MULTIPLE CHOICE
1. Which of the following best describes what Lillian Wald suggested in regards to providing care to individuals and families? a. b. c.
Public health nurses should encourage clients to join the Henry Street settlement for mutual growth and support among the families.
Public health nurses should focus on providing care in the client’s home.
Public health nurses should recognize the larger social and economic forces that the family cannot control.
d. Public health nurses should try to understand that educating clients on how to stay healthy is the nurse’s primary responsibility.
ANS: C
Wald emphasized that one could not understand an individual without understanding the
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3. family, and the family is in the grip of larger social and economic forces that they cannot control. It was not suggested by Wald that clients be encouraged to join the Henry Street settlement, focus on providing care in the client’s home, or that it was the nurse’s responsiblity to keep clients healthy.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 107
Which of the following best describes why it is important for the nurse to be knowledgeable about the community when providing care to individuals? a. As nurses travel to meet with clients, they must know the community to find the client’s residence.
b. On the basis of information from community assessment, community health nurses can be visible and vocal advocates for health care reform.
c. d.
Community health nurses are expected to have information about the community to share with individual clients.
Individuals and families are strongly influenced by the community and environment around them.
ANS: D
The nurse must be particularly aware of how individuals and families are influenced by the community and environment around them, although it is indeed important to be an advocate for health care reform and to have information regarding resources available for client services in the process of giving care. It is assumed that community health nurses can read maps—or use a global positioning system in their car—to find client addresses.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 107
Which of the following best describes how the Health Planning Model for care of aggregates differs from the customary nursing process applied to the care of an individual? a. The nurse must be aware of age, gender, race, ethnic group, religion, educational background, occupation, and marital status of the aggregate.
b. c.
The nurse must first decide on and define the aggregate to receive care.
The nurse must determine how best to ensure that each participant receives an

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6. equal number of services.
d. The nurse must choose which health care need should have first priority.
ANS: B
The nurse decides which aggregate to focus on and then carefully defines that aggregate.
Whether caring for an individual, a family, or an aggregate, the nurse must know the demographics of the client and choose which health need has first priority. In caring for aggregates, each participant does not receive an equal number of services, but only those services that each participant needs.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 109
A nurse is using a systems framework when caring for individuals, families, and aggregates in the community. Which of the following best describes an aspect that would be more challenging when caring for an aggregate as opposed to caring for an individual? a. b. c. d.
Ability to communicate clearly with the client
Analyzing power and decision making within the system
Defining the system’s structure and functions
Recognizing the system’s goals
ANS: B
Although all aspects can be challenging, it is probably more challenging to recognize the interacting aspects of a large aggregate system in its power distribution, consensus activities, accommodation, and authority within the decision-making process.
DIF: Cognitive Level: Apply (Application) REF: p. 109
A nurse is caring for an aggregate as his or her client. Which of the following tasks would the nurse complete first? a. Determine the setting of the aggregate b. c.
Gain access into the aggregate
Identify the nurse’s own strengths and preferences d. Review the resources available to use in the community
ANS: C
A nurse should also consider personal interests and strengths in selecting an aggregate for intervention. For example, the nurse should consider whether he or she has an interest in teaching health promotion and preventive health or in planning for organizational change, whether his or her communication skills are better suited to large or small groups, and whether he or she has a preference for working with the elderly or with children. Thoughtful consideration of these and other variables will facilitate assessment and planning. After self-reflection, the nurse will need to determine the setting of the aggregate, consider how to gain access, and identify the community resources available.
DIF: Cognitive Level: Apply (Application) REF: p. 109
A nurse decided that a high-risk aggregate most needed education about diabetes. Which of the following would be the best approach when teaching the group? a. Involve participants in small group activities applying the information.
b. Organize the information into a visual presentation such as a PowerPoint presentation.

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8. c. d.
Share the nurse’s expertise directly with the group at a meeting for that purpose.
Use handouts and pamphlets with pictures consistent with the local cultural groups throughout.
ANS: A
Most persons do not enjoy lectures, so the nurse must initiate small group involvement and participation. Those with less educational experience are more comfortable in informal learning settings. Visual only presentations, such as power point presentations and handouts are not the best approach to use with adult learners. Sharing of the nurse’s expertise is an important part of the teaching process, but will not be effective if the participants are not actively involved in the learning process.
DIF: Cognitive Level: Apply (Application) REF: p. 110
A community health nurse has determined that the number one priority is to help families in which one member has diabetes. Which of the following actions would be most appropriate to maximize services to persons with diabetes? a. b.
Ask friends with diabetes about what services they want improved.
Duplicate the diabetic organization’s services, because not all patients with diabetes have yet received services.
c. Meet with the diabetic organization to see how the public health department can augment what it is offering.
d. Submit a request for funding so that the public health department can also offer services to patients with diabetes.
ANS: C
The nurse should augment existing resources or create a new service rather than duplicate what is already available to the aggregate. It is assumed that if the nurse has concluded that diabetic issues are the number one priority, there is no pressing need to ask specific questions of friends with diabetes.
DIF: Cognitive Level: Apply (Application) REF: p. 110
A nurse is determining the needs of a selected aggregate. Eight percent of the aggregate has diabetes. Which of the following best describes the action that should be taken next to determine if this should be a priority? a. Ask the American Diabetes Association if 8% is a worrisome rate.
b. Discuss the findings with the head of the public health department.
c. d.
Review the literature to determine the national and state diabetic rate.
Determine what the aggregate’s diabetic rate has been in the past.
ANS: C
A rate by itself is meaningless unless compared with previous trends (although the instructor or the head of the local public health department may or may not know that particular piece of information) or with state or national norms. The easiest way to find those norms would be to check the literature to determine the typical incidence in a similar environment or community.
The literature review could include research reports and statistics that will help determine whether this finding represents a priority for this aggregate.
DIF: Cognitive Level: Apply (Application) REF: p. 110

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A nurse has assessed an aggregate, determined the priority health needs, and decided on what intervention to offer. Which of the following will best determine if the intervention will be successful? a.
Accuracy of the nurse’s assessment b. c.
Careful planning and implementation of the intervention
Determination of the aggregate’s perspective of the need for the intervention d. Selection of appropriate evaluation measures both in process and on completion
ANS: C
Interventions are seldom successful unless the aggregate has input into determination of need, its priority, and appropriateness of the intervention.
DIF: Cognitive Level: Apply (Application) REF: p. 110
Which of the following actions must a nurse take to be successful in addition to the typical assessment, diagnosing, and planning directly related to the intervention project? a. Advocate for community empowerment throughout the process.
b. Choose superb people to implement the plan.
c. Confirm administrative support throughout the project.
d. Continue to assess both barriers and resources throughout the project.
ANS: A
An essential component is to have a strong level of community involvement. The nurse is responsible for advocating for client empowerment throughout the process. Attention to community involvement and empowerment helps ensure that the outcomes reflect the community’s needs and will be accepted.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 111
A nurse found that several professionals resented time spent interacting with and teaching clients. Which of the following describes the most likely underlying motivation for resisting client involvement? a. Believing that people could change their lives if they really wanted to do so.
b. Empowering others shifts power from the experts to the community.
c. It is more efficient to plan appropriate care without listening to client ideas.
d. Longtime experience with community members has led to disillusionment.
ANS: B
Successful programs rely on empowering citizens to make decisions about their care.
Empowering citizens causes power to shift from health providers to community members.
Many prefer to remain in positions of power rather than sharing. Client ideas must be included in the planning process in order to get them involved. Empowerment will lead the clients to change their lives.
DIF: Cognitive Level: Apply (Application) REF: p. 111
A nurse assessed carefully and created a comprehensive intervention plan including primary, secondary, and tertiary care for individuals and families. Which of the following factors may the nurse have overlooked? a. b.
Are other staff members interested in such a project?
Are there adequate resources for such a project?

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15. c. Is there support from the administration for the project?
d. Does the nurse have adequate energy and time for such a project?
ANS: B
The nurse must validate the practicality of any planned intervention. This can best be accomplished by examining if there are adequate resources for the project. Interest of other staff members, support from administration, and the nurse’s time and energy should all be considered, but are irrelevant if there are not enough resources to implement the project.
DIF: Cognitive Level: Apply (Application) REF: p. 111
Which of the following must be created before establishing the evaluation plan for a health project? a. A clear set of both short-term and long-term goals b. Decision as to who will collect the evaluation data c. Observable and measurable objectives d. Setting up a computer program to analyze the evaluation data
ANS: C
Goals are generally what is desired, while observable and measurable objectives are used to determine whether or not the goal was achieved and whether the project was successful.
Deciding who will collect the data and analysis of the data are irrelevant if it has not been clearly decided what will be measured through the creation of objectives.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 111
A nurse had all the details carefully arranged for a project: location, speaker, seating arrangement, refreshments, handouts, visual aids, and students to distribute and collect evaluation sheets. Which of the following aspects of the project may be a problem? a. The administrator’s greetings went over time.
b. The environment was so comfortable that no one listened to the presentation.
c. Something totally unexpected and unplanned for happened.
d. A student lost the evaluation sheets.
ANS: C
Although implementation should follow the plan, the nurse must also prepare for unexpected problems. If the project fails, it is crucial to analyze what went wrong so it can be avoided in the future. Planning for the unexpected and unplanned events is the best response as it encompasses a variety of things that may go wrong. Any one or a combination of the other answers may be an unplanned event.
DIF: Cognitive Level: Apply (Application) REF: pp. 111-112
A nurse starts to collect evaluative data for a major health project one month after it starts.
Which of the following best describes the purpose of this data collection? a. Filling out the forms helps the aggregate feel involved in the process.
b. c. d.
Formative evaluation allows the nurse to make changes if needed.
Funding agencies require ongoing evaluations to continue contributing.
The nurse needed to know if the desired outcomes were being achieved.
ANS: B

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Evaluation includes reflecting on each previous stage to determine strengths and weaknesses.
Process evaluation, also called formative evaluation, would allow one to change the project while it is being implemented. By collecting data one month after the project starts, it will be hard to determine if the desired outcomes are being met. Aggregate involvement is not increased by filling out evaluation forms one month after project implementation. Collecting data one month after project implementation is not typically completed to assure ongoing funding.
DIF: Cognitive Level: Apply (Application) REF: p. 112
Which of the following best describes where the majority of time is spent by a community health nurse? a. Caring for individuals b. c. d.
Caring for families
Caring for groups
Caring for aggregates
ANS: A
Although the focus of care is the aggregate, the community health nurse will find the majority of time is spent caring for individuals.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 114
Which of the following best describes the principal outcome of the Hill-Burton Act? a. Increased number of hospital beds b. c. d.
Increased availability of high technology in health care
Reduced overall health care costs
Required certificates of need before expensive new construction is started
ANS: A
The Hill-Burton Act was also called the Hospital Survey and Construction Act, which was to address the need for better hospital access. Federal aid was given to states for construction of hospitals. The Heart Disease, Cancer, and Stroke Amendments of 1965 increased the availability of high technology in health care. The National Health Planning and Resources
Development Act attempted to reduce overall health care costs. State government developed and implemented the requirement for hospitals to obtain approval for certain projects by requiring a certificate of need.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 116
Which of the following best describes the primary purpose of the Heart Disease, Cancer, and
Stroke Amendments of 1965? a. To improve coordination and planning of health care b. c. d.
To increase the availability of high technology in health care
To reduce overall health care costs
To require certificates of need before expensive new construction or technologies are created
ANS: B

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Its purpose was to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements. The National Health Planning and
Resources Development Act attempted to reduce overall health care costs and to increase acceptability, accessibility, continuity, and quality of health care services. State government developed and implemented the requirement for hospitals to obtain approval for certain projects by requiring a certificate of need.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 116
Which of the following best describes a flaw of many of the health care bills passed during the last four decades? a. They avoided interfering with the current health care approach and did not improve problems of access or duplication of efforts.
b. They encouraged each state to do what was best for its residents without consideration of what was best for the nation as a whole.
c. They created new layers of bureaucracy in health care administration.
d. They did not include financing to pay for the suggested changes.
ANS: A
Although each bill attempted to meet some problem in health care planning and delivery, none really improved quality, access, and cost issues. Current health care providers and institutions heavily influenced outcomes.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 117
Which of the following describes why the National Health Planning and Resources
Development Act of 1974 was unsuccessful in its efforts to increase accessibility and acceptability, improve quality, and constrain rising costs? a.
A new president forced the legislation’s repeal.
b. No federal financing was included to implement the law.
c. The federal government made no effort to enforce the law.
d. The law did not affect the current health care delivery system.
ANS: D
The 1974 Act was unsuccessful because it grandfathered in the entire health care system. In other words, nothing had to change.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 117
Which of the following best describes the first efforts at improving community health? a. Environmental planning of water and sewer systems b. Mass community immunizations c. d.
Passing laws requiring quarantine of infected persons
Segregation of ships from harbors until the harbormaster checked the sailors
ANS: A
The first communitywide efforts toward improving health were environmental planning for water and sewer systems. Mass community immunizations, laws regarding quarantine, and segregation of ships were not among the first efforts to improve community health.

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DIF: Cognitive Level: Understand (Comprehension) REF: p. 115
Which of the following is the most important component of the Planning Approach to
Community Health (PATCH) model? a. Ensuring that careful records of the decisions made were kept b. c. d.
Community participation throughout the process
Intensive planning by all professionals involved
Selection of professional outcome measures
ANS: B
An essential element of the PATCH model is community participation. The idea is that health promotion is a process that enables the population to have more control of its own health.
Selection of professional outcome measures, intensive planning by all professionals, and ensuring that careful records of the decisions that were made are kept are not a part of the
PATCH model.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 115
Which of the following best describes the purpose of the Assessment Protocol for Excellence in Public Health (APEX-PH)? a. b. c. d.
To improve the functioning of public agencies by peer evaluation
To provide intensive planning for all professionals involved in public health
An evaluation process involving both community and public organizations
A self-evaluation by all the groups involved in public health planning
ANS: C
The APEX-PH program is a true self-assessment and is intended to be more of a public endeavor involving the community, as well as public organizations.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 115
Which of the following is the most important phase of the Mobilizing for Action through
Planning and Partnership (MAPP) model? a. b. c.
Conduct assessments identifying strengths and current health status
Evaluate current local health care systems and forces for change
Guide the community toward long-range visioning d. Mobilize the community to become involved
ANS: D
The MAPP model is a planning model that is based on first mobilizing the community; then guiding the community toward a shared vision for long-range planning; and, finally, conducting assessments of community strengths, forces of change, health status, and the local health system. Without completion of the first phase, the model is unable to be implemented.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 116
Which of the following best describes why states will increasingly monitor and report on quality and cost of health care? a. Citizens are increasingly complaining of high medical costs in a depressed b. economy.
Congress has been unsuccessful in reducing health care costs.

26. c. Taxation has decreased, resulting in fewer funds available for health care.
d. Hospitals and nursing homes are demanding increased funding.
ANS: B
When Congress rejected President Clinton’s plan for health care in 1994, the federal government withdrew from active health planning. Most states have become very involved in various aspects of health care planning as state funding from the federal government decreased and state budgets are not increasing. States are forced to determine priorities for the resources available. Even though citizens do complain about high medical costs, this is not the reason why states are becoming more involved with health care reporting and monitoring.
Although hospitals and nursing homes may want increased funding, much of this control comes from federal legislation, which is not impacted by the states. Taxation has not decreased.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 117
Which of the following approaches has been suggested to improve the functioning of local and national health planning? a. b. c. d.
Increase nursing involvement.
Invite citizen participation in health care provision.
Invite more health professionals to be involved in health planning.
Increase community involvement among hospitals.
ANS: A
The textbook suggests increased nursing involvement as one method of strengthening local and national health planning. Nurses can assess aggregates, identify health needs, and perform planning, intervention, and evaluation. Health would improve if nurses reemphasized the larger aggregate and shared their insights with planning groups.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 120
MULTIPLE RESPONSE
1. Which of the following best describes the provisions of the Patient Protection and Affordable
Care Act? ( Select all that apply.
) a. It provides free health insurance to all U. S. citizens.
b. c.
It requires most U.S. citizens and legal residents to have health insurance.
It bans insurance companies from denying coverage because of pre-existing medical conditions.
d. It gradually decreases the number of health insurance options available to
Americans.
e. f.
It provides decreased expenses for families by capping out-of-pocket payments.
It requires all school-age children to have access to health care services.
ANS: B, C, E

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3.
The Patient Protection and Affordable Care Act will require most U.S. citizens and legal residents to have health insurance. It puts individuals, families, and small business owners in control of their health care. It reduces premium costs for millions of working families and small businesses by providing hundreds of billions of dollars in tax relief—the largest middle class tax cut for health care in history. It also reduces what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense. It bans insurance companies from denying insurance coverage because of a person’s pre-existing medical condition. Providing free medical insurance, decreasing the number of health insurance options available and requiring all school-age children to have access to health care services are not part of the Patient Protection and Affordable Care Act.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 107 | p. 118
A nurse would like to quickly and easily learn more about an aggregate. Which of the following sources of information would be best for the nurse to use to quickly and easily become informed about an aggregate? ( Select all that apply.
) a. b. c. d. e.
Conduct a telephone survey of those aggregate members
Interview people who have previously been involved with the aggregate
Review any available records or previously gathered data
Send a mail survey to everyone in the surrounding geographic area
Try to find a few key informants and ask for their input f. Use observation without anyone in the aggregate knowing he or she is being observed
ANS: B, C, E
Unfortunately, telephone surveys would probably not be effective because many persons no longer have landlines but rely on cell phones. There would be no easy way to obtain the appropriate telephone numbers. A mail survey would be expensive and time consuming and probably would receive few responses because participants would be asked to think, write, and act to return the survey. Observing without letting persons know they are being observed borders on unethical. However, interviewing persons previously involved and reviewing previously gathered data would be possible.
DIF: Cognitive Level: Apply (Application) REF: p. 107 | p. 110
Which of the following would be the most appropriate indicator for determining the needs of an aggregate? ( Select all that apply.
) a. b. c. d.
Demand for services as seen in the behaviors of the chosen aggregate members
Experts’ determination of what is needed in the situation
Nurse’s own expertise, skill, and preferences
Obvious health disparities between the advantaged and disadvantaged populations e. Review of the literature to determine the typical needs of a typical community f. Verbalized expression of need from the chosen aggregate
ANS: A, B, D, F

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There are four types of needs to be assessed: (1) expressed need as seen in behavior; (2) normative need or the need determined by expert health professionals; (3) perceived need expressed by the aggregate including wants and preferences; and, finally, (4) relative need, which is the gap showing health disparities between the advantaged and disadvantaged populations. The nurse’s expertise and review of the literature are not the most appropriate indicators for determining the needs of an aggregate.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 110
A nurse has completed a community health project. Which of the following actions must be performed by the nurse? ( Select all that apply.
) a. Ask for media coverage of the project to maximize public relations b. Ensure that adequacy and appropriateness of the intervention are measured c. d. e. f.
Be certain the efficiency and cost benefits are measured
Collect statistics for careful analysis
Communicate follow-up recommendations to the community
Write a comprehensive report on the project to be distributed to anyone interested
ANS: B, C, E
A summative evaluation includes measurement of adequacy, appropriateness, efficiency, and cost-benefit measurements. The intervention will have limited impact unless follow-up recommendations are communicated to the aggregate on completion of the project. Media coverage may or may not be helpful, depending on the project and the intervention. Statistics are useless unless carefully chosen to reflect measurement of objectives. Reports are often shelved without being read, so only those immediately involved should have both input into any report and a copy of the outcome findings.
DIF: Cognitive Level: Apply (Application) REF: p. 112
Which of the following important events related to health care occurred during the Reagan administration? ( Select all that apply.
) a. b. c. d.
Increase in national health planning and coordination of efforts
Decrease in both federal control and federal funding
Increase in state funding with concurrent control by local boards of health
Implementation of Medicare funding based on diagnosis-related groups e. Suggestions to shift costs and reduce costs f. Suggestions to mobilize the community to become involved
ANS: B, D, E
The Reagan administration encouraged competition. Emphasis was on cost shifting and cost reduction with greater state power, less centralization, and less national control. The Omnibus
Budget Reconciliation Act of 1981 reduced federal funding, which also decreased federal planning efforts. The federal government recommended eliminating planning agencies. Also during this time was the implementation of basing payments to Medicare on diagnosis-related groups (DRGs). A reduction in federal funding caused cost shifting and cost reduction to be emphasized.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 117