Test Bank Environmental Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition,GRADED A

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Test Bank Environmental Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Why is it important for nurses to understand t... he premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency (EPA). d. Many Americans live in areas that do not meet current national air quality standards. ANS: A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments. Toxicologists do not often consult nurses about environmental pollutants. Pollutant exposures are not routinely reported by nurses. Although there may be problems with air quality standards in the United States, this would not be the primary reason why nurses should understand environmental health. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection ControlNURSINGTB.COM 2. Why is it important for a nurse to have knowledge of environmental health and the effects of chemical, biological, and radiological materials? a. They are a major cause of global warming. b. They are often found in the air, water, and products we use. c. They are frequently linked to the development of chronic illnesses. d. They are products that nurses work with daily. ANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use. These are not a major cause of global warming. They are not frequently linked to the development of chronic illnesses. These are not products that nurses work with daily. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 3. A nurse fulfills the environmental health competency of “assessment and referral.” Which of the following actions has the nurse most likely completed? a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health ANS: C Assessment and referral states that all nurses should be able to successfully complete an environmental health history, recognize the potential environmental hazards and sentinel illnesses, and make appropriate referrals for conditions with probable environmental causes. Advocating for public policy changes is part of advocacy. Understanding policy framework and legislation is part of legislation and regulation. Describing the scientific principles of environmental health is part of basic knowledge and concepts. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 4. How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients ANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. Extrapolation by toxicologists and biomonitoring are modern methods. Completing a chemistry course does not show how to identify these possible relationships. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control NURSINGTB.COM 5. What term is used to refer to the basic science applied to understanding the health effects associated with chemical exposures? a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology ANS: A Toxicology is the study of the health effects associated with chemical exposures. Pharmacology is the branch of medicine concerned with the multiple aspects of drugs. Chemistry is the branch of science with deals with the way that matter is composed. Environmental epidemiology is concerned with the discovery of environmental exposures that cause or protect against illness or disease. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. What statement accurately describes the characteristics of epidemiology? a. It is a science that studies the poisonous effects of chemicals. b. It explains the association between learning disabilities and exposure to lead-based paint at the cellular level. c. It helps nurses understand the strength of the association between exposure and health effects. d. It is a method for tracking the prevalence of health outcomes. ANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects. Toxicology is the science that studies the poisonous effects of chemicals. Environmental surveillance provides data with which to track and analyze the incidence and prevalence of health outcomes. Epidemiology does not examine causes at the cellular level. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. When researching pesticides, the nurse looks at the “family” of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity ANS: B Chemicals are grouped so it’s possible to understand the actions and risks associated with each group. Although some common health risks exist within these families of chemicals, the possible health risks for each chemical should be evaluated individually when a potential human exposure exists. DIF:MSC: Cognitive level: ApplyingNCLEX: Safe and Effective Care Environment: Safety and Infection ControlNURS INGTB.TOP:COM Nursing process: Assessment 8. Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature ANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil, etc.). The other examples do not contain an agent, host, and environment. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 9. When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Identifying areas with an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community ANS: B The use of a GIS allows the PHN to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness. An electronic health record (EHR) would be the most appropriate place to record client data from a foot clinic. Evaluation of effectiveness of a farm safety program would need to be done through some type of assessment or evaluation method—GIS would not be useful to collect this data. GIS is not a scheduling system and would not be helpful when scheduling health promotion programs in the community. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 10. A public health nurse (PHN) is organizing a multidisciplinary team to address the issue of water pollution in the community. Which group of professionals would be invited to address this issue? a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists ANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists. The other professionals are not experts in the area of water pollution in the community. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 11. A nurse would identify which as a point source of air pollution? a. A smoke stack b. The number of cars and trucks c. The amount of fossil fuel consumed in a community d. Ground ozone levels ANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack. Nonpoint sources come from more diffuse exposures, such as from cars and trucks. The amount of fossil fuel that is consumed and ground ozone levels do not identify sources of air pollution. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 12. A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first “P”? a. Present work b. Potential exposures c. Personal protective equipment use d. Past work ANS: A Present work is the first “P.” Potential exposures are part of the “I”—investigate potential exposures. Personal protective equipment use is not part of the mnemonic. Past work is the second “P.” DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 13. What is the greatest single source of air pollution in the United States? a. Waste incineration b. Power plants c. Motor vehicles d. Molds ANS: C Mobile sources such as cars and trucks are the greatest single source of air pollution in the United States. Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 14. A nurse wants to find more information about indoor air quality. Which of the following websites would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. “Right to Know” NURSINGTB.COM d. The Occupational Safety and Health Administration (OSHA) ANS: B Indoor air quality is a growing public health concern in office buildings, schools, and homes and is reflected in the alarming rise in asthma incidence in the United States, particularly among children. Sources of information about indoor air quality include the EPA and the American Lung Association. The NIH is part of the U.S. Department of Health and Human Services (USDHHS) and is responsible for health and biomedical research. “Right to Know” is part of a workplace safety legislation. OSHA regulates safety in factories and businesses. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 15. Employees working with hazardous chemicals have the “Right to Know” about the chemicals they are working with through the creation of which resource? a. Material Safety Data Sheet (MSDS) b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency (EPA) ANS: C The Hazard Communication Standard requires employers to maintain a list of all hazardous chemicals that are used on site. Each of the chemicals should have an associated chemical information sheet known as an MSDS, which is written by the chemical manufacturer. Consumer Confidence Reports summarize the results of the annual testing of the public water supply. The EPA sets forth policies, regulations, and public laws for the safety of the environment and the population. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 16. What is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water ANS: B Nonpoint sources come from more diffuse exposures to pollution. Animal waste is the only diffuse exposure given. The others are considered point sources; point sources are individual, identifiable sources such as smoke stacks. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 17. A nurse is completing the first phase of a risk assessment. Which of the following questions would the nurse most likely try to answer? a. Has the chemical been released into the environment?NURSINGTB.COM b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm? ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans): Is the chemical known to be associated with a negative health effect? The second step is determining if the chemical has been released into the environment: Has the chemical been released into the environment? The third step is estimating how much and by which route of entry the chemical might enter the human body: How much and by which route of entry can the chemical enter the body? The final step considers the previous steps: What is the prediction for potential harm? DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 18. A nurse working at the individual level to reduce pollution in the environment would most likely be involved in what activity? a. Providing a tax incentive to factories that do not pollute b. Making laws related to allowed levels of pollution in the area c. Recycling paper, glass, cans, and plastic d. Moving to an area with less pollution ANS: C Nurses can reduce pollution by doing their part, which can include choosing to recycle paper, glass, cans, and plastic. Providing a tax incentive and creating laws would not be completed at the individual level to reduce pollution in the environment. Moving to an area with less pollution would not help to improve the problem. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 19. What is the first step the nurse would take when addressing the problem of air pollution in the community? a. Setting standards b. Monitoring c. Permitting d. Compliance ANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water. Environmental standards may describe a permitted level of emissions, a maximum containment level, an action level for environmental cleanup, or a risk-based calculation. Monitoring is an ongoing process after an action has happened. Compliance refers to the processes for ensuring that permit/standard/regulatory requirements are met. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control NURSINGTB.COM 20. A city sets the standard of an acceptable level of emissions or a maximum contaminant level allowed for factories. Which concept is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard ANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed. Although this does help to control pollution, environmental standard is best applied in this example. Setting a standard for emissions does not impact waste minimization or land use planning. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 21. A facility is inspected after it has obtained a permit. The inspection is completed for the purpose of observing whether the plans submitted in the permit application are being implemented as approved. Which of the following environmental protection strategies is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring ANS: D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved. Permitting is an important step in controlling pollution. Waste minimization and land use planning are activities aimed at prevention of pollution. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 22. Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act ANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters. The Safe Drinking Water Act authorized the EPA to establish safe standards of purity and required all owners or operators of public water systems to comply with primary standards. The Toxic Substance Control Act gives the EPA the ability to track the 75,000 industrial chemicals currently produced or imported into the United States. The Pollution Prevention Act focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials. DIF: Cognitive level: RememberingNURSING TB. COM Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. A public health nurse (PHN) working with a family living in poverty is concerned about their exposure to environmental hazards. Which of the following factors should the nurse identify as possibly putting the family at risk? (Select all that apply.) a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education e. Unsafe working conditions ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Substandard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. A nurse is assessing for environmental health risks in the community. Which of the following approaches would be most appropriate for the nurse to use? (Select all that apply.) a. Asking legislators to provide a list of environmental pollutants in the area b. Developing a list of exposures associated with urban, rural, or suburban settings c. Assessing the risk by medium such as air, water, soil, or food d. Dividing the environment into functional locations: home, school, workplace, and community e. Recruiting community members to sign a petition to decrease pollution ANS: B, C, D Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by medium such as air, water, soil, or food, and dividing the environment into functional locations: home, school, workplace, and community are ways a nurse can assess the environment. Asking legislators for a list of pollutants or recruiting community members to sign a petition are not effective means to assess for environmental health risks. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control NURSINGTB.COM Chapter 41: The Nurse in Public Health, Home Health, Hospice, and Palliative Care Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. How are official agencies financed primarily? a. Charities b. Individual clients c. Third-party payers d. Tax funds ANS: D Official agencies are financed primarily by tax funds. These agencies are typically operated by state, county, city, or other local government units, such as health departments. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Medicare-certified home health agencies place emphasis on what type of care? a. Chronic b. Distributive c. Intermittent d. Primary ANS:As part of the Conditions of Participation, Medicare C NURSINGTB.COM -certified home health agencies must place an emphasis on intermittent care. Home care services that are provided must be intermittent and provide a skilled service. Primary care refers to the care that is often provided in a physician’s office. Medicare-certified agencies provide care following an acute hospitalization or medical change; they do not provide long- term care for chronic illnesses. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A home care nurse is employed by a proprietary agency. Which statement is true about such an agency? a. It is exempt from federal income taxes. b. It is governed by a board of directors. c. It is a profit-making agency. d. It is reimbursed primarily by tax funds. ANS: C Proprietary agencies are profit-making agencies. Proprietary agencies are free-standing, for- profit agencies that are required to pay taxes. Many are part of large chains and now dominate the home care industry. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse is coordinating care to ensure a comfortable and peaceful death. Which of the following factors should be an important consideration for the nurse? a. The unique stress dying patients often experience b. The cultural values, expectations, and preferences of the family c. The communication style of each family member d. The abilities of the nurse and health care team ANS: B Cultures vary in their beliefs and responses to death. Nurses should know the differences in cultural responses so that they can effectively help people in their time of need. It will be important for the nurse to take cues from the client and the loved ones regarding their needs. The stress experienced by dying patients is different based on the client’s culture. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse has referred a home care client to hospice care. Which of the following best explains the rationale for this referral? a. To provide comfort and peace at a difficult time b. To reduce the cost of care for the terminally ill c. To keep clients at home until the end of life d. To provide care for terminally ill clients expected to live longer than 6 months ANS: A The focus of hospice care is comfort, peace, and a sense of dignity at a very difficult time. Comprehensive services emphasize continuity of care. Hospice care is provided for those NURSINGTB.COM with a life expectancy of less than 6 months. Hospice is the only Medicare benefit that includes medications, medical equipment, 24 hours/7 days a week access to care, and support for family members after death. Hospice care does not reduce the cost of care. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The nurse provides direct care services to a stroke victim to avoid complications. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Thus, direct care for a stroke victim is focusing on limiting disability and encouraging rehabilitation. Primary prevention focuses on preventing the disease before it occurs. Secondary prevention focuses on early detection and screening. Assessment is not a level of prevention. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. A nurse is providing a skilled nursing service. Which of the following best describes the intervention the nurse is performing? a. Teaching the client and family about medication administration b. Consulting with other nurses about the care of a client in the home c. Coordinating services for maximum benefit at minimal cost d. Reviewing nursing assistant charting at the end of each day ANS: A Skilled nursing service is the Medicare term that describes the duties of the registered nurse and refers to the requirement of nursing judgment. Those services involve assessment, teaching, and selected procedures. Teaching the client and family to implement a therapeutic plan, such as taking medications, is an example of a skilled nursing service. Consultation, coordination, and review of documentation do not fit the definition of a “skilled nursing service.” DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is employed in home health nursing practice. Which of the following terms best describes the care that is being provided? a. Intermittent nursing care b. Custodial care c. Family caregiving d. Palliative care ANS: A NURSINGTB.COM Provision of intermittent skilled visits is a component of home health care nursing. Custodial care refers to the care given in long-term care facilities. Family caregiving may be an important role of keeping the client at home, but it is not a necessary component of home care. Palliative care is an extended continuum of chronic serious illness to acute serious illness during which stabilization and exacerbations may occur. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Which organization publishes the current scope and standards of home care practice? a. Centers for Medicare and Medicaid Services b. American Nurses Association (ANA) c. Robert Wood Johnson Foundation d. Visiting Nurse Association ANS: B The ANA publishes scope and standards for Home Health Nursing and Hospice and Palliative Nursing. The Centers for Medicare and Medicaid Services control the regulations and reimbursement mechanisms for the majority of home care services. The Robert Wood Johnson Foundation provides grant funding for a variety of projects that support nursing. The Visiting Nurse Association is a home care agency. DIF: TOP: MSC: Cognitive level: Understanding Nursing process: Evaluation NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse has discovered that a client should be receiving Meals on Wheels. Which of the following steps of the nursing process is the nurse performing? a. Diagnosis b. Planning c. Assessment d. Implementation ANS: C The Standards of Care and the Standards of Professional Performance both include the six steps of the nursing process: (1) assessment, (2) diagnosis, (3) outcomes identification, (4) planning, (5) implementation, and (6) evaluation. As a nurse performs an assessment, the nurse recognizes the current needs of the client. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. Which concepts are used to evaluate client outcomes when using the Omaha System Problem Rating Scale for Outcomes? a. Problem, intervention, and outcome b. Knowledge, behavior, and status c. Knowledge, skill, and attitude d. Problem, category, and modifiers ANS: B The Omaha System Problem Rating Scale for Outcomes uses the concepts of knowledge, NURSINGTB.COM behavior, and status. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. After conducting a comprehensive client assessment, the nurse would organize information about the client’s medication regimen into which domain of the Omaha System Problem Classification Scheme? a. Environmental DIF: TOP: MSC: b. Psychosocial c. Physiological d. Health-related behaviors ANS: D The Omaha System Problem Classification Scheme uses four domains to organize client information. The Health-related behaviors domain includes information related to patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease. The environmental domain includes material resources and physical surroundings both inside and outside the living area. The psychosocial domain includes patterns of behavior, emotion, communication, relationships, and development. The physiological domain includes functions and processes that maintain life. Cognitive level: Analyzing Nursing process: Implementation NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is using the Omaha System Problem Classification Scheme. Which of the following situations is the nurse most likely experiencing? a. Measuring client outcomes b. Collaborating with other professionals c. Providing health education d. Organizing a comprehensive assessment ANS: D The Omaha System Problem Classification Scheme is used to organize a comprehensive assessment according to four priority domains. It’s simple and concrete terms are used to organize a comprehensive assessment, an important standard of nursing practice. It does not measure client outcomes, promote collaboration with other professionals, or provide health education. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A community health nurse is using the Omaha System. Which of the following best describes the rationale for using this system? a. To define each health care provider’s role b. To use nursing diagnoses in community health nursing practice c. To foster collaborative practice d. To provide practitioners a method for communication DIF: TOP: MSC: ANS: C NURSINGTB.COM The goals of developing the Omaha System were to develop a structured and comprehensive system that could be both understood and used by members of various disciplines and to foster collaborative practice. Therefore, the Omaha System was designed to guide practice decisions, sort and document pertinent client data uniformly, and provide a framework for an agency-wide, multidisciplinary clinical information management system capable of meeting the daily needs of clinicians, managers, and administrators. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is trying to facilitate interprofessional collaboration. Which of the following actions should be taken by the nurse? a. Understand who oversees the client’s care. b. Make appropriate referrals. c. Recognize what other professionals do and how they view their roles. d. Request assistance when performing complex skills. ANS: C The factors for successful interprofessional functioning include the categories of knowledge, skill, and attitudes with subheadings including the understanding of the roles of each professional. Cognitive level: Analyzing Nursing process: Planning NCLEX: Safe and Effective Care Environment: Management of Care 16. A home care agency has applied for accreditation from the Joint Commission. What is the next step the agency will take? a. Attend a conference to learn more about the accreditation process. b. Schedule a site visit with the Joint Commission. c. Complete a self-study of the agency. d. Improve methods of documentation of client visits. ANS: C After applying for accreditation, a lengthy self-study must be completed that addresses all aspects of the agency’s operation. Following completion of the self-study, an accreditation team schedules a site visit. Attending a conference to learn more about accreditation should be done before applying. A site visit with the Joint Commission occurs after the self-study DIF: TOP: MSC: has been reviewed. Improving methods of documentation of client visits should be addressed before applying for accreditation. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. Which historical event caused dramatic changes in home care nursing? a. Passage of Medicare legislation b. Establishment of Visiting Nurse Associations c. Creation of the Montefiore Hospital Home Care Program d. Provision of funds by the Civil Works Administration ANS: A NURSINGTB.COM Medicare introduced regulations for home care practice as well as for reimbursement mechanisms. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse is using telehealth technology in the home setting. Which of the following best describes the intervention that is being used by the nurse? a. Uses Web TV to teach clients about their health. b. Shares health information using electronic communications. c. Makes regular visits to clients to check the technology. d. Risks violation of the Health Insurance Portability and Accountability Act. ANS: B Telehealth includes sharing health information between the client and clinicians using electronic communications. Telehealth may or may not include video technology for live interactions. Telehealth allows for monitoring health status and symptom recognition, providing education, increasing communication, and enabling clients to become active partners in their own care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care DIF: TOP: MSC: MULTIPLE RESPONSE 1. A nurse is coordinating care through a high-intensity transitional care program. Which of the following best describes the populations that the nurse is working with? (Select all that apply.) a. Adults with cognitive impairments b. Women with high-risk pregnancies c. Older adults with heart failure d. People who are moving from one state to another e. Men who have just experienced divorce ANS: A, B, C Transitional care ensures the coordination and continuity of health care as clients transfer between different locations and different levels of care in the same location. High-intensity transitional care programs are designed for populations who have complex or high-risk health problems. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which are categories of classifying interventions according to the Omaha System Intervention Scheme? (Select all that apply.) a. Health education b. Case management c. Treatments and procedures d. Direct care services NURSINGTB.COM e. Skilled nursing care ANS: B, C The Omaha System Intervention Scheme is comprised of four broad categories of interventions: (1) teaching, guidance, and counseling; (2) treatments and procedures; (3) case management; and (4) surveillance. DIF: Cognitive level: Remembering TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Which illegal and unethical activities have occurred in health care systems in the past? (Select all that apply.) a. Inappropriate use of home health services b. Inaccurate billing for services c. Excessive administrative staff d. “Kickbacks” for referrals e. Primary care services provided in the home ANS: A, B, C, D Examples of Medicare fraud and abuse in home health and hospice include inappropriate use of services, excessive payments to administrative staff or owners, “kickbacks” for referrals, and billing for visits and/or medical supplies that are not authorized or provided. The home care nurse must abide by established federal regulations when delivering care to clients. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 25: Case Management Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse who is using population management needs to be able to work with integrated care delivery systems. Which of the following describes the rationale for this competency? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary. ANS: A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using population management as part of the nursing care that is provided. Which of the following activities is the nurse most likely completing? a. Census taking to determine the total number of people in the populationNURSINGTB.COM b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually ANS: B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors. Population management does not include census taking, providing case management services for all, or repeating wellness programs on an annual basis. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is referred to by what term? a. Case management b. Care management c. Disease management d. Demand management ANS: B Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A patient with a long history of asthma with many hospital admissions is referred to a case manager for disease management. Which of the following best describes the purpose of this referral? a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring ANS: A Disease management activities target chronic and costly disease conditions that require long- term care interventions. Demand management seeks to control use by providing clients NURSINGTB.COM with correct information. Patients who cannot handle their disease or who need an advanced practice nurse instead of a physician do not explain the referral to disease management. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse is assisting clients to improve their health status. Which of the following types of management is being used by the nurse? a. Care management b. Case management c. Disease management d. Demand management ANS: D Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population. Case management is defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. Disease management constitutes systematic activities to coordinate health care interventions and communications for populations with disease conditions in which client self-care efforts are significant. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A bachelor’s prepared nurse is providing case management services. Which of the following activities would most likely be provided by this nurse? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes ANS: C Working with individuals would be the role of this nurse. Working with community aggregates, systems of disease, and outcomes management processes are implemented by an advanced practice nurse (APN). NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse using a critical path when providing care for a client is most likely engaged in what activity? a. Implementing the six “rights” of case management b. Demonstrating competencies required for practicing case management c. Attempting to achieve a measurable outcome for a specific client d. Effectively managing conflict resolution ANS: C A critical path is a case management tool used to achieve a measurable outcome for a specific client case. The critical path details the essential and sequential activities in care, so that the expected progress of the client was known at a point in time. A critical path does not address the six “rights” of case management or demonstrate the competencies required for practicing case management. A critical path is not used for conflict resolution. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. What are the six “rights” of case management? a. Care, time, provider, setting, price, and outcomes b. Patient, medication, route, time, documentation, and evaluation c. Place, setting, patient, plan, outcomes, and documentation d. Disease process, time, place, beneficence, advocate, and care provider ANS: A Care, time, provider, setting, price, and outcomes are used to judge the effectiveness of case management. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is working as a case manager and is in the process of performing interdisciplinary, family and client conferences. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Planning for outcomes d. Implementation ANS: B Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions based on assessment, and using interprofessional teams. Examples of assessment include developing networks with target populations and dissemination of written materials. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence- based interventions. Examples of implementation include contacting providers and coordinating care activities. DIF: Cognitive level: ApplyingNURS INGTB.TOP:COM Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A case manager has contacted providers and has negotiated services and prices. Which of the following phases of the nursing process is being demonstrated? a. Assessment b. Diagnosis c. Planning/outcome d. Implementation ANS: D The implementation phase of the nursing process occurs when a case manager advocates for clients’ interests and arranges for the delivery of service. Examples of assessment include developing networks with target populations and dissemination of written materials. Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and using interprofessional teams. Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-based interventions. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A case manager uses effective collaboration and team strategies to arrange for services. Which of the following roles is being applied? a. Broker b. Negotiator c. Liaison d. Facilitator ANS: B The case manager who uses effective collaboration and team strategies to make arrangements for services is performing the role of negotiator. The role of broker is used when acting as an agent for provider services that are needed by clients to stay within coverage according to budget and cost limits of the health care plan. When acting as a liaison, the nurse provides a formal communication link among all parties concerning the plan of care management. As a facilitator, the nurse supports all parties in work toward mutual goals. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A case manager provides a formal communication link among all parties concerning the plan of care management. Which of the following roles of the nurse is being implemented? a. Facilitator b. Liaison c. Coordinator d. Negotiator ANS: B The case manager providing a formal communication link among all parties concerning the NURSINGTB.COM plan of care management is performing the role of liaison. As a facilitator, the nurse supports all parties in work toward mutual goals. When working as a coordinator, the case manager arranges, regulates, and coordinates needed health care services for clients at all necessary points of services. The case manager who uses effective collaboration and team strategies to arrange for services is performing the role of negotiator. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A case manager is fulfilling the role of coordinator. Which of the following nursing interventions would most likely be completed? a. Providing information to all parties about the situations affecting the client b. Educating the client and providers in order to make informed decisions c. Supporting all parties to work toward mutual goals d. Arranging, regulating, and balancing needed health services for the client ANS: D The role of coordinator is fulfilled when the nurse arranges, regulates, and balances needed health services for the client. Providing information to all parties about the client’s situation is the role of the monitor/reporter. Educating the client and provider in order to make informed decisions is the role of educator and supporting all parties to work toward mutual goals is the role of facilitator. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. Which knowledge domains are used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning, and legislative change d. Grant application, bargaining contracts, and securing funding ANS: B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research. The other domains listed are not used in case management. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse is using life care planning when working with a client. What would be the most appropriate time for planning to be used? a. When organizing a timeline of life events b. When documenting client information and requests c. When assessing present and future client needs d. When estimating future costs for medical care ANS: C Life care planning is a customized, medically based document that provides assessment of present and future needs. Typically, a life care plan incorporates medical, financial, NURSINGTB.COM psychological, vocational, built environment, and social costs during the remaining life of the client. Life care planning is a tool used in case management. A life care plan assesses the current and future needs of a client for catastrophic or chronic disease over a life span. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse is working as a case manager. Which of the following best describes the diagnoses that the case manager is most likely to encounter? a. Bankruptcy, financial distress, and depression b. Flu, colds, and frequent headaches c. Malaria, bird flu, and Dengue fever d. AIDS, spinal cord injury, and ventilator dependency ANS: D Case-managed conditions include many chronic conditions. AIDS, spinal cord injury, and ventilator dependency are the only chronic conditions listed. The other options are acute or nonmedical conditions. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A public health nurse (PHN) is working with the chronically ill and families with young children needing age-specific health maintenance. Which of the following models of case management is being used? a. Client-focused b. System-focused c. Social service d. Long-term care ANS: A The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. System-focused models address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client- focused b. System-focused c. Social service d. Long-term care ANS: B NURSINGTB.COM The system-focused model addresses the structure and processes of using the population- based tools of disease management and critical pathways to offer care for client populations. The concern in client-focused models is with the relationship between case manager and client to support continuity of care and to access providers of care. The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care. Long-term care is not a model of case management. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. The nurse and client, a 20-year-old expectant mother, are discussing the advantages and disadvantages of breastfeeding. To enhance understanding of the implications of breastfeeding, the nurse says, “Tell me more about how you will work full time and breastfeed.” Which of the following aspects of the advocacy process is being used? a. Verification b. Clarification c. Amplification d. Affirmation ANS: B Clarification is a process in which the nurse and client strive to understand meanings in a common way. Verification is the process used by the nurse advocate to establish accuracy and reality in the informing process. Affirmation is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse upholds a client’s right to make a choice and to act on the choice. Which of the following best describes the action being taken by the nurse? a. Affirming b. Supporting c. Informing d. Amplifying ANS: B Supporters approve and support clients’ actions. Affirming is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals. Informing includes educating clients about the nature of their choices, the content of those choices, and the consequences to the client and is not a one-way activity. Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 21. A case manager supports a client’s decision to return home after having a total hip replacement rather than go to a skilled nursing facility. Which of the following phases of the nursing process is being used? a. Assessment b. Planning/outcome c. Implementation d. Evaluation ANS: C The implementation phase is similar to the advocacy process when the nurse aids the client in decision making and supports the client’s decisions. The assessment/diagnosis phase is similar to the advocacy process of information exchange, gathering data, and illuminating values. The planning/outcome phase is like the advocacy process when generating alternatives and consequences and prioritizing actions. The evaluation phase is most similar to the advocacy processes of affirmation, evaluation, and reformulation. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. What term is used to identify the process of moving conflicting parties toward an outcome? a. Negotiation b. Conflict management c. Problem-purpose-expansion method d. Brainstorming ANS: A The process of moving conflicting parties toward an outcome is called negotiation. Conflict management has the goal of mutual benefit with limited loss, which is directed toward getting all parties to work together. The problem-purpose-expansion method is a way to broaden limited thinking by restating the problem and expanding the problem statement so that different solutions can be generated. In brainstorming, as many alternatives as possible are generated without placing a value on them. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity 23. Mutual benefit with limited loss for everyone is a goal of what process? a. Negotiating b. Assertiveness c. Conflict management d. Cooperation ANS: C Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills directed toward learning all parties’ needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching a goal. The process of moving conflicting parties toward an outcome is called negotiation. Assertiveness is the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. NURSINGTB.COM DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Psychosocial Integrity 24. The nurse is involved in a conflict resolution situation with the parents of a 2-year-old boy. The parents are deciding if “spanking” the child is a disciplinary method that they will employ. The mother says, “I do not believe in spanking. I see it as abusive and demeaning.” Which of the following best describes the statement by the mother? a. Cooperation b. Assertiveness c. Bargaining d. Collaboration ANS: B The mother’s statement is an example of assertiveness, the ability to present one’s own needs. Cooperation is the ability to understand and meet the needs of others. Bargaining is part of the negotiation process when debates include gathering facts based on reasoning that will generate understanding and promote relearning. Collaboration is a dynamic highly interactive and interdependent process in which people work together to share resources and a vision for a goal. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity 25. A nurse is working with an individual who pursues neither his concerns nor another’s concerns. Which of the following conflict management behaviors is being used? a. Accommodating b. Collaborating c. Avoiding d. Compromising ANS: C The individual would be “avoiding.” Avoiding is defined as when an individual pursues neither his or her concerns nor another’s concerns. Accommodating occurs when an individual neglects personal concerns to satisfy the concerns of another. Collaborating is when an individual attempts to work with others toward solutions that satisfy the goals of both parties. Compromising occurs when an individual attempts to find a mutually acceptable solution that partially satisfies both parties. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity 26. What is the first stage of collaboration? a. Trust building b. Consensus c. Collegiality d. Awareness ANS: D The first stage of collaboration is awareness, when one makes a conscious entry into a group NURSINGTB.COM process. This is followed by tentative exploration and mutual acknowledgement, trust building, collegiality, consensus, commitment, and collaboration. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A case manager submits documentation that a nursing visit was completed at a client’s home, but it was never performed. According to the general areas of legal risk, how would this action best be categorized? a. Liability for managing care b. Fraud/abuse c. Negligent referral d. Confidentiality/security ANS: B Fraud/abuse occurs when false statements of claims are made and filed. Confidentiality/security occurs when sensitive information is not secured. Negligent referral occurs when referrals or treatments are inappropriate. Liability for managing care occurs when case management is not used appropriately, when there is harassment, or when care is inappropriately delegated. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse’s excessive attention to cost containment impairs the nurse’s duty to provide measures to improve health. Which of the following ethical principles is being influenced? a. Autonomy b. Beneficence c. Veracity d. Nonmaleficence ANS: B Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to provide measures to improve health or relieve suffering. Autonomy is the individual’s right to choose a provider. Veracity is truth telling which is important to building trusting relationships with clients. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. Care in a managed system is provided by less experienced providers. Which of the following ethical principles is being influenced in this situation? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice ANS: D NURSINGTB.COM Justice calls for equal distribution of health care with reasonable quality. Autonomy is the individual’s right to choose a provider. Beneficence is influenced when excessive attention to cost containment supersedes or impairs the nurse’s duty to provide measures to improve health or relieve suffering. Nonmaleficence is doing no harm, which is addressed when incorporating outcomes measures, evidence-based practice, and monitoring processes in plans of care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What knowledge and skills are required in order to become a competent case manager? (Select all that apply.) a. Knowledge of community resources and financing mechanisms b. Written and oral communication skills c. Proficient negotiation and conflict-resolving practices d. Application of evidence-based practices and outcomes measurements e. Experience with ethical decision making ANS: A, B, C, D The knowledge and skills required to achieve competency include knowledge of community resources and financing mechanisms, written and oral communication and documentation, proficient negotiating and conflict-resolving practices, and the ability to apply evidence- based practices and outcomes measures. Experience with ethical decision making is not part of becoming a competent case manager. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse would like to reduce the risk of liability. Which of the following interventions should be used by the nurse? (Select all that apply.) a. Provide accurate documentation of client visits. b. Inform clients of their rights of appeal. c. Refer clients to the providers of their choice. d. Utilize care planning whenever possible. e. Promote strong community partnerships. ANS: A, B To reduce risk exposure, it is important to provide clear documentation of client encounters and inform clients of their rights of appeal. Client choice is important when choosing a provider; however, the nurse is responsible for using reasonable care when selecting referral choices for a client. Although care planning may be helpful for establishing a plan with the client, it is not necessary in reducing the risk of liability. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 23: Program Management Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. The process of program management is similar to: a. the nursing process. b. the medical model of care delivery. c. the requirements for licensure as a registered nurse. d. summative and formative evaluation. ANS: A The nursing process has the same basic steps as the process of program management. Like the nursing process, the process of program management consists of a rational decision- making system designed to help nurses know when to make a decision to develop a program, where they want to be at the end of the program, how to decide what encompasses a successful program, how to develop a plan to go forward so they will know where they want to be, how to know that they are getting there (formative evaluation), and what to measure to know that the program has successful outcomes (summative evaluation). DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What is a benefit of systematic planning? a. Allowing nurses to oversee materials presentedNURSINGTB.COM b. Ensuring that resources are used to address the needs of the community c. Linking local politicians with the community d. Educating student nurses about public health nursing ANS: B Systematic planning ensures that available resources are used to address the actual needs of people in the community, and it focuses attention on what the organization and health provider are attempting to do for clients. Systematic planning does not allow nurses to be in charge, link politicians with the community, or educate student nurses about public health nursing. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A provider and a client consider the possibilities of solving a problem using one of the solutions identified. Which of the following phases of the program planning process is being used? a. Conceptualizing b. Detailing c. Implementing d. Evaluating ANS: B In the detailing phase, the provider details the costs, resources, and program activities needed to choose one of the solutions from the conceptualizing phase. In the conceptualizing stage, options for solving the problem are created and several solutions are considered. In the evaluating phase, each alternative is weighed to judge the costs, benefits, and acceptance of the idea to the client population, community, and providers. The implementing phase requires obtaining and managing the resources required to operationalize the program in a way that is consistent with the plan. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. To increase the immunization rates among children in the community, a nurse manager is considering holding immunization clinics on Saturdays one month before school begins. Which of the following describes what is happening? a. Formulating b. Planning c. Implementing d. Evaluating ANS: B Planning is selecting and carrying out a series of actions to achieve stated goals. In the formulating phase, the problem is defined, and client need is assessed. The implementing phase requires obtaining and managing the resources required to operationalize the program in a way that is consistent with the plan. Evaluation is determining whether a service is needed and can be used, whether it is conducted as planned, and whether the service actually helps people in need. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse matches client needs, provider strengths and competence, and agency resources. Which of the following types of planning is being used? a. Strategic planning b. Program planning c. Management planning d. Process planning ANS: A Matching client needs, provider strengths and competence, and agency resources is considered strategic planning. Program planning reflects the desire to implement a reality- based program that can be readily evaluated and can reduce the number of unexpected events that occur in a defined population. Management planning assists managers to determine whether the resources of the agency are used properly to actually implement the agency programs. Process planning is not a type of planning discussed by the text. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse completes a program evaluation to identify if the objectives of the program were met. Which of the following describes the action of the nurse? a. Assessment b. Evaluation c. Formative evaluation d. Summative evaluation ANS: C Formative or process evaluation is used to assess whether objectives are met, or planned activities are completed. Assessment is completed to provide a clear understanding of the overall health status of a community, to identify populations at risk, and to document health needs. Evaluation is determining whether a service is needed and can be used, whether it is conducted as planned, and whether the service actually helps people in need. Summative or impact evaluation is used to assess program outcomes or as a follow-up to the results of the program activities. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse surveys a program’s participants after completion of a wellness program to determine if the participants have increased their involvement in daily exercise. Which of the following describes the action of the nurse? a. Assessment b. Evaluation c. Formative or process evaluation d. Summative or impact evaluation ANS: D NURSINGTB.COM Summative or impact evaluation is used to assess program outcomes or as a follow-up to the results of the program activities. Formative or process evaluation is used to assess whether objectives are met or planned activities are completed. Assessment is completed to provide a clear understanding of the overall health status of a community, to identify populations at risk, and to document health needs. Evaluation is determining whether a service is needed and can be used, whether it is conducted as planned, and whether the service actually helps people in need. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. For obtaining information about services needed to meet community needs, business leaders within a community were interviewed. Which of the following describes this method of obtaining needs assessment data? a. Community forum b. Key informant interview c. Survey of existing agencies d. Indicators approach ANS: B Interviewing business leaders within a community is an example of key informant interviews. Community forum is defined as a community, group, organization, or open meeting. Survey of existing agencies provides estimates of client populations via services used at similar community agencies. The indicators approach uses existing data to determine problems. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Focus groups are used to determine the method of cleanup for contaminated groundwater in a neighborhood. Which of the following is a disadvantage of this needs assessment tool? a. Technically demanding b. Expensive c. Bias of leaders d. Time consuming ANS: D Using focus groups to determine the method of cleanup for contaminated groundwater in a neighborhood would be very time consuming. Disadvantages of surveys are that they are expensive and technically demanding. Key informants have the disadvantage of the bias of the leaders. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is planning a health program. Which of the following is the most critical action that should be taken by the nurse?NU RSINGTB.COM a. Assessing need of the community b. Considering alternative solutions or options c. Detailing the costs and resources needed d. Weighing each alternative ANS: A Assessing need provides the reasons and rationale for the program plan. The need within the community must be assessed before alternatives can be proposed or weighed, or the details of the costs and resources can be determined. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse wants to have a clear understanding of the overall health status of a community and to identify populations at risk. Which of the following actions should be taken by the nurse? a. Complete a community assessment. b. Perform a population needs assessment. c. Evaluate past programs in the community. d. Develop program resources for the community. ANS: A Community assessment is a population-focused approach that views the entire community as the client. A population needs assessment focuses on the need for a service for a specific target population. Development of program resources occurs after the community assessment has been completed. Community assessment involves evaluation of current programs and resources in the community, not past programs. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse uses a key informant interview as part of completing a needs assessment. Which of the following describes the primary advantage of using this tool? a. Low cost. b. Provides a picture of services needed. c. Identifies the perspectives of many persons. d. Indicates the extent of services offered by existing programs. ANS: B The main advantage of using a key informant as a needs assessment tool is that it would provide a picture of the services needed. The main advantage of focus groups is the low cost. The advantages of a community forum are the low cost and identification of the perspectives of large number of persons. The advantages of a survey of existing agencies are to know the extent of services offered in existing programs. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. What is the purpose of developing objectives for a program?NURSINGTB.COM a. Giving the speaker-specific topics to cover b. Providing direction for conducting the program c. Providing an enriching experience for participants d. Formulating a mission statement ANS: B Objectives provide direction and provide the mechanism for evaluating specific activities in light of the total program. The formulation of a mission statement clarifies the values and overall purpose of the program and provides a framework for the goals and objectives that follow. The action steps will provide explicit actions to accomplish the objectives, such as giving the speaker-specific topics to cover. An enriching experience for the participants is accomplished through many things, more than the development of program objectives. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A population needs assessment has been completed. Which of the following describes what was done? a. A health status report indicates many people are not using the health department because of long waits. b. The World Health Organization (WHO) encourages all travelers to be up to date on the immunizations when traveling abroad. c. A nurse assesses the health status of older adults with diabetes prior to initiation of a health education program. d. An agency uses a television advertisement to encourage healthy eating by the citizens in the community. ANS: C A population needs assessment focuses on the characteristics of a specific population, its health needs, and the resources available to address those needs. A nurse assessing the health status of older adults with diabetes is an example of a population needs assessment. A health status report indicating that many people are not using the health department because of long waits does not focus on a specific population. The WHO encouraging all travelers to be up to date on the immunizations when traveling abroad does not include the resources available to address those needs. An agency using a television advertisement to encourage healthy eating by the citizens in the community does not focus on assessment of a specific population. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A community identifies cardiovascular disease as a priority need because its mortality rate is four times higher than the rate identified in Healthy People 2020. Which of the following describes the type of approach that was used? a. Pre-active b. Reactive c. Inactive d. Interactive ANS: C The inactive approach defines the problem based on the existing health state of the NURSINGTB.COM population to be served. A pre-active approach projects a future need. A reactive approach defines the problem based on past needs. An interactive approach describes the problem using past and present data to project future population needs. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. It is projected that the incidence of diabetes will increase in the future and therefore creates a need for more diabetic health educators. Which of the following approaches was used to identify this need? a. Pre-active b. Reactive c. Inactive d. Interactive ANS: A A pre-active approach projects a future need. Identifying the need for more diabetes health educators based on the projected incidence of diabetes is an example of the pre-active approach. The inactive approach defines the problem based on the existing health state of the population to be served. A reactive approach defines the problem based on past needs. An interactive approach describes the problem using past and present data to project future population needs. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse is implementing basic program planning. Which of the following would occur during the formulating stage? a. The client and provider analyze available solutions. b. The best plan for funding is presented to administrators. c. The provider group identifies solutions. d. The client identifies problems. ANS: D The first step in the planning process involves the identification of problems, which occurs in the formulating stage. The provider group identifies solutions during the conceptualizing phase. The available solutions are analyzed during the evaluating phase. The best plan is presented and chosen during the implementing phase. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. Which program planning stage defines the problem based on the existing health status of the population to be served? a. Pre-active b. Reactive c. Inactive d. Interactive ANS: C NURSINGTB.COM The inactive stage defines the problem based on the existing health status of the population to be served. A pre-active approach projects a future need. Identifying the need for more diabetes health educators based on the projected incidence of diabetes is an example of the pre-active approach. A reactive approach defines the problem based on past needs. An interactive approach describes the problem using past and present data to project future population needs. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. What question should be answered through a program evaluation? a. Did the audience enjoy the program? b. Is a process evaluation also necessary? c. Are the problems it was designed to solve being solved? d. Was enough information given to change policy? ANS: C Program evaluation is a means of documenting accountability. The question “Are the problems it was designed to solve being solved?” addresses the aspect of accountability. The other questions should not be the focus of program evaluation. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. According to the Centers for Disease Control and Prevention’s (CDC’s) format for evaluation, what would occur during the focus the evaluation design step? a. Writing the program description b. Specifying the indicators that will be used c. Describing the purpose for the evaluation d. Linking the conclusions to the evidence gathered ANS: C Focusing the evaluation design step involves describing the purpose for the evaluation, the users who will receive the report, how it will be used, the questions and methods to be used, and any necessary agreements. Writing the program description occurs when describing the program. Specifying the indicators that will be used is part of gathering credible evidence. Linking the conclusions to the evidence gathered is part of justifying the conclusions. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is monitoring program activities, such as hours of service, number of providers used, number of referrals made, and amount of money spent to meet program objectives. Which of the following aspects of program evaluation is being used? a. Relevance b. Progress c. Efficiency d. Effectiveness ANS: B NURSINGTB.COM The monitoring/tracking of program activities is an example of the progress aspect of program evaluation. Relevance is evaluating the need for the program. Efficiency is evaluating the relationship between program outcomes and the resources spent. Effectiveness is evaluation of the ability to meet program objectives and the results of program efforts. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is creating a program objective. Which of the following would be developed? a. Decrease the incidence of early childhood disease in Center County by providing immunization clinics in all schools between August and December of 2007. b. Provide condoms to sexually active teenagers in the local high school. c. Increase by 25% the number of school-age children wearing seat belts. d. Provide free diabetic screening every other month for 2 years. ANS: A A program objective needs a strong, action-oriented verb, a statement of a single purpose, a statement of a single result, and a time frame for achieving the expected result—To decrease the incidence of early childhood disease in Center County by providing immunization clinics in all schools between August and December of 2007. To provide condoms to sexually active teenagers in the local high school does not include the statement of a result of this action or a time frame. To increase by 25% the number of school-age children wearing seat belts does not have a time frame for achieving the expected result. To provide free diabetic screening every other month for 2 years does not include the statement of a single result of this action or a specific time frame. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse has created the program objective “to decrease the incidence of early childhood disease in Center County by 10% to 25% by providing immunization clinics in all schools before August and December 2018.” Which of the following describes the operational indicator? a. Decrease b. Promoting immunization clinics c. 10% to 25% d. Before August and December 2018 ANS: C The operational indicator is 10% to 25%; decrease is the action verb; promoting immunization clinics is the purpose; and before August and December 2018 is the time frame. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. With the involvement of the local government and health department, a community-wide program is planned to make all public businesses smoke free, thus eliminating exposure to second-hand smoke. Which of the following levels of prevention of program planning and evaluation is being applied? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention refers to screening and early detection. Tertiary prevention refers to rehabilitation and treatment. Assessment is not a level of prevention. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. A nurse is critiquing the program objective ‘to decrease the incidence of early childhood disease in Center County by providing immunization clinics in all schools between August and December of 2018.” Which of the following critiques is accurate? a. It is accurate as written. b. The results are ambiguous. c. The action verb is not action oriented. d. The purpose is not stated. ANS: A A program objective needs a strong, action-oriented verb, a statement of a single purpose, a statement of a single result, and a time frame for achieving the expected result. Thus, the objective is correct as written as it contains all these components. The results are clear—to decrease the incidence of early childhood disease in Center County. The action verb is action oriented—by providing immunization clinics in all schools. The purpose is stated—to decrease the incidence of early childhood disease in Cedar County. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. What is the purpose of performing a cost-accounting study? a. To detect what percentage of cost the clients recover b. To measure how long it takes for clients to see a provider c. To note how many cases are associated with other major risk factors d. To find the actual cost of a program ANS: D Cost-accounting studies are performed to find the actual cost of a program. Cost-accounting studies do not detect what percentage of clients recover, measure how long it takes for NURSINGTB.COM clients to see a provider or note how many cases are associated with other major risk factors. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A nurse needs to collect baseline data before implementing which type of a study? a. Cost- accounting study b. Cost-benefit study c. Cost-effectiveness study d. Cost-efficiency study ANS: C A study designed to measure the quality of a program as it relates to cost is a cost-effectiveness study. A cost-efficiency study is designed to examine the actual cost of performing program services and to focus on productivity versus cost. A study used to assess the desirability of a program by examining costs and benefits is a cost-benefit study. Cost- accounting studies are performed to find the actual cost of a program. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse collects data about productivity of staff members to evaluate a program. Which type of study is the nurse completing? a. Cost-accounting study b. Cost-benefit study c. Cost-effectiveness study d. Cost-efficiency study ANS: D A cost-efficiency study is designed to examine the actual cost of performing program services and to focus on productivity versus cost. A study designed to measure the quality of a program as it relates to cost is a cost-effectiveness study. A study used to assess the desirability of a program by examining costs and benefits is a cost-benefit study. Cost- accounting studies are performed to find the actual cost of a program. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse has provided an organization a philanthropic contribution. Which of the following best describes what the nurse has provided? a. Contract b. Gift c. Grant d. Loan ANS: B Gifts are philanthropic contributions. Contracts are awarded for the performance of a specific task or service, usually to meet guidelines specified by the organization making the award. Grants are awards to nonprofit organizations to allow the recipient tNURSINGTB.COM o implement activities of their own design that address the interests of the funding agency. A loan is money that needs to be paid back to the lender. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 30. A nurse completes a cost-accounting study on a program that targets obese adults, helping them to adopt healthier lifestyle choices. The nurse would like to compare the cost of the program to the cost savings in the health care system by preventing the occurrence of chronic illnesses. Which of the following types of studies would be most appropriate to use in this situation? a. Cost-accounting study b. Cost-benefit study c. Cost-effectiveness study d. Cost-efficiency study ANS: B A study used to assess the desirability of a program by examining costs and benefits is a cost-benefit study. Cost-accounting studies are performed to find the actual cost of a program. A study designed to measure the quality of a program as it relates to cost is a cost- effectiveness study. A cost-efficiency study is designed to examine the actual cost of performing program services and to focus on productivity versus cost. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. After a need and client demand for a program have been determined through the needs assessment process, the next step in the development of the program is to choose a procedural method that will assist the nurse in planning the program to be offered. Which are possible planning methods? (Select all that apply.) a. Program planning method (PPM) b. Multi-attribute utility technique (MAUT) c. Sustainability method d. Effectiveness method e. Population needs assessment ANS: A, B PPM and MAUT are types of planning methods. The sustainability and effectiveness methods are parts of the PPM. Sustainability is an evaluation method to determine if there are resources available to continue the program. Effectiveness is an evaluation method to determine if the program is able to meet its objectives and to evaluate the results of program efforts. A population needs assessment is one of the first steps in program planning but does not describe the entire process of program planning. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 20: The Nurse Managed Health Center: A Model for Public Health Nursing Practice Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which type of nursing center actively integrates service, education, and research in its model? a. Special care b. Free-standing c. Fee-for-service d. Academic ANS: D Academic nursing centers actively integrate service, education, and research in their model. Special care centers provide services and specialized health knowledge and skills to a particular group, and they are an adjunct to comprehensive primary health care models. A free-standing center is an independent center with its own governing board. A fee-for-service center means that payment is provided at time of service and it may include a sliding-scale fee. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which characteristic is common among all nursing centers?NURSINGTB.COM a. Provision of community-based culturally competent care b. Services provided by physicians and health care providers c. Focus on the biological factors contributing to the development of disease d. Fee-for-service reimbursement model ANS: A One characteristic that is common among all nursing centers is the provision of community- based culturally competent care, that is, accessible, acceptable, and responsive to the populations being served. Services are provided by nurses in a nurse center. A variety of reimbursement models are used in nursing centers. Nursing centers use a holistic approach to care. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is employed by a nursing center. Which of the following types of services will be provided here? a. Illness-oriented care b. Direct access to nursing services c. Free services d. Physician diagnosis of health problems ANS: B Nursing centers provide unique opportunities to improve the health status of individuals, families, and communities through direct access to nursing and nursing models of care. A nursing center deemphasizes illness-oriented care, is reimbursed for services, and uses nurses to diagnose and treat. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse working at a nursing center has been asked to develop materials about a health promotion topic that can be used at the center. Which of the following topics would the nurse most likely select? a. Advanced care of the chronically ill elderly at home b. Smoking cessation and weight management techniques c. How to access specialty services d. Providing financial support for nursing students ANS: B Nurse centers are positioned to improve the health and well-being of vulnerable populations. One way to achieve this is by providing access to comprehensive primary health care and health promotion and disease prevention services. Smoking cessation and weight management techniques focus on health promotion, which address the main focus of the nurse center. Advanced care of the chronically ill and accessing specialty services does not address health promotion and disease prevention services. Providing financial support for nursing students does not address a health promotion and disease prevention topic and does not meet the needs of the broad population that may be served by the center. DIF: Cognitive level: AnalyzingNURSI NGTB.TOP:COM Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 5. Which type of nursing center operates under a service model? a. Free-standing center b. Affiliated center c. Comprehensive primary care center d. Proprietary ANS: C The service model includes comprehensive primary care centers, wellness centers, and special care centers. Organizational structure is the typology used to describe a free-standing and affiliated center. Internal Revenue Service Designation is the typology used to describe a proprietary center. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. What is the focus of a special care nursing center? a. A demographical group with special care needs b. An affiliation with a school of nursing c. Providing services while maintaining a not-for-profit status d. Providing fee-for-service care with designated Health Maintenance Organization (HMO) providers ANS: A Special care centers focus on a particular demographical group or those with special needs. Examples are those that focus on persons with HIV/AIDS, adolescent mothers, and the frail elderly. An academic nurse-led center has an affiliation with a school of nursing. A 501(c)(3) center is considered a nonprofit business. An HMO provider provides fee-for- service care with contracted rates by an HMO. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A client would like to enroll in a smoking cessation program. Which of the following types of nursing centers would be most likely to provide this type of programming? a. Academic Nursing b. Wellness c. Comprehensive Primary Care d. Special Care ANS: B Wellness centers focus on health promotion, disease prevention, and management programs. An academic nurse-led center has an affiliation with a school of nursing. A comprehensive primary care center provides health-oriented primary care and public health programs. Special care centers focus on a particular demographic group or those with special needs. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse executive reports that the nursing center receives reimbursement through contracted NURSINGTB.COM rates. Which of the following types of reimbursement mechanism is being used? a. Fee-for-service b. Federally Qualified Health Center (FQHC) c. Health Management Organization (HMO) provider d. Third-party reimbursement ANS: C HMO providers pay at contracted rates. Fee-for-service means payment is provided at time of service. FQHC has federal designation that allows cost-based reimbursement per encounter. Third-party reimbursement involves client billing to a public program or commercial/private insurance. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Individuals, families, groups, organizations, policy makers, and staff who are involved in community collaboration are identified by what term? a. Nursing center workers b. Policy makers c. Stakeholders d. Diversity ANS: C Stakeholders offer diversity in perspective in community collaborative efforts. Policy makers are those involved in creating the policies. Nursing center workers are those who work as staff within the nursing center. Diversity is demonstrated through working with a variety of populations. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. What was the overarching concept upon which Healthy People 2020 was built? a. Establish nursing centers for improving health promotion. b. Create partnerships among individuals, communities, and systems. c. Eliminate disease in lesser-developed countries. d. Further the agenda of the World Health Organization (WHO). ANS: B Healthy People 2020 builds upon shared responsibility to improve the nation’s health. Powerful, productive partnerships among diverse people and groups and long-term commitments to community collaboration are needed to achieve these goals. Healthy People 2020 did not promote the establishment of nursing centers. Healthy People 2020 focuses on the needs of the United States, not that of lesser-developed countries or the agenda of the WHO. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 11. A nurse is working with a group and would like to facilitate successful collaboration. Which of the following would be the most important factor for the nurse to consider? NURSINGTB.COM a. Focus of the group b. Planned change that will occur c. Decisions made by executive director d. Open and frequent communication ANS: D Although the focus of the group and its planned change are important, they are not the most important factor for the nurse to consider. To accomplish anything with the group, open and frequent communication is necessary. Decisions should be made through consensus of the group, not the decisions of one person. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. Which term addresses the multiple levels of intervention required for bringing about and sustaining change? a. Community collaboration b. Community assessment c. Strategic planning d. Partnership ANS: C Strategic planning addresses the multiple levels of intervention required for bringing about and sustaining change. Community collaboration involves the capacity of those involved to enhance the capacity of another person, group, or organization to achieve the common purpose. Community assessment involves examining the community to determine its needs, strengths, and weaknesses. Partnership involves working together to solve community problems. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse would like to improve the ability of the nursing center to be responsive to the needs of the community. Which of the following best describes how this can be accomplished? a. Having staff examine the needs of the community b. Determining the services to be provided by the center c. Involving the community in assessing its own needs d. Addressing the problems in the community ANS: C Nurses work in close partnership with the communities. As the community and center work together, a multilevel approach is needed. For comprehensive community health improvement, strategies are needed at organizational, community, and sociopolitical levels. Thus, it is important to involve the community in the planning of a nursing center. Having the staff examine the community needs does not involve the community. If the nurse determines the services to be provided, this does not demonstrate collaboration and communication with the community. The nurse needs to work with the community in order to determine which problems in the community should be addressed. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A community health center conducts blood lead screenings on a regular basis for children under 6 years old. Which of the following best describes the level of prevention that is being used? a. Tertiary prevention b. Primary prevention c. Secondary prevention d. Health education ANS: C Secondary prevention often involves screening. Primary prevention involves education. Tertiary prevention involves rehabilitation. Health education is provided to improve knowledge about a health topic. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A nursing center is going to be placed in a rural community. Which of the following would have the most power and influence on model development and team composition? a. The rural community b. The community’s mayor c. The nursing center’s executive d. The center’s staff ANS: A The fundamental premise of any nursing center is that the community has the most power and influence. The mayor, nursing executive, and staff do not have as much power as that of the community. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A nurse executive is managing a nursing center. Which of the following would be an expected responsibility of a nurse in this role? a. Managing the business operations b. Managing the data systems c. Providing patient care and referral d. Overseeing contracts and grants ANS: D The nurse executive has many leadership roles and responsibilities including responsibility for overseeing contracts and grants, annual reports, development of the advisory board, and hiring and retention of highly qualified staff. Other staff members will manage the business operations, data systems, and provide patient care and referral. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse executive would like to hNURSire a neighborhood resident who is trained in community INGTB.COM outreach to work at the nursing center. Which of the following would most likely be the title of this position? a. Community health worker b. Support staff member c. Clinical specialist d. Specialty care provider ANS: A Community health workers are typically neighborhood residents who are trained in community outreach, family case management, or on-site services. A support staff member may include a business or operations manager and data operations personnel. A clinical specialist is an advanced practice nurse. A specialty care provider has had advanced education in a specialty area. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nursing student would like to become involved by working at a nursing center. Which of the following would be an appropriate role for a nursing student? a. Leader b. Follower c. Advocate d. Researcher ANS: C Students most often play the role of advocate in a nursing center. Students can promote social justice while engaging in community service learning activities with underserved, vulnerable populations. A student needs to be a leader, but with supervision. A student can collect data but is not yet a researcher. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nurse needs to make the final decision about establishing a nursing center in the local community. Which of the following factors would be the most important for the nurse to consider? a. Legal and regulatory considerations b. Community involvement c. Nursing interest d. Potential grant funding ANS: A Several essential areas must be explored before a final decision is made about establishing a nursing center, including legal and regulatory considerations. Community interests would be important to consider, not necessarily community involvement. All funding sources, not just grant funding, should be considered. The nursing interest is not a main component that needs to be considered when establishing a nursing center. DIF:MSC: Cognitive level: ApplyingNCLEX: Safe and Effective Care Environment: Management of CareNURS INGTB.TOP:COM Nursing process: Planning 20. A nurse develops a plan to describe the development and direction of the nursing center and identifies how the center will meet its goals. Which of the following best describes this plan? a. Feasibility study b. Business plan c. Strategic plan d. Organizational framework ANS: B A business plan describes the development and direction of the nursing center and how goals will be met. A feasibility study identifies the strengths, limitations, and capacity of an organization and the community to support the establishment and continuation of a nursing center. A strategic plan looks into the future and guides the work of the center in that direction. The organizational framework shows how the organization is organized. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is examining the strengths, limitations, and capacity of an organization and the community to support the establishment and viability of a nursing center. Which of the following best describes what the nurse has completed? a. Data collection b. Feasibility study c. Focus groups d. Community forums ANS: B A feasibility study reveals the strengths, limitations, and capacity of an organization and community to support the establishment and viability of a nursing center. Focus groups, community forums, and data collection are all used to complete a feasibility study. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is using the Health Insurance Portability and Accountability Act (HIPAA). Which of the following situations is the nurse most likely experiencing? a. Counseling an employee that his insurance will remain the same after changing jobs b. Supervising staff to ensure that all work has been completed c. Adhering to client confidentiality when providing care d. An employee takes additional time off of work to care for a sick family member ANS: C HIPAA states that staff must monitor and keep client records secure and have mechanisms to transfer client information securely and appropriately. Counseling about insurance, supervising staff to make sure work has been completed, and taking additional time off of work is not part of HIPAA. DIF: Cognitive level: AnalyzingNURSI NGTB.TOP:COM Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse has recently completed a research study in a nursing center. Based on the historical pattern of research in nursing centers, what would likely have been the focus of this research? a. The development and characteristics of nursing centers b. The effects of nursing models of care in nursing centers c. Client outcomes d. Managed competition in nursing centers ANS: A Typically, descriptive data has been collected about clients, types of services, financial support systems, and community relationships over the past three decades. Additional research in the future needs to be done to look at the effects of nursing models of care and client outcomes. There is no need now to look at managed competition in nursing centers. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse executive publishes information about the effectiveness of a prenatal program. Which of the following describes this essential step of evaluation of this program? a. Focusing on design b. Engaging stakeholders c. Ensuring use and sharing lessons learned d. Gathering credible evidence ANS: D A nurse executive providing materials on the effectiveness of a prenatal program is an example of gathering credible evidence. Focus on design, engaging stakeholders, and ensuring use and sharing lessons learned are parts of evaluation. However, these steps are not necessary before publishing information about program effectiveness. Credible evidence must be gathered before publication. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. A nurse is presenting information to community members about the potential development of a retail care clinic in the neighborhood. Which of the following information would the nurse include in this presentation? a. These clinics are typically staffed by physicians. b. These clinics are usually located in community centers. c. These clinics focus on providing information related to health promotion. d. These clinics are often owned by for-profit organizations. ANS: D Retail care clinics are typically staffed by nurse practitioners, located in a high-volume retail business, and provide a limited scope of care including immunizations, routine school physicals, and care for common acute problems. The majority of retail clinics are owned by for-profit organizations and its management does not consider the clinics as nurse-managed health centers. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nursing faculty member is discussing the importance of joining a professional organization as a registered nurse with a group of undergraduate students. Which of the following statements would be most appropriate for the faculty member to include in this discussion? a. “All nurses should be members of the American Nurses Association.” b. “Membership in a professional organization helps nurses organize around critical health issues.” c. “Dues for professional organizations are expensive, so it is important to set aside money to pay these dues.” d. “Membership in a professional organization will foster change in legislation.” ANS: B Membership in a professional organization helps nurses to organize around one or more critical health threats and strategize about what interventions work locally, regionally, and nationally. Membership in organizations should be based on interest, clinical and academic preparation, and employment. Dues for professional organizations vary, but most are not extremely expensive. One of the benefits of membership in a professional organization is that legislation can be influenced, however this in only one of the benefits of belonging to a professional organization. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is looking for financial support when developing a nursing center. Which of the following would be an appropriate source for funding? (Select all that apply.) a. Grant funding b. Charitable organizations c. Private pledges d. Foundations e. State and federal agencies ANS: A, B, C, D Support for nursing centers can come from grants, charitable organizations, private pledges, and foundations. State and federal agencies typically do not provide funding for nursing centers. DIF: Cognitive level: ApplyingNURS INGTB. COM Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is performing the role of researcher in a nurse center. Which of the following types of data would most likely be collected by a nurse in this setting? (Select all that apply.) a. Client use of services b. Trends in community characteristics c. Staff compliance with HIPAA d. Client satisfaction e. Morbidity rates ANS: A, B, D Trends in health care services, client responses, and changes in community characteristics must be documented and summarized periodically. Outcome measurements such as client use of on-site services, childhood and adult immunization patterns, pregnancy outcomes, emergency department and hospital use, and other health indexes including client satisfaction and quality-of-life measures should also be collected. Staff compliance with HIPAA is a legal responsibility of staff and data should not need to be collected about this topic. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care Chapter 19: Health Education Principles Applied in Communities, Groups, Families, and Individuals for Healthy Change Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the goal of providing education across the three levels of prevention? a. Enabling clients to attain optimal health b. Identifying and treating health problems early to eliminate disability c. Enabling populations to break into individuals d. Teaching people about Healthy People 2020 ANS: A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of disability may not be possible. Health education does not teach about the Healthy People 2020 document or break populations into individuals. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Which statement about education is true? a. It emphasizes the provider of knowledge and skills. b. It emphasizes the recipient of knowledge and skills. c. It is a process of gaining knowledge and expertise.NURSINGTB.COM d. It results in behavioral change. ANS: A Education is the establishment and arrangement of events to facilitate learning. Education emphasizes the provider’s role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and skills. Education does not necessarily result in change, as change is typically not easy for most people. Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse uses Healthy People 2020 as a guide when planning health education in the community. Which of the following actions would be taken by the nurse? a. Focus on avoiding cigarette smoking and using alcohol in moderation. b. Educate clients using primary and secondary levels of prevention. c. Use Bloom’s taxonomy when planning educational objectives. d. Design health fairs aimed at individuals. ANS: B Healthy People 2020 focuses on implementing health promotion in priority areas using primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care education. Health fairs targeted at specific populations can provide a venue for providing primary and secondary prevention. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. What does the cognitive domain of learning include? a. Changes in attitudes and the development of values b. The performance of skills c. Memory, recognition, understanding, reasoning, and problem solving d. Memorization of one set of skills before moving on to the next ANS: C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain includes changes in attitudes and the development of values. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Memorization of skills is only one part of the cognitive domain. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 5. A nurse is teaching a client about how to complete a wound dressing change. Which of the following conditions must be met before learning will occur? a. Must be able to memorize the instructions, relay this information to a partner, and NURSINGTB.COM demonstrate the dressing change. b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person. c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time. d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to practice the dressing change. ANS: D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the necessary requirements of the learner. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A health educator is trying to change a client’s attitudes about smoking. Which of the following domains would be used? a. Cognitive b. Affective c. Psychomotor d. Developmental ANS: B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. The nurse is teaching a new diabetic client how to give himself an insulin injection. Which of the following domains would be used? a. Developmental b. Cognitive c. Affective d. Psychomotor ANS: D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and MaintenanceNURSINGTB.COM 8. A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby. Considering the events of instruction, which of the following should the nurse do next? a. Ask the mother about her previous experience with breastfeeding. b. Demonstrate how to position the baby for breastfeeding. c. Show the mother a video about breastfeeding. d. Have the mother demonstrate breastfeeding. ANS: A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is “Tune in”: listen before starting to teach; the client’s needs should direct the content. Thus, this should be done before the nurse does any demonstration, shows audiovisual resources, or requests return demonstrations. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. A nurse has evaluated the learning needs of a community support group. Which of following steps should the nurse take first when developing an educational program for them? a. Consider any potential barriers to learning. b. Establish goals and objectives for the program. c. Select appropriate materials for the program. d. Assess the dynamics of the group. ANS: B Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the educational process are: (1) identifying educational needs, (2) establishing educational goals and objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5) evaluating the educational process. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 10. A nurse is developing a goal for a client who is learning how to care for an ostomy. Which of the following would be most appropriate to develop? a. The client will look at his stoma without disgust each time his ostomy bag comes off. b. The client will be able to independently take care of his ostomy bag within 3 months. c. The client will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. The client will successfully describe to the nurse how to care for his ostomy when he is asked. ANS: B Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time. The other choices describe objectives.NURSINGTB.COM DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 11. A community health nurse is writing an objective. Which of the following would be most appropriate for the nurse to write? a. Each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials. b. The client will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment. ANS: A Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms. The objective “each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials” contains the components of a written objective. “The client will perform a blood sugar test on herself with an accurate blood sugar reading” does not provide any measurable terms. “The community will take their children to receive immunizations within 1 month of the immunization due date” does not provide a measurable percentage of the members of the community. “Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment” focuses on a long-term goal, rather than a short-term objective and does not provide a time frame for when this would be measured. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 12. A nurse is using the educational process of selecting appropriate educational methods when planning a community health program. Which of the following steps of the nursing process does this action most resemble? a. Assessment b. Evaluation c. Implementation d. Planning ANS: D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. NURSINGTB.COM Planning is similar to selecting appropriate educational methods. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 13. A nurse is teaching a group of clients newly diagnosed with diabetes how to give themselves injections. Which of the following formats would be most appropriate for the nurse to use? a. Demonstration b. Health fair c. Lecture d. Non-native language session ANS: A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done. Health fairs target specific populations and are held in a variety of locations. Non-native language sessions are a way to adapt the health fair to a population that does not speak English. Lecture is a non-interactive method of teaching. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 14. A nurse is implementing an educational program about the importance of being physically active. Which of the following steps would the nurse complete first? a. Provide learning guidance. b. Present the stimulus. c. Gain the learner’s attention. d. Ask learners to recall prior learning. ANS: C Gaining the learner’s attention must happen first before learning can take place. The following steps of implementation include telling the learners the objectives of the instruction, asking learners to recall previous knowledge, presenting the essential materials, helping the learners apply the information, encouraging learning to demonstrate what they have learned, and providing feedback to help learners improve their knowledge and skills. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A nurse is implementing a community health education program at a local church. Which of the following educational principles should the nurse implement when providing this education? a. Refer to trustworthy sources. b. Use an active voice. c. Create the best learning environment. d. Accentuate the positive health behaviors of the participants. ANS: C The environment must be conducive to learning for educational programs to be effective. The environment should be free of distractions and conNURSINGTB.COM sistent with the message. The other strategies may assist with the educational program but are not one of the major educational principles discussed in the textbook. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 16. A nurse is working with a group of clients diagnosed with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. Which of the following principles of effective education is the nurse using? a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidance ANS: A The educator should have the learners recall previous knowledge related to the topic of interest. The principle of gaining attention should have been applied as the program started the week before. Recall should be done before new material is presented and before learning guidance is provided. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. During a class on newborn care given at a local health department, a nursing student asks the participants to practice with baby dolls. Which of the following steps of promoting effective education is the student using? a. Eliciting performance b. Assessing performance c. Enhancing retention and transfer of knowledge d. Gaining attention ANS: A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned. Gaining attention occurs at the beginning of the program. Assessing performance occurs at the end of the program. Enhancing retention and transfer of knowledge occurs as the learners are asked to apply the information to their lives and situations (not to the care of the dolls). DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 18. A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. Which of the following concepts is being applied? a. Authoritarianism b. Learning style c. Pedagogy d. Andragogy ANS: D NURSINGTB.COM Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners. In pedagogy the teacher assumes full responsibility for making decisions about what will be learned, and how and when it will be learned. In authoritarianism the leader controls group movement and progress through interpersonal power. Learning style refers to how someone learns best. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 19. A nurse is working for a public health department as the community health educator. Which of the following is a potential barrier that a nurse may experience? a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking necessary knowledge ANS: D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information. Clients with low literacy levels and limited vocabularies are learner-related barriers, not a barrier of the educator. Memorizing the information to teach may cause problems with the presentation but would not be a barrier for the educator. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. A nurse is working with an individual who has a low literacy level. Which of the following barriers to learning should the nurse anticipate? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of anxiety d. Being overly dependent on others ANS: B Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home. The level of anxiety may vary among these individuals; it is more common for these individuals to request to read it later. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance NURSINGTB.COM 21. A client diagnosed with diabetes reports to the nurse that she has been learning more about controlling her blood sugars by reading information found on the Internet. Which of the following statements by the nurse would be appropriate? a. “Looking at the date the content was posted on the website is important.” b. “The Internet is an unreliable source of information and should not be used.” c. “The best sources of information are found on pharmaceutical websites.” d. “Your physician will provide you better information than the Internet.” ANS: A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated. The Internet has reliable information, but the quality of the information must be assessed. Pharmaceutical websites may have biased information. Physicians are another source of information, but this may or may not be better than what is found on the Internet. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 22. When a nurse is evaluating the components of an educational program. Which of the following best describes the action that is being taken by the nurse? a. Short-term evaluation b. Educational product c. Process evaluation d. Long-term evaluation ANS: C Process evaluation means looking at the components of an educational program. The educational product is the outcome of the educational process. Short-term evaluation evaluates the immediate effects of a health program. Long-term evaluation is geared toward following and assessing the status of an individual, family, community, or population over time. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 23. A nurse has been working on a regular basis with a group that demonstrates cohesion. Which characteristic is the nurse most likely to describe? a. Inclusion of several leaders. b. Demonstrates diverse attitudes and values. c. All members share a common goal. d. The group has an efficient number of members. ANS: C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members. A group with several leaders may have difficulty obtaining cohesion if each of the leaders has a different idea. Common attitudes and values among the group members will be important for the group to obtain cohesion. Efficiency does not play a role in developing cohesion. DIF: Cognitive level: ApplyingNURS INGTB.TOP:COM Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A nurse recognizes the importance of group norms when planning community health education. Which of the following provides the best explanation for why this is important? a. Allows for creativity and variety among group members. b. Influences members’ perception of community. c. Are helpful in evaluating the effectiveness of the group. d. Maintains the group through various supports to members. ANS: D Group norms serve to maintain the group through various supports to members. They are the standards that guide, control, and regulate individuals and communities. They suggest what a group believes is important, what it finds acceptable or objectionable, or what it perceives as of no consequence. Group norms may limit the creativity and variety among the group members. Members’ perception of the community could be influenced by group norms, but this is not why this consideration should be made when planning community health education. Group norms are not used to evaluate the effectiveness of the group. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. A group member has taken on the role of the “gatekeeper.” Which of the following actions would most likely be taken by this member? a. Seek and accept the authority or direction of others. b. Guide and direct the group activity. c. Control outsiders’ access to the group. d. Focus the movement toward the main work of the group. ANS: C The gatekeeper controls outsiders’ access to the group. The follower seeks and accepts the authority or direction of others. The leader guides and directs group activity. The task specialist focuses or directs movement toward the main work of the group. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 26. A nurse uses the leadership behavior of reflecting when providing education to community members about how to lead healthy lifestyles. Which of the following actions is most likely being taken by the nurse? a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussion ANS: A Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A leader controls group members through rewards and often keeps members in the dark about the goals and rationale behind prescribed actions. What type of leadership does this describe? a. Democratic b. Patriarchal c. Socialist d. Paternal ANS: B Patriarchal is authoritative and permits one to control members through rewards and threats. Paternal leaders win respect and dependence through parent-like devotion. Democratic leadership is cooperative in nature and promotes and supports members’ involvement in all aspects of decision making and planning. Socialist leadership supports community ownership and involvement of the community. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. What characteristic should the nurse expect when working with an established education group? a. The group membership will change from week to week. b. The members all have the same interests. c. They prefer lectures rather than demonstrations. d. The group already has operating methods that have been successful. ANS: D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful. An established group would have a stable group membership. Learning occurs better in all groups with demonstrations instead of lectures. In an established group, they may be together because of a common interest, but may not share all the same interests. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 29. A nurse is working with a group focused on improving the health of the community. Which of the following interventions should be used by the nurse? a. Making decisions for the group to move the process along b. Inviting business leaders to participate in the group process c. Maintaining members through recognition and encouragement d. Teaching topics that are of national importance ANS: C Maintaining members is an important intervention to facilitate group process. The topics that are taught should be of importance to the group. The group should be part of the decision-making process. The membership of the group should be maintained, inviting new NURSINGTB.COM members to the group may hinder the processes of the group. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 30. Which Core Competency of communication is used by nurses engaged in group work? a. Soliciting input from individuals and organizations b. Using simple language when presenting information c. Asking the group to develop the program of interest d. Presenting material to lay audiences ANS: A Soliciting input from individuals and organizations is a communication competency. Various strategies should be used to present the information. The group should assist in determining the topic but not developing the program. The material should be presented to professional and lay audiences. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 31. A nurse is planning to evaluate a group’s progress toward a health goal. Which of the following components should be included in the evaluative process? a. Type of teaching strategy used b. Recognition of accomplishments in the group c. Conflict that occurred in the group d. The type of leadership in the group ANS: B Recognition of accomplishments in the group and of the group is built into the evaluative process. The type of teaching strategies used, types of leadership, and conflict are not part of the evaluative process of the group. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is using basic educational principles when conducting an effective educational program. Which of the following principles would the nurse most likely be using? (Select all that apply.) a. Use a clear, succinct style. b. Use an active voice. c. Refer to Internet sources. d. Use aids to highlight key points. e. Repeat information several times. ANS: A, B, D Using a clear, succinct style, active voice, and using aids to highlight key points are all basic educational principles that should be used by the nurse. Reliable sources must be used, and NURSINGTB.COM information found on the Internet is not always reliable. Repeating information is not an education principle. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance Chapter 18: Building a Culture of Health to Influence Health Equity Within Communities Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. A nurse is educating the community about modifiable behaviors. Which of the following is the nurse most likely to discuss? a. Smoking, poor diet, and alcohol consumption b. Cancer, emphysema, and cardiovascular disease c. Age and gender d. Genetic abnormalities ANS: A Modifiable behaviors remain the major contributors to deaths in the United States. Tobacco use, poor diet, physical inactivity, and alcohol consumption are examples of modifiable behaviors. Cancer, emphysema, cardiovascular disease, gender, age, and genetic abnormalities are not modifiable behaviors. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. A nurse is utilizing a disease-oriented approach when providing care to a client. Which of the following interventions will the nurse most likely provide? a. Promotion of a greater level of positive healthNURSINGTB.COM b. Education about common disease processes c. Acute care management of chronic disease d. Education about medication compliance ANS: D A disease-oriented approach assumes that humans are composed of organ systems and cells; in this instance, health care focuses on identifying what is not working properly with a given system and repairing it. In this context, health behavior begins with patient compliance with health professionals’ recommendations. This approach does not promote a greater level of positive health as this would be related to health promotion. This approach does not provide education about common disease processes or acute care management of chronic disease. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 3. The biomedical model defines health as what? a. An avoidance of illness b. The absence of disease c. The promotion of healthy behaviors d. A protection from illness and disease states ANS: B The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. What is a health-oriented perspective viewpoint? a. Health as the absence of disease b. Human lifestyle based on one’s prescribed regime c. Humans as complex and interconnected with the environment d. Community education as the role of the registered nurse ANS: C The health-oriented perspective includes the view that humans are complex and interconnected with others and the environment. Health behavior within this perspective involves a holistic view of lifestyle and interaction with the environment and not simply compliance with a prescribed regimen. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse using the integrative model for community health promotion. Which of the following best describes how the nurse would apply the dimension of client system? a. Concentrating on individual health behaviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients d. Focusing on disease-oriented careNURSIN GTB.COM ANS: C The client system is multidimensional with nursing and health care targeting the multiple levels of clients. When the individual is the client, the environment includes the family, the broader aggregate, and the community of which the individual is a part. The nurse and health care provider are concerned with how these environments affect the individual’s health. The focus for care is on health promotion, illness prevention, and illness care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A public health nurse (PHN) collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. Which of the following client systems of the integrative model does this describe? a. Community b. Aggregate c. Family d. Individual ANS: A Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people. The community is the environment for the aggregate and is the system being applied. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A public health nurse (PHN) collaborates with a physician’s clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed? a. Aggregate level health promotion b. Aggregate level illness prevention c. Family level illness care d. Individual level health promotion ANS: A Each succeeding level of the client system is more complex. In this situation, the PHN is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education. Illness prevention is linked to the negative view of the absence of disease. Illness care is the care provision of someone with the disease. DIF: Cognitive level: ApplyingNURS INGTB.TOP:COM Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation? a. Family level health promotion b. Individual level illness prevention c. Aggregate level illness prevention d. Individual level health promotion ANS: B The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention. Health promotion focuses on positive measures of health. The family level and aggregate level both focus on inclusion of more than one person. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. When applying the integrative model for community health promotion, a nurse assesses the neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe? a. Individual b. Family c. Aggregate d. Community ANS: D The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions. This is the broadest client system as the nurse is examining the neighborhood. Individual focus is looking at individuals, family focuses on families, and aggregates focuses on populations. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse provides a screening for school-aged children to screen for hearing deficits. Which of the following is being demonstrated by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Health promotion activities are interventions focused on improving one’s health. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 11. According to Leavell and Clark, what does primary prevention consists of? a. Health promotion and rehabilitation b. Health promotion and specific protection c. Early diagnosis and prompt treatment d. Health maintenance and early diagnosis ANS: B Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. A client wears a seat belt whenever riding in an automobile. Which of the following best describes the client’s behavior? a. Illness prevention b. Health promotion c. Specific protection d. Health protection ANS: C Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health protection strategies include environmental measures to improve health and quality of life. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 13. A client walks 5 miles a day because of a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection ANS: B The client is exercising to prevent an illness that runs in the family. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health maintenance focuses on maintaining health. Health NURSINGTB.COM protection strategies include environmental measures to improve health and quality of life. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. A client runs 5 miles a day because it improves mood and energy level. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection ANS: A The client is exercising to improve and promote health. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of life. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A community is searching for additional funding so that a bike trail can be built in the community. Which of the following best describes this example? a. Health promotion b. Illness prevention c. Specific protection d. Health protection ANS: D Health protection strategies include environmental measures to improve health and quality of life. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 16. Which of the following statements is correct? a. Genes, biology, and health behavioral choices account for 75% of population health. b. Medical care accounts for 25% of population health. c. Physical and social environments account for 75% of population health. d. Genes, biology, and health behavioral choices account for 25% of population health. ANS: D Genes, biology, and health behavioral choices account for 25% of population health and social determinants of health, including medical care; the physical and social environment NURSINGTB.COM account for the remaining 75%. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. What does the National Prevention Strategy provide? a. Recommendations on what can be done to improve population health b. Assistance in interpreting Healthy People 2020 c. A basis for public health nursing practice d. Health risk appraisal instruments ANS: A The National Prevention Strategy offers recommendations on what can be done to improve population health in specified contexts and across goal areas. This document does not assist in interpreting Healthy People 2020, providing a basis for public health nursing practice, or providing health risk appraisal instruments. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 18. Which of the following describes one advantage of the Health Belief Model (HBM)? a. It is one of the most recently developed models based on evidence-based practice principles. b. It can reduce the incidence of diseases and disabilities. c. It can assist with planning programs to increase an individual’s motivation to take positive health action. d. It promotes individual’s participation in community-based screening programs. ANS: C The Health Belief Model (HBM) can assist with planning programs to increase an individual’s motivation to take positive health action. This theory was one of the first theories of health behavior, which began in the 1950s. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. There is nothing to support that the use of this model will reduce the incidence of diseases and disabilities. It focuses on motivation of changing health behaviors, not participating in screening programs. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 19. A nurse is using the Health Belief Model (HBM) when developing health programs in the community. Which of the following is the nurse most likely involved in? a. Conducting group risk appraisal and risk reduction b. Considering the factors that will motivate the participants to change their health behaviors c. Completing a community wellness inventory d. Considering legislative changes that are necessary to improve environmental living conditions and sanitation ANS: B NURSINGTB.COM The HBM can assist with planning programs to increase an individual’s motivation to take positive health action. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. Conducting a group risk appraisal and risk reduction, completing a community wellness inventory, and considering legislative changes do not address an individual’s motivation to adopt a health behavior. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 20. A nurse is using Anderson and McFarlane’s model to complete a community health assessment. Which of the following information about the community would the nurse be collecting? a. Resources available to promote health b. Interactions among subsystems c. Physical environment d. Demographics ANS: B A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it. This model does not address the resources available to promote health, physical environment, or demographics. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. The Framingham Heart Study was successful in achieving what goal? a. Providing information on the effectiveness of risk-reduction interventions b. Documenting the relationship between social variables and heart disease c. Identifying factors contributing to the development of coronary heart disease (CHD) d. Demonstrating the effects of mass media in modifying high-risk behavior ANS: C The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. By collecting periodic health assessments and morbidity and mortality data, major risk factors associated with CHD mortality were identified. The investigators used health risk appraisals to relate the risk factors in well individuals to the probability of future cardiovascular disease. This study did not provide information on the effectiveness of risk-reduction interventions, document the relationship between social variables and heart disease, or identify factors contributing to the development of heart disease. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is performing interventions at the individual level of care. Which of the following is the nurse most likely completing? (NURSISelect all that apply.NGTB.COM ) a. Teaching well-balanced nutrition to a mother with a malnourished child b. Providing a parent age-specific information for immunizations c. Assessing the community for other cases of malnutrition d. Assessing other families on the same street for similar problems e. Planning a social marketing campaign about seat belt safety ANS: A, B Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. Which community-based programs resulted in equally favorable health risk changes for both control and treatment groups? (Select all that apply.) a. Framingham Heart Study b. Stanford Five-City Heart Disease Prevention Program c. North Karelia Study d. Minnesota Heart Health Program e. Dutch Heart Health Community Intervention ANS: B, C, D, E The Stanford Five-City Heart Disease Prevention Program, North Karelia Study, Minnesota Heart Health Program, and Dutch Heart Health Community Intervention provided beginning scientific evidence for the implementation of community-level risk reduction programs, although the results were modest and often not statistically significant. The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 01: Public Health Foundations and Population Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the primary focus to be addressed concerning the improvement of the health of the American people in the twenty-first century? a. Bioterrorism and global health threats b. Delivery of individual care and hygiene c. The need for increased hospital and acute care d. Chronic disease and disability management ANS: A There are new concerns, and of the most serious are bioterrorism and globally induced infections, such as the avian flu. These threats will divert health care funds and resources from other health care programs to be spent for public safety. The others are not related to public health or are concerns that have been present for many years. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Health Promotion and Maintenance 2. A community is concerned about the threat of bioterrorism. Which of the following best describes the basis for this concern? a. Bioterrorism has the potential to dissolve community-based programs. b. This threat could cause the health care system to collapse.NURSINGTB.COM c. The threat may divert funds from other public safety health care programs. d. Fear of bioterrorism will increase the need for shelters. ANS: C Bioterrorism may have an impact on the availability of resources for public safety health care programs. Because funds are diverted it is possible that community-based programs would be eliminated, the health care system could experience changes, and that there would be an increase in the need for shelter. However, all the remaining options would happen because of the diversion of funds. DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Physiological Integrity 3. Which statement describes the consequence of the successful implementation of the Affordable Care Act? a. Americans will pay closer attention to their health status. b. Most of the population will be covered by health insurance. c. Public health departments will need to increase the number of nursing positions. d. The prevalence of obesity will decrease. ANS: B One consequence of successful implementation of the Affordable Care Act might be that the majority of the population would be covered by insurance and public health agencies will not need to provide direct clinical services in order to assure that those who need them can receive them. The Affordable Care Act will not directly cause Americans to pay closer attention to their health status or decrease the prevalence of obesity. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. The public health nurse (PHN) must participate in the essential services of public health. What is one of the essential services of public health nursing? a. Monitoring health status by completing a community assessment b. Diagnosing and investigating health problems in the world c. Informing, educating, and empowering people about health issues d. Working in law enforcement to regulate health and ensure safety ANS: C The PHN monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The PHN would not diagnose or solve “world” problems, or work in law enforcement. Rather, the PHN would participate with local regulators to protect communities and empower people to address health issues. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 5. A public health department is using the mission of public health as described by the Institute of Medicine when planning its health programming. Which of the following activities will NURSINGTB.COM most likely be implemented? a. Tracking avian flu outbreaks and doing surveillance in the United States b. Providing a flu shot for an elderly person at the health department c. Keeping track of alternative therapies in use in the United States d. Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta ANS: A The Institute of Medicine’s stated mission on public health is “to generate organized community and technical knowledge to prevent disease and promote health.” Tracking avian flu outbreaks and doing surveillance applies this concept at a population level. Providing a flu shot for an elderly person only addresses individual care. Keeping track of the use of alternative therapies does nothing to prevent disease or promote health of the population. Keeping snake antivenom is aimed at disease care for an individual, not health promotion or disease prevention. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care ANS: C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge but is not a core function. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. What is the purpose of public health core functions? a. Clarifying the role of the government in fulfilling the mission of public health b. Ensuring the safety of populations in receiving quality health care c. Providing community-based individualized care to every person in the United States d. Uniting public and private providers of care in a comprehensive approach to providing health care ANS: A As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government’s role. NURSINGTB.COM DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. Which of the following statements about public health is accurate? a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b. Expenditures and resources for public health have increased in recent years. c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and food safety. d. Reform of the medical insurance system is the single change needed to improve the health of Americans. ANS: C Fielding and Tilson have asserted that most of the increase in life span has been made through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. Medical treatment has not made as significant of an impact on the life span as public health measures. Funding for public health in recent years has been on a gradual decline. Although reform of the medical insurance system may help improve the health of Americans, there are many other factors that will need to be addressed. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A public health nurse (PHN) collects data and monitors the health status of the population. Which of the following core public health functions is the nurse addressing? a. Assessment b. Prevention c. Assurance d. Policy development ANS: A Assessment consists of systematic data collection and monitoring health status. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. The public health nurse (PHN) compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is the nurse addressing? a. Assurance b. Assessment c. Prevention d. Policy development ANS: B Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. A public health nurse (PHN) develops and implements local public health policies through partnerships with agencies, organizations, and consumers within the community. Which of the following core public health functions is the nurse addressing? a. Assessment b. Prevention c. Assurance d. Policy development ANS: D Policy development deals with developing and implementing health policies. Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. A nurse provides for the availability of essential personal health services for people who would otherwise not receive health care. Which of the public health core functions is the nurse addressing a. Assessment b. Prevention c. Assurance d. Policy development ANS: C Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 13. The nurse manager makes sure that the staff members who work in a local clinic are competent in their job responsibilities. Which of the public health core functions is being demonstrated? a. Assurance b. Assessment c. Prevention d. Policy development ANS: A Assurance refers to making sure a competent health care workforce is available. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing healtNURSINGTB.COM h policies. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 14. Which intervention is the nurse most likely to implement when addressing one of the primary goals of public health? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old woman ANS: C The correct answer is concerned with the health of many people, while the other answers address individual interventions. According to the Core Functions Project, all levels of health care, including population-based public health care, must be funded or the goal of health of populations may never be reached. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A community health nurse collects data about the number and proportion of persons aged 25 or older with less than a high school education. Which term best describes this type of data? a. Sociodemographic characteristics b. Health status data c. Health risk factors d. Health care resource consumption information ANS: A The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Health risk factors discuss proportions of populations who have particular health conditions or health risks. Health care resource consumption refers to spending on health care per capita. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 16. The public health nurse (PHN) analyzes data related to the number and type of United States Environmental Protection Agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional status ANS: C Health risk factors discuss proportions of populations who have particular health conditions or health risks; breathing air of poor quality is a risk to health. The number and proportion of people is a sociodemographic characteristic. Health status includeNURSINGTB.COM s birth and death rates. Functional status refers to reports of good health status by members of the population. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is implementing quality performance standards in a public health department. Which statement best describes the importance of this action? a. Quality performance standards are used to guide improvement in the public health system. b. Quality performance standards rigidly control public health. c. Quality performance standards guide administrators to monitor public health at the national level. d. Quality performance standards can be used as hiring guidelines for nurses. ANS: A These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services (PHSs). These standards were developed around the 10 essential PHSs. They focus on the overall public health system rather than on single organizations and describe an optimal level of performance. They are intended to support a process of quality improvement. State and local communities can assess their performance using certain available tools. They are not meant to control public health or be used for hiring guidelines. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. To better address emerging public health issues, a public health nurse (PHN) plans to complete continuing education in this area. Which content areas should be included in the course that is chosen? a. Leadership b. Ethics c. Communication d. Finance ANS: B Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: (1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory research, (5) policy, (6) law, (7) global health, and (8) ethics. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. The public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management b. Workforce needs assessment c. Acute care services d. Curriculum developmentNU RSINGTB.COM ANS: A Workforce needs assessment, acute care services, and curriculum developments are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: (1) analytic/assessment, (2) policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems thinking. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 20. Why is public health nursing considered a nursing specialty? a. It has a distinct focus and scope of practice. b. It requires a master’s degree in nursing. c. It is focused on disadvantaged citizens. d. It performs interventions at the acute care level. ANS: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. The necessary basic preparation for public health nursing is what level of nursing education? a. Associate degree b. Baccalaureate degree c. Master’s degree d. Doctor of Nursing Practice ANS: B A Bachelor of Science in nursing (BSN) is the necessary basic preparation to function as a beginning staff PHN. An Associate degree is not enough for basic preparation. A Master’s degree or Doctor of Nursing Practice degree would be part of preparation for advanced practice. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 22. A public health nurse (PHN) has been prepared at the graduate level. Which activity should the practitioner be able to complete? a. Teaching public and community health nursing b. Assessing and intervening successfully at the aggregate level c. Diagnosing and treating disease while having earned prescriptive authority d. Running for political office as experts in public health policy ANS: B According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad NURSINGTB.COM range of practice areas within public health and are not limited to only nursing and medicine. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A public health nurse (PHN) provides clinic-based services for HIV-positive citizens in the community. Which term best describe this activity? a. Primary prevention b. Health education c. Tertiary prevention d. Policy making ANS: C This clinic is for clients who already have a disease process; therefore, it is tertiary prevention (preventing deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care). Primary prevention is using general and specific measures in a population to promote health and prevent the development of disease (incidence) and using specific measures to prevent disease in those who are predisposed to developing a particular condition. Health education would involve providing specific education to this population. Policy making is formulating plans by an organization in order to make decisions. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 24. A nurse is working in the community with an aggregate/population. Who is the nurse most likely to interact with? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who drink coffee ANS: A A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. Members of a community who can be defined in terms of geography or a special interest can be seen as constituting a population. The clients in the first option share a geographical and special circumstance (school) characteristic. Christians around the world are too large of a geographical space. A patient cannot be an aggregate/population as there is no one to interact with. People who drink coffee share a common interest but may not share a common geographical location to interact. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 25. How is a population best defined? a. High-risk group b. Those interacting within a school or institutional setting c. Collection of individuals who share at least one common characteristic d. Geographical location within a communityNURSINGTB.C OM ANS: C A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. High-risk groups, school or institutional setting, and geographical location within the community all describe types of populations, not the definition of population. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 26. Population-focused practice concentrates on defining the problems or needs of and implementing solutions for whom? a. Individuals b. Aggregates c. Communities d. Geographical regions ANS: B Aggregates are a defined population made up of individuals in communities of a specific geographical region. Population-focused practice is implemented with defined populations or subpopulations. This is larger than the scope of individual care but may not address the larger needs of the entire community or geographical region. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 27. A nurse is using a population focus when providing public health nursing care. Which statement best describes the care that is being provided? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered. ANS: C PHNs are concerned with the health of the entire population. Priority is given to the entire population, not just the group at highest risk or those outside of institutional settings. Direct caregiving is not the focus of public health nursing care. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 28. A nurse is working in a community health nursing practice setting. Which intervention is the nurse most likely to implement? a. Administering a flu shot to a client in a physician’s office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation center ANS: A NURSINGTB.COM Community health nursing practice focuses on the health of individuals, families, and groups and the effect of their health status on the health of the whole community. Administering a flu shot to an individual is the only example that meets this criterion. Performing a client assessment focuses only on individual care, not the community. Providing supervision of staff does not focus on the community. Conducting a flu shot clinic at a community center focuses on protecting the community as a whole and would be considered public health nursing practice. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 29. Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the whole community. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice. ANS: A Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff PHN; however, this is not a requirement for public health nursing or community health nursing practices. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 30. A nurse is implementing community-based nursing care. Which intervention is the nurse most likely to complete? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a community ANS: B Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition. Assessing the health needs of a community, promoting the health needs of an entire community, and investigating environmental health problems in a community would be considered public health nursing practice. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM 31. A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse performing? a. Community-oriented b. Public health c. Community health d. Community-based ANS: D Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the whole community. Community health nursing focuses on the health status of individuals and the effect of their health status on the whole community. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 32. The nurse is investigating environmental health problems caused by contaminated ground water. Which type of nursing practice is being implemented? a. Community-oriented b. Community-based c. Policy development d. Tertiary care ANS: A Community-oriented nursing emphasizes the prevention of disease and disability. Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Policy development seeks to build constituencies that can help bring about change in public policy. Tertiary care focuses on highly specialized medical care. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 33. A public health staff nurse (PHN) who has a clear understanding of population-focused practice, would most likely engage in what activity? a. Volunteering for a local community action coalition b. Performing interventions with individuals in the community c. Improving the effectiveness of care provided d. Considering earning a PHN certification ANS: C Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. PHN specialists are prepared at the master’s level and function in an administrative role. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance NURSINGTB.COM 34. Public health nurse (PHNs) are looking to improve population-focused care in the community. Which activity best describes a key opportunity for the nurses to accomplish this goal? a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practice ANS: B PHNs must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 35. A local senator has proposed changes to the health care delivery system in the United States. Based on current trends, what is most likely to occur? a. There will be new opportunities provided for public health specialists. b. It will result in isolated care being provided to individuals. c. There will be an increased emphasis in specialty care. d. It will increase the utilization of acute care services. ANS: A Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are considered barriers to public health nursing? (Select all that apply.) a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d. The steady decline in the number of job opportunities in the area. e. The inability to equally distribute the increasing funds. ANS: A, B, C Barriers exist in thinking that nurses only work in a hospital at the bedside, the process of role socialization in public health which can be a very autonomous profession, and that few nurses have had advanced education in public health. The number of jobNURSINGTB.COM opportunities continues to increase, but the amount of funding allotted to public health continues to decline. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care Chapter 17: Community as Client: Assessment and Analysis Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources ANS: C People, place, and function are the critical attributes in the definition of community. These attributes are found in most definitions of community. The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse has collected data about the services available in the community and is using the 7 “A’s” to evaluate these services. Which of the following questions will the nurse most likely ask? a. Can the community members allocate resources to support the service? b. Can the community members afford the service?NURSINGTB.COM c. Will the community members allow strategies to be implemented to improve the service? d. Will the community members approve of the services provided? ANS: B The 7 “A’s” include: Is the community aware of its needs and of the service? Is it accessible to community members? Is the service available when the community needs it? Can the community members afford the service? Does the community find the service acceptable? Is the service adequate to meet the needs of the community? And, are the services appropriate to meet the needs of the community? The following questions do not address the 7 “A’s”: Can the community members allocate resources to support the service? Will the community members allow strategies to be implemented to improve the service? And, will the community members approve of the services provided? DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is caring for the community as the client. Which of the following is most likely the focus of the nurse’s care? a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community ANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education. Provision of care for aggregates and families does not address the larger scope of community as client. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A collection of individuals who have one or more personal or environmental characteristics in common is defined as what? a. Community b. Group c. Family d. Aggregate ANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. A community is a group of people that share something in common, such as geographic location, interests, or values. A group is people who are located close together. A family is considered parents and children living together in a household. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which data source provides information about the function of the community? NURSINGTB.COM a. Local restaurant b. Elected officials c. County health department d. Civic groups ANS: C Function refers to the aims and activities of the community. Civic groups and elected officials refer to people. Local restaurant refers to a place. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Why must change for the community as a client often occur at several levels? a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify. ANS: A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels. Society must also be involved in the change by supporting individual choices. There may be certain geographic areas that have higher health risks than others, but this does not explain why care must occur at several levels. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse centers practice around the principle of doing the greatest good for the greatest number. Which of the following ethical principles is being applied? a. Distributive justice b. Utilitarianism c. Social justice d. Health disparities ANS: B Utilitarianism means doing the greatest good for the greatest number. Distributive justice means treating people fairly and distributing resources and burdens equitably among the members of a society. Social justice means ensuring that vulnerable groups are included in the equitable distribution of resources. Health disparities are the inequalities that exist among different populations. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is investigating the structure of the community. Which of the following indicators NURSINGTB.COM would the nurse most likely collect data about? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization ANS: D The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse focuses intervention strategies on the structural dimension of community health. Which of the following best describes the focus of these strategies? a. Health services b. Primary prevention c. Health promotion d. Secondary prevention ANS: A The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Health promotion activities are interventions focused on improving one’s health. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A leader of a support group introduces a nurse to its members and discusses the professional relationship he has with the nurse for the past several years. Which of the functions is the leader performing? a. Gatekeeper b. Insider c. Community health workers d. Advocate ANS: A Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Insiders are those who grew up in the community, have personal ties to the people there or comes from a similar cultural or ethnic background. Community health workers are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. An advocate is someone who speaks up for and supports the needs of the community. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A community has residents who provide information to the city council so that decisions can be made about the health of the community. Which of the following characteristics is being displayed? a. Active partnerships b. Passive participation c. Gatekeeping d. Focus groups ANS: B Coalitions are active partnerships in which all participants share leadership and decision making to some degree. Unfortunately, some community health efforts view community residents only as sources of information and receivers of interventions; this limits residents to passive participation. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. A focus group is like an interview in that it collects data mainly through asking open-ended questions to participants but to a small group rather than an individual. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse lives in a community that demonstrates commitment. Which of the following would most likely be supported within this community? a. Creation of a community club by the city council to facilitate community involvement b. Collaboration among area restaurant owners to develop healthier menus c. Collaboration with the health department to build a new recreation center d. Development of a cooperative agreement with a neighboring city to share needed services ANS: C Commitment to the health of the community requires a process of change at each appropriate level on the continuum. The most successful change processes often arise from collaborative practice models that involve the community and nurses in joint decision making. Participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision making. Collaboration by restaurant owners to develop healthier menus only addresses one population of the community and does not show involvement by nurses and the larger community. Creation of a community club by the city council does not engage the larger community in this decision. Developing a cooperative agreement with a neighboring city does not show commitment between the members of both communities. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is trying to develop community partnerships. Which of the following interventions would be the most appropriate for the nurse to use? NURSINGTB.COM a. Involve the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines. ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines. Partnerships should involve a variety of individuals from various backgrounds. There should be a balance of power and information sharing among all of the participants. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What are the main characteristics of partnership? a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utility ANS: A The main characteristics of partnership are awareness, flexibility, and negotiated distribution of power. Rights, responsibilities, and consensus are not the main characteristics of partnership. Commitment, participation, and articulation are not the main characteristics of partnership. Collaboration, advocacy, and utility are not the main characteristics of partnership. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. A nurse has identified the boundaries of the community. Which of the following steps should the nurse take next when completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used. ANS: A The first step of the community assessment is to define the community. In order to do this, geographic boundaries, the population within the boundaries, the purpose of the assessment, and a data collection plan will be identified. Those inhabiting the community are a primary focus of the assessment. A variety of strategies are used to identify this central core of the community. The next step involves gathering and generating data to learn more about the community. After the community has been completely assessed then nursing diagnoses can be formulated, interventions planned, and finally interventions evaluated. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 16. A nurse is completing a community assessment. Which of the following actions would be most likely for the nurse to complete? a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community. ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources. The focus of the community assessment is on the needs of the community, not on individuals. The core functions of public health nursing are not all used during the community assessment process. The community assessment should identify both the strengths and weaknesses of the community. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 17. A nurse interviews the school nurses in a community to determine their roles in schools because this data is not available. Which of the following processes is the nurse using? a. Photovoice b. Spatial data c. Primary data d. Secondary data ANS: C Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Spatial data involves looking at the locations of places within the community. Photovoice, also called photo elicitation, is a community assessment technique in which community members take photos to represent a topic or theme about community health. Secondary sources include published data about the community, such as census data. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nurse schedules an appointment with a provider who has a practice in the community to learn more about the community’s beliefs regarding childhood immunizations. Which of the following is being demonstrated? a. Informant interview b. Participant observation c. Active participation d. Windshield survey ANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. Active partnerships are those in which all participants share leadership and decision making to some degree. Windshield surveys are a NURSINGTB.COM method of simple observation, providing a quick overview of a community. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A community health nurse is conducting informant interviews in a small community. Which of the following would the nurse most likely contact? a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area ANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants. Key informants need not hold any formal title, but are generally viewed as community leaders by other community members and often have a long history in the community. The state department of health, surrounding communities, and CDC do not meet the definition of an informant. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. Which of the following types of data is being collected? a. Quantitative b. Qualitative c. Focus groups d. Participant observation ANS: B Qualitative data is collected through interviews and observation. This data is the descriptions provided by these individuals through interviews. Quantitative data is the numbers that can be found about the community, such as crime statistics. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse reads the local community newspaper to gather data about the community. Which method of data collection is being used? a. Informant interview b. Focus group c. Participant observation d. Windshield survey ANS: C Participant observation refers to the deliberate sharing in the life of a community, such as NURSINGTB.COM participating in a local fair or festival, or attending a political or social event. The nurse is deliberately sharing in the life of the community by reading the newspaper. An informant interview is a method of community data collection that involves directed conversation with selected community members. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Windshield surveys are a method of simple observation, providing a quick overview of a community. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation. Which method of data collection is being used? a. Participant observation b. Windshield survey c. Focus group d. Informant interviews ANS: B Windshield surveys are a method of simple observation, providing a quick overview of a community. By making observations of the community, the nurse is completing a windshield survey. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. A focus group is similar to an interview in that it collects data mainly through asking open- ended questions to participants, but to a small group rather than an individual. An informant interview is a method of community data collection that involves directed conversation with selected community members. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 23. A nurse analyzes data from minutes at a community meeting when completing a community assessment. Which of the following methods of data collection is being used? a. Secondary data b. Informant interviews c. Primary data d. Windshield survey ANS: A Secondary sources include published data about the community. The data is secondary because it is collected by someone else. An informant interview is a method of community data collection that involves directed conversation with selected community members. Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Windshield surveys are a method of simple observation, providing a quick overview of a community. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 24. A nurse is using health status indicators to complete a community assessment. Which of the following best explains what the nurse is doing? a. Interviewing key informants in the community b. Examining morbidity and mortality rates in the community c. Surveying local businesses in the community d. Observing community members ANS: B Health indicators are numerical measures of health outcomes, such as morbidity and mortality, as well as determinants of health and population characteristics. Generally, these data are from secondary sources such as websites or printed materials. Interviewing key informants, surveying local businesses, and making observations are all methods of primary data collection. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 25. What is the purpose of writing a community nursing diagnosis? a. To assist with developing the evaluation measures for program planning b. To clearly describe the strengths and weaknesses of the community c. To lead to the outcomes and strategies to address and improve the identified health problem d. To increase the likelihood that the problem will be solved ANS: C The community nursing diagnosis, no matter which classification system is used, leads to expected outcomes and evidence-based health promotion strategies to address and improve the problem identified in the diagnosis. This becomes the nursing care plan. The expected outcomes and evaluations derived from the nursing diagnosis systems suggest subsequent evaluation measures for identified needs or problems. A community assessment describes the strengths and weaknesses of a community. The likelihood of solving a problem is not influenced by writing a community nursing diagnosis. DIF: Cognitive level: Understanding TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 26. A nurse is writing a nursing diagnosis at the community level using the North American Nursing Diagnosis Association (NANDA) system as a guide. Which of the following diagnoses would most likely be developed? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors, as evidenced by client crying and stating she has no support system ANS: B NURSINGTB.COM There are three parts of the NANDA system: (1) identification of the problem or potential problem; (2) its relation to factors, stressors, or health issues; and (3) supporting data that documents the problem. The “risk of” identifies a specific problem or health risk faced by the community. “Among” identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. “Related to” describes characteristics of the community. DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care 27. A nurse plans on implementing a community-wide influenza immunization program. Which of the following factors should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The community’s readiness to participate in the program ANS: D The factors that influence implementation in the community are the nurse’s chosen roles, the type of health problem selected as the focus for intervention, the community’s readiness to take part in problem solving, and characteristics of the social change process. The community’s readiness to participate is more important than public policy, the existence of formal groups in the community, and the number of community members who have already received the vaccine. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 28. A nurse is engaging in the evaluation phase of community health program planning. Which of the following would be part of effective completion of this phase? a. Demonstrate the ability to improve the health of the participants. b. Develop measurable objectives and goals before implementation. c. Encourage full participation by community members. d. Improve the health of the population through the program. ANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established, and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed. Participation by community members and improvement of the health of the population may be measured through the evaluation phase but would not demonstrate completion of this phase. The evaluation phase may determine if the participants’ health is improved, but improvement of health is not part of the completion of this phase. DIF: Cognitive level: AnalyzingNURSI NGTB.TOP:COM Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 29. A nurse is trying to increase participation in a free colorectal screening program for middle- aged adults who lack health insurance. Which of the following implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media ANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people. The other methods will take much longer for the information to spread to the community members. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A nurse is defining the community as part of the community assessment process. Which of the following best describes how the community may be defined? (Select all that apply.) a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern e. Individuals with certain interests ANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions. Individuals comprise a community but would not be an accurate definition of a community. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is assessing the safety in the community using primary data. Which of the following data would be useful for the nurse to collect? (Select all that apply.) a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurse’s own observations e. Morbidity and mortality rates ANS: B, C, D Other nurses, social workers, health care providers, community members, and the nurse’s own observations are reliable sources of information aboNURSINGTB.COM ut the safety of an area. The number of billboards would not be important data to collect when assessing for safety in the community. Morbidity and mortality rates would be considered secondary data. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care Chapter 16: Promoting Healthy Communities Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is the goal of the Healthy Communities and Cities initiative? a. Promoting health through community participation b. Reorganizing the current health care system c. Maximizing the cost-benefit ratio of health care d. Improving the quality of care in communities ANS: A The goal of the Healthy Communities and Cities initiative is the promotion of health through community engagement and collaboration. This leads to addressing the health and quality of life for all through a process that includes diverse citizen participation, mobilization of all sections of the community, and community ownership. Reorganization of the current health care system, maximizing the cost-benefit ratio of health care, and improving the quality of care in communities are not part of the Healthy Communities and Cities initiative. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Wearing seat belts is required in many communities. Children of a certain age must be restrained in a car seat or seat belt when riding in a car. Which of the following best NURSINGTB.COM describes what has happened in this community? a. Unilateral action of lawmakers b. Participation in health fairs c. Healthy public policy d. Media interest in protecting the public ANS: C Examples of healthy public policy are seat belt legislation, nonsmoking policies, and immunization policies for school-age children. Participation in health fairs involves providing health education and resources out in the community. Unilateral action of lawmakers does not demonstrate community involvement. Media interest does not create the legislation. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 3. What occurred when the Healthy Communities and Cities concept was brought to the United States? a. The cities chosen for the initial work were Los Angeles and New York City. b. Canada adopted the program at the same time for continuity across borders. c. The same strict guidelines that were implemented in Europe were used. d. Smaller communities and localities were targeted instead of large cities. ANS: D The concept of Healthy Communities was used to incorporate localities that were not necessarily cities. The initial projects were Healthy Cities Indiana and the California Healthy Cities project. Healthy Communities and Cities operate in other parts of the world under different names and national networks have been developed among countries. There are not strict guidelines for implementation of this program. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. The Healthy Communities and Cities initiative supports what idea? a. Healthy cities and communities must be both environmentally and socially sustainable. b. Healthy public policy is the responsibility of elected officials. c. Physical environments cannot be changed; thus, strategies must be developed in order to cope with them. d. The World Health Organization (WHO) is the primary source of information for cities. ANS: A Healthy cities and communities must be both environmentally and socially sustainable through a strategy of primary care. Healthy public policy should involve collaboration at all levels. Supportive environments should be created. The WHO originally began this movement, but now sharing occurs among those participating in this initiative. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 5. A nurse utilizes the Centers for Disease Control and Prevention’s (CDC’s) Healthy Communities Program. Which of the following factors does the nurse recognize that will influence the continuance of this program? a. Time b. Community participation c. Federal involvement d. Technology ANS: B Community participation can influence the continuance of the Healthy Communities and Cities movement. Time, federal involvement, and technology are not as major of factor to continuation as is participation by the community. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. Healthy Communities and Cities is based on which of the following premises? a. When people can work out their own locally defined health problems, they will find sustainable solutions to those problems. b. When the health of a community is improved, the focus will be on life expectancy rather than quality of life. c. When health professionals assume a leadership role, the health of the community will improve. d. When cities recruit enough health professionals to care for those needing medical care, the cities health will improve. ANS: A Healthy Cities is based on the premise that when people can work out their own locally defined health problems, they will find sustainable solutions to those problems. Healthy Cities aims to add to quality of life. Healthy Cities focuses on collaboration by all members of the community. Healthy Cities uses a multifaceted approach to problem solving when trying to improve health. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nurse was involved in the initial implementation of the Healthy Communities and Cities initiative in the United States. Which of the following problems would have most likely been addressed? a. Reduction to the amount of pollutants released into the environment b. Provision of fire and police protection c. Creation of a coalition to address health disparities d. Elimination of crime and violence from the community ANS: C The concept of a healthy community or city is based on the belief that the health of the community is largely influenced by the environment in which people live and that health problems have multiple causes: social, economic, political, environmental, and behavioral. Creation of a coalition engages residents in addressing the problem, which is impacted by multiple factors. The initial activities of this initiative focused on the problems of diverse NURSINGTB.COM populations. Reduction of the amount of pollutants and provision of fire and police protection do not address problems of diverse populations. Although crime and violence in a community may be decreased, it is not possible to eliminate it. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A nurse is implementing interventions to improve the health of the community. Which of the following approaches would be taken by the nurse? a. A top-down approach with rational-empirical problem solving b. A top-down approach with community practice planned by experts c. A bottom-up approach with facilitation of communication d. A bottom-up approach with multisectoral planning and action for health ANS: D A bottom-up approach with multisectoral planning and action for health incorporates community participation. A bottom-up approach uses broad-based community problem solving that includes health professionals, local officials, service providers, and other community members, including those at risk for health problems. The top-down approach describes when professionals and experts tell the citizens what to do rather than involving and asking them. Social planning stresses rational-empirical problem solving, usually by outside professional experts with a top-down approach. This approach does not focus on building community capacity or fostering fundamental social change. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. A nurse is implementing the Community Health Promotion Model. Which of the following underlying principles should the nurse use to facilitate active participation? a. Individuals should work in groups to complete necessary tasks. b. Individuals participating should represent all segments of the population. c. People will work together if they like the leadership. d. People will participate when they see the issues as worthy of their time. ANS: D People participate when they feel a sense of community and see their involvement in the issues as relevant and worthy of their time. This is the second step of the Community Health Promotion Model. There should be a broad-based representation on the planning committee, but it may not represent all segments of the population. The tasks may need to be completed by both groups and individuals. Although the likability of leadership may influence who participates, it most likely will not influence whether they are able to work together. NURSINGTB.COM DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is leading a team responsible for evaluating the health of a community using the Community Health Promotion Model. Based on this model, which of the following steps would you expect the nurse to complete? a. Ensuring high technological access before the plan can be implemented b. Soliciting the consent of every member of the community c. Assessing the community d. Restructuring the public health policy in the community ANS: C Assessing the community is one of the nine steps of the Community Health Promotion Model. Restructuring public health policy, soliciting consent of all community members, and ensuring high technological access before implementing the plan are not part of this model. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse performs a community assessment as part of the Community Health Promotion Model. Which of the following best describes the rationale for this action? a. Becoming more acquainted with the multiple factors that influence health status b. Surveying the citizens in the community about their wants and needs c. Allowing special interest groups a voice in health policy d. Providing a narrow focus for the committee work ANS: A The purpose of including a community assessment in the implementation of the Community Health Promotion Model is to become more acquainted with the multiple biological, behavioral, social, and physical factors that describe and influence health status of residence. The assessment provides the frame of reference for identifying the community’s strengths, needs, and resources. The community assessment involves multiple factors, which is more than surveying citizens or asking special interest groups for their opinions. The community assessment has a broad focus, not a narrow focus. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A nurse is designing interventions and evaluating results of Healthy Municipalities and Cities. Which of the following considerations would be made by the nurse? a. Influence of individual actions b. Acute care hospital services in the community c. Social results and endorsement of law makers for policy changes d. Effectiveness of health services, including delivery of preventive services ANS: D The effectiveness of health services, including the delivery of preventive services, should be considered when designing interventions and evaluating the results of Healthy Municipalities and Cities. Influence of individual actions, acute care hospital services, and social results and endorsement of law makers are not part of Healthy Municipalities and NURSINGTB.COM Cities. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse is implementing the steps of the Community Health Promotion Model. Which of the following does this most resemble? a. Collaboration process b. WHO’s Ottawa Charter c. Nursing process d. CDC’s monitoring program ANS: C The steps of the Community Health Promotion Model are very similar to the nursing process. The steps include assessment, planning, implementation, and evaluation. The collaboration process, WHO’s Ottawa Charter, and the CDC’s monitoring program do not contain steps like the Community Health Promotion Model. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. A nurse is involved in implementing the Community Health Promotion Model. Which of the following best describes the action being taken by the nurse? a. Changing public policy b. Establishing a team to plan and coordinate the work c. Providing nursing diagnoses for the community d. Revising an objective for Healthy People 2020 ANS: B A structure in the community for health promotion should be developed through the establishment of a steering committee that will plan and coordinate the work. The nurse would not change public policy, but rather provide information based on data to policy makers. The nurse would not be revising objectives in Healthy People 2020 as that is not an action that individuals are able to take. Nursing diagnoses are not written as part of this model. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What principles were used in the creation of the Healthy Cities movement? (Select all that apply.) a. Primary care b. Equity in health promotion c. Community participation d. High technologic environments e. Relationship building NURSINGTB.COM ANS: A, B, C The Healthy Cities movement was based upon the principles of primary care, equity in health promotion, and community participation. Relationship building and high technologic environments were not part of the creation of the Healthy Cities movement. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. According to the Ottawa Charter for Health Promotion, which of the following are included in the areas for health promotion action? (Select all that apply.) a. Creating supportive environments b. Developing personal skills c. Building healthy public policy d. Reorienting health services e. Developing community partnerships ANS: A, B, C, D Creating supportive environments, developing personal skills, building healthy public policy, and reorienting health services are all areas for health promotion action identified by the Ottawa Charter for Health Promotion in 1986. Developing community partnerships was not addressed by the Ottawa Charter for Health Promotion. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse uses the Community Health Promotion Model to address the problem of increasing teenage pregnancy rates in the community. Which of the following steps would be used by the nurse? (Select all that apply.) a. Identifying interest in the topic through use of community forums b. Building a partnership with parents of teenagers to address this problem c. Counseling teenagers about effective birth control methods d. Contacting other cities with similar problems and issues e. Referring teenagers to Planned Parenthood ANS: A, B The implementation of the Community Health Promotion Model includes identifying interest by community forums and building the partnership. Counseling and referring teenagers and contacting other cities may be used by the nurse but are not part of the steps identified by the Community Health Promotion Model. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 11: Population-Based Public Health Nursing Practice: The Intervention Wheel Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. Which statement about the Intervention Wheel is true? a. It provides a graphic illustration of population-based public health practice. b. It describes in detail the components of public health nursing. c. It demonstrates the practice of community health nurses for policy and lawmakers. d. It is a framework used by all health departments in the United States. ANS: A The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. Since the Intervention Wheel was first published in 1998, what related event has occurred? a. It has guided national policy. b. It has been used as a tool in deciding licensure issues for State Boards of Nursing. c. It has been incorporated into the publNURSINGTic health curricula of many nursing programs.B.COM d. It has gained wide acceptance internationally. ANS: C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally but is not used widely at the international level. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. Public health interventions are implemented with: a. legislators, policy makers, and community leaders. b. individuals and families, communities, and systems. c. children, adolescents, and adults. d. health departments, public health agencies, and visiting nurses’ associations. ANS: B It is important to know that public health nurses (PHNs) work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan. c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health. ANS: D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated?NURSINGTB.COM a. Individual b. Systems c. Community d. Government ANS: C Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by “The Wheel.” DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A public health nurse (PHN) uses Assumption 2, “Public health nursing practice focuses on populations,” to guide practice. Which of the following would be considered a population of interest? a. Healthy school children b. Homeless individuals c. A person recently diagnosed with diabetes d. Teenage parents ANS: A A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A public health nurse (PHN) is conducting an assessment of the community’s health. Which of the following is being accomplished through this activity? a. Define one problem that will be the focus for a year. b. Assess a social network of interacting individuals usually in a defined territory. c. Minimize the effects of health risks and hazards. d. Intervene at the population level by changing laws and regulations. ANS: B A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase. DIF:MSC: Cognitive level: ApplyingNCLEX: Safe and Effective Care Environment: Management of CareNURS INGTB.TOP:COM Nursing process: Evaluation 8. A public health nurse (PHN) utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished? a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, systems, individuals, and families d. Utilizing primary, secondary, and tertiary prevention ANS: C PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice. The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. Public health nurses (PHNs) across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used? a. Describe the proper order of implementation. b. Emphasize surveillance as the focus of public health practice. c. Guide practice and generate agency protocols. d. Improve the health status of communities, systems, individuals, and families. ANS: D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. What is the purpose of the color-coded wedges on the Intervention Wheel? a. The interventions are grouped together in related wedges. b. The wedges consist of referral information for each wedge. c. The element of health teaching is the predominant feature of each wedge. d. Coalition building must be implemented with each wedge. ANS: A Each wedge consists of related interventions. The other answers describe some of the individual wedges. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A public health nurse (PHN) is using collaboration, coalition building, and community organizing to develop a new progNURSram in the community. Which of the following strategies is INGTB.COM the nurse most likely using? a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies ANS: B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. What levels of practice are encompassed by the Intervention Wheel? a. Communities, individuals and families, and systems b. Assessment, diagnosis, and evaluation c. Primary, secondary, and tertiary d. Communities, populations, and aggregates ANS: A Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. Public health nurses (PHNs) utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented? a. Systems b. Community c. Policy d. Individual ANS: D The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by “The Wheel.” DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 14. An occupational health nurse works with an employer to develop a workplace wellness NURSINGTB.COM program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. Government ANS: B Systems level of practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by “The Wheel.” DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 15. A public health nurse (PHN) is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse? a. Involve the entire community in solving the health problem. b. Identify health problems in the community. c. Change laws, policies, and practices that influence population-based issues. d. Provide outreach services to populations at risk. ANS: C Systems level practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A public health nurse (PHN) is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse? a. Participating in the “Great American Smokeout” b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco products ANS: B Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice. Participating in the “Great American Smokeout” occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual level of practice. Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not health teaching. NURSINGTB.COM DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied? a. Screening b. Referral and follow-up c. Surveillance d. Health teaching ANS: A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and follow-up assist individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 18. A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-up ANS: B One example of coalition building is promoting alliances among organizations for a common purpose. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented? a. Collaboration b. Surveillance NURSINGTB.COM c. Health teaching d. Screening ANS: C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities. Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 20. A public health nurse (PHN) is conducting a community assessment. Which of the following is the best example of this action? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse cases ANS: D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A public health nurse (PHN) is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse likely use? a. A 50-year-old woman receives annual mammograms. b. School absences in a community decline. c. Teachers have increased awareness of health problems. d. Those in poverty utilize the free mammogram program. ANS: A Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual level. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM 22. A public health nurse (PHN) is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits ANS: C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed. DIF: Cognitive level: Analyzing TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are the cornerstones of public health nursing practice? (Select all that apply.) a. Focus on the health of the entire population. b. Reflect community priorities and needs. c. Promote health through strategies driven by epidemiological evidence. d. Are grounded in an ethic of collaboration. e. Provide a framework for ethical decision making. ANS: A, B, C Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care NURSINGTB.COM Chapter 03: Public Health, Primary Care, and Primary Health Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. In the United States, what are most health care dollars spent on? a. Prescription drugs b. Hospital care c. Physician services d. Public health services (PHSs) ANS: B The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item. The money spent for PHSs is significantly lower than the other categories of expenditures. Other significant drivers of the increasingly high cost of health care include prescription drugs, technology, and chronic and degenerative disease. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. What has caused the number of uninsured Americans to dramatically increase? a. Medicare took over payment of health care costs. b. With a declining population, the costs for health care rose. c. Nursing salaries greatly increased, causing health care costs to rise. d. Health insurance coverage was dropped from employmentNURSINGTB.C - based health plans. ANS: D Although most Americans continue to obtain health insurance from their employer as a benefit, employment does not guarantee insurance. Employer-sponsored health insurance is sensitive to both the general economy and changes in health insurance premiums. As costs for insurance premiums rose, employers either shifted more of these costs to their employees or declined to offer employment-based health coverage at all. Medicare provides coverage only to the elderly and other special populations. The costs for health care are continuing to rise regardless of the size of the population. There has not been a significant change to nursing salaries, and a change in nursing salaries would not impact the number of uninsured Americans. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. A nurse is working with a community to decrease the occurrence of influenza. Which of the following U.S. Department of Health and Human Services (USDHHS) or simply HHS) goals is being applied? a. Strengthen Health Care. b. Advance the Health, Safety, and Well-being of the American People. c. Increase Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs. d. Advance Scientific Knowledge and Innovation. ANS: B One of the objectives of Advance the Health, Safety, and Well-being of the American People is to reduce the occurrence of infectious diseases. The goal of Strengthen Health Care focuses on improving health care services, quality, and coverage. The goal of Increase Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs focuses on improving programming and application of found data. The goal of Advance Scientific Knowledge and Innovation focuses on scientific discovery and application of the new knowledge. DIF: Cognitive level: Remembering TOP: Nursing process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year could be attributed to what cause? a. Cardiovascular disease b. Obesity c. Medical error d. Drug overdose ANS: C In 1999 it was thought that our health care system was expensive, and that access and quality were not optimal, but we had not considered this important fact: many people die of preventable medical errors in the United States. This number is not the correct statistic for cardiovascular disease, obesity, or drug overdose. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of CareNURSINGTB.COM 5. Residents of rural communities report that they must travel for long distances to obtain health care services. As a result, they seek health care only for emergencies and severe illnesses. Which aspect of the health care system in the United States is illustrated in this situation? a. Access to care b. Cost c. Quality d. Advances in technology ANS: A One significant problem is poor access to care. Access can refer to inability to pay for care and inability to access care. Cost refers to the health care expenditures that happen to pay for the services received. Quality refers to the quality of health care that is provided. Advances in technology refer to the medical advancements made to treat diseases. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is exploring a job opportunity at a community health center. Which expectation would the nurse have about the center? a. Would be situated in a large metropolitan area. b. Provides care only to the economically disadvantaged. c. Offers comprehensive primary care services and supportive services. d. Is used for preventive services such as flu shots. ANS: C Community health centers serve the entire community for primary health care (PHC) services, regardless of income. They are in a high need or medically underserved community, which can be urban or rural. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. A nursing program has initiated a recruitment campaign focusing on increasing the minority students in its program. Which of the following best describes the rationale for this program? a. The number of minority versus non-minority nurses should be equal. b. Minority health care professionals who share the same culture with the clients may provide more effective care. c. The profession should be more diverse. d. Minority nurses can mentor other nurses when providing care for diverse populations. ANS: B It is thought that increasing minority representation in the health workforce not only is a commitment to diversity, but also will improve the health care delivery system. Minority health professionals can be expected to practice in underserved areas at a greater rate and health professionals who share the same culture and language with the clients they serve can provide more effective care. It has been suggested that the number of minority nurses should NURSINGTB.COM be representative of the population served rather than there being equal numbers of minority and non-minority nurses. Minority nurses are able to mentor other nurses; however, is not the main reason that there is a focus on increasing recruitment of minorities. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A community health nurse is utilizing telehealth. Which factor best describes the rationale for its use? a. Enables clients to get nursing care in their homes. b. Substitutes for health department delivered care. c. Improves access to care in rural areas. d. Replaces face-to-face care for those who cannot afford it. ANS: C Telehealth provides increased access to health care using a computer monitor and telephone line. It is useful for monitoring clients with chronic disease but is not a substitute for health care. Telehealth may or may not be accompanied by home care nursing. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. What is one of the goals of the World Health Organization (WHO)? a. Providing public health nurse (PHC) services to everyone b. Preventing outbreaks of disease c. Preventing the transmission of communicable disease among nations of the world d. Providing humanitarian support in times of disaster ANS: A The WHO adopted a resolution in 1977 accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. This has been adapted to meet the needs of the new century and was deemed “Health for All in the 21st Century.” The focus of this initiative is PHC services. The WHO does not prevent outbreaks of disease, prevention, transmittal of disease, or provide humanitarian support. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A public health agency is considering implementing an electronic health record. Which action best describes one of the benefits the agency will experience? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) standards ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-toN-date assessments; incorporation of protocol remindersURSINGTB.COM for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors. There is no data to support that the agency will have improved client compliance or cost savings. Electronic medical records are not a requirement by JCAHO. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse interacts with a 25-year-old woman at a community health center who is obtaining a gynecological examination and birth control pills. Which of the following types of care is the client receiving? a. Tertiary health care b. Public health care c. Public health care (PHC) d. Specialized care ANS: C PHC includes basic health care services with the emphasis on prevention. Tertiary health care is highly specialized medical care. Public health care focuses on care for populations. Specialized care focuses on only one aspect of a patient’s health. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A client is receiving public health care (PHC) services. Which of the following expectations would the client have? a. The care would be provided by a physician. b. Private insurance would be necessary to receive care. c. The emphasis of care provided would be on prevention. d. A referral would be made to a specialist after receiving services. ANS: C The focus of PHC is a broad range of services that are designed to be affordable for the recipients of the care and the governments who provide them. The emphasis of care is on prevention and the means of providing the care is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods. All clients can receive PHC services regardless of insurance status. Those receiving primary care services may or may not need referral to a specialist. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 13. A nurse who was working in public health care (PHC) has gotten a new job in primary care. Which of the following differences would be seen by the nurse in this new care setting? a. Focus on individuals. b. Services provided by specialists. c. Autonomy in the practice setting. d. Community focused care is provided. ANS: A NURSINGTB.COM Primary care focuses on individuals. It is also provided by generalists, is dominated by health care professionals, and is not community focused. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 14. What initiative began because of a resolution adopted by the WHO in 1977? a. Declaration of Alma Ata b. Medicare c. Healthy People d. Public Health Care (PHC) movement ANS: D The WHO adopted a resolution accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. The name of the resolution that was adopted was the Declaration of Alma Ata. Medicare began as part of the Social Security Act. The Healthy People initiative began as part of the 1979 Surgeon General’s Report addressing the health needs of Americans. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 15. What statement is true about public health care (PHC) in the United States? a. It has dramatically improved since the passage of the Declaration of Alma Ata. b. It focuses on the use of government-funded insurance programs. c. It lacks community participation and a multidisciplinary health care delivery team. d. IT utilizes Preferred Provider Organizations to meet needs of the citizens. ANS: C Although PHC has been endorsed by the United States, it faces many challenges. PHC emphasizes broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team; however, this is not the primary method of health care delivery in the United States. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 16. A community health nurse reviews Healthy People 2020 when considering the health needs that will be addressed in the community. Which goal would the nurse find in this document? a. Promote healthy behaviors for children. b. Cure cancer. c. Eliminate health disparities. d. Provide primary care to all citizens. ANS: C Elimination of preventable disease, disability, injury, premature death; achievement of health equity; elimination of health disparities; and creation of social and physical environments that will promote good health and healthy development and behavior at every stage of life are the four major goals cited in Healthy People 2020. NURSINGTB.COM DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance 17. An 80-year-old client comes to the community health center with a large bag of medications. The client tells the nurse these medications are unaffordable on just Social Security. Which statement is the best response by the nurse? a. “Let’s go through these medications and see which ones we can delete.” b. “You can get these medicines at this clinic for free.” c. “I will consult with our social worker to see if Medicare will pay for these medications.” d. “These medications are important. Do your best to pay for them.” ANS: C This elderly patient probably is eligible for benefits through Part C, the Medicare Advantage program, but often a patient needs help negotiating the system. Finding prescriptive coverage through an insurance plan with the help of a social worker is a better choice than eliminating medications, trying to get medications for free (which is only a short-term solution in most cases), and telling the client to find a way to pay for the medications when she does not have the resources. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 18. A nursing student is researching advanced practice nursing options. Which of the following discoveries would most likely be made by the nursing student? a. Nurse practitioners may work independently depending on the state practice act. b. Certified nurse midwives have limited prescriptive authority. c. Clinical nurse specialists typically provide primary care services. d. The Doctorate in Nursing Practice emphasizes the importance of research. ANS: A Nurse practitioners may work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered. Certified nurse midwives have prescriptive authority in some form in all states. Clinical nurse specialists may provide primary care services, but often work in consultation, research, education, and administration. The Doctorate in Nursing Practice role is a clinical role. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 19. Which federal agency included in the public health system is most involved with the health and welfare of United States citizens? a. Centers for Medicaid and Medicare Services b. U. S. Department of Health and Human Services c. U. S. Public Health Service (USPHS; or simply PHS) d. Health Resources and Services Administration ANS: B The U. S. Department of Health and Human Services is charged with regulating health care and overseeing the health status of Americans. The Centers for Medicare and Medicaid NURSINGTB.COM Services develops and oversees the rules and regulations specific to these two insurance programs. The PHS is a major component of the Department of Health and Human Services. The PHS consists of eight agencies: (1) Agency for Healthcare Research and Quality, (2) Agency for Toxic Substances and Diseases Registry, (3) Centers for Disease Control and Prevention, (4) Food and Drug Administration, (5) Health Resources and Services Administration, (6) Indian Health Service, (7) National Institutes of Health, and (8) Substance Abuse and Mental Health Services Administration. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 20. A nurse works to promote the passage of a public health law to protect the health of the community. Which activity would the nurse most likely be promoting? a. Requiring all persons to have health insurance coverage b. Administering flu shots in the late fall and early winter c. Mandating immunizations for all children entering kindergarten d. Monitoring and licensing nuclear power plants ANS: C Public health laws protect the community. Required immunizations are an example. Requiring health insurance coverage would not protect the community. Administration of flu shots is not promotion of a law. Monitoring and licensing nuclear power plants are beyond the scope of public health. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 21. A nurse is working in a state health department. Which program would the nurse most likely be working with? a. Senior health b. Dental services c. H1N1 flu education d. Mental health ANS: C Typical programs in a state health department include: communicable disease service, H1N1 flu services, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 22. A nurse is employed by the Department of Homeland Security. Which activity would be expected by this department? a. Prevention and protection against terrorist attacks b. Regulation of licensure of medical personnelNURSINGTB.CO M c. Inspection of the safety of food and cosmetics d. Regulation of managed care organizations ANS: A The Department of Homeland Security was created after the terrorist attacks of September 11, 2001. Its mission is to prevent and deter terrorist attacks and to protect against and respond to threats and hazards to the nation. Regulating the licensure of medical personnel, inspecting the safety of food and cosmetics, and regulating managed care organizations are not responsibilities of this department. These activities are regulated by other state or federal government agencies. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are some of the untoward events categorized in the Institute of Medicine (IOM) report about medical errors? (Select all that apply.) a. Wrong-site surgery b. Adverse drug events c. Improper transfusions d. Restraint-related deaths e. Poor staffing patterns ANS: A, B, C, D The untoward events of wrong-site surgery, adverse drug events, improper transfusions, and restraint-related deaths are listed in the IOM report. Although poor staffing patterns may result in medical error, this is not one of the untoward events discussed in this report. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is entering the health care workforce. Which expectation should the nurse have for the workforce? (Select all that apply.) a. There is a shortage of nurses in the United States. b. Schools of nursing turn away qualified applicants due to lack of faculty and limitations of clinical sites. c. By 2026 there are expected to be 438,100 new nursing positions. d. More students are choosing laboratory science, pharmacy technology, and radiology technology over nursing. e. There is a shortage of physician specialists in the United States. ANS: A, B, C The first three options are true. The laboratory science, pharmacy technology, and radiology technology programs have all seen declining enrollments. There is a shortage of primary care physicians as more physicians are choosing to specialize. 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