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Exam #1 Evolve Questions

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Jennifer is a community health nurse in a large metropolitan area. According to the American Nurses Association's Code of Ethics (2001), community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing:

A. Socioeconomic issues.
B. Psychosocial issues.
C. Sociocultural issues.
D. Developmental issues.
C.

The Code of Ethics of the American Nurses Association (2001) promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. Community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing sociocultural issues, such as human rights, homelessness, violence, and stigma of illness. Directing care toward socioeconomic issues, psychosocial issues, or developmental issues focuses on individuals, families, or groups, which in turn contributes to the health of the total population.
Mary is a nursing student doing her senior project in community health. Part of her assignment is to conduct an activity that illustrates "social health" within a group in her community. The most appropriate activity for Mary to organize would be a:

A. neighborhood block party.
B. food bank in a local church.
C. community yard sale.
D. school fundraiser for the school band
B.

Social health is a positive interaction among groups with an emphasis on health promotion and illness prevention. The correct choice is a food bank in a local church because a food program alleviates problems with hunger and nutrition that affect health. The other options do not relate to health.
It has been estimated that individual behaviors and environmental factors are responsible for what percentage of all premature deaths in the United States?

A. 20%
B. 40%
C. 50%
D. 70%
C.

According to Orleans and Cassidy (2011), 50% of all premature deaths in the United States are a result of individual behaviors and environmental factors. According to Mokdad, Marks, Stroup, and Gerberding (2004), tobacco use leads the list of "actual causes of death" at almost 20% of annual deaths in the United States.
Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by:

A. supporting political activities to improve social and environmental conditions of immigrant families.
B. administering bedside nursing care to immigrants and their families.
C. teaching the immigrant family members to provide health care in the home.
D. obtaining and administering medications to the immigrants and their family members.
A.

These early public health nurses saw that neither administering bedside clinical nursing, including obtaining and administering medication, nor teaching family members to deliver care in the home adequately addressed the true determinants of health and disease. They resolved that collective political activity should focus on advancing the health of aggregates and improving social and environmental conditions by addressing the social and environmental determinants of health. Wald and her colleagues (1971) impacted the health of the community by organizing the community, establishing school nursing, and taking impoverished mothers to testify in Washington, DC.
Disease prevention activities protect people from disease and the effects of disease. An example of primary disease prevention is:

A. teaching people with diabetes how to prevent complications.
B. administering vaccines to children before kindergarten.
C. checking the skin of farm workers for signs of skin cancer.
D. identifying and testing individuals exposed to someone with tuberculosis.
B.

Primary prevention activities prevent a problem before it occurs; an immunization is given to prevent a disease before it occurs. Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis, such as checking the skin for signs of skin cancer or identifying and treating individuals who have been exposed to contagious diseases. Aims of tertiary prevention are to keep health problems from getting worse, reduce the effects of disease and injury, and restore individuals to their optimal level of functioning. Examples of tertiary prevention include teaching prevention of complications from disease or referring a patient with a stroke for rehabilitation.
Every 10 years, the U.S. Department of Health and Human Services publishes a national prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is to:

A. achieve access to preventive services of all Americans.
B. improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident.
C. reduce health disparities among Americans.
D. increase independence of older Americans.
B.

One of the new objectives for Healthy People 2020 focuses on preparedness for major health incidents. Achieving access to preventive services of all Americans and reducing health disparities among Americans were goals of Healthy People 2000, and increasing the independence of older Americans was a goal of the original 1979 Healthy People version.
Which of the following is an example of "community health nursing" rather than "community-based nursing"?
A. An RN assisting a doctor in a pediatrician's office
B. An RN visiting a home-bound patient to monitor for congestive heart failure
C. An RN reviewing school clinic records to determine which children are not up to date on their immunizations
D. An RN dispensing medications in a nursing home
C.

"Community health nursing" focuses on groups of people, with the primary responsibility being the population as a whole (as with a school). Care typically focuses on health promotion and illness prevention, such as the nurse who reviews school clinic records to determine which children are not up to date on their immunizations. "Community-based nursing" is setting specific and emphasizes care to individuals, often in homes and ambulatory clinics, and typically addresses acute and chronic health conditions. The other options are examples of nurses providing care to individuals.
Which of the following entities strives to improve the health of all the public by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities?
A. Managed care organizations (MCOs)
B. Medicare
C. Public health system
D. Affordable Care Act
C.

The Public health system strives to improve the health of entire populations by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities. Although MCOs and government financing entities (Medicare and Medicaid) focus on the health of their clients, they do not focus on the community and population in general. The focus of the Affordable Care Act is to mandate health insurance for individuals.
A variety of health indicators are used by health providers, policy makers, and community health nurses to measure the health of the community. Indicators that illustrate the health status of a community and may be useful in analyzing health patterns over time include: (Select all that apply.)
A. morbidity.
B. mortality.
C. birth rates.
D. life expectancy.
E. cancer incidence rates.
A, B, D, E

Some of the more commonly reported health indicators used by health providers, policy makers, and community health nurses to measure the health of the community are life expectancy, infant mortality, age-adjusted death rates, and cancer incidence rates. Birth rates do not provide relative data to measure the health of a community.
Public health efforts focus on prevention and promotion of population health. The local level of the health care system provides direct services to community members through community and personal health services. An example of a health service that targets the larger community, rather than individuals, is: (Select all that apply.)
A. providing well-infant care.
B. a mobile immunization clinic.
C. condemning or repairing unsafe housing.
D. encouraging family planning.
E. airing a weekly public service announcement to remind women to do breast self-examination.
B, C, E

A mobile immunization clinic, repairing unsafe housing, and airing weekly public service announcements all target the larger population of a community. Providing well-infant care and encouraging family planning target individuals.
In which of the following historical ages would people have had an increased risk for contracting salmonella, anthrax, Q fever, or tuberculosis from the proximity of domesticated animals and herds?
A. Hunting and gathering stage
B. Settled village stage
C. Preindustrial cities stage
D. Industrial cities stage
B.

During the settled village stage of the Mesolithic period and Neolithic period, people became sedentary, formed villages, and domesticated herds of animals. They lived in close proximity to the animals and contracted diseases such as salmonella, anthrax, Q fever, and so forth because of cross-contamination of water and food supply. In the hunting and gathering stage, groups may have avoided many contagious diseases because the scattered aggregates were small, nomadic, and separated from other aggregates. In the preindustrial stage, large urban centers formed to support the expanding population. In the industrial cities stage, there was an increase in respiratory diseases such as tuberculosis, pneumonia, and bronchitis and in epidemics of infectious diseases such as diphtheria, smallpox, typhoid fever, typhus, measles, malaria, and yellow fever.
During the Renaissance period, much was learned about health and disease. The Elizabethan Poor Law was enacted during this time to:
A. govern personal and community hygiene such as contagion, disinfection, and sanitation.
B. make local parishes responsible for caring for the poor in the community.
C. enforce hygienic codes from Leviticus and establish leper houses.
D. legislate social reform, addressing issues such as child welfare and factory management.
B.

Under the Elizabethan Poor Law, parishes established workhouses to employ the poor. Orphaned and indigent children were considered wards of the parish and were often forced to work long hours and live in substandard housing that negatively affected their health. The Minoans created laws that governed personal and community hygiene. In the Middle Ages, the church enforced hygienic codes from Leviticus and established leper houses. Social reform was legislated by the General Board of Health for England in 1848.
Edwin Chadwick's Report on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britain greatly contributed to the development of the:
A. National Organization for Public Health Nursing.
B. American Medical Association.
C. General Board of Health for England.
D. National Institute.
C.

Chadwick's report was published in 1842 and began a move toward legislation resulting in social reform. The General Board of Health for England was established in 1848 as a result of this social reform. The National Organization for Public Health Nursing was formed as an organization for public health nurses. The American Medical Association was formed as an organization for physicians in the mid-1800s. The National Institute is a scientific organization based in Washington, DC.
What discovery by Edward Jenner resulted in one of the greatest medical advances of the 18th century?
A. The benefits of isolation in the control of communicable disease such as bubonic plague
B. The discovery that cholera was transmissible through contaminated water
C. The identification of modern epidemiologic principles, such as agent-host-environment
D. The development of the smallpox vaccination that resulted in immunity after inoculation with the cowpox virus
D.

Edward Jenner's observation of a decline in the incidence of smallpox among people who worked with cows lead to his investigation of the connection between cowpox and smallpox and the development of the smallpox vaccination that prevented the disease in humans. At the time, the incidence of smallpox among the general population was 95%, and the death rate was 10%. Isolation and other epidemiologic principles were not recognized as beneficial in controlling communicable disease until modern times. John Snow demonstrated in 1854 that cholera was transmissible through contaminated water.
Lemuel Shattuck, a Boston bookseller with an interest in public health, published the 1850 book Report of the Massachusetts Sanitary Commission. Which of the following was NOT a recommendation of the report?
A. Keeping a record of vital statistics
B. Developing well-infant and well-child care programs
C. Introducing modern family planning methods in the United States
D. Beginning a system of vaccination and health education
C.

Shattuck recommended major health reform that included keeping vital statistics; providing environmental control; food, drug, and communicable disease control; well-infant, well-child, and school-age child health programs; mental health care; vaccination; and health promotion. His recommendations were not implemented until nearly 19 years later, when a state board of health was formed in Massachusetts. Modern family planning methods were not introduced until the 20th century.
The first visiting nurse in the United States was:
A. Lillian Wald.
B. Mary Brewster.
C. Florence Nightingale.
D. Francis Root.
D.

Francis Root was an 1877 graduate nurse sent by the Women's Board of the New York City Mission to provide care to sick individuals in their homes. This was considered an innovation in nursing care in the United States and the precursor to modern visiting nurses' associations. Lillian Wald and Mary Brewster established a district nursing service in New York City in 1893. Florence Nightingale began her work in the mid-19th century and is credited with establishing "modern nursing."
Modern community health nursing requires the nurse to __________, which empowers people to understand and address their health issues and disease.
A. practice from a population focus
B. adopt a medical model of care
C. return to earlier models of prevention
D. focus on the individual and family
A.

Population-focused nursing care includes people in solving their own health problems and focuses resources and health programs in a way to improve the health of entire populations, which include individuals, families, and communities. Adopting a medical model of care and returning to earlier models of prevention will not empower people to understand and address their health issues. Modern community health nurses focus on the population, not the individual and family.
Which of the following was NOT a public health service provided by the Romans?
A. A supervisor of the public baths
B. Street cleaners
C. Supervision of the sale of food
D. Housing for the indigent population
D.

Public health services provided by the Romans included a water board to maintain the aqueducts, a supervisor of the public baths, street cleaners, and supervision of the sale of food. Housing for the indigent population was not a public service provided by the Romans; in fact, inhabitants of the Roman slums did not share in public health amenities, and their health suffered accordingly.
When nonindustrial cultures adopt Western customs and transition into urban environments, Western diseases begin to appear. Epidemiologic studies suggest that common risk factors that contribute these health conditions include: (Select all that apply.)
A. changes in diet.
B. environmental alterations.
C. economic changes.
D. increased population density.
E. occupational hazards.
A, B, D, E

Epidemiologic studies suggest that common risk factors that contribute to chronic health conditions are changes in diet (e.g., increases in refined sugar and fats and lack of fiber), environmental alterations (e.g., use of motorized transportation and climate-controlled living and work sites), and occupational hazards. An increase in population and population density also increase mental and behavioral disorders. Economic improvements in nonindustrialized communities would decrease the risk of disease. Economic changes in nonindustrialized communities are not listed as a common risk factor that contributes to chronic health conditions.
Lillian Wald and Mary Brewster's Henry Street Settlement was a model of modern health care. Which of the following services was provided to people living in the Lower East Side of New York City by the Henry Street Settlement nurses? (Select all that apply.)
A. Emergency care and first aid
B. Home visits to ill mothers and children
C. School health services
D. Industrial health services to local workers
E. Support programs for immigrants
B, C, D, E

The Henry Street Settlement was a model comprehensive health care center that provided many services, including home visits to mothers and children, support services for immigrants, the first school health and industrial health programs, and many other services. Emergency care and first aid were not provided services.
One dimension of a community, which looks at personal characteristics and risks of a group, is called:
A. aggregate of people.
B. location in space and time.
C. social system.
D. census tract.
A.
An aggregate is a community composed of people who share common characteristics. An aggregate of people describes the "who" of a community, including personal characteristics and risks. Location in space and time looks at the geographical location of a community. Social system is the relationships that community members form with each other. Census tracts facilitate the organization of resident information in specific community geographic locales.
Which of the following groups is an example of a community of solution? A group:
A. that lives within a specific geographic location.
B. concerned with reducing teenage suicides.
C. with the same ethnic background.
D. in which all members enjoy hiking.
B.
A community of solution forms when a common problem unites individuals. The group members may have little in common other than the desire to address the problems that bring them together. A geographic community is a group that lives within a specific geographic location. Other types of communities may be defined by members of the same ethnic background or members that share the same interests, such as hiking.
Which of the following sources of information about a community's health would give the community health nurse information about births, deaths, and marriages and aid in providing indicators of population growth or reduction?
A. Census tracts
B. Vital statistics
C. National Health Survey data
D. Needs assessment
B.
The official registration records of births, deaths, marriages, divorces, and adoptions form the basis of data in vital statistics. When compared with previous years, vital statistics provide indicators of population growth or reduction. Census tracts facilitate the organization of resident information in specific community geographic locales. National Health Survey Data describes health trends in a national sample. A needs assessment is completed by the community health nurse to gain understanding of the community's perspective on health status, the services used or required, and concerns.
A community health nurse assessment phase of the nursing process conducted research to identify the distribution pattern of breast cancer within a population and the associated risk factors. This is called:
A. statistical analysis.
B. needs assessment.
C. census collection.
D. Epidemiology
D.
Epidemiology involves the analysis of data to discover the patterns of health and illness distribution in a population. It also involves conducting research to explain the nature of health problems and identify aggregates at increased risk. Statistical analysis is a general term for the analysis of data. A needs assessment is completed by the community health nurse to gain understanding of the community's perspective on health status, the services used or required, and concerns. Census information is collected every 10 years by the U.S. Census Bureau to describe the population characteristics of the nation.
One of the first steps in community assessment may involve the community health nurse driving or walking through an area and making observations about such things as environmental layout and location of agencies, hospitals, industries, and so forth. This is called a(n):
A. census survey.
B. needs survey.
C. informant survey.
D. windshield survey.
D.
Community health nurses often perform a windshield surveys by driving or walking through an area and making organized observations to help gain an understanding of the environmental layout, including geographic features and the location of agencies, services, businesses, and industries and to locate possible areas of environmental concern through sight, sense, and sound. A needs assessment is completed by the community health nurse to gain understanding of the community's perspective on health status, the services used or required, and concerns. Census information is collected every 10 years by the U.S. Census Bureau to describe the population characteristics of the nation. To conduct an informant survey, the community health nurse may gather data by interviewing key informants in the community. Informants may be knowledgeable residents, elected officials, or health care providers.
Which of the following methods of gathering data is most effective for remote and vulnerable segments of a community and for those communities with underdeveloped opinions?
A. Interviewing community informants
B. Community forum
C. Focus groups
D. Telephone surveys
C.
Focus groups are effective for remote and vulnerable segments of a community and for those with underdeveloped opinions. These sessions can produce greater interaction and expression of ideas than surveys and may provide more insight into an aggregate's opinions. The community health nurse may gather some data by interviewing key informants in the community. Informants may be knowledgeable residents, elected officials, or health care providers. A community forum may be held to discuss selected questions. A telephone survey may be useful for selected questions.
When writing a community diagnosis, the community health nurse notes that the "among" phrase:
A. presents a synthesis of all assessment data.
B. provides the supporting data.
C. specifies the aggregate that will benefit from the nurse's plan.
D. describes the cause of the health problem and directs focus of interventions.
C.
The "among" phrase specifies the aggregate that will be the beneficiary of the nurse's action plan. The identification of the health problem represents a synthesis of all assessment data. The "related to" phrase describes the cause of the health problem and directs the focus of the intervention. The health indicators are the supporting data. The "related to" phrase describes the cause of the health problem and directs the focus of the intervention.
Identify the etiologic or causal statement component of the following community diagnosis: "There is an increased risk for undetected testicular cancer among young men related to insufficient knowledge about the disease and the methods for preventing and detecting it at an early stage as demonstrated by high rates of late initiation of treatment."
A. Risk for undetected testicular cancer
B. Young men
C. Insufficient knowledge about the disease and methods of prevention
D. High rates of late initiation of treatment
C.
The "related to" phrase describes the cause of the health problem and directs the focus of the intervention. "Risk for undetected testicular cancer" is the identified problem. "Young men" is the identified aggregate. "Insufficient knowledge" is the "related to" phrase.
Epidemiologic data can be useful in the planning phase of the community assessment process because they:
A. help discover the patterns of health and illness distribution in a population.
B. help construct benchmarks to gauge achievement of program objectives.
C. identify the aggregate at risk.
D. explain the nature of the health problem.
B.
Inherent in the planning phase of the nursing process is a plan for the intervention and its evaluation. Epidemiologic data can be useful as a basis for determining success. By comparing baseline data, national and local data, and other relevant indicators, the nurse can construct benchmarks to gauge achievement of program objectives. The other options are useful assessment phase of the nursing process.
The steps in the community assessment process for community health nurses are: (Select all that apply.)
A. writing a community diagnosis.
B. evaluating the outcomes.
C. collecting assessment data.
D. identifying the cause of the problem.
E. planning community interventions.
A, B, C, E
The steps of the community assessment process for community health nurses are collecting the assessment data, synthesizing assessment data into diagnostic statements about the community's health, planning interventions, and evaluating the outcomes. Identifying the cause of the problem helps with planning the interventions.
A community health nurse working as a school health nurse conducted a community assessment and determined that the focus of programs and health education for the academic year should address the problem of childhood obesity. In planning, it is important for the nurse to allow time for individual nursing assessment and education for children who are overweight or obese and to plan classroom education programs. The nurse is demonstrating an understanding of which important community health nursing concept?
A. Health planning
B. Aggregate health care
C. Community as client
D. Use of the nursing process
C.
Community health nurses focus care on health needs of aggregates; however, individual, families, and groups are important parts of aggregates. Appropriate nursing care and health promotion planned for aggregates affect individuals and vice versa. Use of the nursing process is one part of health planning for the community. Health planning is an essential component of community health nursing practice.
What legislation resulted in increased consumer involvement in the U.S. health care system and a review of the allocation of health care resources?
A. Partnership for Health Program
B. Hill-Burton Act
C. Regional Medical Services Programs
D. National Health Planning and Resources Development Act
D.
The National Health Planning and Resources Development Act addressed the need for the provider and consumer to be involved in the planning and improving of health services as well as placing the system of private practice examination. The Partnership for Health Program provided federal grants to states to establish and administer a local agency program to enact local comprehensive health care planning. The Hill-Burton Act was passed by Congress to address the need for better hospital access. The Regional Medical Programs intended to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals.
A community health nurse is using the health planning model to improve a client's health. The nurse prepares for unexpected problems or complications in the client's care. This attention to unexpected problems takes place during which step?
A. Assessment
B. Planning
C Intervention
D. Evaluation
C.
During the intervention step of the health planning model, the nurse must prepare for unforeseen problems or complications and consider alternatives to meet the client's needs. The nurse gathers information about the needs of the community during the assessment step. During the planning step, the nurse determines which problems or needs require intervention and identifies the desired outcomes or ultimate goals of the interventions. Evaluation determines success or failure of the project.
Before participating in health care planning, a community health nurse must understand the concept of:
A. community as client.
B. individual as client.
C. family as client.
D. environment as client.
A.
It is essential that community health nurses understand and are comfortable with the concept "community as client" before participating in health care planning. When focusing on the individual or family, nurses must remember that these clients are members of a larger population group or community, and environmental factors influence them.
The community health nurse understands that a client's health can be negatively or positively affected by his or her suprasystem. Which of the following correctly describes a client's suprasystem? The suprasystem includes:
A. only health-related resources, such as primary care providers and insurance sources.
B. only non-health-related resources, such as use of public transportation.
C. all resources available for use by the client, including health-related and non-health-related resources.
D. all official (governmental) agencies used by the client or family, such as the health department or social services.
C.
The suprasystem includes a variety of organizations and community resources. Some are health related, such as the presence or absence of hospitals, clinics, primary care providers, or health centers. Support services such as Meals on Wheels, public transportation, and recreational facilities are also important. Governmental agencies used by the client are also assessed as part of the suprasystem.
Systems theory provides a framework that includes interventions that are possible at the three levels of prevention. The level of prevention that includes early diagnosis is:
A. primary prevention.
B. secondary prevention.
C. tertiary prevention.
D. supralevel prevention.
B.
Secondary prevention can include early diagnosis and treatment of diseases that will reduce the severity of the disease. Primary prevention consists of health promotion and activities that protect the client from illness or dysfunction. Tertiary prevention applies to irreversible disability or damage and aims to rehabilitate and restore an optimal level of functioning. Option D is not a type of prevention.
Public service announcements, dissemination of pamphlets, and focus groups are examples of measures that can be used by the community health nurse. These are also known as:
A. levels of intervention.
B. nursing assessment.
C. evaluation methods.
D. nursing interventions.
D.
Public service announcements, dissemination of pamphlets, and focus groups are all types of nursing interventions that can be used by the community health nurse. Intervention levels apply to aggregates, communities, or individuals. Assessment includes the collection of data to determine the needs of the community or aggregate. Evaluation determines the success or failure of a project. Methods may include verbal or written feedback, surveys, or other tools that measure whether objectives were met.
Which of following factors is NOT necessary to consider when determining priorities for health problem interventions?
A. The aggregate's preferences
B. The number of individuals affected by the health problem
C. The nurse's preferences
D. The availability resources
C.
Factors that assist the nurse in determining priorities for aggregate health care include the aggregate's preferences; the number of people affected; the severity of the health problem; and the available solutions, resources, time, and individuals with skills to help solve the problem. Often the nurse will prefer to provide information and interventions that he or she is most comfortable with, but that may not be what is needed most.
The rationale behind the Patient Protection and Affordable Care Act is to:
A. put individuals, families, and small business owners in control of their health care.
B. increase federal aid to states for hospital facilities.
C. improve the quality of care in rural areas and introduce systematic statewide health care planning.
D. force the implementation of health maintenance organizations.
A.
The act puts individuals, families, and small business owners in control of their health care. The Hill-Burton Act provided federal aid to states for hospital facilities, resulting in improved quality of care in rural areas and systematic statewide planning. Implementation of health maintenance organizations is not required by the Patient Protection and Affordable Care Act.
The Patient Protection and Affordable Care Act of 2010 includes several elements that involve health planning. These elements include: (Select all that apply.)
A. creation of an innovation center within the Centers for Medicare and Medicaid Services.
B. provisions of monies for funding community health centers, school-based clinics, and the National Health Service Corps to improve access to care.
C. creation of task forces on preventive services and community preventive services to develop, update, and disseminate evidence-based recommendations on health care delivery.
D. establishment of an independent payment advisory board to make proposals to reduce the growth in Medicare spending.
E. the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals to improve the health manpower and facilities available to the communities.
A, B, C, D
Provisions from the Patient Protection and Affordable Care Act of 2010 include:
Creation of task forces on preventive services and community preventive services to develop, update, and disseminate evidence-based recommendations on health care delivery; establishment of the National Prevention, Health Promotion, and Public Health Council, an agency that will be charged with development of a national strategy to improve the nation's health; creation of an innovation center within the Centers for Medicare and Medicaid Services; and development of a national quality improvement strategy that will seek to improve delivery of health care services and population health.
Provision of billions of dollars for funding community health centers, school-based clinics, and the National Health Service Corps to improve access to care; establishment of an independent payment advisory board to make proposals to reduce the growth in Medicare spending; and establishment of a workforce advisory committee to develop a national workforce strategy and to suggest ways to enhance the workforce supply by supporting education of health professionals through scholarships and loans.
Regional Medical Programs were intended to establish regional cooperative arrangements among medical schools, research institutions, and hospitals to improve the health manpower and facilities available to the communities.
The community health nurse is caring for a client who abstains from eating any form of meat. This dietary preference is commonly practiced by which of the following religions?
A. Hinduism
B. Mormonism
C. Judaism
D. Islam
A.
People of the Hindu faith abstain from eating meat of any type. Mormons do not necessarily restrict meat from their diets. Whereas Muslims abstain from eating pork, Jews do not eat pork, predatory fowl, shellfish, or other water creatures.
What is the process used when conceptual differences, which impact the provision of health care, exist between the client and the nurse?
A. Cultural diversity
B. Cultural negotiation
C. Cultural competence
D. Cultural imposition
B.
Cultural negotiation refers to the process in which messages, instructions, and belief systems are manipulated, linked, or processed between the professional and lay models of health problems and preferred treatment. In each act, the nurse gives attention to eliciting the client's views regarding a health-related experience (e.g., pregnancy, complications of pregnancy, or illness of an infant). Cultural diversity is a multifaceted and complex concept that refers to the differences among people, especially those related to values, attitudes, beliefs, norms, behaviors, customs, and ways of living. Cultural competence is respecting and understanding the values and beliefs of a certain cultural group so that one can function effectively in caring for members of that cultural group. Cultural imposition is a person's tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture.
Almost 13% of residents in the United States were born in other countries. More than half (53.1%) of these individuals were born in:
A. Asia.
B. Europe.
C. Africa.
D. Latin America.
D.
A total of 53.1% of the individuals who are foreign born in the United States were born in Latin America. This is the highest percentage for foreign-born persons.
When making health-related decisions, clients from different cultural backgrounds depend on relationships. One type of relationship involves the client seeking assistance from other members of the family and allowing a relative to make decisions about important health-related issues. This relationship is a(n):
A. lineal relationship.
B. collateral relationship.
C. cultural relationship.
D. individual relationship.
A.
Lineal relationships involve a client seeking assistance from another family member and allowing a relative to make important decisions related to health matters. A collateral relationship's focus is primarily on group goals, and family orientation is important. A cultural relationship is characterized by tolerance and respect. Individual relationships refer to personal autonomy and independence. Individual goals dominate, and group goals become secondary.
While caring for a client from a different culture, the community health nurse must assess the client's health-related beliefs. All of the following questions would be appropriate and would elicit the desired information except:
A. "Are there certain foods you eat when you are sick?"
B. "When do you know you are sick enough to visit a health care provider?"
C. "Is it OK if I speak in English?"
D. "What does health mean to you?"
B.
Determining the meaning of health, health practices, and habits and usual health practices of the client will help the nurse provide culturally sensitive care that will be accepted by the client. "Is it OK if I speak in English?" does not address health.
Which of the following minority groups has a 35% higher mortality rate from cancer than nonminority groups?
A. African Americans
B. Asians
C. Latin Americans
D. Italian Americans
A.
Cancer mortality rates are 35% higher in African Americans than in whites. African Americans receive less information about cancer and heart disease than nonminority groups. African Americans tend to underestimate the prevalence of cancer, give less credence to the warning signs, obtain fewer screening tests, and receive a diagnosis at later stages of cancer than whites.
A community health nurse is caring for a client who often stares at the floor while the nurse is talking. This client is likely to be of what ethnic group?
A. Latin Americans
B. Native Americans
C. African American
D. European
B.
There are certain ethnic groups who avoid eye contact. These include Asian, Native American, Arab, Indochinese, and Appalachian clients.
A community health nurse is caring for a family that includes the husband, wife, children, and other blood relatives. This type of family is called a(n):
A. nuclear family.
B. communal family.
C. extended family.
D. nuclear dyad.
C.
An extended family includes a husband, wife, children, as well as other blood relatives. A nuclear family includes the husband, wife, and child or children. A communal family is a group of men and women with or without children. A nuclear dyad is the husband and wife alone, either childless or with no children living at home.
The phrase "All Chinese people like rice" is an example of:
A. cultural stereotyping.
B. culture-bound syndrome.
C. cultural imposition.
D. ethnocentrism.
A.
The tendency to view individuals of common cultural backgrounds similarly and according to a preconceived notion of how they behave is called cultural stereotyping. Culture-bound syndrome is a condition that is culturally defined. Cultural imposition is a person's tendency to impose his or her own beliefs, values, and patterns of behavior on individuals from another culture. Ethnocentrism is a person's tendency to view his or her own way of life as the most desirable, acceptable, or best and tendency to act in a superior manner toward individuals from another culture.
While caring for a client from an Asian culture, the community health nurse might expect which of the following behaviors? (Select all that apply.)
A. The client is quiet and compliant, asking few questions.
B. The client asks many questions related to the health problem and the nurse's instructions.
C. The client may avert his or her eyes during the conversation.
D. Folk healers and complementary health care providers may also be present.
E. The client may provide the nurse with the answers he or she thinks the nurse wants to hear.
A, C, E
Asian and Native American clients are likely to appear quiet and compliant. Asian, Native American, Indochinese, Arab, and Appalachian clients may consider direct eye contact impolite or aggressive, and they may avert their own eyes during the conversation. Asian clients may provide the nurse with the answers they think the nurse wants to hear. The nurse must be aware that this behavior does not mean that the client or family understands his or her instructions and they will not necessarily be compliant in future health behavior.
The nurse working in the community is aware that there are different models for studying the epidemiology of a health condition in a population. One model of investigation of the interrelationships and characteristics of disease is the epidemiologic triangle. This model analyzes what three elements?
A. Incidence, prevalence, and etiology
B. Agent, host, and environment
C. Person, place, and time
D. Virus, bacteria, and fungus
B.
The epidemiologic triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunologic susceptibility to the agent. Environmental conditions at the time of exposure are also considered. Examination of these three elements allows assessment of the problem, determination of protective factors, and evaluation of the vulnerability of the host to disease. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community. Answers A and D do not represent an epidemiologic model.
When chronic disease became a more important cause of death in developed countries, different epidemiologic models were developed to study the many factors involved in the development of these health conditions. Which of the following is an example of such a model?
A. Person-place-time model
B. Epidemiologic triangle
C. Web of causation
D. Wheel model
C.
Chronic disease is marked by a complexity of relationships among causal factors. The web of causation model illustrates the interrelationships. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community. The epidemiologic triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunological susceptibility to the agent. The wheel model is an example of a model that stresses the multiplicity of host and environmental interactions.
In the 1850s, a researcher studied a cholera epidemic among people living in different sections of London. The researcher who used epidemiologic methods to study the epidemic and used rates as an epidemiologic tool was:
A. Joseph Lister.
B. William Farr.
C. John Snow.
D. Edward Jenner.
C.
John Snow is recognized as the researcher who applied epidemiologic methods in the investigation of a cholera epidemic in London in the 1850s. Joseph Lister is considered the pioneer of antiseptic surgery. William Farr was a 19th century British epidemiologist who is regarded as a founder of medical statistics. Edward Jenner developed the smallpox vaccine.
A community health nurse participating in planning programs for the coming year considers incidence rates to better understand the needs of the community. Which statement below is the most accurate explanation of incidence rates?
A. New cases of a disease or condition in a community over a period of time are included in incidence rates.
B. The number of all cases of a specific disease or condition in a population at a given point in time relative to the population at the same point in time is included in incidence rates.
C. Incidence rate refers to the number of new cases of a disease in those exposed to the disease.
D. The term incidence rate refers to the percentage of deaths in a specific period of time from a specific cause.
A.
Incidence rates describe the occurrence of new cases of a disease or condition in a community during a period of time relative to the size of the population at risk for that disease or condition during that same time period. In calculating this rate, the numerator is the number of new cases during the specific period of time, and the denominator consists only of those who are at risk for developing the disease or condition during the specific period of time. A prevalence rate is the number of all cases of a specific disease or condition in a population at a given point in time relative to the population at the same point in time. Attack rates document the number of new cases of a disease in those exposed to the disease. The percentage of deaths in a specific period of time from a specific cause refers to the mortality rate.
An epidemic is occurring in a public health nurse's community, and the nurse is working with the epidemiologist and other health professionals seeking to identify the causative agent. What phrase best describes such efforts?
A. Cohort study
B. Descriptive epidemiology
C. Point prevalence study
D. Analytic epidemiology
D.
Analytic epidemiology may be defined as close examination of identified possible causes of disease using advanced epidemiologic methods. Cohort studies obtain information about the cause of disease by establishing a relationship between the presumed causal factors and the effect. The study of the amount and distribution of disease constitutes descriptive epidemiology. When prevalence rates describe the number of people with the disease at a specific point in time, they are sometimes called point prevalences.
A community nurse is reviewing health statistics to gain a better understanding of a population's health needs. Crude rates are available for several health occurrences. What statement accurately describes crude rates?
A. In calculating a crude rate, the numerator is the size of the population at risk.
B. In calculating a crude rate, the average population size may be used as denominator.
C. The denominator in a crude rate represents the population at risk for the event.
D. Crude rates are used frequently because they avoid bias in interpretation.
B.
Crude rates are calculated by using the number of events as the numerator. The denominator used may be the average population size or the population size at midyear and not the population at risk. Crude rates are subject to certain biases in interpretation.
The percentage of deaths resulting from a specific cause provides the nurse with information about areas in which public health programs might make significant contributions in reducing deaths. Select the statistic often used for this purpose.
A. Proportionate mortality rate
B. Crude death rate
C. Age-adjusted death rate
D. Standardized mortality rate.
A.
Proportionate mortality rate is calculated using the number of deaths resulting from a specific cause in a specific time period as the numerator and the total number of deaths in the same time period as the denominator. In crude death rates, the numerator is the number of deaths, and the denominator is the average population size or the population size at midyear multiplied by a constant. Age adjustment or standardization reduces bias when there is a difference between the age distributions of two populations.
The health literature accessed by the community health nurse often addresses the probability of an adverse event. What term refers to the likelihood that healthy people exposed to a specific factor will experience a specific health condition?
A. Prevalence
B. Rates
C. Risk
D. Incidence
C.
The term risk refers to the probability of an adverse event. Prevalence is the number of all cases of a specific disease or condition in a population. Rates are arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted. Incidence describes the occurrence of new cases of a disease or condition in a community over a period of time.
Through epidemiologic investigations, effective prevention measures are often identified. When the nurse is engaged in providing prevention for the community before disease has developed, the prevention activities meet the definition for what level of prevention?
A. Primary
B. Secondary
C. Tertiary
D. Pathogenic
A.
Primary prevention occurs when intervention activities take place before disease development. Immunization is an example of primary prevention that provides specific protection. Secondary prevention occurs after pathogenesis, namely screening and physical examinations that are aimed at early diagnosis. Tertiary prevention focuses on rehabilitation and limitation of disability. Pathogenic does not describe a type of prevention.
The public health nurse is working with a specific population and is preparing to participate in a descriptive epidemiology study. Which of the statements apply to descriptive epidemiology? (Select all that apply.)
A. Descriptive epidemiology seeks to answer questions about the amount of disease in a given population.
B. Descriptive epidemiology seeks to answer questions about the cause of disease in a given population.
C. Descriptive epidemiology seeks to answer questions about the cure for disease in a given population.
D. Descriptive epidemiology seeks to answer questions about the distribution of disease in a given population.
A, D
The study of the amount and distribution of disease constitutes descriptive epidemiology. Patterns identified through descriptive epidemiology may indicate possible causes. When these possible causes are investigated with different and more advanced epidemiologic methods, this is analytic epidemiology.