a. health promotion and rehabilitation. b. health promotion and specific protection. c. early diagnosis and prompt treatment. d. health maintenance and early diagnosis.b. health promotion and specific protection.A client wears a seat belt whenever riding in an automobile. Which of the following best describes the client's behavior? a. Illness prevention b. Health promotion c. Specific protection d. Health protectionc. Specific protectionA 5-feet, 6-inch, 25-year-old female who weighs 120 pounds walks 5 miles a day because she has a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protectionb. Illness preventionA 5-feet, 6-inch, 25-year-old woman who weighs 120 pounds runs 5 miles a day because it improves her mood and energy level. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protectiona. Health promotionA community is searching for additional funding so that a bike trail can be built in the community. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Specific protection d. Health protectiond. Health protectionWhich of the following statements is correct? a. Genes, biology, and health behavioral choices account for 75% of population health. b. Medical care accounts for 25% of population health. c. Physical and social environments account for 75% of population health. d. Genes, biology, and health behavioral choices account for 25% of population health.d. Genes, biology, and health behavioral choices account for 25% of population health.The National Prevention Strategy provides: a. recommendations on what can be done to improve population health. b. assistance in interpreting Healthy People 2020. c. a basis for public health nursing practice. d. health risk appraisal instruments.a. recommendations on what can be done to improve population health.Which of the following describes one advantage of the Health Belief Model (HBM)? a. It is one of the most recently developed models based on evidence-based practice principles. b. It can reduce the incidence of diseases and disabilities. c. It can assist with planning programs to increase an individual's motivation to take positive health action. d. It promotes individual's participation in community-based screening programs.c. It can assist with planning programs to increase an individual's motivation to take positive health action.A nurse is using the HBM when developing health programs in the community. Which of the following is the nurse most likely involved in? a. Conducting group risk appraisal and risk reduction b. Considering the factors that will motivate the participants to change their health behaviors c. Completing a community wellness inventory d. Considering legislative changes that are necessary to improve environmental living conditions and sanitationb. Considering the factors that will motivate the participants to change their health behaviorsA nurse is using Anderson and McFarlane's model to complete a community health assessment. Which of the following information about the community would the nurse be collecting? a. Resources available to promote health b. Interactions among subsystems c. Physical environment d. Demographicsb. Interactions among subsystemsThe Framingham Heart Study was successful in: a. providing information on the effectiveness of risk-reduction interventions. b. documenting the relationship between social variables and heart disease. c. identifying factors contributing to the development of coronary heart disease (CHD). d. demonstrating the effects of mass media in modifying high-risk behavior.c. identifying factors contributing to the development of coronary heart disease (CHD).A nurse is performing interventions at the individual level of care. Which of the following is the nurse most likely completing? (Select all that apply.) a. Teaching well-balanced nutrition to a mother with a malnourished child b. Providing a parent age-specific information for immunizations c. Assessing the community for other cases of malnutrition d. Assessing other families on the same street for similar problems e. Planning a social marketing campaign about seat belt safetyA, BWhich community-based programs resulted in equally favorable health risk changes for both control and treatment groups? (Select all that apply.) a. Framingham Heart Study b. Stanford Five-City Heart Disease Prevention Program c. North Karelia Study d. Minnesota Heart Health Program e. Dutch Heart Health Community InterventionB, C, D, EWhich group has the highest rate of violence? a.Older, Caucasian men b.Young, minority men c.Young, Caucasian women d.Older, minority womenB Young, minority men have the highest rate of unemployment in the United States, ranging upward to 50% even in times of prosperity. Unemployment may precipitate aggressive outbursts. Most analyses conclude that the differential rates of violence between African Americans and Caucasians in the United States have more to do with socioeconomic disparities, such as poverty, unemployment, and overcrowding, than with race.Homicide is the second leading cause of death among which population? a. Individuals between 15 and 24 years of age b. Native American infants c. Caucasian women between 25 and 34 years of age d. African American children between 15 and 19 years of ageA Homicide is the second leading cause of death for individuals between 15 and 24 years of age. Rates of homicide for children under the age of 1 were highest in Non-Hispanic blacks and American Indian/Alaska Native infants.What factor associated with crime and violence is particularly important to community health nursing practice? a. Violence is a universal problem. b. Violence impacts everyone in the United States. c. Nurses must spend a great deal of time on the results of violence. d. Significant mortality and morbidity result from violence.D Communities across the United States are concerned about crime and violence rates because of significant mortality and morbidity that often result. These issues are closely related to community health nursing. While it is true that violence is universal, and so to some degree affects all citizens, resulting in the need for nursing care, these issues relate to nursing in general and especially those involved in direct care of the patient's physical and emotional needs.Which statement about rape is true? a. Rural areas are high-risk areas for rape to occur. b. Most rapes occur in the winter. c. Male victims suffer more emotional trauma than females. d. College women are at high risk for experiencing rape.D College women are at particularly high risk for sexual victimization in the United States, with research estimating that approximately 25% of female college students will experience an attempted or completed rape at some point during their college experience. It appears that the emotional trauma for a male rape victim is at least as serious as that for a woman.Homicides are least likely to be perpetrated by a(n): a. friend. b. acquaintance. c. family member. d. stranger.D Homicides are least likely to be committed by a stranger. When strangers are involved, many of these are related to the illegal substance abuse network. Homicides are usually perpetrated by friends, acquaintances, or family members during an argument.The greatest risk factor for suicide in adult women is: a. divorce. b. unemployment. c. intimate partner violence. d. terminal illness.C The greatest risk factor for actual and attempted suicide in adult women is intimate partner violence.A public health nurse (PHN) is working in a community where there have been multiple closures of large factories, leaving many individuals without employment. Which of the following is this population most at risk for? a. Becoming an abuser at home b. Committing violence in and outside the home c. Developing addictive behaviors d. Neglecting the needs of their childrenB Unemployment is associated with violence within and outside the home. Abuse may increase both in and outside of the home due to unemployment. Applying for unemployment benefits is not a risk for this population. Neglecting the needs of their children only addresses what could happen inside of the home and not outside of the home.A nurse is developing a community program to prevent violence. Which of the following should be the first action taken by the nurse? a. Talk to people who are victims of violence for their opinion b. Identify factors that lead to violence c. Develop a plan of action to combat violence d. Evaluate current community programsB A community's population can influence the potential for violence. The starting point is the identification of factors that lead to violence, such as poverty, urban crowding, and racial inequality. In addition, one's perceptions of the safety in a community can be influenced by racism and perceptions of criminality.A nurse is counseling a client who has been abusive toward a spouse. Which of the following experiences has the client most likely had in the past? a. Perceived or actual crisis b. History of social isolation c. Previous exposure to violence d. Long-term marital strainC Perpetrators of intimate partner violence often believe that violence within an interpersonal relationship is a normal behavior pattern, based on their upbringing, living conditions, and increased stress.A nurse is working with children who may be at risk for experiencing abuse. In which situation is child abuse most likely to occur? a. When the parents have high expectations for their children b. When the parents' sense of control is threatened c. When the parents are sensitive to their children's needs d. When the parents lack a social support networkD Parents with a lack of social support, history of abuse as a child, or who have minimum education, a tendency toward depression, or multiple stress factors may be at risk for abusing their children. Parents who have high expectations for their children or are sensitive to their children's needs do not have a tendency toward abuse. Parents who have their sense of control threatened do not have a tendency toward abuse.What type of abuse is occurring when a child does not receive the basic nurturing and caring needed for healthy development? a. Sexual abuse b. Emotional neglect c. Physical neglect d. Child AbuseB Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child. Physical neglect is failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care and is most often associated with extreme poverty. Child abuse ranges from violent physical attacks to passive neglect. Sexual abuse is a form of child abuse when a child has had nonconsensual sexual contact of any kind.A nurse is caring for a child who lives in extreme poverty. Which of the following types of abuse is this child at greatest risk for? a. Sexual abuse b. Emotional neglect c. Physical neglect d. Child abuseC Physical neglect is failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care. Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child. Child abuse ranges from violent physical attacks to passive neglect. Sexual abuse is a form of child abuse when a child has had nonconsensual sexual contact of any kind.A nurse is making a home visit to a low-income, frail, older person's home. Which of the following would most likely cause the nurse to suspect adult maltreatment? a. The older person reports giving money to family members on a regular basis. b. The windows of the house are in need of repair. c. The older person spends a great deal of time watching television. d. There are dogs running loose in the yard of the home.A Older adults are at risk for financial abuse through fraud, coercion to relinquish property rights, and money mismanagement. A low-income, frail, older person would most likely not be giving money to family members on a regular basis, because the client would need the money to meet basic needs.A nurse is working with a recent rape survivor. Which of the following actions would be most appropriate for the nurse to implement? a. Provide continuous care once the victim enters the health care system b. Examine evidence for its authenticity c. Work with the criminal justice system to find the rapist d. Provide long-term therapy for psychological traumaA Not only do nurses often provide continuous care, in some states nurses are trained as sexual assault examiners who gather forensic evidence. Nurses provide victims with privacy, respect, and assurance of confidentiality. The nurse would not be providing long-term therapy for the survivor or have the responsibility to find the rapist.A nurse is completing a community assessment. Which of the following community characteristics would be identified as a factor for violence? a. Lack of family cohesion b. High crime rate c. Social isolation d. Substance abuseB High crime rate is the only "community characteristic." Lack of family cohesion is a familial factor. Social isolation and substance abuse are individual factors.A nurse helps the community to take a stand against violence and advocates for elected officials and local media to make nonviolence a priority. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Primary careA Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Being an advocate for nonviolence demonstrates primary prevention. Secondary prevention refers to interventions aimed at early detection and screening. Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Primary care is not a level of prevention.A nurse assists an injured victim in finding a safe location to live after being abused. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Primary careB Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Finding shelter for a victim of abuse demonstrates secondary prevention. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Primary care is not a level of prevention.A nurse is providing tertiary prevention. Which of the following interventions should be included? a. Education b. Prevention c. Referral d. DetectionC Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Nurses should know about available community resources for abuse victims and perpetrators. Education and prevention primarily deal with primary prevention strategies. Detection is part of secondary prevention.A nurse is assessing an individual who has been the victim of domestic violence. Which part of the body should the nurse assess first? a. Front of the body b. Back of the body c. Proximal parts of the body d. Distal parts of the bodyC Attacks are often inflicted on proximal parts of the body that can easily be disguised by clothing, so the nurse should assess this area first.A nurse is caring for a woman who has been battered for a number of years. Which of the following has the client most likely seen an increase in over the years? a. Self-blame b. Remorse by the man c. Severity of the abuse d. Emotional strengthC Severity of abuse and its frequency is most likely to increase over time. Both the man and the woman tend to blame the incident on something external. The man's remorse tends to lessen over time.A nurse working at a battered woman's shelter is counseling a pregnant woman who has just entered the shelter. When assessing the client's history, which information would the client most likely report? a. A history of abuse before pregnancy b. A history of child abuse c. A history of multiple pregnancies d. A history of substance abuseA Abuse before pregnancy is the most important risk factor for physical battery during pregnancy. A history of child abuse, multiple pregnancies, and substance abuse are not as closely associated with the risk of physical battery during pregnancy.A child has reported to the school nurse that he is being bullied. Which of the following is most likely happening to this child? a. Difficulty talking to the guidance counselor b. Inclusion in group activities c. Intimidation by a peer d. Discipline from parents at homeC Bullying has become a major problem in schools. Bullying can be physical and/or psychological abuse, intimidation, or verbal abuse; the exclusion of some children in group activities is another form of bullying.A community health nurse visits a home and notices multiple bruises on a 4-year-old child. The mother reports that her husband is an alcoholic and is currently sleeping. What is the most appropriate action for the nurse to take? a. Question the mother about sexual abuse b. Initiate interventions directed at family violence c. Report the case of suspected child abuse to authorities d. Refer the mother to a social worker or Al-Anon groupC It is required by law that nurses report all cases of suspected child abuse. The mandatory reporting laws protect reporters from legal action on cases that are never substantiated. It is essential that this is the first action to be taken by the nurse. After this action is taken, it may be appropriate to initiate interventions related to decreasing family violence or asking specifically about abuse. Referral of the mother to a social worker would not assist in decreasing the potential abuse that may be occurring.A nurse is assessing a school-age child whose parents have reported recent violent activity from the child that is atypical from this child. Which of the following may have contributed to the child's change in behavior? a. Getting a new pet b. Watching too much television c. Playing violent video games d. Having a new sibling at homeC Research on violent television and films, video games, and music demonstrates that media violence increases the likelihood of aggressive and violent behavior, both immediately and long-term. Parents and caregivers are critical in monitoring what reaches their children.A nurse is assisting with community planning. Which of the following facilities should the nurse encourage be developed to reduce the potential for crime and violence in the community? (Select all that apply.) a. Playgrounds b. Movie theaters c. Swimming pools d. Shopping malls e. RestaurantsA, B, C Recreational facilities including playgrounds, movie theaters, and swimming pools all provide socially acceptable outlets for a variety of feelings, including aggression. Shopping malls and restaurants would not be considered recreational facilities.A nurse is providing care to a child who has been abused. Which characteristics are most likely present in this child's family? (Select all that apply.) a. The parents are unemployed. b. There is no support network willing to offer assistance. c. The parents are not knowledgeable about child development. d.The mother seems frightened of her partner. e. There is no primary caregiver in the home.A, B, C, D Risk factors for child abuse include unemployed parents, no support network, parents not knowledgeable about child development, and a mother who is scared of her partner.