Test 2

Question 1

After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information?
A) It influenced the speed with which health-focused bills passed the legislature.
B) The report set up the organizational structure of the U.S. Public Health Service.
C) It emphasized sanitary progress, forming the basis for current public health practice.
D) It de-emphasized the issues addressed in the Hebrew hygienic code

Answer 1

Ans: C
Feedback:
The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress by addressing public health concepts and methods that form the basis of public health practice today. It did not affect getting bills passed by legislation, nor was it involved in setting up the organizational structure of the U.S. Public Health Service.
The Hebrew hygienic code, probably the first

Question 2

Over the past century, many health-related changes have occurred, affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply.
A) High levels of chronic disease
B) Shortened life spans
C) Increased teen pregnancies
D) Abuse of multiple substances
E) Increased maternal mortality
F) Multidrug-resistant diseases

Answer 2

Ans: A, C, D, F
Feedback:
Issues today include high levels of chronic disease, an increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today. With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today do not exist.

Question 3

During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community’s healthcare needs. Which of the following would the nurse include as a current societal event?
A) Large disparity in male/female wages
B) Rural to urban migration
C) Rampant child labor
D) Widespread violence

Answer 3

Ans: D
Feedback:
Today, society is faced with widespread violence and terrorism. Populated urban areas continue to lose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago, child labor laws were just forming, and child labor was rampant.

Question 4

When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the
understanding that these agencies are
A) voluntary.
B) tax-supported.
C) proprietary.
D) privately funded.

Answer 4

Ans: B
Feedback:
Official health care agencies, later called public health agencies, are tax-supported; thus, they must provide services determined by the federal, state, or local government. Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for
profit or nonprofit.

Question 5

After describing the Public Health Service to a group of students, which description would
indicate the need for additional discussion?
A) It offers consultation through national
advisory health councils and special advisory committees made up of lay experts.
B) The Secretary of Health and Human Services
is ultimately responsible for it.
C) The Secretary of Health and Human Services
is an elected position.
D) A major function is to administer grants and
contracts with other government agencies.

Answer 5

Ans: C
Feedback:
The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.

Question 6

provision of care to clients in a clinic setting
at the local health department. This nurse is engaging in which core public health function?
A) Clinical
B) Assessment
C) Policy development
D) Assurance

Answer 6

Ans: D
Feedback:
The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community; policy development would involve helping to establish policies that will address the problems assessed; and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical care is not a core public health function.

Question 7

Which of the following statements about the
core public health functions are true?
A) Public health nurses practice as partners with other public health professionals within these
core functions.
B) Assessment involves the actual provision of services.
C) Policy development relates to assessment.
D) Assurance means that the public health agency must directly provide the needed services.

Answer 7

Ans: A
Feedback:
Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that population-based services are provided, whether by public health agencies or private sources.

Question 8

Which one of the following groups of actions fulfills the three core public health functions in their proper order?
A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school
B) Identifying a source of pollution in the community, educating residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution
C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for pregnant adolescents
D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer

Answer 8

Ans: A
Feedback:
The three core public health functions are assessment, policy development, and assurance. Assessment is data collection; policy development would be based on the assessment; and assurance is the process of translating established policies into services. Counting the number of fully immunized kindergarten students would be an assessment; encouraging the school officials to exclude children who are not fully immunized would be policy development; and offering immunization clinics at the school would be an assurance. Identifying a source of pollution in the community would require assessing and educating residents about precautions that should be taken when the pollution exceeds minimum standards, which would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance; determining how many pregnant adolescents currently attend the school would be assessment; and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance. Lobbying for a citywide ban on smoking in public would be policy development; providing smoking cessation services in the community would be assurance; and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.

Question 9

A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health?
agencies? Select all that apply.
A) American Diabetes Association
B) The U.S. Public Health Service
C) The National Institutes of Health
D) Women, Infants, and Children Program (WIC)
E) National Society for Autistic Children
F) Planned Parenthood Federation of America

Answer 9

Ans: A, E, F
Feedback:
The American Diabetes Association, the National Society for Autistic Children, and the Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and nonprofit organizations. The
U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies that receive federal funds to
operate; thus they are not voluntary agencies.

Question 10

Which of the following best describes a
public health care agency?
A) The agency most often has a very specific
focus.
B) The agency is responsible for promoting and protecting the health of all within its jurisdiction.
C) The agency only employs nurses and
environmental health practitioners.
D) The agency can perform its work
independently with complete autonomy.

Answer 10

Ans: B
Feedback:
Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish the broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and inter-organizational collaboration.

Question 11

Which of the following statements best describes the difference between the function of public sector health care agencies and
private-sector health care agencies?
A) Private sector health services are complementary and supplementary to government health agencies.
B) Public-sector healthcare agencies usually meet the needs of people with special needs.
C) Private sector health agencies are usually constrained in developing innovations in health care.
D) Public health sector agencies generally satisfy the healthcare needs of a community.

Answer 11

Ans: B
Feedback:
Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private-sector healthcare agencies usually meet the needs of people with special needs, rather than public-sector healthcare agencies that focus on the entire population within their jurisdiction. Private-sector healthcare agencies are less constrained than public-sector healthcare agencies in developing innovations in healthcare. A part of the reason for the development of private-sector healthcare agencies is the impatience or dissatisfaction with government (public health) programs.

Question 12

Which of the following statements best describes the difference between the function of public sector health care agencies and
private-sector health care agencies?
A) Public-sector healthcare agencies are more likely to pilot or subsidize demonstration projects.
B) Private-sector healthcare agencies are more
likely to promote health legislation.
C) Public-sector healthcare agencies are more likely to generate new research and innovation.
D) Private sector health care agencies usually
focus on needs that are met.

Answer 12

Ans: B
Feedback:
Private-sector health agencies are more likely to promote health legislation, whereas public-sector health care agencies are more likely to be responsible for carrying out health legislation. Private-sector healthcare agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private-sector healthcare agencies strive to detect unmet
needs rather than meeting needs.

Question 13

Which of the following statements about the International Health Organization is most accurate?
A) PAHO is completely separate from the WHO.
B) UNICEF promotes child and maternal health
and welfare globally.
C) WHO focuses primarily on developing
countries.
D) WHO and UNICEF are agencies of the
United Nations.

Answer 13

Ans: B
Feedback:
The United Nations International Children’s Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from the WHO. WHO focuses on the promotion of health worldwide, not just in developing countries. The United States Agency for International Development (USAID) focuses on developing countries. WHO and UNICEF are both agencies of the United Nations.

Question 14

An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans?
A) Social Security Act
B) Hill-Burton Act
C) Patient Protection and Affordable Care Act
D) Omnibus Budget Reconciliation Act

Answer 14

Ans: C
Feedback:
The Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs and the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), the Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in healthcare planning, safety, and funding.

Question 15

A group of students is preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true:? Select all that apply.
A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions.
B) The Shepard-Towner Act provided funds to
states for hospital construction.
C) The Hill-Burton Act provided funds to states for the administration of programs to support the health and welfare of mothers and infants.
D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance.
E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four
block grants.
F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.

Answer 15

Ans: A, D, and E
Feedback:
The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill-Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for the administration of programs to support the health and welfare of mothers and infants. The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the
privacy of medical records.

Question 16

A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, Why do I need to know this information? My focus is my clients. Which response by the presenter would be most appropriate?
A) You are required to know this information because your agency receives government funding.
B) You might be in management one day and have to deal with cost control and reimbursement. economics
C) Although it seems foreign to you, it’s an important topic that you might have to deal with someday.
D) This knowledge is important to the success of your practice and to the agency’s survival.

Answer 16

Ans: D
Feedback:
At the local level (the community health nurse and the employing agency), healthcare economics is very important for survival.
Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable.
Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of healthcare economics

Question 17

When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of
The following would the nurse include?
A) Quantity of services available
B) Consumer’s willingness to buy services
C) Aggregate perspective of economic stability
D) Allocation of the available resources

Answer 17

Ans: C
Feedback:
Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumption, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer’s willingness to buy services) and studies how allocation and distribution affect consumer demand for
goods and services.

Question 18

As part of a community-wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse
include in the plan? Select all that apply.
A) It is a state health insurance program for
elderly and the disabled.
B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services.
C) Medicare Part D covers prescription drug costs.
D) Medicare Part A is supplementary and voluntary.
E) Medicare beneficiaries can make changes to their coverage at any time.

Answer 18

Ans: B, C
Feedback:
Medicare is a federal health insurance program that covers citizens and some legal aliens who are over 65 years old (not a state program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. Prescriptions are covered under Medicare Part
D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to their coverage during open enrollment periods.

Question 19

After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional
Is teaching necessary?
A) Medicaid has a monthly fee that recipients
must pay.
B) Medicaid is administered by each state.
C) Medicaid focuses on preventative services.
D) It is possible to be on both Medicare and
Medicaid.

Answer 19

Ans: A
Feedback:
Medicaid funds come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined based on financial need and residency status. Finally, some low-income
Medicare-eligible people also receive Medicaid.

Question 20

What does a health nurse identify as a drawback to retrospective reimbursement? A) Spending was limited to the most necessary
tests and treatments.
B) Services for sickness were encouraged rather than wellness.
C) Consumers had to bear the increased
accountability for cost containment.
D) Payments for services were based on rates
calculated from predictions.

Answer 20

Ans: B
Feedback:
Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illnesses and providing additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatments. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.

Question 21

Which of the following statements about trends and issues influencing healthcare economics and community health services
delivery are true? Select all that apply.
A) The United States has the most cost-effective
health care system in the world.
B) One explanation for the high cost of the US healthcare Care System is the need to practice defensive medicine by ordering excessive
tests and x-rays.
C) In the United States, the health-related quality
of life is lower than in most other countries.
D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated.
E) In a survey published in 2009, most US physicians identified that their health care system worked well.

Answer 21

Ans: B, C, and D
Feedback:
The United States has one of the least cost-effective health care systems in the world. One explanation for the high cost of the US healthcare system is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than in most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system
worked well.

Question 22

Which of the following statements about
What care rationing is most accurate?
A) It will not occur in the United States because
of our country’s values.
B) The danger of rationing is that it compromises quality and effectiveness.
C) Rationing in health care has never been
practiced.
D) Advances in knowledge and technological
capabilities will eliminate the need for rationing in the future

Answer 22

Ans: B
Feedback:
The danger of rationing is that it compromises quality and effectiveness. Rationing has already been practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing decisions.

Question 23

When describing managed competition as a potential solution to resolve the healthcare crisis, which of the following would be
included? Managed competition would
A) promote cost containment and universal
access to health care.
B) eliminate burdensome government
regulations.
C) reduce state and federal control over health
care delivery.
D) discourage consumers from making
responsible choices.

Answer 23

Ans: A
Feedback:
Managed competition would ideally promote cost containment and universal access to health care. Governmental regulations and control would still be present, as would insurance companies. Managed care would encourage consumers to make responsible choices.

Question 24

Which statement regarding the potential
Which impact of health care reform on community health nursing is most accurate? A) Healthcare reform does not affect community
health nursing.
B) Community health nurses know that outcome research is unnecessary.
C) Public health nurses can lead the effort to make health care more accessible to all citizens.
D) Community health nurses will only be able to work in public health agencies.

Answer 24

Ans: C
Feedback:
Public health nurses can lead the effort to make health care more accessible to all citizens. Healthcare reform affects community health nursing. Community health nurses recognize the importance of outcome research to document the value of nursing interventions with at-risk populations.
Community health nursing has important ties
to both private and public health agencies.

Question 25

An instructor is discussing the worldwide distribution of AIDS. Which term would the instructor use to describe this situation? A) Epidemic B) Pandemic C) Endemic D) Pathogenicity

Answer 25

Ans: B Feedback: Pandemic is the term used to describe an epidemic that is distributed worldwide. An epidemic refers to a disease occurrence that exceeds the normal frequency in a community or region. Endemic is used to describe the continuing presence of a disease or infectious agent in a given geographic area. Pathogenicity refers to an agent's capacity to cause disease in a host.

Question 26

After a class describing the contributions of Florence Nightingale to epidemiology, the instructor determines that the class needs additional instruction when they state which of the following is associated with Nightingale? A) Establishment of the need for a clean environment B) A sophisticated coding system for medical conditions C) Proper wound cleansing and bandaging techniques D) Separation of infected individuals from those injured

Answer 26

Ans: B Feedback: Nightingale's colleague, William Farr, is credited with developing a more sophisticated system for coding medical conditions. Nightingale's contributions included establishing the need for a clean environment, properly cleaning wounds and bandaging them, and separating infected soldiers from those who were injured.

Question 27

When applying the epidemiologic triad model to a community's plan of care, which of the following would the community health nurse address? A) Incidence, prevalence, and case fatality B) Health, illness, and injury C) Host, agent, and environment D) Immunity, causation, and risk

Answer 27

Ans: C Feedback: The epidemiological purpose of this model is to demonstrate the relationship among host, agent, and environment. Each component has to be present to a certain degree for any disease, illness, or injury to exist or happen. If one component is missing, illness or injury will not occur. Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are terms used in epidemiology but do not refer to the epidemiologic triad model.

Question 28

Which of the following would the community health nurse identify as a key component of the host? A) Infectivity B) Antigenicity C) Virulence D) Inherent resistance

Answer 28

Ans: D Feedback: The host, a susceptible human or animal, can sometimes have the ability to resist pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are characteristics of the agent

Question 29

Which of the following statements apply to the concept of causality? Select all that apply. A) Causality is the relationship between cause and effect. B) The chain of causation is the most recent theory of causality. C) The web of causation theory is the most recent theory of causality. D) The chain of causation clearly explains causation in noninfectious diseases. E) Epidemiology has changed its view of causality over time.

Answer 29

Ans: A, C, and E Feedback: Causality is the relationship between cause and effect. The web of causation theory is the most recent theory of causality. Epidemiology has changed its view of causality over time. The chain of causation was the first theory of causality. The chain of causation could not sufficiently explain causation in noninfectious diseases because the chain of causation is too linear.

Question 30

A community health nurse is explaining the chain of causation to a family that includes a child who has developed Lyme disease. The nurse correctly describes the opening in the child's skin caused by the actual tick bite as the A) reservoir. B) mode of transmission. C) portal of entry. D) host

Answer 30

Ans: C Feedback: The opening in the child's skin caused by the actual tick bite is the portal of entry in the chain of causation. The mode of transmission would be the tick biting the child. The reservoir would refer to the tick. The host would be the child who has been bitten by the tick.

Question 31

A community health nurse is integrating the epidemiology of wellness into practice. Which of the following would the nurse include? A) Lifestyle with its self-created risks B) Communicable disease control C) The natural history of disease D) Vital statistics and reportable diseases

Answer 31

Ans: A Feedback: Today, there is an increased focus on lifestyle behaviors and how they relate to a person's state of wellness or illness. It is a basic component of a wellness model. Communicable disease control focuses on an illness state, not a wellness state, and is not part of a wellness model. The four states of the natural history of a disease or health condition are not part of the wellness model. Vital statistics and reportable diseases are not part of the wellness model.

Question 32

The nurse is examining the possibility that multiple factors are involved in the development of a disorder. The nurse is applying which of the following? A) Chain of causation B) Web of causation C) Strength of association D) Temporality

Answer 32

Ans: B Feedback: The web of causation is being used to apply the concept of multiple causes to explain the existence of health and illness states. It was a refinement of the chain of causation, such that it looked at the combination of multiple factors as implicated in the development of poor outcomes. The chain of causation focuses on one factor in the development of a condition. The strength of association is an element of causation in noninfectious diseases that refers to the ratio of disease rates in those with and without the causal factor. Temporality, also involved with the causation of noninfectious diseases, is an element in which exposure to the suspected factor must precede the onset of the disease.

Question 33

The nurse is reviewing a research article that describes the use of the bacille Calmette Guerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to leprosy. The individuals did not develop leprosy. The nurse interprets this as most accurately demonstrating which type of immunity? A) Herd immunity; B) Passive immunity C) Cross-immunity D) Active immunity

Answer 33

Ans: C Feedback: Cross-immunity refers to a situation in which a person's immunity to one agent provides immunity to a related agent as well. This immunity can be active or passive. Herd immunity describes the immunity level present in a population group. Passive immunity refers to short-term resistance acquired either naturally or artificially. Active immunity is long-term and can be acquired naturally or artificially.

Question 34

The nurse educator knows that a nursing student understands the basics of immunity when the student nurse states A) Herd immunity only pertains to cows. B) Active immunity can be attained via the use of vaccines. C) passive immunity can be attained through the use of vaccines. D) Cross-immunity is immunity that causes a person who is immune to one disease to also be immune to a completely different infectious agent.

Answer 34

Ans: B Feedback: Active immunity can be attained through the use of vaccines. Passive immunity is immunity that is given to a person, either by maternally provided protection for newborn infants or from antibody products that provide temporary resistance. Herd immunity describes the immunity level that is present in a population group. Cross-immunity is immunity that causes a person who is immune to one disease to also be also immune to a related infectious agent.

Question 35

When assessing several populations, the nurse notes each population's relative risk. Using the relative risk ratios below, which population would require a major emphasis for risk reduction intervention? A) 0.59 B) 1.13 C) 1.79 D) 2.45

Answer 35

Ans: D Feedback: A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group. Therefore, interventions to reduce this population's risk would be most important.

Question 36

Which of the following statements about risk is true? Select all that apply. A) Risk is the probability that a disease or unfavorable health condition will develop. B) Risk means that the person who has the most Negative influences will definitely develop the disease or unfavorable health condition. C) Risk refers to positive and negative influences on a person's likelihood of developing a specific disease. D) Risk can be measured using the relative risk ratio, which is based on the ratio of incidence in an exposed group to the incidence rate in an unexposed group. E) Risk is unimportant when determining the most effective points for community health intervention.

Answer 36

Ans: A, C, and D Feedback: Risk is the probability that a disease or unfavorable health condition will develop. Risk also refers to positive and negative influences on a person's likelihood of developing a specific disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an exposed group to the incidence rate in an unexposed group. Risk does not mean that the person who has the most negative influences will definitely develop the disease or unfavorable health condition; it refers to the probability that the person will develop the disease or unfavorable health condition. The relative risk ratio assists in determining the most effective points for community health intervention in regard to particular health problems.

Question 37

While visiting a family's home, the community health nurse finds out that the two children in the home were exposed to chickenpox. Assessment of the children reveals no signs of fever or lesions. The nurse determines that the children may be in stage of the disease? A) Susceptibility B) Subclinical disease C) Clinical disease D) Resolution

Answer 37

Ans: B Feedback: The children have been exposed but have not yet developed the signs of chickenpox. Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is not present, and individuals have not been exposed. During the clinical stage, signs and symptoms are beginning to develop. During the resolution stage, the disease causes sufficient anatomic or functional changes to produce recognizable signs and symptoms.

Question 38

For a communicable disease, would quarantine be most effective? A) Susceptibility stage B) Subclinical disease stage C) Clinical disease stage D) Resolution stage

Answer 38

Ans: B Feedback: Quarantine is the isolation of persons who are susceptible to a communicable disease and have been exposed to that communicable disease until the incubation period of the subclinical disease stage has passed. Quarantining people during the susceptibility stage itself is not indicated, as individuals have not been exposed. The proper action for people who are in the clinical disease stage and beyond is isolation until the danger of spreading the communicable disease has passed.

Question 39

The nurse is reviewing actual census data for information for use in an epidemiologic study. Which of the following would the nurse be least likely to find? A) Occupational status B) Housing quality C) Births recorded D) Educational level

Answer 39

Ans: C Feedback: Vital statistics data provides information about the number of births recorded. The census includes information about age, sex, race, ethnic background, type of occupation, income gradient, marital status, educational level, and other standards such as housing quality. If the nurse is reviewing actual census data, she is least likely to find births recorded, which is vital statistics.

Question 40

on the use of nursing home services and the common diagnoses of those using these services. Which source of information would be most appropriate for the nurse to investigate? A) National Center for Health Statistics B) Consumer Product Safety Commission C) Environmental Protection Agency D) Cancer disease registries

Answer 40

Ans: A Feedback: The National Center for Health Statistics provides valuable health prevalence data from surveys of Americans. Among the information available is the National Nursing Home Survey, which provides information on those who are using these services, their diagnoses, and other characteristics. The Consumer Product Safety Commission and Environmental Protection Agency would provide information about environmental issues. Cancer disease registries would provide information specific to the diagnosis of cancer.

Question 41

Which of the following is true about incidence and prevalence? Select all that apply. A) Prevalence is the number of new cases of a disease or health condition. B) Incidence is the number of new cases of a disease or health condition. C) Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. D) Incidence refers to all of the people with a particular health condition existing in a given population at a given point in time. E) When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

Answer 41

Ans: B, C, and E Feedback: Incidence is the number of new cases of a disease or health condition. Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

Question 42

A community health nurse is preparing to carry out an experimental epidemiologic study. Which of the following would be most important for the nurse to do? A) Focus the study on evaluating the cause of a disease B) Ensure carefully controlled conditions during the study C) Expose both groups to the same factor or condition D) Ensure that there are a substantial number of subjects

Answer 42

Ans: B Feedback: Experimental studies are carried out under carefully controlled conditions. In human populations, experimental studies should focus on disease prevention or health promotion rather than testing the cause of disease. The investigator exposes an experimental group to some factor and simultaneously observes a control group similar in characteristics to the experimental group but without the exposure factor. An experimental study need not be elaborated to provide important data.

Question 43

A community health nurse is participating in a case-control observational study. Which of the following would most likely explain this? type of study? A) Description of patterns of occurrence of illness and injury in a population; B) Investigation of development of health illnesses conditions over a long period of time C) Studying of a cohort with evaluation of variables associated with the disease or injury D) Comparison of persons with and without a Health and illness conditions

Answer 43

Ans: D Feedback: Comparing people with and without a certain condition is known as a case-control study. A study that describes patterns of occurrence in a population is a descriptive study. Following people over a long period of time is a longitudinal study. And cohorts are groups studied over time.

Question 44

After teaching a group of students about the various types of epidemiologic research studies that can be done, the instructor determines that the teaching was effective when the students describe a community trial as which of the following? A) A type of experimental study conducted at the community level B) An inexpensive type of analytic research study C) A study that gathers volunteers for the experimental group D) A way to locate health problems in a variety of communities

Answer 44

Ans: A Feedback: A community trial is conducted as an experimental study with large populations. Some of the community receives treatment, while the other part does not. This is probably the most expensive type of experimental study. It involves a great number of subjects, the support of the governmental forces as well as the population involved, a large number of staff over a long period of time, and the cost of the intervention itself. When a whole community is involved, individuals are not approached to be volunteers. What makes it a community study is that the entire community is part of the study. The health problem was identified prior to the implementation of the study. The introduction of an intervention in one community with no introduction in a similar community forms the study population, and the health problem being studied is then monitored between the two populations. The health problem has to be identified first in this type of study.

Question 45

When using descriptive epidemiology, which type of study would the community health nurse expect to include? A) Prevalence study B) Case-control study C) Cohort study D) Count study

Answer 45

Ans: D Feedback: Descriptive epidemiology includes investigations that seek to observe and describe patterns of health-related conditions that occur naturally in a population. The simplest measure of a description is a count. Prevalence, case-control, and cohort studies are types of studies involved with analytical research.

Question 46

epidemiologic study from the first step to the last. A) Collect the data. B) Identify the problem. C) Analyze the findings. D) Disseminate the findings. E) Review the literature. F) Develop conclusions and applications. G) Design the study.

Answer 46

Ans: B, E, G, A, C, F, D Feedback: The proper order of the steps in the epidemiologic study from the first step to the last is to identify the problem, review the literature, design the study, collect the data, analyze the findings, develop conclusions and applications, and disseminate the findings.

Question 47

When implementing an epidemiologic research study, which of the following would the community health nurse complete as the final step? A) Analyze the data B) Design the study C) Disseminate findings D) Review the literature

Answer 47

Ans: C Feedback: The last step in the research process is to disseminate the findings. After identifying the problem and reviewing the literature, the researcher designs the study, collects the data, analyzes the findings, and develops conclusions and applications.

Question 48

When reporting the identification of a communicable disease and need for investigation, which of the following must be notified first? A) Centers for Disease Control (CDC) B) State health department C) Local health department D) National Reported Disease list

Answer 48

Ans: C Feedback: The local health department is the initial point of notification for a communicable disease investigation. Each local health department or agency will investigate the specific disease. The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as guidance for State reportable diseases

Question 49

Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that apply. A) Immunization of children and adults B) Disease investigation and case/contact finding C) Diagnosing cases of communicable diseases D) Prescribing treatment for communicable diseases E) Environmental interventions F) Community Education

Answer 49

Ans: A, B, E, F Feedback: Appropriate interventions that may be implemented by community health nurses include immunizations of children and adults, environmental interventions, community education, screening programs, and disease investigation and case/contact finding.

Question 50

Which of the following statements accurately describes the important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply. A) Review the information received from the news media reporter for completeness B) Review disease information, including the reservoir, incubation period, infectious period, symptoms, and treatment C) Take all appropriate treatments to the interview site D) Investigate only laboratory-confirmed communicable diseases E) Eradicate the disease

Answer 50

Ans: A, B Feedback: Steps to take prior to contacting an individual regarding communicable disease include reviewing the information received from the reporters for completeness (this refers to the individual reporting the communicable disease to the public health agency and not the news media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition;review the disease information (including reservoir, incubation period, infectious period symptoms, and treatment); and identifying the specific questionnaire for the reported disease orusing a generic disease investigation form and reviewing the questionnaire. It is not appropriate for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory-confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding a communicable disease is one of the first steps in the process of investigation.

Question 51

Which of the following entities would the community health nurse know are required to report known or suspected cases of reportable diseases in every state in the United States? Select all that apply. A) Physicians, dentists, and nurses B) Laboratory directors C) Any individual who knows of or suspects the existence of a reportable disease D) Medical examiners E) Administrators of schools and child care centers

Answer 51

Ans: A, D, E Feedback: In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; and administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors, and any individual who knows of or suspects the existence of a reportable disease.

Question 52

A community health nurse is presenting a program about hepatitis prevention and risk reduction to a local community group. The nurse determines that the group has understood the program when they identify which method is the major mode of transmission for hepatitis B? A) Oral-fecal route B) Exposure to contaminated blood C) Airborne droplet nuclei D) Infected rodents, such as mice and rats

Answer 52

Ans: B Feedback: Hepatitis B can occur in certain high-risk groups, including injected drug users, heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal-oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is transmitted via infected rodents.

Question 53

When reviewing the trends in communicable diseases for a county, the community health nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan for prevention and control, integrating the understanding that this disease is most likely transmitted by which mode? A) Vector B) Airborne C) Vehicle-borne D) Direct

Answer 53

Ans: A Feedback: In the United States, vector-borne illnesses have received renewed attention with accumulating information about Lyme's disease, transmitted to humans by a tick vector. Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host, such as through touching. biting, kissing, or sexual intercourse.

Question 54

After a community health nurse implements an educational program for a local community group about food safety, which statement indicates that the teaching was successful? A) Handwashing is unnecessary if we use gloves. B) After cooking the meat, we'll put it on the same platter that we used for the raw meat. C) Our cooked foods should be cooled quickly. D) If we peel the carrots, we don't need to wash them before eating.

Answer 54

Ans: B Feedback: Cooled foods should be cooled quickly. Surfaces, hands, and utensils should be washed in warm, soapy water (even when gloves are used, gloves do not prevent cross-contamination). Foods, when cooked, should not come into contact with dishes, utensils, or containers used when the foods were raw and uncooked. Foods that are to be eaten raw and uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are to be peeled that grow on the ground or come in contact with soil.

Question 55

A community health nurse is teaching a group of clients about infection control and mentions the role of vectors in transmitting diseases. Which of the following would be examples? of some common vectors? Select all that apply. A) Chemicals B) Mosquitoes C) Salmonella D) Fleas E) Roaches

Answer 55

Ans: B, D, E Feedback: A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not vectors and Salmonella is an infectious agent.

Question 56

Which of the following statements about modes of transmission are true? Select all that apply. A) Direct transmission requires contact with a contaminated, inanimate material. B) Indirect transmission is also known as vehicle-borne illness. C) Food- and water-related illnesses are considered to be spread by indirect transmission. D) Vector transmission requires contact with a nonhuman carrier, such as an animal or insect. E) Airborne transmission commonly occurs from coughing and sneezing.

Answer 56

Ans: B, C, D, E Feedback: Direct transmission occurs by immediate transfer of infectious agents from a reservoir to a new susceptible host. Indirect transmission requires contact with a contaminated inanimate material and is also known as vehicle-borne illness. Food- and water-related illnesses are considered to be spread by indirect transmission. Vector transmission requires contact with anonhuman carrier such as an animal or insect. Airborne transmission commonly occurs from coughing and sneezing.

Question 57

Community health nurses practice within the three levels of prevention. Which of the following would the community health nurse engage in at the primary level of prevention for communicable disease control? Select all that apply. A) Providing TB skin test to children entering kindergarten B) Administering immunizations to senior citizens C) Teaching kindergarten students to wash their hands D) Encouraging parents to complete their children's immunizations E) Providing chest x-rays to people with positive TB skin tests F) Administering prompt treatment for the symptoms of gonorrhea

Answer 57

Ans: B, C, and D Feedback: Primary prevention interventions include administering immunizations, teaching about hand washing, and encouraging adherence to the recommended schedule for childhood immunizations. Providing TB skin testing and chest x-rays and promptly treating symptoms of gonorrhea are examples of interventions at the secondary level of prevention.

Question 58

The nurse educator has just discussed the education of aggregates using mass media with targeted health messages. Which of the following statements by the nursing student would demonstrate the student's ability to analyze and apply the information? A) Television would be the most important venue of mass media to educate the general public, as everyone has a television. B) The target audience must be assessed for educational level, salience of the issue, involvement in the issue, and access to the media channel used. C) Pamphlets should be assessed to make sure They are at a twelfth grade reading level. D) It is unnecessary to consider culture when planning the health message.

Answer 58

Ans: B Feedback: To effectively deliver a health promotion and disease-prevention message, the message must reach the target (at-risk) population. This requires correct identification of the characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and access of the target audience to the media channels used. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease prevention message to ethnic and racial minority groups. Television may not be the most important venue for mass media to educate the general public. Pamphlets may not be the best way to educate the aggregate, and the reading level of any literature must be specific for the target audience. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease prevention message to ethnic and racial minority groups.

Question 59

A community health nurse has identified the index case. The nurse is involved in which of the following? A) Contact investigation B) Screening C) Isolation D) Quarantine

Answer 59

Ans: A Feedback: The index case (diagnosed person) results from contact investigation and partner notification. Screening describes programs that deliver a testing procedure to detect disease in groups of asymptomatic, apparently healthy individuals. Isolation refers to the separation of the infected person from others for a period of communicability to limit transmission; quarantine refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period. Contact investigation and notification is one of two approaches to secondary prevention of communicable diseases.

Question 60

The three main approaches to the tertiary Prevention of communicable disease includes which of the following? A) Education, immunization, and screening B) Screening, immunization, isolation and quarantine C) Case and contact investigation, notification, and treatment D) Care and treatment, isolation and quarantine, and safe handling and control of infectious wastes

Answer 60

Ans: D Feedback: The three main approaches to the tertiary prevention of communicable disease include care and treatment, isolation and quarantine, and safe handling and control of infectious wastes. The primary prevention techniques for communicable disease include education, immunization, and screening. The secondary prevention techniques for communicable disease include case and contact investigation, notification, and treatment.

Question 61

If an agency discards used needles and syringes in plastic milk jugs, which of the four key elements of an infectious waste management program that are applicable to community practice would the agency be violating? A) Health professionals must be able to correctly distinguish biohazardous waste from biomedical waste. B) The waste management program must have administrative support and authority to institute practice guidelines. C) Handling of the infectious wastes must be minimized. Containers should be rigid, leak-resistant, and impervious to moisture. D) An enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

Answer 61

Ans: C Feedback: The handling of infectious waste must be minimized. Containers should be rigid and leak-proof. resistant and impervious to moisture; they should have sufficient strength to prevent rupture or tearing under normal conditions; and they should be sealed to prevent leakage. Containers for sharps must also be puncture-resistant. Other key elements of an infectious waste managementprogram that are applicable to community practice include that health professionals must be able to correctly distinguish biohazardous waste from biomedical waste; the waste management program must have administrative support and authority to institute practice guidelines; and an enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

Question 62

The community health nurse determines that the adult population in the community has an increased incidence of vaccine-preventable disease. Which of the following are factors that may contribute to low vaccination levels among adults? Select all that apply. A) Lack of comprehensive vaccine delivery systems to the public and private sectors for adults (similar to the Vaccines for children) program for children) B) Lack of statutory requirements for vaccination of adults C) Health care providers may lack current information about recommended adult immunizations and may miss opportunities to vaccinate adults during contacts in offices, outpatient clinics, and hospitals. D) Adults fear injections for immunizations but do not worry about adverse effects after vaccination. E) A multitude of comprehensive vaccination programs exist in settings where healthy Adults congregate at workplaces and other locations.

Answer 62

Ans: A, B, C Feedback: Low vaccination levels among adults are associated with several factors: limited comprehensive vaccine delivery systems that are available; lack of statutory requirements for vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts in offices, outpatient clinics, and hospitals. Additionally, there is a lack of comprehensive vaccination programs in settings where healthy adults congregate, and clients and providers may fear adverse reactions after vaccination.

Question 63

A community health nurse would recommend pneumococcal vaccine for which group? A) 1-year-old children B) 30-year-old adults who have simple respiratory tract infections C) Adults over 65 who have COPD D) Healthy adults in their 50s

Answer 63

Ans: C Feedback: Primary prevention includes a pneumococcal vaccine, especially for high-risk groups. ages 2 years old and up, including those with chronic diseases, immune-suppressing health conditions, or those who are asplenic. Reimmunization is recommended only for high-risk children or adults over 65 years old who had their first vaccination before age 65. The vaccine is not effective in children younger than 2 years of age and is not recommended for the healthy population between the ages of 2 and 65 years.

Question 64

Which of the following statements about Is immunization the most accurate? A) Immunization is helpful in the spread of all communicable diseases. B) Immunization cannot provide herd immunity. C) Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. D) Immunization is the process of administering antibodies to a person.

Answer 64

Ans: C Feedback: Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. There are many communicable diseases that a vaccine is not known for. Immunization can help to promote herd immunity. Immunization does not involve the administration of antibodies to a person

Question 65

A family member has developed tuberculosis (TB) and the remainder of the family members are undergoing tuberculosis skin testing to determine their status. The nurse assesses the indurations and determines that a family member with which size induration is positive for TB. A) 2 mm B) 3 mm C) 4 mm D) 5 mm

Answer 65

Ans: D Feedback: An induration of 5 mm or more is considered positive for individuals in close contact with others who have TB. Indurations <5 mm are not considered positive.

Question 66

The community health nurse observes an increase in the development of multidrug resistant tuberculosis. The nurse understands that a major reason for this occurrence is individual clients would most likely be A) political and social response to declining rates of TB over the past decade. B) a reduction in funding for surveillance and research. C) noncompliance with the therapy for the full, recommended period. D) a premature sense that TB has been defeated.

Answer 66

Ans: C Feedback: On an individual-case basis, the most common means by which resistant organisms are acquired by noncompliance with therapy for the full, recommended period. Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include the political and social response to declining rates of TB over past decades, which has resulted in funding cuts for surveillance, treatment, and research, and a premature sense that TB was defeated.

Question 67

Which of the following statements about the prevention of sexually transmitted diseases is true? Select all that apply. A) Many people who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. B) Screening programs have actually reduced the incidence of Chlamydia as infected people are identified and treated. C) The proper use of condoms prevents transmission of all sexually transmitted infections. D) Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other sex partners if sexual contact is only practiced when the person does not have any visible sores.

Answer 67

Ans: A, B, D Feedback: Many people who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. Screening programs have actually reduced the incidence of Chlamydia, as infected persons are identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection transmission but does not eliminate the transmission of all sexually transmitted infections. It is possible for a person who has HSV-2 infection to transmit the infection to other sexual partners if Sexual contact is practiced even when the infected partner does not have a visible sore.

Question 68

Which one of the following statements is true about the consequences of biologic terrorism with anthrax and smallpox? A) Anthrax is not usually spread by person-to-person contact, so is not a good agent of biological terrorism. B) Smallpox is globally eradicated and therefore does not present a problem. C) Most adults are immune to smallpox due to routine immunization. D) As many as one in five persons who become ill with cutaneous anthrax die, and inhaling anthrax can cause death in 3 to 5 days.

Answer 68

Ans: D Feedback: The case-fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial The symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and expected death within a matter of days. Anthrax is not usually spread by person-to-person contact, but it has been demonstrated to be an agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist attacks. Many adults are not immune to smallpox as it has not been used for routine immunization for 40 years.

Question 69

Which of the following statements about Confidentiality, privacy, and discrimination are the most accurate. A) It is permissible for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. B) It is permissible for a community health nurse to tell the contacts of a person who is infected with a communicable disease, which disease they have been exposed to, and the name of the source. C) It is permissible for any health care provider to report any cases of known or suspected communicable diseases to the news media. D) Only the identity of the index case of a communicable disease needs to be protected.

Answer 69

Ans: A Feedback: It is permissible and necessary for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. It is important that the contacts of a person who is infected with a communicable disease, which they have been exposed to, are not acceptable for the community health nurse to reveal the identity of the source. It is permissible and often helpful for a community health nurse to involve the news media in informing the public of information about the specific disease, including mode of transmission, prevention, and treatment options, but not the identities of the cases. It is important to assure the individual being interviewed that the information will be maintained in a confidential manner and that the goal is care and treatment.

Question 70

A community health nurse is presenting an in-service for a group of other community health nurses about the ecological perspective of environmental health. Which of the following would the nurse incorporate into the program? when describing this concept? A) The study of governmental and private sector regulations of the environment B) A technological view of strategies for preventing illness and injury C) Identification of not only the physical environment but also the social and cultural factors that exist for populations D) The role of the community health nurse in preventing injury, disease, and illness

Answer 70

Ans: C Feedback: The ecological perspective identifies not only the physical environment but also the social and cultural factors that exist for populations. Nurses who display this type of approach provide a more comprehensive level of care. It is not a study of the governmental and private sector regulations, a technological view, or the nurse's role in preventing injury, disease, and illness.

Question 71

When applying the ecological perspective to environmental health, a community health nurse integrates which of the following concepts as most essential? A) Primary prevention is limited in this area. B) The need for foresight in designing innovations C) No one factor can be viewed in isolation. D) Implications of scientific advances are fully understood.

Answer 71

Ans: C Feedback: With the ecological perspective, no one factor can be viewed in isolation. The preventive approach involves all three levels of prevention, of which primary prevention is the most important. This approach also requires foresight in designing innovations and involves implications associated with the unprecedented advances in science and technology.

Question 72

Which of the following concepts is used by public health professionals to illustrate that the determinants of health interact to affect health? A) Precautionary principle B) Ecological perspective C) Sustainability D) Upstream focus

Answer 72

Ans: B Feedback: The ecological perspective is used by public health professionals to illustrate that the determinants of health interact to affect health. The precautionary principle states that in the absence of clear data that indicates the safety of an action, chemical, or material that poses a threat to human health, it should not be used. Sustainability is the ability to meet the needs the present without compromising the ability of future generations to meet their own needs. Upstream focus identifies the root causes of disease and manufacturers of illness.

Question 73

Which of the following statements about an Upstream focus is the most accurate? A) The upstream approach does not focus on socioeconomic factors and the environmental origins of disease and health problems. B) The focus of an upstream approach is the institution and system level. C) The upstream approach pertains to the purity of water supplies. D) The focus of an upstream approach is healthy lifestyle issues.

Answer 73

Ans: B Feedback: The focus of an upstream approach is at the institution and system level, not just healthy lifestyle issues. The upstream approach does focus on socioeconomic factors and the environmental origins of disease and health problems. The upstream approach does not pertain to the purity of water supplies.

Question 74

When the public health nurse uses an upstream approach to improve heart health, the nurse would examine which one of the following factors? A) Unhealthy diets B) Decreased physical activity C) Smoking tobacco D) Lack of safe places to exercise

Answer 74

Ans: D Feedback: The upstream approach focuses on factors at the institutional and system level rather than looking at healthy lifestyle issues. Healthy diets, increased physical activity, and smoking cessation are all healthy lifestyle issues The root causes of the decreased physical activity would include a lack of safe places to exercise.

Question 75

A public health nurse who uses the upstream approach would likely focus on which one of the following contributors to unhealthy diets: in the community? A) Consumer preference for sweet, greasy, and salty foods B) Marketing strategies of fast food businesses C) Busy lifestyles within the community D) Individual acceptance of obesity

Answer 75

Ans: B Feedback: A public health nurse who uses the upstream approach would likely focus on factors that are at the institutional and system level rather than looking solely at healthy lifestyle issues. Consumer preference for sweet, greasy, and salty foods; busy lifestyles within the community; and individual acceptance of obesity are lifestyle issues. The marketing strategies of fast food businesses are one root cause of unhealthy diets in the community.

Question 76

The nursing student is preparing a report for class relating to Healthy People 2020 and environmental health. Which of the following should be included in this report? Select all that apply. A) The agency that prepared this initiative is the World Health Organization. B) The overall goal is to

Answer 76

Ans: B, D, E Feedback: The overall goal of Healthy People 2020 is to promote health for all through a healthy environment. The document does provide guidance for nurses to identify targets for health (not instructions for individuals). The six areas that are focused on include outdoor air quality, surface and ground water quality, toxic substances and hazardous wastes, homes and communities, infrastructure and surveillance, and global environmental health. The agency that prepared this initiative is the U.S. Department of Health and Services.

Question 77

Which one of the following statements about assessment (one of the core public health functions) and how it can be applied to What environmental health is most accurate? A) Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs. B) Assessment is least valuable when related to where the person attends school. C) It is not necessary for nurses to have a background in the environmental health sciences. D) Assessment should be limited to the general population and should not include the increased vulnerability of certain groups.

Answer 77

Ans: A Feedback: Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs. With assessment, priority should be given to locations where people spend the majority of their time (home, work, school). Where persons attend school is too limiting as many people do not go to school and the priority should be given to home and work. The ability to perform critical assessments for environmental health requires background in the environmental health sciences. Public health nurses must also be aware of the increased vulnerability of certain groups.

Question 78

The core public health function of policy development related to environmental health includes which one of the following? A) Policy development is best left to legislators. B) To be an effective advocate for change, it is only necessary that the nurse speak out. C) There are many ways for public health nurses to participate in policy development related to environmental health. D) Public health nurses are public servants and therefore cannot advocate for public policy.

Answer 78

Ans: C Feedback There are many ways for a public health nurses to participate in policy development related to environmental health that start with the nurse being informed about the hazards in the community, existing legislation that protects people in the community, and governmental and nongovernmental groups in communities that can be partners in the efforts to protect health They may write letters to their legislators, inform community members, and write letters to the editors of local newspapers and periodicals. Nurses can also present testimony at public forums or hearings. Policy development is not best left to legislators. It is important for nurses to advocate for policy development to care for the environment. Public health nurses are public servants, and that is why they must advocate for policy development that favors the environment.

Question 79

A community health nurse is enacting policy development by preparing a presentation for a group of state health officials about the issue of water pollution in the United States. Which of The following would the nurse include? Select all that apply. A) Globally, the availability of clean water is becoming a very serious threat to human survival. B) Water pollutants consist solely of chemicals. C) Recently, there has been an increase in concern about pharmaceuticals contaminating water supplies. D) All water that is to be consumed is regulated through the EPA. E) The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised.

Answer 79

Ans: A, C, E Feedback: Globally, the availability of clean water is becoming a very serious threat to human survival. Recently, there has been an increase in concern about pharmaceuticals contaminating water supplies. The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised. Water pollutants consist of organic and inorganic chemicals, contamination with microbes, pharmaceuticals, pesticides and insecticides, and radionuclides. The EPA only regulates public water systems.

Question 80

A community health nurse is working with the local health departments to educate the citizens about the effects of radon exposure and its link to possible illness. Which of the following would the nurse identify as being a major health concern associated with radon? A) Skin cancer B) Lung cancer C) Diarrhea D) Cardiovascular disease

Answer 80

Ans: B Feedback: Radon is a leading cause of death from lung cancer. Skin cancer is associated with sun exposure. Diarrhea and cardiovascular disease are not associated with radon exposure.

Question 81

During a community program about food safety, a participant asks,

Answer 81

Ans: D Feedback: There are many possible risks to the food supply, some even having more serious effects than food-borne illness. Risks occur at all points from food production to food consumption. Radiating food does occur in the United States. A recent concern has been raised about genetically modified foods being marketed. Genetically modified foods may interfere with the safety of food for human consumption and also questions about the ecological impact and sustainability have been raised.

Question 82

Which of the following groups of people have increased vulnerability to environmental hazards to human health related to food? Select all that apply. A) Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins to the unborn fetus. B) Persons who have altered immunity are more likely to be affected by food exposures. C) Middle-aged males D) Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size. E) Adult women who are non-childbearing

Answer 82

Ans: A, B, D Feedback: Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins to the unborn fetus. Persons who have altered immunity are more likely to be affected by food exposures. Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size. Middle-aged males and adult women who are non-childbearing adults are not especially vulnerable to environmental hazards to human health.

Question 83

Which of the following are variables that occur in nature and could have a negative impact on humans? Select all that apply. A) The effect of climate change upon weather extremes (droughts, floods, and storms) B) Changes in rainfall and water supply for soil C) Ecology of microbial growth D) Risks for waterborne and food-borne pathogens in drinking water, seafood, and fresh produce because of climate variability E) There is adequate food supply and always will be.

Answer 83

Ans: A, B, C, D Feedback: The variables related to the food supply that occur in nature and could have a negative impact on humans include the effect of climate change upon weather extremes (droughts, floods, and storms); changes in rainfall and water supply for soil; ecology of microbial growth; and risks for water-borne and food-borne pathogens in drinking water, seafood, and fresh produce because of climate variability. There are currently food shortages in parts of the world, and this is likely to continue and may worsen.

Question 84

An instructor is reviewing the evolution of environmental health and the development of various agencies designed to protect health. As part of the review, the instructor includes the Environmental Protection Agency (EPA), describing its primary goal as which of the following? A) Identify and address world health issues B) Protect occupational safety and health C) Monitor food and drug production and availability D) Set standards and monitor and enforce environmental protection

Answer 84

Ans: D Feedback: The EPA was established for the purpose of standard setting, monitoring, and enforcement of environmental protection. The World Health Organization (WHO) identifies and addresses world health issues. The Occupational Safety and Health Administration (OSHA) protects occupational safety and health. The Food and Drug Administration (FDA) is responsible for monitoring food and drug production and availability.

Question 85

When educating clients, which of the following parts of the communication process would be most important for the nurse to ensure? A) Limit setting B) Feedback loop C) Goal direction D) Nonverbal expression

Answer 85

Ans: B Feedback: A major component of the communication process is the feedback loop, which allows both the sender and the receiver to check on the success of the transference of meaning and to renegotiate the message to allow for clarity and better understanding. Limit setting may or may not be appropriate. Although therapeutic communication is goal directed and involves nonverbal expressions, these are not parts of the communication and they are not as important as making sure the message has been understood correctly.

Question 86

A community health nurse sends an e-mail stating a request to the local health department. This is an example of which part of communication? A) Sender B) Message C) Decoding D) Channel

Answer 86

Ans: D Feedback: A channel is the medium through which the sender conveys the message. It may be written, spoken, or nonverbal. Sending an e- mail is an example. The sender is the person conveying the message. The message is the expression of the purpose of the communication. Decoding is the translation of the message into an understandable form by the receiver.

Question 87

Which of the following steps of the communication process does the community health nurse who is serving as the sender have the most control of? Select all that apply. A) The receiver B) The decoding C) The message D) The channel E) The feedback loop F) The encoding

Answer 87

Ans: C, D, F Feedback: The community health nurse who is serving as the sender in the communication process has the most control over the sender, the message, the channel (the medium through which the sender conveys the message), and the encoding (the sender decides which specific signals or codes such as language, words, gestures, and body language to use). The community health nurse does not have much control over the receiver, the decoding (the receiver's interpretation of the message), or the feedback loop (a way for the sender and receiver to check on the success of the transference of meaning and to renegotiate the message to allow for clarity and better understanding), all of which are controlled by the receiver.

Question 88

Which of the following would a community health nurse identify as most important to the skills involved with communication? A) Active listening B) Paraphrasing C) Nonverbal messages D) Rapport

Answer 88

Ans: C Feedback: Sending skills involve the ability to transmit messages effectively. There are two main channels for sending messages: nonverbal and verbal. Active listening and paraphrasing are involved with receiving skills. Rapport is an interpersonal skill.

Question 89

When communicating with a group of clients, which of the following would the nurse identify as a barrier to the communication process? A) The nurse's sharing of complete and accurate information with the clients B) The clients' use of medical terminology in the discussion C) The clients' offering of feedback to allow the nurse to learn what the client understands D) The clients' interpretation of the message through their own perceptions

Answer 89

Ans: D Feedback: Selective perception is the interpretation of a message through their own perceptions, and projects this onto the communication process as they decode a message. Sharing complete and accurate information, client's use of medical terminology, and the clients' offering of feedback to allow the nurse to learn what the client understands are important skills of effective communication.

Question 90

A community health nurse is dealing with a family in crisis. The nurse remains calm and firmly reassuring when communicating with them. This nurse is avoiding which barrier to communication? A) Filtering information B) Emotional influence C) Language barrier D) Selective perception

Answer 90

Ans: B Feedback: The nurse is avoiding emotional influence, that is, how a person feels at the time a message is sent or received, which can influence its meaning. Senders can distort messages, and receivers can interpret messages incorrectly when emotions cloud their perception. Emotions can interfere with rational and objective reasoning, thus blocking communication. Filtering information means manipulating information by the sender to influence the receiver's response. Language barriers involve the different interpretations of words by people. Selective perception involves the receivers interpreting a message through their own perceptions, which are influenced by their own experiences, interests, values, motivations, and expectations.

Question 91

Which of the following statements about filtering messages is most accurate? A) Filtering is always intentional. B) Filtering is never intentional. C) Only clients use filtering. D) Filtering leads to miscommunication and misinterpretation.

Answer 91

Ans: D Feedback: Filtering leads to miscommunication and misinterpretation. Filtering can be intentional or unintentional and may be used by clients or nurses.

Question 92

During an interview with several clients, the community health nurse assumes responsibility for and strives to understand the feelings and thoughts of the client. The nurse is demonstrating which of the following? A) Reflection B) Respect C) Empathy D) Active listening

Answer 92

Ans: D Feedback: Active listening is the skill of assuming responsibility for and striving to understand the feelings and thoughts in a sender's message. The nurse actively works to discover what the clients mean. Reflection involves restating what clients or others have said to clarify the received meaning. Respect involves conveying an attitude that clients and others have importance, dignity, and worth. Empathy is the ability to communicate understanding and to vicariously experience the feelings and thoughts of others.

Question 93

Which action by a community health nurse demonstrates respect to the client? A) Feeling the same emotion that the client has B) Addressing the client as Mr. or Mrs. C) Being open and genuine with the client D) Having self-awareness

Answer 93

Ans: B Feedback: Showing respect means conveying the attitude that clients and others have importance, dignity, and worth, such as by the manner in which the nurse addresses people, for instance, by using the courtesy titles of Mr. or Mrs. until it is determined how the client wants to be addressed. Putting one's self in the client's shoes demonstrates empathy; this is not the same as feeling the same emotion that the client has. Being open and genuine establishes rapport. Having self-awareness is a part of empathy that allows an individual to accurately demonstrate this understanding to the client.

Question 94

Which one of the following statements about health literacy and health outcomes is most accurate for clients who have low literacy? A) It is important to make the message as basic and simple as possible because the client likely has low intelligence. B) It is best to use written materials for clients who have low literacy. C) It is very important for clients who have low literacy to have ample opportunity to provide feedback. D) Health literacy is not a very important factor in mortality and morbidity.

Answer 94

Ans: C Feedback: It is very important for clients who have low literacy to have ample opportunity to provide feedback that will demonstrate understanding. Communication with low-literacy, high-risk groups should be simplified with easy-to-read materials. At the same time, there is the danger of making the communication so simple that the reader feels insulted. It has been well documented that most health information pamphlets, brochures, and other materials cannot be read or comprehended by adults who have low literacy. Those who have the lowest literacy levels have the highest mortality and morbidity.

Question 95

Which of the following are key issues related to health literacy? Select all that apply. A) Health literacy is characterized as critical to health promotion and disease prevention. B) Limited health literacy only affects those who have low educational levels. C) Poor health literacy skills can contribute to increased health care costs. D) Health literacy involves the ability to read, understand, and act on health information. E) Health literacy goes beyond the basic definitions of literacy.

Answer 95

Ans: A, C, D, E Feedback: Health literacy is characterized as critical to health promotion and disease prevention. Limited health literacy affects people of all races, incomes, ages, and educational levels. Poor health literacy skills have been associated with poorer health status and increased health care costs because people with a low literacy level are less knowledgeable about their health conditions and are less likely to seek preventative care. Health literacy involves the ability to read, understand, and act on health information. Health literacy goes beyond the basic definitions of literacy and includes cultural literacy, computer literacy, scientific, media, and technological literacy.

Question 96

While working with a community group, a community health nurse observes the group sharing ideas and opinions and being creative. The nurse determines that the group is in which stage? A) Forming B) Storming C) Norming D) Performing

Answer 96

Ans: C Feedback: During the norming stage, trust and openness are more apparent, and there is a sharing of ideas and opinions and creativity. The formation stage is characterized by members becoming oriented toward each other. The storming stage involves conflict and competition with the group getting down to sharing more sensitive issues. The performing stage is characterized by the ability to work as

Question 97

Which of the following descriptions of the five stages of group development is accurate? Select all that apply. A) All groups eventually reach the performing stage. B) The storming stage is detrimental to group development. C) Loss of group affiliation often occurs with adjourning. D) The group begins to focus more on maintenance than just tasks during the norming stage. E) Conflict is inherent in the forming stage.

Answer 97

Ans: C, D Feedback: During the adjourning stage, the group must disengage, and this may cause feelings of loss. The group begins to focus more on maintenance than just tasks during the norming stage. Not all groups reach the performing stage. The storming stage is necessary to allow group members to identify roles and expectations and get a feel for how the group will work together. Conflict is to be avoided at the forming stage but must occur at the storming stage.

Question 98

A community health nurse is part of a group dealing with health issues. During one of the meetings, the nurse states, Let's all take about 5 minutes to share ideas so that everybody will have a chance to be heard. The nurse is demonstrating which of the following? A) Encouraging B) Gatekeeping C) Blocking D) Mediating

Answer 98

Ans: B Feedback: The nurse is demonstrating the maintenance role behavior of gatekeeping by trying to make it possible for another member to make a contribution to the group, such as by saying, We haven't heard from Jim yet, or by suggesting limited talking time for everyone so that all will have a chance to be heard. Encouraging is demonstrated by being friendly, warm, and responsive to others, praising others and their ideas, and agreeing with and accepting the contributions of others. Blocking is demonstrated by going off on a tangent, citing personal experiences unrelated to the problem, arguing too much on a point, or rejecting ideas without consideration. Mediating involves attempts to harmonize, conciliate differences in point of view, or suggest compromises.

Question 99

A community health nurse working as part of a group uses the group as a sounding board, often expressing personal, non-group feelings. This nurse is demonstrating which of the following nonfunctional behaviors? A) Self-confession B) Aggression C) Competition D) Sympathy-seeking

Answer 99

Ans: A Feedback: Self-confession involves using the group as a sounding board, expressing personal, nongroup-oriented feelings or points of view. Aggression involves working for status by criticizing or blaming others, showing hostility toward the group or some individual and deflating the egos or status of others. Competition involves vying with others to produce the best idea, talk the most, play the most roles, and gain favor with the leader. Sympathy seeking involves trying to induce other group members to be sympathetic to one's problems or misfortunes, for example, by deploring one's own situation or disparaging one's own ideas to gain support.

Question 100

When the community health nurse encourages the group members of a collaborative partnership of interdisciplinary teams to effectively share ideas and frustrations on an equal, reciprocal basis, the community health nurse is focusing on which of the five characteristics of collaboration in community health? A) Maximized use of resources B) Clear responsibilities C) Shared goals D) Mutual participation

Answer 100

Ans: B Feedback: When the community health nurse encourages the group members of a collaborative partnership of an interdisciplinary team to effectively share ideas and frustrations on an equal, reciprocal basis, the community health nurse is focusing on the mutual participation characteristic. The characteristic of maximized use of resources involves designing the collaborative partnership of those who are most knowledgeable and in the best positions to influence a favorable outcome. The characteristic of clear responsibilities involves each member of the partnership playing a specific role with related tasks. The characteristic of shared goal involves each member of the team entering the collaborative relationship with broad needs or purposed to be met and specific objectives to accomplish.

Question 101

A collaborative community health group working with the teenage population to improve health draws on the expertise of school nurses and others working with adolescents to develop a plan. The group is demonstrating which characteristic of collaboration? A) Shared goals B) Mutual participation C) Maximized use of resources D) Clear responsibilities

Answer 101

Ans: C Feedback: Maximizing the use of community resources involves drawing on the expertise of those who are most knowledgeable and in the best positions to influence a favorable outcome. In this case, it would be school nurses and others working with adolescents. Shared goals are demonstrated by recognition of the specific reasons for entering into the relationship, that is, the improved health of adolescents. Mutual participation involves the reciprocal exchange among team members, with all team members contributing and receiving mutual benefit. Clear responsibilities involve each member playing a specific role with related tasks.

Question 102

Several community health agencies are collaborating on health promotion strategies. The community health nurse observes that the team is working on assessment, planning, implementation, and evaluation. The nurse correctly concludes that A) The team is made up solely of nurses. B) The team is in the beginning phase. C) the team is determining the goals they will work toward. D) the team is working together to accomplish desired goals.

Answer 102

Ans: D Feedback: The three phases common to the collaboration process are the beginning phase, when the team relationship is being established and are identifying the project needs and determining the goals toward which they will work. The second phase occurs when team members start working together to accomplish the desired goals. The work of the second phase may include assessment, planning, implementation, and evaluation that will recur cyclically until the goals are satisfactorily accomplished. The third phase occurs when the need for team members to work together has ended.

Question 103

The student nurse correctly identifies the four characteristics of contracting as: Select all that apply. A) format. B) partnership and mutuality. C) negotiation. D) commitment. E) legal fees.

Answer 103

Ans: A, B, C, D Feedback: The four features of contracting in community health nursing are partnership and mutuality, commitment, format, and negotiation. Legal fees are not involved, as contracting in community health nursing is not legally binding.

Question 104

When the nurse and client enter a contract in community health nursing, the nurse and client participation and agreement between them, which characteristic of the contract is being enacted? A) Partnership and mutuality B) Commitment C) Format D) Negotiation

Answer 104

Ans: A Feedback: The four features of contracting in community health nursing are partnership and mutuality (the nurse and the client share participation and agreement), commitment (the involved parties make a decision that binds them to fulfilling the purpose of the contract), format (outlining of specific terms of the relationship), and negotiation (the parties propose to accept certain responsibilities that are agreed upon by both parties).

Question 105

Contracting would be effective to use with client groups based on the understanding that this method is beneficial for which of the following? A) Encouraging client participation in the decision-making process B) Contributing to a trusting nurse or client relationship C) Decreasing client stress during home visits D) Reducing client visit time by over 50%

Answer 105

Ans: A Feedback: The nurse and the client contribute to the formulation of the contract, thus fostering client participation in decisions regarding the direction and activities within the contract. Contracting also involves commitment, format, and negotiation. Contributing to trust, decreasing client stress, and reducing visit time are not considered benefits associated with contracting.

Question 106

A community health nurse is contracting with a client receiving services in the home. The nurse and client are negotiating the activities for which each will be responsible. This correlates with which phase of the nursing process? A) Assessment B) Nursing diagnosis C) Planning D) Evaluation

Answer 106

Ans: C Feedback: Dividing responsibilities via negotiation would be part of the planning/intervention phase of the nursing process. The assessment phase would involve an exploration of needs. The nursing diagnosis phase would correlate with goal establishment. The evaluation would involve formative and summative assessments of progress toward goals and renegotiation or termination.

Question 107

After teaching a group of students about the process of contracting, which statement by the group indicates successful teaching? A) The process is dynamic as it moves through various phases. B) Contracting involves a unidirectional client-nurse relationship. C) The process must move backward before it can move forward. D) Once the contract is developed, it remains relatively stable.

Answer 107

Ans: A Feedback: Contracting is a dynamic process that moves through phases. It forms a reciprocal relationship between clients, nurses, and other people. The process moves forward, focused on meeting clients' needs, and enables the collaborating group to facilitate ultimate achievement of clients' goals.

Question 108

After teaching a class about the stages of change, the instructor determines that the class understands the information when they identify the following as the proper sequence of stages? A) Unfreeze, plan, and integrate B) Plan, organize, and coordinate C) Plan, relearn, and integrate D) Unfreeze, change, and refreeze

Answer 108

Ans: D Feedback: According to Lewin, change occurs in the following stages: unfreezing the old behavior, implementing the change, and then refreezing the new change in place to integrate it into the system. Planning, relearning, integrating, and coordinating are not stages of change.

Question 109

When implementing a program for teaching parenting to a group of teenagers, the community health nurse determines that the group is in the changing/moving stage of change when the group demonstrates which of the following? A) Motivation for change B) Integration of the change C) Lack of resistance to the change D) Beginning adoption of the change

Answer 109

Ans: D Feedback: During the changing or moving stage, people experience a series of attitude transformations, ranging from early questioning to full acceptance and commitment to accomplishing the change. They examine, accept, and try the innovation and the nurse helps them see the value of the change, encourages them to try it, and assists them in adopting it. Motivation for the change is part of the unfreezing stage. Showing a lack of resistance to the change and integration of the change characterize the refreezing stage.

Question 110

A client who needs to lose weight as part of an overall plan to become healthier has contracted with a nurse for behavior change. The client is working on increasing fruits and vegetables in his or her diet and currently consumes less than one fruit or vegetable per day. The nurse knows that the client is in the unfreezing stage of change when the client stated: A)

Answer 110

Ans: A Feedback: In the first stage, a disequilibrium develops and the system is more vulnerable to change. People in this stage have a sense of dissatisfaction and have a void that they would like to fill. When the client stated,

Question 111

A community health nurse is applying the normative3reductive strategy of change when working with clients. In doing so, the nurse engages them into changing their behavior in addition to providing education, based on which assumption? A) Information alone is not enough, and behaviors change through persuasion. B) Compliance by the client system will occur through the use of power to effect change. C) People are rational and will adopt a new practice because it is in their best interest. D) The clients can assume a high degree of responsibility for their own help.

Answer 111

Ans: A Feedback: Normative3reductive strategies not only give information but also directly influence people to change attitudes and behaviors through persuasion. Use of power or coercion is associated with the power3coercive change strategy. The Empiric3rational change strategy is based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest. The empiric3rational strategy is best used with clients who can assume a relatively high degree of responsibility for their own health.

Question 112

The community health nurse is presenting sexuality education to a group of sixth grade students. The community health nurse tells the students that they must never have unprotected sexual intercourse or they will die from a sexually transmitted infection and displays pictures of people dying from AIDS. The nurse is using which change strategy? A) Normative3reeducative B) Rational3empiric C) Power3coercive D) Planned change

Answer 112

Ans: C Feedback: The community nurse in this scenario is using power3coercive change strategies that are based on fear. Normative3reeducative change strategies present new information and directly influence people's attitudes and behaviors through persuasion. Empiric3 rational change strategies are based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest.

Question 113

As part of a community-wide program addressing the needs of seniors in the county, the nurse engages the seniors as well as their families in the program. The nurse is demonstrating which principle for effecting positive change? A) Participation B) Proper timing C) Resistance to change D) Interdependence

Answer 113

Ans: A Feedback: The principle of participation requires involvement of the persons who will be affected by the change. The principle of proper timing requires that it be the right time to introduce the change. The principle of resistance to change involves responding to the instinctive nature of the desire to preserve the status quo because change poses a threat to stability and security. The principle of interdependence requires the view that every system has many subsystems intricately related such that a change in one part of the system may affect other parts.

Question 114

unsuccessful attempts before quitting 1 year ago today. The nurse decides to share this information with the group and tells them that all the attempts he or she had made before stopping smoking were necessary steps for his or her eventual success. Which principle of change was the nurse enacting? A) Principle of flexibility B) Principle of self-understanding C) Principle of interdependence D) Principle of proper timing

Answer 114

Ans: B Feedback: The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it. The principle of flexibility is the ability of the change agent to adapt to unexpected events and make the most of them. The principle of interdependence is that a change in one part of a system affects other parts and a change in one system may affect other systems. The principle of proper timing relates to the knowledge that even the right change may not occur if the timing is not right.

Question 115

The community health nurse is talking to a group of clients about the health importance of consuming a low-fat diet. The clients are members of a particular cultural group that grows their own food and consumes a lot of animal protein. The clients state that their forefathers ate a diet that was high in animal protein and they had lived into their 90s. The community health nurse expects this argument and points out that their ancestors did not have the luxury of modern machines and they had to engage in a lot more activity than the current generation. This is an example of which principle of effecting change? A) Principle of participation B) Principle of proper timing C) Principle of self-understanding D) Principle of resistance to change

Answer 115

Ans: D Feedback: The nurse was aware that all systems instinctively resist change and was prepared to discuss aspects of the clients' cultural background that related to their current state of health. This is the principle of resistance to change. The principle of participation means that persons affected by the proposed change should participate as much as possible in every step of the planned change process. The principle of proper timing requires that it be the right time to introduce the change. The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it.

Question 116

Which of the following are examples of a community health nurse providing health promotion teaching? Select all that apply. A) The community health nurse teaches a class of kindergartners how to properly wash their hands. B) The community health nurse is a guest on a radio talk show to provide information how to avoid an infection that is endemic. C) The community health nurse encourages an individual whose blood pressure screening was elevated to have his or her blood pressure rechecked in 1 week D) The community health nurse teaches a group of preschoolers about different fruits and vegetables that they might like to try. E) The community health nurse teaches a mother and baby exercise group. F) The community health nurse leads a group of stroke survivors in soft exercise.

Answer 116

Ans: A, D, E Feedback: Health promotion is behavior that is motivated by the desire to increase well-being and actualize human potential. This is different from disease prevention/health protection, which is behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. The activities of teaching a class of kindergartners how to properly wash their hands, teaching a group of preschoolers about different fruits and vegetables that they might like to try, and teaching a mother and baby exercise group are focused on well- being and not a particular illness. The activities of being a guest on a talk show to provide information how to avoid an infection that is endemic, encouraging an individual whose blood pressure screening was abnormal to have their blood pressure rechecked in 1 week, and leading a group of stroke survivors in soft exercise are focused on avoiding specific illnesses and not on improved general health.

Question 117

Which of the following statements most accurately describes the nurse's role as an educator related to the social determinants of health? A) The nurse must focus on individual behavior and encourage people to take responsibility for their own behavior. B) The nurse must examine one or two factors that contribute to our state of health. C) The nurse must look at the root causes of disease and health inequities. D) The nurse must lecture people about what is right and wrong behavior.

Answer 117

Ans: C Feedback: Community health nurses must look at the social determinant of health as the root causes of disease and health inequities. This requires that nurses look beyond the individual behavior and have a broader scope of what underlies illness.

Question 118

A community health nurse has been teaching nutrition to a group of seniors in a local senior center. After attending the nurse's class on nutrition, the nurse determines the group's cognitive level of learning. Which of the following indicates knowing? A) Comparing the nutrient value in foods B) Eating well-balanced meals C) Planning recipes that are low in fat D) Naming three foods high in iron

Answer 118

Ans: D Feedback: Naming three foods reflect the knowledge level of the cognitive domain of learning. Comparing nutrient values reflects analysis; eating well-balanced meals reflects application; and planning recipes reflects synthesis.

Question 119

A teaching plan for a group of new mothers has the following objective:

Answer 119

Ans: C Feedback: At the application level, the learner not only understands the material but can apply it to new situations, transferring understanding into practice. This is reflected by words such as practice, demonstrate, use, illustrate, and employ. Knowledge level learning would be reflected by words such as define, repeat, list, name, or recall. Comprehension level learning would be reflected by words such as restate, describe, explain, identify, and discuss. Analysis level learning would be reflected by words such as distinguish, debate, question, compare, examine, or calculate.

Question 120

Which of the following interventions by the nurse is most likely to have a positive influence on the client's adoption of a new healthy behavior? A) Providing feedback about what the client is doing incorrectly B) Providing feedback about what the client is doing correctly C) Not providing feedback D) Not providing role modeling of the desired change

Answer 120

Ans: B Feedback: The nurse who recognizes clients' participation in a group praises them for completing assignments or commends them for sticking to diet plans will have more success than the nurse who only criticizes failures.

Question 121

To ensure learning in the psychomotor domain, which of the following would be most important for the nurse to ensure about the learner? A) Has a sensory image of how to do the skill B) Has the ability to perform the necessary skill C) Is willing to listen to the information about the skill D) Can continue to practice the skill independently

Answer 121

Ans: B Feedback: For psychomotor learning to occur, the nurse must ensure that the learner is physically, intellectually, and emotionally capable of performing the skill. Otherwise, the other two conditions, having a sensory image and practicing the skill, would not occur. A willingness to listen is an important aspect for all learning, especially learning in the affective domain.

Question 122

A community health nurse develops a written teaching plan for a community education program about nutrition and salt-reduction. Which objective would reflect synthesis learning in the cognitive domain? A) The client will create an enjoyable meal using low-sodium foods. B) The client will compare the salt content in a.variety of packaged foods. C) The client will practice eating meals that contain low-sodium foods. D) The client will list foods that are low in sodium.

Answer 122

Ans: A Feedback: Synthesis, the fifth level of cognitive learning, is the ability not only to break down and understand the elements of a situation but also to form elements into a new whole. Synthesis combines all of the earlier levels of cognitive learning to culminate in the production of a unique plan or solution. The objective with the verb create demonstrates this level. Being able to compare foods of varying salt content reflects analysis. Practicing eating meals demonstrates application. Listing foods demonstrates knowledge.

Question 123

good attendance and group participation in her Saturday class on newborn care for young mothers. The participants receive free transportation and a $10 food voucher for attending. When they participate, prizes are distributed. This nurse is using behavioral theory to encourage clients, focusing the teaching on which of the following concepts? A) Meeting a hierarchy of needs B) The learner's self-confidence and personal mastery C) A person's natural tendency to learn D) Changes in response to a stimulus

Answer 123

Ans: D Feedback: Behavioral theory is grounded in stimulus3 response behaviors, and changes occur in response to stimuli. The nurse is also using conditioning through reinforcement as described by Skinner. Meeting a hierarchy of needs is based upon Maslow, a humanistic theorist. Self- confidence and personal mastery reflect social learning theory. A person's natural tendency to learn is based upon humanistic theories.

Question 124

A 32-year-old wife and mother of two children was a bank manager before entering the nursing program. She is finishing a Baccalaureate nursing program in a few months. She learns best when she can plan and carry out her own learning activities, uses past experiences to help with current learning, and applies learning immediately. Which learning theory best fits this woman's learning style? A) Knowles' adult learning theory B) Bandura's social learning theory C) The Gestalt3Field family of theories D) Maslow's Hierarchy of Needs theory

Answer 124

Ans: A Feedback: The woman's behaviors support the tenets of Knowles' adult learning theory. She is a self- directed learner, experienced, ready to learn, and is problem centered rather than theoretically oriented. Bandura's social learning theory attempts to explain behavior and facilitate learning. With social learning theory, learners are benefitted by role models, building self- confidence, persuasion, and personal mastery. The Gestalt3Field family of cognitive theories assumes that people are neither good nor bad; they simply interact with their environment and their learning is related to perception. Maslow's hierarchy of needs requires lower level basic needs to be met before working toward self-actualization.

Question 125

A community health nurse is preparing a teaching program for a group of elementary school-aged children about substance abuse awareness. The nurse would implement strategies that address which cognitive phase of development? A) Preconceptual B) Intuitive thought C) Concrete operations D) Formal operations

Answer 125

Ans: C Feedback: Elementary school-aged children would most likely be in the concrete operations stage of cognitive development where the child can solve concrete problems and recognize others' viewpoints. The preconceptual stage would apply to children between the ages of 2 to 4 years when language development is rapid and everything is related to

Question 126

When choosing an appropriate model for health education, community health nurses often select the PRECEDE3PROCEED model for which reason? A) It emphasizes the desired outcome of the teaching. B) The steps are similar to those of the nursing process. C) The nurse's perception of the problem is the key to this model. D) Evaluation of outcomes is the final step.

Answer 126

Ans: B Feedback: The steps of the PRECEDE3PROCEED model are similar to the nursing process, and thus this model has become a useful tool for nurses teaching in the community. It does emphasize outcomes with evaluation of the outcomes as the final step. But these are not reasons for nurses selecting this model. The client's or community's perception of the problem is key to this model.

Question 127

Which of the following statements accurately describe Pender's Health Promotion Model? Select all that apply. A) It has been revised to reflect a number of major theoretical changes. B) It is not effective. C) others. D) It is unrelated to interpersonal influence of It allows the community health nurse to predict health promotion behaviors which enhances the ability to work with clients. E) Individual characteristics and experiences are seen to interact with behavior-specific cognitions and affect to influence specific behavioral outcomes.

Answer 127

Ans: A, D, E Feedback: Pender's Health Promotion Model has been revised from the earlier framework that was published in 1980 and has been revised to reflect a number of major theoretical changes. It is viewed as an effective model. It focused on predicting behaviors that influence health promotion and includes the variable of interpersonal influence of others.

Question 128

Which of the following statements about teaching at three levels of prevention is most accurate? A) Ideally, the community health nurse would focus at the tertiary level of prevention. B) The outcome of focusing on the tertiary level of prevention is to help diminish years of morbidity and limit subsequent infirmity. C) It is ideal to focus on the primary level of prevention. D) Community health nurses do not spend a significant share of time teaching at the secondary level.

Answer 128

Ans: C Feedback: Ideally, the community health nurse focuses on the primary level. Because the primary level of prevention is not possible in all cases, a significant share of the nurse's time is spent teaching at the secondary or tertiary level.

Question 129

Which of the following is the best example of a community health nurse focusing on the secondary level of prevention? A) Teaching clients how to navigate the health care system to receive prompt treatment B) Teaching clients about the importance of immunization C) Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem D) Teaching a class on sensible nutrition for adolescents

Answer 129

Ans: A Feedback: The secondary level of prevention would be exemplified by the community health nurse when teaching clients how to navigate the health care system to receive prompt treatment. Teaching clients about the importance of immunization is focused on the primary level of prevention. Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem is focused on the tertiary level of prevention. Teaching a class on sensible nutrition for adolescents is focused on the

Question 130

A community health nurse is providing informal teaching to groups of parents about typical childhood developmental milestones. Which of the following would the nurse mostly likely be using? A) Lecture B) Demonstration C) Anticipatory guidance D) Visual images level of prevention.

Answer 130

Ans: C Feedback: Informal teaching such as anticipatory guidance and counseling requires the teacher to be prepared, but there is no defined plan of presentation. Lecture and demonstration are formal methods of teaching. Visual images also are often used with formal teaching.

Question 131

Which question would the community health nurse use as a guide to determine a client's participation in a teaching program? A)

Answer 131

Ans: D Feedback: To determine client participation, one of the first questions that need to be answered is,

Question 132

Which of the following is the best example of a positive learning environment for a group of developmentally disabled adults? A) A local diner, seated near the door to the kitchen during lunchtime B) A brightly lit conference room with comfortable chairs C) A kindergarten classroom with small chairs that are low to the ground D) A park on a beautiful, sunny day

Answer 132

Ans: B Feedback: A brightly lit conference room with comfortable chairs would be the best example of a positive learning environment among the choices listed. A local diner, seated near the door to the kitchen during lunchtime would not be a good choice as it is likely very noisy. A kindergarten classroom with small chairs that are low to the ground would not be a good choice as the adults could not comfortably sit in the chairs. A park on a beautiful, sunny day would not be a good choice as there would be too many distractions making it difficult for the clients to focus.

Question 133

non-English speaking country about the need for immunizations, the nurse should include which in his or her plans? A) Using a lot of pictures B) Guessing about the native language and attempting to speak it C) Using an interpreter D) Talking clearly and slowly, being sure to enunciate each word

Answer 133

Ans: C Feedback: Planning to use an interpreter when presenting information to a group of new immigrants from a non-English speaking country is the best option among those listed. Pictures will not effectively convey the meanings that the clients need. Guessing about the native language and attempting to speak it will not be effective either, as the nurse should never assume anything and unless the language is native to the nurse, the nurse will not be any more effective at communicating with the clients. Talking clearly and slowly, being sure to enunciate each word, might be appropriate for a group of immigrants from a non-English speaking country who have been in this country for a while and have been learning the language.

Question 134

Which of the following are factors to consider related to the social determinants of health? Select all that apply. A) Being marginalized B) Access to safe housing C) Safe workplaces D) Being related to a politician E) Access to social and economic opportunities

Answer 134

Ans: B, C, E Feedback: Factors that influence an individual's ability to maintain good health include social factors, such as access to social and economic opportunities and equitable social interactions, and physical factors, such as access to safe housing and safe workplaces. Being related to a politician may or may not have a positive impact on the social determinants of health.

Question 135

Which of the following endings to this sentence most accurately describes the reason a community health nurse must consider the social determinants of health? The community health nurse must consider the social determinants of health A) because the social determinants of health affect a wide range of health, functioning, and quality-of-life outcomes and risks. B) because in our country all people are treated equally. C) because it is the right thing to do. D) because the community health nurse believes in social justice.

Answer 135

Ans: A Feedback: The social determinants of health affect a wide range of health, functioning, and quality- of-life outcomes and risks. There is a growing inequity in the distribution of disease, illness, and wellness across our society and not all people are treated equally. It is not enough to do this because it is the right thing to do. If the community health nurse believes in social justice, this is one thing but really implementing social justice in considering outcomes and risks is more accurate.

Question 136

appropriate source of information for the nurse to investigate when attempting to determine the importance of an issue for a community-based intervention? A) Special interest groups B) Client's concern C) State health department D) Local community priorities

Answer 136

Ans: B Feedback: A client's concern may be the initial spark that leads the nurse to identify a need, but this would be most restrictive source of information and thus would be limited in scope. Therefore, when determining the feasibility of a community-based intervention, several methods can be used to determine the importance of the issue including federal agencies, special interest groups, state health departments, and local community priorities. These sources would provide information about whether or not a problem has affected a sufficient percent of the population to warrant intervention.

Question 137

A community health nurse is attempting to identify a target group for a program using geographic information system (GIS). Which type of information would the nurse be able to obtain? A) Family status B) Past interventions used C) Previous health problems D) Areas needing more study

Answer 137

Ans: A Feedback: GIS information includes information about race, age, and family status. Information about past interventions used or previous health problems can be obtained from talking with other nurses and health professionals. Areas needing more study can be obtained from the Guide to Community Preventive Services: Systematic Reviews and evidence- based recommendations, a federally sponsored initiative that provides recommendations about population-based interventions.

Question 138

A community health nurse has just moved to your community. Which might be good ways for this community health nurse to identify group and community health problems? Select all that apply. A) Interview health professionals in the agency and other agencies to determine the needs B) Read about it in a national magazine C) Refer to the geographic information system (GIS) data for the community D) It is not necessary for the community health nurse to do so. It is best for the community health nurse to just pitch in and work to solve the problems of the community.

Answer 138

Ans: A, C Feedback: Interviewing health professionals in the area about the problems, what should be done, and what has been tried in the past and their input on why past interventions failed. Referring to the geographic information system (GIS) data for the community can look at groups of people by race, age, and family status. Reading about it in a national magazine is too broad of an approach as factors that affect the nation may or may not reflect what is happening in your community. It is critical for the community health nurse to identify group and community health problems in order to effectively influence the health of the community.

Question 139

Which of the following change strategies would be most effective in maximizing the cooperation of the target population? Select all that apply. A) Use only one strategy that the nurse is most familiar with B) Knowing that as a nurse, the nurse knows more about the health topic than their audience C) Employ multiple strategies to promote health, prevent disease, and ensure a safe environment for populations D) Learning about the target population's beliefs regarding the health topic E) Focusing on health promotion and not disease prevention

Answer 139

Ans: C, D Feedback: Standard 5B of the Public Health Nursing: Scope and Standards of Practice calls on the public health nurse to

Question 140

A community health nurse has identified the target population and is determining an appropriate intervention. Which of the following would be most important for the nurse to do next? A) Develop an intervention based on the nurse's previous experiences B) Review the literature for research on previously attempted interventions C) Access the National Center for Health Statistics Web site for data D) Learn about the target population's beliefs and ideas

Answer 140

Ans: D Feedback: Nurses may think that they know more about a topic, and therefore, their solutions are better than the target population's solutions. However, if nurses don't learn about the target population's beliefs and only consider their own, they will not be able to work out a solution with the target population that is acceptable and appropriate for them. Thus, the interventions will most likely be unsuccessful. Although reviewing the literature for research would be helpful on identifying possible strategies, the nurse needs input from the target population. Accessing the NCHS Web site would provide information about whether a problem has affected a sufficient percent of the population to warrant intervention. It would not be helpful in determining an appropriate intervention.

Question 141

In an effort to ensure success of a proposed community intervention program, the community health nurse would include which of the following? A) Formal leaders B) Advisory group C) Target population D) Local knowledge

Answer 141

Ans: B Feedback: A key factor for ensuring the success of any intervention is to appoint an advisory group that includes representatives from the target and service communities. Formal leaders are important in obtaining information about the possible target population. The target population is important in making sure that the planned intervention is appropriate. However, it does not ensure that the intervention will be successful. Local knowledge provides information about possible environmental and social factors influencing the problem. However, it also does not help to ensure the success of the planned intervention.

Question 142

Which of the following interventions targeting health problems is most likely to be effective? A) Teaching about prenatal care to a group of men in a men's homeless shelter B) Teaching about prenatal care in a home for unwed mothers C) Teaching about prenatal care to a group of cub scouts D) Teaching about prenatal care to a group of senior citizens

Answer 142

Ans: B Feedback: It is crucial to analyze the extent to which individuals and families are affected by the problem. It would be a waste of resources to provide teaching about prenatal care to any of the listed groups except the home for unwed mothers.

Question 143

In order to evaluate a health program, which of the following should the community health nurse focus on when planning the program? A) Measurement of goal attainment B) Creation of objectives that are specific, measurable, attainable, relevant, and timely. C) Patient satisfaction D) Measurement of consistency with standards

Answer 143

Ans: B Feedback: When planning a health program, the community health nurse should focus on the creation of objectives that are specific, measurable, attainable, relevant, and timely (acronym SMART). The other options describe what must be measured in the evaluation of the health program.

Question 144

A review of factors influencing a population's behavior related to childhood obesity reveals several reinforcing factors. Which of the following would the community health nurse identify? A) Children's belief that they like to be similar to other children of the same age B) Children's view of themselves as becoming independent from adults C) Offering of incentives to students' modeling positive food choices D) Proposed monitoring of children's behavioral changes by the local PTA

Answer 144

Ans: C Feedback: Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. It also includes authority figures such as teachers or managers, as well as agency and community decision makers, as these individuals also influence the target population. In this case, it would be the offering of incentives to student's modeling positive food choices. The children's belief in being similar to others and view as becoming independent are examples of predisposing factors. Proposed monitoring would be an example of enabling factors.

Question 145

Which of these behaviors is most likely changeable? A) Smoking cessation among a group of people who have smoked for 20 or more years B) Smoking cessation at a work place where smoking is common and deeply embedded. C) Smoking cessation in a school for students who have only recently started smoking D) Smoking cessation in a public environment where cigarettes are openly sold and people are allowed to smoke

Answer 145

Ans: C Feedback: The behaviors that are easiest to change include those that are still in the developmental stage and have only recently been established (as would students who have only recently started smoking and not among a group of people who have each smoked for 20 or more years or at a work place where smoking is common); are not deeply imbedded in cultural patterns or lifestyle (not in a workplace where smoking is deeply imbedded nor in a public environment where cigarettes are openly sold and persons are allowed to smoke).

Question 146

The community health nurse is identifying factors that would influence behavior change. Which of the following would the nurse identify as enabling factors? A) Attitudes of the target population B) Knowledge of the family of the target population C) Availability of resources D) Values of the authority figures

Answer 146

Ans: C Feedback: Enabling factors include the availability of resources, the accessibility of resources, laws, and government support for the health behaviors or for the health program, as well as skills. Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices. Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. It also includes authority figures such as teachers or managers, as well as agency and community decision makers, as these individuals also influence the target population. These factors must be addressed as they can interfere with successful behavioral change and create barriers to behavioral change.

Question 147

When the community health nurse is examining barriers to successful behavioral change, the nurse identifies that there are no laws in the community that prohibit smoking in public areas, which leads to increased smoking and increased risks to health related to secondhand smoke. The nurse believes that a possible solution is to advocate for a citywide bans on smoking in public locations. Which type of factor is affecting the behavior in the community? A) Enabling factors B) Predisposing factors C) Reinforcing factors D) Unrelated factors

Answer 147

Ans: A Feedback: Enabling factors include the availability of resources, the accessibility of resources, laws, and government support for the health behaviors or for the health program, as well as skills. Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices. Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends of the target population. These factors must be addressed as they can interfere with successful behavioral change and create barriers to behavioral change.

Question 148

Several quality management models are helpful in measuring and improving the quality of care. They are designed differently but are developed to enhance care giving. Which of the following uniquely places the client within the model? A) Quality Health Outcomes model B) Donabedian model C) Omaha System model D) QSEN project

Answer 148

Ans: A Feedback: The Quality Health Outcomes model includes the client in the model and proposes a two- dimensional relationship among components. The Donabedian model consists of three components: environment structure, processes, and outcomes. The Omaha System model addresses process indicators, client outcome measures, and satisfaction with care. The QSEN project was spurned by the IOM report Err is Human and focuses on knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics.

Question 149

A community health nurse is assisting with the evaluation of the outcomes of a program. The client's response to care is being measured quantitatively. The nurse identifies this as which of the following? A) Benchmarking B) Quality indicators C) Process D) Structure

Answer 149

Ans: B Feedback: Quality indicators are quantitative measures of a client's response to care. Benchmarking uses continuous, collaborative, and systematic processes for measuring and examining internal programs' strengths and weaknesses and includes studying another's processes in order to improve one's own. Process refers to activities and behaviors used to improve or maintain the client's status. Structure refers to the care environment, such as client mix, philosophy, facility, and staff.

Question 150

When participating in quality improvement activities, a community health nurse would be least likely to engage in which of the following? A) Daily prioritizing of care needs for a caseload of clients B) Completing necessary documentation efficiently C) Seeking supervision for a difficult client case D) Reviewing organizational personnel

Answer 150

Ans: D Feedback: Nursing administration would be responsible for developing a formalized quality management program that would include a review organizational structure, personnel, and environment. Quality improvement activities for community health nurses include daily prioritizing of care needs for a caseload of clients, seeking supervision or skills development for a difficult case, and systematizing charting so that needed documentation is efficiently completed.

Question 151

Ans: D Feedback: Nursing administration would be responsible for developing a formalized quality management program that would include a review organizational structure, personnel, and environment. Quality improvement activities for community health nurses include daily prioritizing of care needs for a caseload of clients, seeking supervision or skills development for a difficult case, and systematizing charting so that needed documentation is efficiently completed.

Answer 151

Ans: A Feedback: As part of the process aspect of quality management, staff is encouraged to contribute to evaluation of the standards and revise them as needed. Adequate resources and funding are components of the structure aspect. Reviewing services provided is a component of the outcome aspect.

Question 152

After teaching a group of students about the various models used in program evaluation, the instructor determines that the students have understood the teaching when they state which of the following as the model most basic? A) Quality Health Outcomes model B) Donabedian model C) Quality and Safety Education for Nurses D) Omaha System model

Answer 152

Ans: B Feedback: The Donabedian model is recognized as a simplistic and basic method of measuring quality that has been used widely over the past 35 years. The Quality Health Outcomes model takes the Donabedian model a step further by including the client in the model. The QSEN project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, safety and informatics. The Omaha System model focuses on process indicators, client outcome measures, and satisfaction with care.

Question 153

A community health nurse who is part of a committee that is deciding on which model to use for program evaluation reviews the Omaha System model. The nurse needs additional review of this model after identifying which of the following as an aspect for rating outcomes? A) Client knowledge B) Client behavior C) Client status D) Client ownership of problem

Answer 153

Ans: D Feedback: Ownership of the problem is component of the community, the group that shares a physical environment and ownership of a health-related problem. Knowledge, behavior, and status are how outcomes are rated in this model.

Question 154

A community health nurse is participating in an agency program evaluation using the Quality Practice Settings Attributes model. The nurse is assisting with evaluation of the professional system. Which of the following would the nurse need to address? A) Communication with clients B) Staffing ratios C) Safety of practice D) Continuing education

Answer 154

Ans: D Feedback: Using the Quality Practice Settings Attributes model, evaluation of the professional system would address hiring, orientation, training, and continuing education. Communication with clients, families, and professionals are areas evaluated in the communication system. Staffing ratios are addressed in the care delivery process. Collaboration is addressed with the leadership element.

Question 155

One community health agency has developed a clinical pathway that has proved useful with clients with heart failure. After review, another community health agency providing care to similar clients decides to implement that pathway. This reflects which of the following? A) Structure B) Process C) Outcomes D) Benchmarking

Answer 155

Ans: D Feedback: Benchmarking uses continuous, collaborative, and systematic processes for measuring and examining internal programs' strengths and weaknesses and includes studying another's processes in order to improve one's own. The example reflects external benchmarking which occurs between similar agencies providing like services. Structure is reflected in the agency's organization, facility, personnel, and philosophy. Process reflects the standards, attitudes, and activities. Outcomes reflect the expected results, goals, efficiency, and satisfaction.

Question 156

A group of students are reviewing material in preparation for test on program evaluation models. The students demonstrate understanding of the material when they identify which model as dynamic with interventions always acting through the system and client? A) Donabedian model B) QSEN project C) Quality Health Outcomes model D) Quality Practice Setting Attributes model

Answer 156

Ans: C Feedback: The Quality Health Outcomes model includes the client in the model and proposes a two- dimensional relationship among components. Interventions always act through the system and the client, creating a dynamic model. The Donabedian model is recognized as a simplistic and basic method of measuring quality. Structure, process, and outcome can be depicted in a box- shaped model. The QSEN (Quality and Safety Education in Nursing) project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies that include patient-centered care, teamwork and collaboration, evidence- based practice, quality improvement, safety and informatics. The Quality Practice Setting Attributes model is used as a tool to assist in ensuring the quality of nursing practice and the nursing profession by promoting continuing competence.

Question 157

When devising a social marketing strategy for a community health issue, which of the following concepts is being integrated when the selection of one option inherently requires giving up on another option? A) Self-interest B) Competition C) Consumer orientation D) Exchange

Answer 157

Ans: B Feedback: The concept of competition is being integrated by selecting one option that inherently involves the giving up of another option. Self-interest is demonstrated when people act in their own interests. Consumer orientation is reflected in the problem-solving process directed at the target. Exchange is demonstrated when an individual gives something to get something.

Question 158

A community health nurse is seeking seed money to set up a health promotion program for pregnant adolescents. The nurse would seek which type of grant? A) Planning B) Start-up C) Management D) Facility

Answer 158

Ans: B Feedback: The type of grant would be a start-up grant, for example, seed money. Other types of grants include planning grants (i.e., initial project development), management or technical assistance grants (e.g., for fund raising or marketing), and facilities or equipment grants (e.g., money for a building, computer, or van).

Question 159

When composing a letter of inquiry, which of the following would a community health nurse include? A) Names and academic credentials of all the personnel who will be involved in implementing the program B) An extensive literature review of the evidence that supports the planned interventions C) Other funding sources for the project or program (prospective and committed) D) Lengthy description of the organization

Answer 159

Ans: C Feedback: The letter of inquiry is normally only two to three pages in length and includes a concise overview of the project. For example, it would likely include an overview of the organization and its purpose, the reason for the funding request, clearly stated need or problem to be addressed, overview of the proposed project or program, and other funding sources for your project or program (prospective and committed). The letter is brief, yet clearly lays out your plan. Names and academic credentials of all the personnel who will be involved in implementing the program, an extensive literature review of the evidence that supports the planned interventions, and a lengthy description of the organization would make the letter of inquiry unnecessarily long when it should be concise.

Question 160

As the community health nurse engages in the process of seeking grant funding, the nurse ensures that the appropriate steps are followed. Place the following in their proper sequence. A) Contact funders B) Acquire proposal guidelines C) Define the project D) Identify the proper funding source E) Be aware of submission deadline

Answer 160

Ans: C, D, A, B, E Feedback: When seeking grant funding, define the project, identify the right funding sources, contact the funders (think of the funder as a resource), acquire proposal guidelines, and know the submission deadline.

Question 161

When developing a teaching plan for a class that describes health policy, which of the following would the instructor include as an example of a regulatory health policy? A) Licensure of health professionals B) Federal subsidies for nursing education C) Benefits for needy groups D) Allocating resources among groups

Answer 161

Ans: A Feedback: Regulatory health policy regulates or licenses services or people providing services in the community. Distributive health policy subsidizes nursing education, benefits the needy, and allocates resources among and between groups.

Question 162

Which of the following is an example of a distributive health policy? A) Reporting of communicable disease B) Federal funds for nursing education C) Medicare D) Arms control agreement

Answer 162

Ans: B Feedback: Distributive health policy promotes nongovernmental activities that are thought to be beneficial to society as a whole. An example of a distributive policy is the Nurse Training Act, Title VIII of the Public Health Service Act, which was established in 1965 and provided federal subsidies for nursing education in an effort to address the need for a more nurses. Reporting of communicable diseases and arms control agreement are examples of regulatory health policy at the national and international levels respectively. Medicare is an example of a redistributive health policy.

Question 163

Which of the following effects of a health system in disarray have the most direct influence for a public health nurse at this present time? A) The United States is often touted as having the best health care system in the world. B) Fewer jobs for nurses C) Crisis in public health related to underfunding and underappreciation of the core functions of public health leading to substantial reduction in public health programs D) Changes in the Medicare payment system

Answer 163

Ans: C Feedback: Currently, there is serious underfunding and underappreciation of the core functions of public health, which has led to massive layoffs of staff and substantial reduction in public health programs. The United States is often touted as having the best health care system in the world. However, this may be in question related to the expense of our current health problems and the lack of benefit to the health of all Americans. There is currently a serious nursing shortage that is projected to only get worse in the coming decades. There are changes in the Medicare payment system and this does affect health care in general but most public health programs do not receive Medicare support.

Question 164

Community health nurses are attending an in- service program about health policy. Which of the following would the nurses expect to be included in the description? A) Reflection of a community's values B) Creation for several influential people C) Development by those outside of the community D) Indication of needs of the community's poor

Answer 164

Ans: A Feedback: Health policy should reflect a community's values and should not only be created for certain groups such as the influential or the poor. It needs to come from the people within the community and be for all of them.

Question 165

A group of community health nurses are discussing health care policy in the United States. Which of the following reflects the consensus view? A) Market forces should solve the problem. B) The government should assume responsibility. C) Health care policy needs to change. D) Health care policy is flawed but adequate.

Answer 165

Ans: C Feedback: Most people agree that health care policy in the United States must change, but there is little agreement among policy makers and citizens about how this should occur. Some believe market forces should be allowed to work this problem out; others believe the government should assume responsibility. Health care policy is not viewed as being adequate.

Question 166

When describing public health nursing to a group of community health nurses, which of the following would be identified as its foundation? A) Social marketing B) Social justice C) Social disparities D) Advocacy

Answer 166

Ans: B Feedback: The concept of social justice is seen as the very foundation of public health nursing. Social marketing is the means to influence behavior of target populations for program development. Addressing social disparities or inequalities are one component of public health nursing. Advocacy involves pleading the case of another and pursuing influencing outcomes.

Question 167

Which of the following statements about special interest groups and policy making are true? Select all that apply. A) Others will be persuaded by facts alone. B) Power is wielded by special interest groups, business, and industry. C) Nurses need to provide input to policy circles through advocacy. D) Nurses need to provide leadership at decision- making tables. E) There are power struggles behind all legislation and health care regulation.

Answer 167

Ans: B, C, D, E Feedback: Nurses need to provide input to policy circles through advocacy and leadership at decision- making tables. It is naïve to believe that others will be persuaded by facts alone. Power is wielded by special interest groups, business, and industry. There are power struggles behind all legislation and health care regulation.

Question 168

The community health nurse is reviewing how managed care today has changed from its initial proposal. Which of the following would the nurse identify as an important change? A) Current emphasis on cost containment B) Focus on choosing a practitioner C) Expansion in types of care provided D) Increase in nonprofit agencies

Answer 168

Ans: A Feedback: Managed care has evolved and the emphasis has shifted from prevention to cost containment. Reductions in reimbursement particularly for disadvantaged patients (e.g., those covered under Medicaid and Medicare), reductions in the choice of practitioners, and limitations on the types of care available transformed this system as originally envisioned. Most managed care today is for profit, setting up a dichotomy between the insured and the owners/investors.

Question 169

Which of the following statements about professional organizations and public policy is the most accurate? A) Professional organizations increase polarization and cause a group to be more united and strong. B) Professional organizations encourage selfishness and self-interest. C) Professional organizations focus solely on protecting their turf. D) A united voice on public policy is more powerful than individuals pleading with legislators.

Answer 169

Ans: D Feedback: A united voice on public policy is more powerful than individuals pleading with legislators. The other statements about professional organizations are not true. They do not increase polarization and if they did, it would not cause the group to be more united and strong. Professional organizations do not increase selfishness and self-interest, and professional nursing organizations do not focus solely on

Question 170

Which of the following statements reflect progress in public policy that can be attributed to professional nursing organizations? Select all that apply. A) Professional nursing organizations have elevated nursing professionalism. B) Professional nursing organizations have given voice to the inequalities that affect our society. C) Professional nursing organizations have developed the paradigms that influence and affect public health. D) Nursing is regarded as a major player in Washington when discussing health care policy. E) Professional nursing organizations have a long and consistent relationship with public policy.

Answer 170

Ans: A, B, C Feedback: Professional nursing organizations have elevated nursing professionalism, have given voice to the inequalities that affect our society, and have developed the paradigms that influence and affect public health. Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be fully realized. to the inequalities that affect our society, and have developed the paradigms that influence and affect public health.

Question 171

Which is the best way for any nurse to advocate for change and exert power? A) Pursuing an advanced degree B) Running for state congressional seat C) Actively participating in a professional nursing organization D) Becoming a member of a local not-for-profit agency board of directors

Answer 171

Ans: C Feedback: A major way in which nurses have been successful with advocacy is through membership in their professional organization. Influencing policy may be achieved by obtaining advanced education, which would be helpful in pursuing higher level positions, and political office whether at the local or state level. Influencing policy is not the same as advocating.

Question 172

After a class on nursing and political activism, which statement by the nursing student would indicate that the teaching was successful? A) Nurses have just now become increasingly active in the political arena. B) Nurses are the smallest group of providers with the largest voice. C) Nurses are considered major political players in Washington. D) The ANA provides nurses with a collective political voice.=

Answer 172

Ans: D Feedback: A professional nursing association such as the ANA builds a collective voice for nurses. Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be realized. Nursing also is not thought of as a major player in Washington when discussing health care policy.

Question 173

Which of the following statements about power and empowerment are true accurate? Select all that apply. A) Power is the ability to act or produce an effect and possess control, authority, or influence over others. B) Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. C) If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. D) All of the power belongs to the legislators. E) Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.

Answer 173

Ans: A, B, C, E Feedback: Power is the ability to act or produce an effect and possess control, authority, or influence over others. Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. Professionals hold the power and authority by virtue of their place in the bureaucracy. Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.

Question 174

A community health nurse integrates understanding of power and empowerment when working with clients by demonstrating which of the following? A) Partnership with clients B) Hierarchical relationship C) Authority over clients D) Client autonomy

Answer 174

Ans: A Feedback: The various definitions of empowerment and the expansion of the definition of health, which now includes the social, political, and economic determinants of health, have changed our thinking on how best to interact with the communities we serve. This also suggests a change in the relationship between professionals and communities; a change from the customary hierarchical patient/ provider relationship to one of a partnership.

Question 175

How can nursing fulfill the potential to transform nursing and take the power to influence policy development? Select all that apply. A) Practicing to the full extent of their education and training B) Achieving higher levels of education and training through an improved education system that promotes seamless academic progression C) Act as full partners, with physicians and other health professionals, in redesigning health care in the United States D) Improve data collection and an improved information infrastructure to ultimately influence effective workplace planning and policy making E) Most nurses are already involved in the regulatory framework development.

Answer 175

Ans: A, B, C, D Feedback: The four key messages from The Future of Nursing: Leading Change, Advancing Health include the following: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. It is not yet true that most nurses are already involved in the regulatory framework development.

Question 176

Organize the following stages in the policy process in the order they should be considered. A) Policy Adoption B) Policy Evaluation C) Policy Formulation D) Policy Implementation

Answer 176

Ans: C, A, D, B Feedback: The order of the stages in the policy process is formulation, adoption, implementation, and evaluation.

Question 177

Which stage in the policy process is exemplified by the activities of identifying the health problem and/or using a goal-oriented approach? A) Policy adoption B) Policy evaluation C) Policy formulation D) Policy implementation

Answer 177

Ans: C Feedback: Policy formulation involves identifying goals, problems, and potential solutions. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy implementation follows adoption and occurs when the policy is put to use. Policy evaluation compares policy outcomes or effects with the intended or desired effects.

Question 178

When involved in the policy process, the community health nurse must keep in mind that which of the following should be the strongest influence? A) Social conditions B) Political conditions C) Public need D) Health planning

Answer 178

Ans: C Feedback: The social and political conditions that affect policy formulation are limitless, but public need and public demand should be the strongest influences. Health planning may be an approach to policy formulation.

Question 179

A community health nurse identifies a problem of increased infant mortality with adolescent pregnancies. The nurse decides to address this problem with a health policy. nurse is engaging in which stage of the policy process? A) Formulation B) Adoption C) Implementation D) Evaluation

Answer 179

Ans: A Feedback: Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Implementation follows adoption and occurs when the policy is put to use. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.

Question 180

A community health nurse is involved in assessing the community's capacity to define strategies to enhance compliance with a policy. The nurse is working in which stage of the policy process? A) Formulation B) Adoption C) Implementation D) Evaluation

Answer 180

Ans: C Feedback: Implementation of health policy occurs when an individual, group, or community puts the policy into use. It involves overt behavior changes as the policy is put into nursing practice. As an implementer, the community health nurse assesses the capacity of the community to formulate and define strategies that will enhance the community's compliance with the policy. Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.

Question 181

When engaging in the policy process, which of the following would the community health nurse do last? A) Define the problem B) Gather information C) Look for alternatives D) Choose the approach

Answer 181

Ans: D Feedback: Policy analysis involves the following sequential steps: define the problem, information gathering, looking for alternatives to the approach, and choose the most appropriate approach.

Question 182

When analyzing health policy, which question would be most important for the community health nurse to ask? A) How much does it cost? B) What is the result? C) Why is it in place? D) Who benefits from it?

Answer 182

Ans: D Feedback: When analyzing policy, nurses need to answer two general questions: Who benefits from this policy? and who loses from this policy? Whether the policy should be advocated by the community as a whole depends on the degree to which the policy benefits the community without being detrimental to individuals or the country. Cost, results, and reasons why are not key elements to address in policy analysis.

Question 183

Which of the following statements about advocacy and lobbying and the influence of both on policy are true? Select all that apply. A) Advocacy can be defined as pleading the case of another or championing a cause. B) Lobbying is the act of influencing legislators. C) Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. D) Policy and politics are not related to each other. E) Public policy is a rational process.

Answer 183

Ans: A, B, C Feedback: Advocacy can be defined as pleading the case of another or championing a cause. Lobbying is the act of influencing legislators. Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. Policy and politics go hand in hand; neither exists without the other. Public policy is not a rational process.

Question 184

Which of the following would be important for a politically involved nurse to do? Select all that apply. A) Communicate ideas effectively B) Get to know local representatives C) Avoid involvement with community boards D) Be firm and unyielding in approach E) Stay current about health care issues

Answer 184

Ans: A, B, E Feedback: The politically involved nurse should aim to accomplish three primary goals: (1) generate support for one's views by communicating ideas effectively and getting to know and influence representatives at local, state, and national levels; (2) create professional legitimacy by keeping abreast of current issues in health care and nursing and becoming involved in professional nursing organizations, community boards or committees, or political office at the local, state or national level; and (3) resolve conflict and effectively negotiate and compromise.

Question 185

Which of the following would be most appropriate for the community health nurse to do first when planning an initial home visit to a family? A) Obtain the basic supplies that will be needed B) Gather appropriate educational materials C) Contact the family via telephone D) Review the referral information

Answer 185

Ans: D Feedback: The first step is to obtain the referral and review it to gather information about the possible needs of the family and the reason for the visit. Once this is done, then the nurse would obtain the basic supplies and education materials that might be needed and contact the family to arrange the visit.

Question 186

When planning for a home visit, which of the following would be most helpful to ensure a successful home visit? A) Documentation in a timely manner B) Summarizing the main visit points C) Providing incidental teaching D) Scheduling an appropriate visit time

Answer 186

Ans: D Feedback: As part of planning the community health nurse would contact the family to set up an appropriate time for the visit. Documenting in a timely manner ensures successful evaluation. Providing incidental teaching and summarizing the main visit points help to ensure successful implementation.

Question 187

A community health nurse arrives at a family's home. Which of the following behaviors by the nurse would be non-therapeutic? A) Maintaining eye contact with the family members B) Paging through paperwork for information C) Sitting on the furniture near the family members D) Placing car keys in the nurse's carry-all bag

Answer 187

Ans: B Feedback: Community health nurses, like all nurses, need to be aware of their own body language. Fidgeting with car keys during the entire visit, noisily chewing gum, giving minimal eye contact, continuously looking at or paging through paperwork, appearing rushed, and refusing to sit on any of the furniture are behaviors that tell the family a great deal about the nurse, including how he or she feels about being in their home. These actions are nontherapeutic. Sitting on the furniture near family members demonstrates interest in the family. Placing car keys in the carryall bags prevents inadvertent distractions.

Question 188

A community health nurse is about to make the first home visit to a family based on a referral from the hospital where the high-risk infant was born to an adolescent mother about 6 days ago. The nurse plans to assess the family and home environment and provide anticipatory guidance. On arrival, the mother sleepily answers the door after the nurse rings the bell and knocks several times. The mother lets the nurse in but is not happy to see the nurse. She gets the infant and places him in the nurse's arms, then sits across the room and turns on the TV. Which response by the nurse would be most appropriate? A) You must be very tired caring for a newborn baby, B) I wasn't planning to hold the baby. You should hold him; you are the mother. C) I need to talk to you, so please turn off the TV. D) How do you feel being a mother at 17?

Answer 188

Ans: A Feedback: It is always best to acknowledge a client's feelings, and from the scenario, observations and referral information, being fatigued 6 days after having a baby is very possible. The option about holding the baby is not the best way to respond to the mother or the first comment to make, but holding the baby gives the nurse an opportunity to role model infant interaction and caring and assess his or her cleanliness and clothing appropriateness. However, the nurse may want to say that he or she would like to wash his or her hands before holding the baby. This gives the nurse an additional opportunity to teach and assess another room when washing hands. Asking to turn off the TV might be appropriate after a few moments of introductory conversation. It would be best to ask the mother to turn the TV down because of difficulty hearing her. The nurse will win the mother's favor with this approach better than by asking her to turn off the TV. Asking how she feels being a mother at 17 might be information to gather, but asking it directly as a first comment sounds like a put-down. There are better ways to obtain this information a bit later in the visit.

Question 189

While making a family health visit, an older relative who is visiting has been drinking and becomes verbally abusive and increasingly loud. Which action by the community health nurse would be best? A) Continue the visit with caution B) Suggest the relative go in another room and take a nap C) Ask the sober family members to take the visitor home D) Terminate the visit, making plans for another visit

Answer 189

Ans: D Feedback: Terminating the visit is the best choice. It appears the problem is escalating, and the nurse's safety should always come first. Continuing the visit puts the nurse and possibly the other family members at risk. Making a suggestion to go into another room and take a nap may agitate the relative and make a deteriorating situation worse. Making a suggestion for a family member to take the visitor home may agitate the relative and make a deteriorating situation worse. Additionally, this is the client's home and the suggestion should be the client's.

Question 190

Which of the following things does a nurse who is traveling by automobile to make a home visit need? Select all that apply. A) A full gas tank and well-operating vehicle B) A map that includes the geographic location where the home visit will be made C) A cellular telephone D) A bus schedule E) Exact change

Answer 190

Ans: A, B, C Feedback: A nurse who is traveling by automobile to make a home visit needs the following: a full gas tank and well-operating vehicle, a map that includes the geographic location where the home visit will be made, and a cellular telephone. If the nurse is not using public transportation, the nurse does not need exact change for each bus trip or a bus schedule.

Question 191

Which of the following are specific safety measures the nurse should apply when making a home visit? Select all that apply. A) Plan to reschedule the visit if you find a large group of people assembled between you and the client's door. B) Immediately leave the home when family members begin to physically fight with one another. C) Enter the residence before you determine that the family you are intending to visit does live there and is home. D) Travel only in pairs for all home visits. E) If someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction. F) Leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit and your cellular phone number at your base of operation.

Answer 191

Ans: A, B, E, F Feedback: It is most important to leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit, and your cellular phone number at your base of operation. Specific safety measures the nurse should apply when making a home visit include planning to reschedule the visit if you find a large group of people assembled between you and the client's door; immediately leaving the home when family members begin to physically fight with one another; and if someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction. It is not appropriate for the nurse to enter the residence before determining that the family that is to be visited does live there and is home. It is not necessary to travel only in pairs for all home visits.

Question 192

Which one of the following has a negative influence on family health and individual health? A) The level at which a family functions significantly affects the individual's level of health. B) A healthy family fosters individual growth and sustains members during times of crisis. C) Family patterns dictate whether members participate in their own health care. D) Individuals can obstruct the family's health and families can obstruct individual family members' health.

Answer 192

Ans: D Feedback: A negative influence on family health and individual health is that individuals can obstruct the family's health and families can obstruct individual family members' health. The level at which a family functions significantly affects the individual's level of health; that a healthy family fosters individual growth and sustains members during times of crisis; and the influence of families that dictate whether members participate in their own health care are all positive influences.

Question 193

When assessing a family, which of the following would lead the nurse to question the health of a family? A) Role relationships are inflexible. B) Coping is actively attempted. C) Family members communicate regularly. D) The family lacks regular links with the broader community.

Answer 193

Ans: D Feedback: In a healthy family, role relationships are structured effectively so that they can change with changing family needs. Active coping, regular family communication, and regular links with the broader community reflect a healthy family.

Question 194

community health nurse to take his or her shopping to purchase some of the food items he or she needs for his or her diet. Which response by the nurse would be most appropriate? A) I can't; I'm going in a totally different direction. B) You need to find some other way to get to the store. C) I'll help you find a way to get to the store. D) Use the foods you have in the house and shop next week.=

Answer 194

Ans: C Feedback: The nurse needs to empower the client and helping the client find a way to get to the store promotes the skill of planning so that the client can begin to manage her own needs effectively. Telling the client that the nurse is going in a different direction, telling him or her to find some other way to get to the store, and telling him or her to use the foods in the house are neither therapeutic nor do they promote empowerment.

Question 195

A community health nurse, visits an 81-year- old newly diagnosed insulin-dependent diabetic who lives alone. The nurse has visited the family three previous times and is visiting early in the morning to observe his client's insulin administration technique. The nurse finds the client depressed over his or her situation one morning. The nurse suggests that together they list positive points about his or her situation and discuss his or her feelings. This is an example of which of the following? A) Strengthening B) Data collection C) Goal-directed questioning D) Measuring family functioning

Answer 195

Ans: A Feedback: The nurse is demonstrating a communication technique called strengthening which is used to assist the family in becoming independent of the nurse's services. Data collection, goal- directed questioning, and measurement of family function are methods used for assessment.

Question 196

Which one of the following is a principle that guides and enhances family nursing practice? A) The nurse should expect that the family will be normal and will not change. B) The nurse should start where the family is at the present time and not the ideal level of functioning. C) The nurse should focus on each family member individually. D) The nurse should evaluate the family based on consistency with traditional family patterns.

Answer 196

Ans: B Feedback: When working with families, community health nurses begin at the present, not the ideal level of functioning. This is accomplished after the nurse views the family collectively, not individually. The nurse should expect that what is normal for one family is not necessarily normal for another and that families are constantly changing. The nurse should recognize the validity of family structure variations.

Question 197

A community health nurse is attempting to empower a family to become independent. Which of the following would be most appropriate? A) Focus attention on the problem areas B) Do for the family what they cannot C) Emphasize the family's strengths D) Reinforce positive traits

Answer 197

Ans: CFeedback: To help empower families, the community health nurse needs to emphasize the family's strengths. It is the nurse's job to recognize the strengths in families and to help families recognize them as well. Focusing on problem areas portrays a negative view and can undermine the nurse's efforts. Doing for the family what they cannot fosters dependency. Reinforcing positive traits may be appropriate if those positive traits are strengths. Not all positive traits are strengths.

Question 198

A community health nurse is applying an interactional framework to assess a family's health. Which of the following would the nurse do? A) View them in terms of the family's internal relationships B) Look at them from a life-cycle perspective C) Evaluate the members' changing roles and tasks D) Assess them as a social system relating to other social systems

Answer 198

Ans: A Feedback: An interactional framework describes the family as a unit of interacting personalities and emphasizes communication, roles, conflict, coping patterns, and decision-making processes. A developmental framework studies the family from a life-cycle perspective by examining the members' changing roles and tasks in each progressive stage. A structural3functional framework describes the family as a social system relating to other social systems in the environment.

Question 199

A community health nurse constructs an eco- map for a family based on the understanding that this tool is useful for which reason? A) Family relationships over three or more generations are depicted. B) The ecological system of a family's neighborhood is charted. C) It was originally devised to depict the complexity of the client's story. D) Directions for gathering data about neighborhoods are provided.

Answer 199

Ans: C Feedback: An eco-map depicts the complexity of the client's story. Lines are drawn to indicate connections to other systems with arrows signifying the direction of energy or flow of resources, and the absence of lines indicates a lack of connections. The family's neighborhood is one component, but not the central focus of the eco-map. A genogram displays family information about complex family patterns such as family relationships over three or more generations, arrows signify the direction of energy or flow of resources, and absence of lines indicates a lack of connections.

Question 200

A community health nurse is collecting data about the family's demographics. Which of the following would the nurse include? Select all that apply. A) Dietary patterns B) Housing C) Climate D) Socioeconomic status E) Education of members F) Ethnicity

Question 201

When a community health nurse is conducting a family assessment on an assigned family, which of the following would be most appropriate? A) Use quantitative data only to maintain and preserve objectivity B) Interview one family member to avoid confusion and repeated information C) Use a checklist format, completing the tool in the family's presence D) Make several visits and accumulate data from all family members

Answer 201

Ans: D Feedback: Completing a family assessment takes time. It is better to keep notes from several visits with the family and observe the family as a group during some family activity. The nurse should not use obtrusive questionnaire techniques or take notes in the family's presence. Quantitative data will give a one-sided view of family data. It is best to interview all family members over time. The nurse should collect both quantitative and qualitative data, which will provide a rich family assessment.

Question 202

During a home visit and assessment of an infant and new mother, the nurse determines that the infant looks healthy. The mother asks several questions and listens attentively. One The question she asks is whether the nurse is going to visit her again. Which response would be most appropriate? A) Your baby looks healthy. You should not have any further questions. B) The agency limits the number of visits I can make; I will let you know. I plan to visit again. What would you like to do? accomplish at the next visit. D) I can come weekly for the next 16 weeks. and then a staff nurse will visit.

Answer 202

Ans: C Feedback: The response about what the client wants to accomplish together represents a mutual approach, giving power to the client and hints at accomplishing things together on subsequent visits. Noting that the infant looks good and that the mother should not have further questions closed-ended and nurse-focused and does not promote open communication between the client and and the nurse. The option about limiting visits is inaccurate; the nurse has more control over the number of visits than this response implies, unless the visit is part of a special and very limited program. Even then, it would not be phrased this way. The final option is about 16 weekly visits followed by a staff nurse, sounds overwhelming and unrealistic. Very few clients receive this much service from public health agencies.

Question 203

A community health nurse determines that it is time to teaching a family about health promotion activities when they say which of the following? A) Is there a place we can go for the medicine? B) It's time we do something about eating right. C) When are you coming back to visit? D) Our grandchildren visit every summer.

Answer 203

Ans: B Feedback: Teaching health promotion activities should begin only after family members express an interest and recognize a need, such as the statement about eating right. Asking about where to get medicine and when the nurse is coming back do not reflect an interest or need. The statement about grandchildren reflects information about the family structure and demographics.

Question 204

Which of the following would a community health nurse use when conducting an outcome evaluation? A) Organization B) Family progress C) Timing D) Performance

Answer 204

Ans: B Feedback: Outcome evaluation involves determining the change in the family's health status or progress. Organization and timing are components of the structure3process evaluation. Performance is part of self- evaluation.

Question 205

The nurse educator knows that the nursing student has grasped the concept of self- evaluation when the nursing student makes which one of the following statements? A) It is important for the family to evaluate itself. B) It is important for the nurse's growth and effectiveness as a community health nurse. C) Evaluations by others are not helpful. D) Individuals can always see their own strengths or flaws.

Answer 205

Ans: B Feedback: Self-evaluation is important for the nurse's growth and effectiveness as a community health nurse. Self-evaluation is referring to the nurse's growth and not the family's. Sometimes, we cannot see our own strengths or flaws, and evaluations by others are. helpful

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