Chapter 7

Question 1

In working as an advocate for specific population groups, the nurses recognize that they are engaging in population-based nursing, which was established by:

a. Florence Nightingale. c. Clara Barton.
b. Faye Abdellah. d. Jane Delano.

Answer 1

A: Nightingale’s actions to improve the health care of soldiers on the battlefield and the poor and infirm in London was directed at vulnerable populations. The primary thrust of this advocacy is directed at population groups. INTRODUCTION

Question 2

The development, provision, and evaluation of multidisciplinary health care services to population groups experiencing increased health risks or disparities in partnership with health care consumers and the community in order to improve the health of the community and its diverse population groups is called:

a. population-focused nursing practice. c. population-based health care practice.
b. population-based nursing practice. d. population-based care.

Answer 2

C: Population-based health care practice is the development, provision, and evaluation of multidisciplinary health care services to population groups experiencing increased health risks or disparities, in partnership with health care consumers and the community in order to improve the health of the community and its diverse population groups. Population-focused nursing practice is defined by nursing activities that focus on all of the people and reflects responsibility to and for the people. Population-based nursing practice is defined as the practice of nursing in which the focus of care is to improve the health status of vulnerable or at-risk population groups within the community by employing health promotion and disease prevention interventions across the health continuum. Population-based care requires active partnership of both providers and recipients of care. POPULATION-BASED HEALTH CARE PRACTICE

Question 3

The nurse recognizes that there are certain variables that increase or decrease the probability of illness or death, and that these variables can be modified. Such variables are called:

a. health determinants. c. vulnerable population groups.
b. underserved. d. health risk factors.

Answer 3

D: Health risk factors are variables that increase or decrease the probability of illness or death. Health risk factors may be modifiable. Health determinants are variables that include biological, psychosocial, environmental, and health system factors that may cause changes in the health status of individuals, families, groups, populations, and communities. Vulnerable population groups are subgroups of a community who are powerless, marginalized, or disenfranchised and are experiencing health disparities. The underserved are those people who have not received adequate medical care services. POPULATION-BASED HEALTH CARE PRACTICE

Question 4

When engaging in population-based health care, a goal of the nurse would be to do which of the following?

a. Maintain access to health care services c. Reduce health care disparities
b. Maintain quality of health care services d. Increase health care delivery costs

Answer 4

C: The goals of population-based health care include reduction of health disparities among different population groups, improvement of access to health care services, improvement of quality of health care services, and reduction of health care delivery costs. POPULATION-BASED HEALTH CARE PRACTICE

Question 5

During the course of practice, the nurse must be aware of the health of an individual, family, group, population, or community, also known as their:

a. health status. c. health needs.
b. quality of life. d. health assets.

Answer 5

A: Health status is the level of health of an individual, family, group, population, or community. Quality of life is the level of satisfaction one has with the condition of one’s life. Health needs is not a level of health. Health assets are health-promoting attributes of individuals, families, communities and systems. POPULATION-BASED HEALTH CARE PRACTICE

Question 6

While caring for a population, the nurse recognizes that differences in health risks and health status that reflect the groups’ poor health status are known as:

a. illness prevention. c. health promotion.
b. health disparities. d. minority health.

Answer 6

B: Health disparities are differences in health risks and health status measures that reflect the poorer health status that is found disproportionately in certain population groups. POPULATION-BASED HEALTH CARE PRACTICE

Question 7

According to the report Healthy People 2020, which of the following has occurred?

a. Significant reduction in both smoking and obesity
b. Significant reduction in smoking cessation
c. Significant reduction in obesity
d. Significant increase in smoking cessation

Answer 7

B: According to the report Healthy People 2020, there has been a significant reduction in smoking cessation. There has also been a significant increase in obesity in the U.S. population during the first decade of this century. POPULATION-BASED HEALTH CARE PRACTICE

Question 8

The nurse understands that the current U.S. Population is a diverse one according to the U.S.Census data for 2005, with what percentage of people identifying themselves as members of an ethnic minority group?

a. 21 percent c. 29 percent
b. 25 percent d. 33 percent

Answer 8

D: The U.S. census reported that 67 percent of the population were non-Hispanic white. The ethnic minority population accounted for 33 percent of the population. CULTURALLY INCLUSIVE HEALTH CARE

Question 9

A staff nurse asks the nurse manager, “How can I tell if our organization provides culturally inclusive health care?” The most appropriate response by the manager is that the organization:

a. includes multiple methods of providing health care.
b. will focus on serving two to three minority populations only.
c. has more men than women in the health care workforce.
d. uses standard interventions for all populations as a safeguard.

Answer 9

A: A culturally inclusive health care system promotes increased awareness of the injustices of the system, will increase the diversity of health care workers, and includes multiple methods of providing health care using a variety of intervention strategies to achieve outcome measures tailored to the diversity of the population groups served. CULTURALLY INCLUSIVE HEALTH CARE

Question 10

As the nurse, if you were going to determine the health status of a community, as opposed to assessing the health system or assessing the population, you would assess which of the following factors?

a. Level of education and socioeconomic status
b. Availability of health resources 24 hours per day
c. Age, gender, and ethnic patterns
d. Housing and safety of neighborhoods

Answer 10

D: Housing and safety of neighborhoods is directly related to community health. Availability of health resources is related to assessing the health system level. Age, gender, and ethnic patterns comprise assessing the individual population level, as well as assessing the level of education and socioeconomic status. TABLE 7-3 POPULATION-BASED HEALTH DETERMINANTS ASSESSMENT TEMPLATE-EXCERPT

Question 11

As nurses whose population-focused efforts involve advocating for the rights of children, the mentally ill, the indigent, and immigrants, these nurses recognize that they are advocating for the same groups as which person who also helped to establish the Children’s Bureau?

a. Dorothea Dix c. Lillian Wald
b. Mary Agnes Snivley d. Isabel Hampton Robb

Answer 11

C: Lillian Wald, well known for her establishment of the Henry Street Settlement, also helped establish the Children’s Bureau. Dorothea Dix was superintendent of the Union Army Nurses. Mary Agnes Snivley formed the Canadian Nurses Association. Isabel Hampton Robb was the first superintendent of the John’s Hopkins Training School. POPULATION-BASED NURSING PRACTICE

Question 12

The nurse recognizes that clients may have strengths and resources that they can use to combat health threats. These strengths and resources are called:

a. protective factors. c. defense mechanisms.
b. activities of daily living. d. holistic interventions.

Answer 12

A: Protective factors are client strengths and resources that can be used to combat health threats. POPULATION-BASED NURSING PRACTICE

Question 13

When a nurse employs population-based interventions that focus on changing the law, the nurse’s interventions are considered at which of the following levels?

a. Community c. Individual
b. Systems d. Group

Answer 13

B: Population-based interventions at the systems level focus practice on changing laws, power structures, policies, and organizations. Population-based interventions at the community level focus practice on changes involving community norms, attitudes, practices, and behaviors. Population-based interventions at the individual level focus practice on changes in the knowledge, attitudes, beliefs, practices, and behaviors of individuals, families, and groups. POPULATION-BASED NURSING PRACTICE INTERVENTIONS

Question 14

The nurse understands that when using a nontraditional model of population-based nursing practice, the primary goal is to:

a. contain costs. c. maintain quality of care.
b. increase costs. d. decrease quality of care.

Answer 14

A: The primary goal of a nontraditional model of population-based nursing practice is to contain or reduce costs. The secondary goal is to improve the quality of care. TRADITIONAL VERSUS NONTRADITIONAL MODEL

Question 15

A nurse implementing a nontraditional population-based nursing practice model would recognize which of the following?

a. The total community is the primary focus.
b. Identifying at-risk or vulnerable population groups is a strategy.
c. An at-risk or high-risk population is the primary focus.
d. Assessing the total community’s needs is a strategy.

Answer 15

C: The nontraditional population-based nursing practice model includes the at-risk or high-risk population as the primary focus. The traditional population-based nursing practice model includes total community is the primary focus. Assessing total community’s needs and identifying at-risk or vulnerable population groups are not population-based strategies. TRADITIONAL VERSUS NONTRADITIONAL MODEL

Question 16

When assessing, diagnosing, planning, implementing, and evaluating nursing practice in a population-based nursing practice, the nurse is using which of the following?

a. NANDA c. Nursing process
b. Comorbidities d. Population assessment

Answer 16

C: The nursing process is used in population-based nursing practice to assess, diagnose, plan, implement, and evaluate nursing practice. The North American Nursing Diagnosis Association (NANDA) develops nursing diagnoses. Population groups may have multiple diagnoses, called comorbidities. Population assessment is structured by using this model as a guide for data collection. APPLICATION OF NURSING PROCESS TO POPULATION-BASED NURSING PRACTICE

Question 17

As a community health nurse, you are planning interventions for the community. Which of the following should be considered first?

a. Interventions must be thoroughly researched to ensure they are evidence based.
b. Interventions must be designed to include specific culturally diverse populations of the community.
c. Key community or population group representatives must be included in the planning.
d. Interventions must be planned to be cost effective and to include complementary therapies.

Answer 17

C: Planning always involves a collaborative process with the clients first to ensure the intervention is designed to fit the specific needs of the clients, to build on assets, to take into account existing resources, and to ensure that follow-through is more likely. Interventions need to be evidence based whenever possible. Cultural diversity should also be taken into consideration when designing interventions. APPLICATION OF NURSING PROCESS TO POPULATION-BASED NURSING PRACTICE

Question 18

In evaluating a population-based nursing practice, the nurse asks, “Did their health status improve?” The nurse asks this question to address which goal?

a. Access c. Cost
b. Quality d. Equity

Answer 18

B: The goal of quality would address the question, “Did their health status improve?” Other questions that would be addressed include “Were their health risks reduced?” and “Were they satisfied with the services they received?” PROGRAM EVALUATION

Question 19

In evaluating a population-based nursing practice, the nurse asks, “Were patients able to afford what we had to offer?” The nurse would ask this question to address which of the following goal?

a. Access c. Cost
b. Quality d. Equity

Answer 19

C: The nurse’s question—“Were patients able to afford what we had to offer?”—focuses on cost. Questions related to access would focus on finding and providing services to high-risk, underserved, vulnerable populations. Questions of quality would relate to changes in health status as a result of interventions, and questions related to the goal of equity would focus on the use of resources to meet the needs of the population. PROGRAM EVALUATION

Question 20

In evaluating a population-based nursing practice, the nurse asks, “Did we offer service regardless of age, gender, race, ethnicity, health care status, or location?” The nurse asks this question to address which goal?

a. Access c. Cost
b. Quality d. Equity

Answer 20

A: The goal of access would address the question, “Did we offer service regardless of age, gender, race, ethnicity, health care status, or location?” Questions of quality would relate to changes in health status as a result of the interventions. Questions related to the goal of equity would focus on the use of resources to meet needs, and questions related to cost would focus on affordability. PROGRAM EVALUATION

Question 21

In evaluating a population-based nursing practice, the nurse asks, “Did we have enough resources left over to meet the essential health needs of lower-risk population groups?” The nurse asks this question to address which goal?

a. Access c. Cost
b. Quality d. Equity

Answer 21

D: The goal of equity would address the question, “Did we have enough resources left over to meet the essential health needs of lower-risk population groups?” Questions related to quality would focus on changes in health status as a result of interventions. Questions related to the goal of access would focus on providing services regardless of age, gender, race, ethnicity, and health care status. Questions of cost would focus on affordability. EVALUATION

Question 22

The local nursing program has opened a nurse-run health clinic. Services at the clinic will be available to poor, minority families who have not benefited from the services that have been accessible in their community. The nursing program is primarily addressing which of the goals of Healthy People 2020?

a. Create social and physical environments that promote good health for al
b. Attain high quality, long lives free of preventable diseases, disability, injury, and premature death.
c. Achieve health equity, eliminate disparities, and improve the health of all groups.
d. Promote quality of life, healthy development and healthy behaviors across all life stages.

Answer 22

C: The nursing program is addressing the Healthy People 2020 goal of achieving health equity, eliminating disparities, and improving the health of all groups. This nurse-run clinic will address the health disparities that exist. Research has documented that the needs of poor, minority individuals have not been sufficiently addressed. POPULATION-BASED HEALTH CARE PRACTICE

Question 23

A group of community health nurses provides services to pregnant adolescents who come from families living below the poverty level. The adolescents are living in communities with high infant mortality rates, high crime and drug rates, and very few prenatal clinics. The nurses are practicing which type of health care?

a. Population-based health care c. Long-term health care
b. Acute health care d. Short-term health care

Answer 23

A: Population-based health care involves the development, provision, and evaluation of care services to population groups experiencing increased health risks and disparities, in partnership with health care consumers and the community, in order to improve the health of the community and its diverse population groups. POPULATION-BASED HEALTH CARE PRACTICE

Question 24

A nurse works in a local, free community clinic. The nurse uses an assets-based approach, in which the community group’s strengths and resources are identified first. The nurse’s approach facilitates which of the following?

a. Development of partnerships c. Ultimate power of the community agency
b. Ultimate power of the nurse d. Development of a contract

Answer 24

A: An assets-based approach lends itself to identifying how the community can manage its own health needs by building on community and population group strengths and resources. Identifying assets and resources would be one of the first steps to developing a partnership. In a true partnership, neither the nurse nor the community have all of the power because it is a mutual relationship. TABLE 7-5 NURSING PROCESS APPLIED TO POPULATION-BASED NURSING-ASSESSMENT EXAMPLES

Question 25

A nurse wanting to determine the health status of a community would most likely do which of the following?

a. Identify the number of hospitals in the community
b. Review the crime statistics for the community
c. Speak with the ministers and teachers in the community
d. Examine the morbidity and mortality rates of the community

Answer 25

D: To determine the health status of the community, the nurse should examine morbidity and mortality rates for the community. Other indications of the community’s health status may include birth and death rates, life satisfaction inventories, and lifestyle functioning measures. TABLE 7-8 NURSING PROCESS APPLIED TO POPULATION-BASED NURSING-EVALUATION ELEMENTS

Question 26

According to a 2010 report from the Institute of Medicine (IOM), by 2045 half of the people in the United States will be:

a. Hispanic Americans.
b. African Americans.
c. Asian Americans.
d. Members of racial minority population groups.

Answer 26

D: According to the IOM, by 2045 half of the people in the United States will be members of racial minority population groups. This includes Hispanic Americans, African Americans, and Asian Americans combined with other racial minority population groups. No one racial minority population group will represent half of the population. POPULATION-BASED HEALTH CARE PRACTICE