Community and Public Health Nursing 10th Edition Rector Test Bank
Chapter 1 The Journey Begins: Introduction
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A)
After teaching a group of nursing students
about the similarities and differences between
public health and community health, which of
1. the following statements by a nursing student
would indicate knowledge of the similarities
and differences between public health and
community health?
“Community health nursing is defined as
nursing care that is provided in a community
setting, rather than an institutional setting.”
“Public health nursing is defined as nursing
care that is provided in an institutional
setting.”
“Public health nursing is focused on the
health of individuals.”
“Community health nursing can shape the
quality of community health services and
improve the health of the general public.”
D
Feedback:
Operating within an environment of rapid
change and increasingly complex challenges,
this nursing specialty holds the potential to
shape the quality of community health
services and improve the health of the general
public.
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B)
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Which of the following statements would best
2. describe the difference between public health
nursing and community health nursing?
Public health nursing is focused on the private
aspects of health, and community health
nursing is focused on the public aspects of
health.
In our textbook, the term community health
practice refers to a focus on specific,
designated communities and is a part of the
larger public health effort.
Public health nursing and community health
nursing relate to the very same types of
services and perspectives.
Both public health nursing and community
health nursing are practiced exclusively
within institutions.
B
health.
In our textbook, the term community health
practice refers to a focus on specific,
designated communities and is a part of the
larger public health effort.
Public health nursing and community health
nursing relate to the very same types of
services and perspectives.
Both public health nursing and community
health nursing are practiced exclusively
within institutions.
B
Feedback:
In this textbook, community health practice
refers to a focus on specific, designated
communities. It is a part of the larger public
health effort and recognizes the fundamental
concepts and principles of public health as its
birthright and foundation for practice. Public
health nursing is focused on the public aspects
of health. Public health nursing and
community health nursing have distinctive
types of services and perspectives. Neither
public health nursing nor community health
nursing is practiced exclusively within
institutions.
B)
C)
D)
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A)
Which of the following is most accurate about
the concept of community?
A community is a collection of people who
share some important features of their lives.
Community members live in the same
geographic location.
Community members are biologically related.
A community is made up of people who do
not necessarily interact with one another and
do not necessarily share a sense of belonging
to that group.
A
Feedback:
The broad definition of a community is a
collection of people who share some
important features of their lives. Community
members may not live in the same geographic
location as in a common-interest community
or a community of solution. A population is
made up of people who do not necessarily
interact with one another and do not
necessarily share a sense of belonging to that
group.
not necessarily interact with one another and
do not necessarily share a sense of belonging
to that group.
A
Feedback:
The broad definition of a community is a
collection of people who share some
important features of their lives. Community
members may not live in the same geographic
location as in a common-interest community
or a community of solution. A population is
made up of people who do not necessarily
interact with one another and do not
necessarily share a sense of belonging to that
group.
D)
A group of students are reviewing material for
a test on populations, communities, and
4.
aggregates. Which of the following indicates
that the students understand these concepts?
Members of a population share a sense of
belonging.
Communities and populations are types of
aggregates.
Individuals of a community are loosely
connected.
Members of an aggregate share a strong bond.
B
Feedback:
An aggregate refers to a mass of grouping of
distinct individuals who are considered as a
whole and who are loosely associated with
one another. Communities and populations
are types of aggregates. A population is made
up of people who do not necessarily interact
with one another and do not necessarily share
a sense of belonging to the group. A
community is a collection of people who
chose to interact with one another because of
common interests, characteristics, or goals,
which form the basis for a sense of unity or
belonging.
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B)
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Which of the following would a community
5. health nurse identify as a community of
common interest?
The global community
Small rural town in a northern state
National professional organization
Counties addressing water pollution
C
Feedback:
Which of the following would a community
5. health nurse identify as a community of
common interest?
The global community
Small rural town in a northern state
National professional organization
Counties addressing water pollution
C
Feedback:
A common-interest community shares a
common interest or goal that binds the
members together. Membership in a national
professional organization is one example. The
global community and a small rural town in a
northern state would be examples of a
geographic community. Counties addressing a
water pollution problem would be an example
of a community of solution.
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B)
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The nurse is working with a community of
6. solution. Which of the following would the
nurse expect to find?
A health problem affecting the group
Common goal binding members together
Sharing of a similar goal
Locational boundaries
A
Feedback:
A community of solution involves a group of
people coming together to solve a problem
that affects them. A common-interest
community involves a collection of people
widely scattered geographically who have an
interest or goal that binds the members
together. A geographical community is one
defined by its geographical or locational
boundaries.
Which one of the following statements made
by a student would the nurse educator
7.
recognize as evidence that a student
understands the health continuum?
The distinction between health and illness is
well demarcated.
Illness refers to a state of being relatively
unhealthy.
The term health is limited to reflect an
individual's state.
Treatment of acute conditions reflects the
current focus of health care.
B
understands the health continuum?
The distinction between health and illness is
well demarcated.
Illness refers to a state of being relatively
unhealthy.
The term health is limited to reflect an
individual's state.
Treatment of acute conditions reflects the
current focus of health care.
B
Feedback:
Although society typically depicts an absolute
line of difference between being either well or
ill, health is considered a relative term. Thus,
illness is viewed as a state of being relatively
unhealthy. Health is typically described as a
continuum that involves a range of degrees
from optimal health at one end to total
disability or death at the other. The line of
demarcation is not clear. Health applies to
individuals, families, and communities.
Traditionally, most health care has focused on
the treatment of acute and chronic conditions
at the illness end of the continuum, but this
emphasis is shifting to focus on the wellness
end.
A)
B)
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D)
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When discussing the concept of the health
continuum with a class, the nurse educator
8.
would be certain to include which statement
in the description?
Wellness is a relative concept, not an
absolute, and illness is a state of being
relatively unhealthy.
A client's placement on the health continuum
is static throughout time.
Health is best described as cyclic.
The health continuum can only be applied to
individuals.
A
Feedback:
Wellness is a relative concept, not an
absolute, and illness is a state of being
relatively unhealthy. The continuum can
change. Because health involves a range of
degrees from optimal health at one end to
total disability or death at the other, it is often
described as a continuum. The health
continuum applies not only to individuals but
also to families and communities.
C)
Health is best described as cyclic.
The health continuum can only be applied to
individuals.
A
Feedback:
Wellness is a relative concept, not an
absolute, and illness is a state of being
relatively unhealthy. The continuum can
change. Because health involves a range of
degrees from optimal health at one end to
total disability or death at the other, it is often
described as a continuum. The health
continuum applies not only to individuals but
also to families and communities.
D)
After discussing the leading health indicators
with a class, which condition if stated by the
9.
class as one of these indicators suggests that
the class has understood the information?
Cardiac disease
Mental health
Sedentary lifestyle
Maternal health care
B
Feedback:
Mental health is a leading health indicator.
Other leading health indicators include
physical activity, overweight and obesity,
tobacco use, substance use, responsible sexual
behavior, injury and violence, environmental
quality, immunization, and access to health
care.
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B)
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Which of the following statements about
10. health promotion and disease prevention is
the most accurate?
Health promotion and disease prevention
include all efforts that seek to move people
closer to optimal well-being or higher levels
of wellness.
Disease prevention differs from health
promotion in that disease prevention is
targeted toward a specific disease or diseases.
Health promotion can be described in terms of
primary, secondary, and tertiary prevention.
The goal of disease prevention is to raise
levels of wellness for individuals, families,
populations, and communities.
B
Feedback:
Health promotion includes all efforts that seek
to move people closer to optimal well-being
Disease prevention differs from health
promotion in that disease prevention is
targeted toward a specific disease or diseases.
Health promotion can be described in terms of
primary, secondary, and tertiary prevention.
The goal of disease prevention is to raise
levels of wellness for individuals, families,
populations, and communities.
B
Feedback:
Health promotion includes all efforts that seek
to move people closer to optimal well-being
or higher levels of wellness. The goal of
health promotion is to raise levels of wellness
for individuals, families, populations, and
communities. Disease prevention is targeted
toward a specific disease or diseases and
consists of primary, secondary, and tertiary
prevention.
B)
C)
D)
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A group of community health nursing
students design a health education program
for a group of pregnant teens that includes
11. teaching nutrition during pregnancy,
demonstrating helpful exercises, and
discussing their concerns. This is an example
of which of the following?
Health promotion
Treatment of disorders
Rehabilitation
Evaluation
A
Feedback:
The student nurses are engaging in health
promotion activities. Health promotion
incorporates all efforts that seek to move
people closer to optimal well-being or to
higher levels of wellness. Treatment of
disorders would include direct care for issues
involving the group, such as complications
that might arise in this population.
Rehabilitation would involve activities to
minimize disability or restore or preserve
function. Evaluation would involve an
analysis of the effectiveness of these
activities.
A)
B)
C)
D)
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E)
The community health nurse is developing a
plan of primary prevention activities. Which
12.
of the following might the nurse include?
Select all that apply.
Teaching about safe-sex practices to high
school students
Encouraging older adults to install safety
devices in the bathroom
Providing regular immunization programs for
communicable diseases
Participating in cholesterol screening
programs at health fairs
Providing skin testing for tuberculosis for
children over 1 year of age
Working with a group testing water samples
for contamination
A, B, C
Feedback:
Primary prevention activities are those taken
to keep illness or injuries from occurring.
These include teaching about safe-sex
practices, encouraging older adults to use
safety devices in the bathroom, and providing
regular immunization programs for
communicable diseases. Cholesterol
screening programs, skin tests for
tuberculosis, and working with a group testing
water samples for contamination are examples
of secondary prevention activities.
F)
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B)
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D)
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A community health nurse is preparing a
presentation for a group of nursing students
about community health nursing. Which of
13.
the following descriptions about community
health nursing would the nurse most likely
include in the presentation?
Focusing on addressing continuous needs
Working with the client as an equal partner
Engaging in tertiary prevention as the priority
Encouraging clients to reach out to the nurse
B
Feedback:
The community health nurse works with the
client as an equal partner, encouraging
autonomy. At any time, the nurse deals with
continuous and episodic needs
simultaneously. Primary prevention is the
priority for community health nurses. The
community health nurse engages in primary
Working with the client as an equal partner
Engaging in tertiary prevention as the priority
Encouraging clients to reach out to the nurse
B
Feedback:
The community health nurse works with the
client as an equal partner, encouraging
autonomy. At any time, the nurse deals with
continuous and episodic needs
simultaneously. Primary prevention is the
priority for community health nurses. The
community health nurse engages in primary
prevention as the priority, having the
obligation to actively reach out to all who
might benefit from a specific activity or
service.
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C)
D)
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A community health nurse is working with
other members of a team that will be
implementing a citywide immunization
14. program. The nurse is coordinating the
services and addressing the needs of the
population groups to ensure which of the
following?
Involvement of the community
Client participation
Continuity of service
Plan for follow-up
C
Feedback:
Working in cooperation with other team
members and coordinating services and
addressing the needs of population groups are
essential to interprofessional collaboration. In
doing so, the community health nurse is
preventing fragmentation and gaps thereby
ensuring continuity of service. Involvement of
the community and client participation are
important but these help to ensure that the
clients are viewed as equal partners of the
health care team. A plan for follow-up may or
may not be appropriate. In addition, it is the
only aspect that may be addressed with the
program.
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B)
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A community health nurse works to ensure
15. the greatest good for the greatest number of
people by applying which of the following?
Secondary prevention activities
Autonomy
Justice
Utilitarianism
D
Feedback:
The ethical theory of utilitarianism promotes
the greatest good for the greatest number.
Primary prevention activities, not secondary
prevention, are the priority. Autonomy refers
to the freedom of choice. Justice involves
treating people fairly.
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When working in the community, the
community health nurse adopts the teaching
16. plan to ensure that the population understands
the basic information provided to address
which of the following?
Self-care
Health disparities
Health literacy
Episodic needs
C
Feedback:
Consumers are often intimated by health
professionals and are uninformed about health
and health care affecting the quality of care.
Adopting a teaching plan to ensure that the
population understands the basic information
addresses health literacy, the ability to read,
understand, and use health care information
appropriately. Doing so helps to ensure that
the teaching plan will be effective. Self-care
refers to the process of taking responsibility
for developing one's own health potential by
actively participating in promoting one's own
health. Health disparities reflect differences in
all aspects of health care related to vulnerable
populations. Episodic needs are one-time
specific negative health events that arise and
are not an expected part of life.
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B)
C)
D)
Ans:
Health disparities
Health literacy
Episodic needs
C
Feedback:
Consumers are often intimated by health
professionals and are uninformed about health
and health care affecting the quality of care.
Adopting a teaching plan to ensure that the
population understands the basic information
addresses health literacy, the ability to read,
understand, and use health care information
appropriately. Doing so helps to ensure that
the teaching plan will be effective. Self-care
refers to the process of taking responsibility
for developing one's own health potential by
actively participating in promoting one's own
health. Health disparities reflect differences in
all aspects of health care related to vulnerable
populations. Episodic needs are one-time
specific negative health events that arise and
are not an expected part of life.
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C)
D)
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Which of the following would be crucial for
the community health nurse to address as the
17. priority when dealing with policy makers
about the development of community health
programs?
Research-based best practices
Population's make up
Amount of services to be provided
Scarcity of the available resources
A
Feedback:
Decisions for programs or services are often
made on the basis of cost-effectiveness or
cost–benefit. Therefore, community health
nurses must provide policy makers with
information about best practices, grounded in
research. Although population make up,
amount of services to be provided, and
scarcity of resources are factors that may need
to be considered, the community health nurse
must demonstrate evidence-based practice.
After a class that described the differences
between acute care nursing and community
18. health nursing, which statement by the class
about community health nurses indicates
successful teaching?
Use a reactive approach.
Seek out potential health problems.
Concentrate on the illness end of the
continuum.
Emphasize curative care.
B
Feedback:
Community health nurses, in contrast to acute
care nurses, seek out potential health
problems, identifying high-risk groups and
instituting preventive programs; use a
proactive approach; concentrate on the
wellness end of the health continuum; and put
less emphasis on curative care.
A)
B)
C)
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B)
C)
Which of the following activities would be
19. associated with a community health nurse?
Select all that apply.
Examining infants in a city well-baby clinic
Caring for elderly stroke victims in their
homes
Providing emergency care in an acute care
facility
Carrying out epidemiologic research
Participating in health policy analysis
A, B, D, E
Feedback:
Community health nurses work in every
conceivable kind of community agency, from
a state public health department to a
community-based advocacy group. Their
duties rang from examining infants in a wellbaby clinic or teaching elderly stroke victims
in their homes to carrying out epidemiologic
research or engaging in health policy analysis
and decision making. Providing care in an
acute care facility would not be an activity
associated with a community health nurse.
The term health can be described in many
20. different ways. A community health nurse
would view health as which of the following?
The absence of disease
The potential to lead a productive life
An environment free of toxins
A holistic state of well-being
D
Feedback:
Community health nurses view health as a
holistic state of well-being, which includes
soundness of mind, body, and spirit. Along
with this foundational view is the emphasis on
wellness, which includes the definition of
health as well as the capacity to develop a
person's potential to lead a fulfilling and
productive life. Health is more than just the
absence of disease or an environment free of
toxins.
C)
D)
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B)
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Ans:
While interviewing a client, which of the
following statements would a nurse identify
21.
as reflecting an objective dimension of
health?
“I'm feeling better since I started taking that
medication.”
“Life is pretty good right now, except for an
occasional upset stomach.”
“I'm able to wash myself in the mornings with
just a bit of help.”
“Sometimes when I wake up, I don't even
want to face the day.”
C
Feedback:
The objective dimension of health involves
one's ability to function in daily activities.
The statement about being able to care for
one's self is an example. The statements of
feeling better with medication, life being
pretty good, and not wanting to face the day
are examples of the subjective dimension of
health, which involves how people feel.
C)
just a bit of help.”
“Sometimes when I wake up, I don't even
want to face the day.”
C
Feedback:
The objective dimension of health involves
one's ability to function in daily activities.
The statement about being able to care for
one's self is an example. The statements of
feeling better with medication, life being
pretty good, and not wanting to face the day
are examples of the subjective dimension of
health, which involves how people feel.
D)
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B)
When employing a population-oriented focus,
22. the community health nurse would do which
of the following?
Assess the groups' relationships looking for a
common need.
Consider the members individually for
similarities.
Focus on the geographical area of the
population.
Promote the groups' dependency for
improving health.
A
Feedback:
A population-oriented focus requires the
assessment of relationships, considering the
groups or communities in relationship to the
rest of the community to discover common
needs or risks for a common health problem.
The nurse does not consider the groups or
communities separately but rather in context.
The population may or may not be delineated
by the geographical area. The community
health nurse encourages individuals'
participation to promote their autonomy rather
than permitting dependency.
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Ans:
A community health nurse is involved in a
project to evaluate the health of a city. Which
23. of the following findings would suggest that
the city would most likely need additional
programs?
Citizens are actively involved in the city's
department of recreation and after-school
programs.
The construction of affordable organized
housing developments and communities is
nearing completion.
Approximately one third of the people are
A)
B)
C)
D)
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A community health nurse is involved in a
project to evaluate the health of a city. Which
23. of the following findings would suggest that
the city would most likely need additional
programs?
Citizens are actively involved in the city's
department of recreation and after-school
programs.
The construction of affordable organized
housing developments and communities is
nearing completion.
Approximately one third of the people are
recently unemployed due to closure of the
automotive factory.
Several new recreational facilities for adults
and children have been created at several
locations.
C
Feedback:
A healthy city is one in which there is
continual creation and improvement the
physical and social environments with
expansion of community resources so that
people can mutually support one another. It is
characterized by the meeting of basic needs
for all of the city's people. This would include
food, water, shelter, income, safety, and work.
Loss of employment of one third of the city's
workforce would be a threat to the health of
the city and necessitate intervention. Active
involvement in the city's functioning,
affordable housing, and recreational facilities
are suggestive of a healthy city.
Chapter 2 Public Health Nursing in the Community
A community health nurse is engaging in
1. assurance activities. Which of the following
would best explain these activities?
Gathering and analyzing information that will
A)
affect the health of the people to be served
Providing leadership in facilitating
community groups toward meeting their
B)
needs, often involving changes in and
additions to existing laws
Being involved in activities to make certain
C)
that necessary services are being provided to
the community
Accessing relevant data that enable
D)
identification of strengths, weaknesses, and
needs within the community
Ans:
C
A)
affect the health of the people to be served
Providing leadership in facilitating
community groups toward meeting their
needs, often involving changes in and
additions to existing laws
Being involved in activities to make certain
that necessary services are being provided to
the community
Accessing relevant data that enable
identification of strengths, weaknesses, and
needs within the community
C
Feedback:
Assurance activities are those activities that
make certain that services are provided and
include focusing on the availability of
necessary health services throughout the
community, maintaining the ability of public
health agencies and private providers to
manage day-to-day operations as well as the
capacity to respond to critical situations and
emergencies. Assessment involves gathering
and analyzing information that will affect the
health of those to be served and accessing
relevant data to enable the nurse to identify
strengths, weaknesses, and needs. Policy
development involves providing leadership in
facilitating community groups.
B)
C)
D)
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When fulfilling the function of assessment,
which of the following would be most
2.
important for the community health nurse to
do?
Secure the trust of the clients
Gather appropriate information
Interact with key community leaders
Use a variety of assessment tools
A
Feedback:
Although securing and maintaining the trust
of others is pivotal to all nursing practice, it is
even more critical when working in the
community. Trust can afford a nurse access to
client populations that are difficult to engage,
to agencies, and to health care providers. As
difficult as it may be for the nurse to gain the
trust and respect of the community, if it is
ever lost, these attributes can be difficult if
not impossible to regain. Gathering
information, interacting with key community
leaders, and using a variety of assessment
tools are important, but they can only occur
after trust is established.
Gather appropriate information
Interact with key community leaders
Use a variety of assessment tools
A
Feedback:
Although securing and maintaining the trust
of others is pivotal to all nursing practice, it is
even more critical when working in the
community. Trust can afford a nurse access to
client populations that are difficult to engage,
to agencies, and to health care providers. As
difficult as it may be for the nurse to gain the
trust and respect of the community, if it is
ever lost, these attributes can be difficult if
not impossible to regain. Gathering
information, interacting with key community
leaders, and using a variety of assessment
tools are important, but they can only occur
after trust is established.
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C)
D)
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The community health nurse is engaging in
the core function of policy development. With
3.
which of the activities would the nurse most
likely be involved?
Monitoring health status to identify
community health problems
Empowering communities about important
health issues
Linking individuals to needed personal health
services
Ensuring a competent health care workforce
is available
B
Feedback:
With policy development, the community
health nurse would be involved in informing,
educating, and empowering people about
health issues. Monitoring health status is
associated with the assessment function.
Linking individuals to needed personal health
services and ensuring a competent public
health and personal health care workforce are
associated with assurance.
A community health nurse is collaborating
with local community leaders to prepare a
4.
community disaster plan. Which function is
the nurse fulfilling?
Research
Assurance
Policy development
Assessment
B
Feedback:
Community health nurses perform the
assurance function at the community level
when they collaborate with community
leaders in the preparation of a community
disaster plan. Research is demonstrated by
gaining new insights and innovative solutions
to health problems. Policy development
would involve client information, education
and empowerment, mobilization of
community partnerships, and the development
of plans and policies to support community
health efforts. Assessment involves
monitoring health status for community health
problems and diagnosing and investigating
health problems and hazards in the
community.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A community health nurse has collected data
for several months on the birth weights of
5. newborns to mothers who smoked throughout
their pregnancy. This nurse is acting in which
role?
Collaborator
Manager
Researcher
Clinician
C
Feedback:
The nurse is assuming the role of a researcher,
that is, engaging in systematic investigation
that includes data collection. In the
collaborator role, the nurse would work with
numerous members of the health team,
working jointly with others in a common
endeavor. In the manager role, the nurse
exercises administrative direction toward the
accomplishment of specified goals. In the
clinician role, the nurse ensures the provision
Manager
Researcher
Clinician
C
Feedback:
The nurse is assuming the role of a researcher,
that is, engaging in systematic investigation
that includes data collection. In the
collaborator role, the nurse would work with
numerous members of the health team,
working jointly with others in a common
endeavor. In the manager role, the nurse
exercises administrative direction toward the
accomplishment of specified goals. In the
clinician role, the nurse ensures the provision
of health care services to individuals,
families, groups, and populations.
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B)
C)
D)
Ans:
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A nurse in community health nursing setting
works with police officers, social workers,
6. health educators, and other nurses to promote
the health of clients. The nurse is acting in
which role?
Clinician
Educator
Researcher
Collaborator
D
Feedback:
The nurse is assuming the role of collaborator.
In this role, the community health nurse
works jointly with many individuals to benefit
client care. In the clinician role, the nurse
ensures the provision of health care services
to individuals, families, groups, and
populations. As an educator, the nurse is the
health teacher and provides information to
community clients. In the researcher role, the
community health nurse engages in
systematic investigation, collection, and
analysis of data for solving problems and
enhancing community health practice.
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A)
B)
C)
D)
Ans:
A community health nurse is interviewing for
employment. The interviewer describes some
of the typical activities that the nurse would
be involved in, such as making home visits to
7.
families, holding immunization clinics for
infants and children, and setting up flu-shot
clinics for elders. The interviewer is
describing which role?
Educator
Advocate
Clinician
Manager
C
Feedback:
The interviewer is describing direct care
activities associated with the clinician role. As
an educator, the nurse is the health teacher
and provides information to community
clients. In the advocate role, the nurse pleads
for the clients' cause or acts on their behalf. In
the manager role, the nurse exercises
administrative direction toward the
accomplishment of specified goals.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A community health nurse is reviewing his or
her schedule for the day. Included in his or
8. her activities are planning client care, leading
a staff conference, and supervising a new staff
member. This nurse is fulfilling which role?
Advocate
Manager
Collaborator
Researcher
B
Feedback:
When functioning in the manager role, the
nurse exercises administrative direction
toward the accomplishment of specified
goals. Overseeing client care as a case
manager, supervising ancillary staff,
managing caseloads, running clinics, or
conducting community health needs
assessment projects are examples of activities
associated with the manager role. In the
advocate role, the nurse pleads for the clients'
cause or acts on their behalf. In the
collaborator role, the nurse would work with
numerous members of the health team,
Manager
Collaborator
Researcher
B
Feedback:
When functioning in the manager role, the
nurse exercises administrative direction
toward the accomplishment of specified
goals. Overseeing client care as a case
manager, supervising ancillary staff,
managing caseloads, running clinics, or
conducting community health needs
assessment projects are examples of activities
associated with the manager role. In the
advocate role, the nurse pleads for the clients'
cause or acts on their behalf. In the
collaborator role, the nurse would work with
numerous members of the health team,
working jointly with others in a common
endeavor. In the researcher role, the
community health nurse engages in
systematic investigation, collection, and
analysis of data for solving problems and
enhancing community health practice.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
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While providing care to a family at a local
center, the community health nurse contacts
the local department of social services to help
the family attain assistance with health
9.
insurance coverage. The nurse also gives the
family a list of pharmacies where they can get
their prescriptions filled. The nurse is acting
in which role?
Educator
Leader
Clinician
Advocate
D
Feedback:
The nurse is acting in the role of advocate, by
pleading their cause and acting on their
behalf. The nurse acts as an advocate by
showing clients what services are available,
the ones to which they are entitled, and how
to obtain them. As an educator, the nurse is
the health teacher and provides information to
community clients. As a leader, the nurse
directs, influences, or persuades others to
effect change that will positively impact
people's health and move them toward a goal.
In the clinician role, the nurse ensures the
provision of health care services to
individuals, families, groups, and populations.
Leader
Clinician
Advocate
D
Feedback:
The nurse is acting in the role of advocate, by
pleading their cause and acting on their
behalf. The nurse acts as an advocate by
showing clients what services are available,
the ones to which they are entitled, and how
to obtain them. As an educator, the nurse is
the health teacher and provides information to
community clients. As a leader, the nurse
directs, influences, or persuades others to
effect change that will positively impact
people's health and move them toward a goal.
In the clinician role, the nurse ensures the
provision of health care services to
individuals, families, groups, and populations.
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B)
C)
D)
Ans:
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B)
C)
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D)
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A)
B)
C)
Which of the following best exemplifies the
10. attributes of a community health nurse in the
researcher role?
Gaining the trust and respect of the staff
members
Interpreting abstract ideas so others can
understand
Implementing a staff development program
for a technique
Evaluating the correlation between variables
in specific health conditions
D
Feedback:
Attributes of a researcher include a spirit of
inquiry, careful observation, analytic skills,
such as evaluating the possible cause and
effect of a situation, and tenacity. Gaining the
trust and respect of staff, interpreting abstract
ideas, and implementing a staff development
program are examples of the management
skills used in the role of manager.
Which of the following statements about the
11. role of educator within the framework of
public health nursing functions is true?
The educator role has the potential for finding
greater receptivity and providing higher-yield
results.
People are unable to recognize the value of
health and are not well motivated to achieve
higher levels of wellness.
It is only possible for a nurse to reach a
Which of the following statements about the
11. role of educator within the framework of
public health nursing functions is true?
The educator role has the potential for finding
greater receptivity and providing higher-yield
results.
People are unable to recognize the value of
health and are not well motivated to achieve
higher levels of wellness.
It is only possible for a nurse to reach a
limited number of persons.
The public's higher level of health
consciousness hinders the educator's role.
A
Feedback:
The educator role has the potential for finding
greater receptivity and providing higher-yield
results. People are recognizing the value of
health and are increasingly motivated to
achieve higher levels of wellness. With an
emphasis on populations and aggregates, the
educational efforts of community health
nursing are appropriately targeted to reach
many people. One factor that enhances the
educator role is the public's higher level of
health consciousness.
A)
B)
C)
D)
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Ans:
C)
D)
Ans:
12.
Which of the following statements about the
importance of the role of collaborator is true?
Community health nurses frequently practice
in isolation.
Successful community health practice
depends on multidisciplinary collegiality and
leadership.
Community health nurses must assert
themselves as the most powerful person on
the health care team to ensure each client
receives services that are necessary.
It is best for community health nurses to focus
on what they, as nurses, can do for their
clients.
B
Feedback:
Community health nurses seldom practice in
isolation. As collaborators, nurses work
jointly with others in a common endeavor,
cooperating as partners. Successful
community health practice depends on
multidisciplinary collegiality and leadership.
The community health nurse's collaborator
role requires skills in communicating, in
It is best for community health nurses to focus
on what they, as nurses, can do for their
clients.
B
Feedback:
Community health nurses seldom practice in
isolation. As collaborators, nurses work
jointly with others in a common endeavor,
cooperating as partners. Successful
community health practice depends on
multidisciplinary collegiality and leadership.
The community health nurse's collaborator
role requires skills in communicating, in
interpreting the nurse's unique contribution to
the team, and in acting assertively as an equal
partner.
D)
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Which of the following statements about the
13. community health nurse's selection and
practice of each role is true?
Within a given time, a community health
nurse may practice multiple roles.
The knowledge that vulnerable populations
need someone to guide them through the
complexities of the health care system and the
nurse can serve as an advocate for them
The researcher role for community health
nurses involves only the use of quantitative
statistics.
The leadership role consists solely of
managing staff.
B
Feedback:
Community health nurses wear many hats
while conducting day-to-day practice. At any
given time, however, one role is primary.
They need someone to guide them through the
complexities of the system and assure the
satisfaction of their needs. This is particularly
true for minorities and disadvantaged groups.
Although research technically involves a
complex set of activities conducted by
persons with highly developed and
specialized skills, research also means
applying that technical study to real-practice
situations. As leaders, community health
nurses seek to initiate changes that positively
affect people's health.
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B)
C)
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D)
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Ans:
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A community health nurse is involved in
education, screening, referral, and support for
14. the individuals of a specific religious
congregation. The nurse is practicing in which
setting?
Occupational health nursing
Faith community nursing
School nursing
Residential institution nursing
B
Feedback:
In faith community nursing, the practice focal
point is the faith community and the religious
belief system provided by the philosophical
framework. It may be called church-based
health promotion, parish nursing, or primary
care parish nursing practice. Occupational
health nursing occurs in business and industry
settings. School nursing, as the name implies,
involves practicing in the school system,
including from preschools to colleges and
universities. Residential institution nursing
occurs in any facility where the clients reside
such as a halfway house or continuing care
center.
Which of the following differentiates the
15. home setting for community health nursing
from other settings?
The nurse acts primarily as an educator.
The client is viewed within his or her
environment.
Technologically advanced care is limited.
The home is being used less frequently today.
B
Feedback:
In the home, unlike most other health care
settings, clients are on their own “turf,” such
that the client is the host, comfortable and
secure in familiar surroundings, and the nurse
is a guest. Although education may be a major
component of care in the home, all
community health nursing roles are performed
to varying degrees. In addition,
technologically advanced care in the home is
increasing in demand, with the home being
environment.
Technologically advanced care is limited.
The home is being used less frequently today.
B
Feedback:
In the home, unlike most other health care
settings, clients are on their own “turf,” such
that the client is the host, comfortable and
secure in familiar surroundings, and the nurse
is a guest. Although education may be a major
component of care in the home, all
community health nursing roles are performed
to varying degrees. In addition,
technologically advanced care in the home is
increasing in demand, with the home being
the most frequently used setting for
community health nursing.
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C)
D)
Ans:
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After teaching a group of students about the
various settings for community health
nursing, the instructor determines that this
16.
teaching was successful when the students
identify which of the following as an example
of ambulatory service setting?
Local preschool
Halfway house
Continuing care center
Family planning clinic
D
Feedback:
Ambulatory service setting includes a variety
of venues for community health nursing in
which clients come for day or evening
services that do not include overnight stays.
One example is a family planning clinic. A
local preschool would be an example of a
school setting. A halfway house and
continuing care center are examples of
residential institutions.
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A)
B)
C)
D)
Ans:
A)
B)
C)
After teaching a group of students about the
changing roles of the community health nurse
in the occupational setting, the instructor
17.
determines that the students need additional
teaching when they state which of the
following?
Occupational health nurses are increasing
their role as employee advocates.
Health education is a key function of the
occupational health nurse.
There is a greater emphasis on the
occupational health nurse's role as a clinician.
A)
B)
C)
D)
A)
B)
C)
D)
Ans:
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Ans:
changing roles of the community health nurse
in the occupational setting, the instructor
17.
determines that the students need additional
teaching when they state which of the
following?
Occupational health nurses are increasing
their role as employee advocates.
Health education is a key function of the
occupational health nurse.
There is a greater emphasis on the
occupational health nurse's role as a clinician.
Collaboration with other health care providers
fosters the offering of better services.
C
Feedback:
The clinician role was primary for many
years, as nurses continued to care for sick or
injured employees at work. However,
recognition of the need to protect employees'
safety and, later, to prevent their illness led to
the inclusion of health education in the
occupational health nurse role. Occupational
health nurses also act as employee advocates,
assuring appropriate job assignments for
workers and adequate treatment for jobrelated illness or injury. They collaborate with
other health care providers and company
management to offer better services to their
clients. They act as leaders and managers in
developing new health services in the work
setting, endorsing programs such as
hypertension screening and weight control.
A community health nurse is working as a
lobbyist for health legislation for AIDS
18.
research at the state capital. This nurse is
practicing in which setting?
Faith community
Ambulatory service
Residential institution
Community at large
D
Feedback:
The community at large is not confined to a
specific philosophy, location, or building. It
serves as the setting for practice of a nurse
who serves on health care planning
committees, lobbies for health legislation at
the state capital, runs for a school board
position, or assists with flood relief in another
state or country. Faith community nursing
focuses on activities involving the faith
community and religious belief system.
Ambulatory service
Residential institution
Community at large
D
Feedback:
The community at large is not confined to a
specific philosophy, location, or building. It
serves as the setting for practice of a nurse
who serves on health care planning
committees, lobbies for health legislation at
the state capital, runs for a school board
position, or assists with flood relief in another
state or country. Faith community nursing
focuses on activities involving the faith
community and religious belief system.
Ambulatory service settings include a variety
of venues in which clients come for day or
evening services that do not include overnight
stays. Residential institutions include any
facility where clients reside.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Which of the following is included in the
most accurate description of school nursing?
This is one community health setting where
the role is static.
The primary role of school nurses is clinician.
The practice of school nurses is widening.
School nurses rarely act as advocates.
C
Feedback:
School nurses, whose primary role initially
was that of clinician, are widening their
practice to include more health education,
interprofessional collaboration, and client
advocacy.
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B)
C)
D)
Ans:
A community health nurse is assuming the
20. role of a manager. Which function would be
most important for the nurse to address first?
Planning
Organizing
Leading
Controlling
A
Feedback:
The management process incorporates a series
of problem-solving activities or function:
planning, organizing, leading, and controlling
and evaluating. Although these activities
occur simultaneously, they are sequential with
planning being the first activity.
Organizing
Leading
Controlling
A
Feedback:
The management process incorporates a series
of problem-solving activities or function:
planning, organizing, leading, and controlling
and evaluating. Although these activities
occur simultaneously, they are sequential with
planning being the first activity.
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A)
B)
C)
D)
E)
F)
Ans:
A)
B)
C)
D)
E)
A nursing student is interviewing a
community health nurse about the various
roles the nurse assumes and the skills and
21. behaviors necessary to perform each role.
Which of the following would the community
health nurse identify as being essential to the
role of an advocate? Select all that apply.
Assertiveness
Ability to plan
Ability to negotiate
Risk taking
Holistic view
Questioning attitude
A, C, D
Feedback:
As an advocate, the community health nurse
must be assertive, willing to take risks, be
able to communicate and negotiate well, and
be able to identify resources and obtain
results. The ability to plan is associated with
the manager role. A holistic view is critical to
the community health nurse acting as a
clinician. A questioning attitude is necessary
for the role as a researcher.
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B)
C)
D)
Ans:
A community health nurse works in a busy
community health nursing practice. Today, the
22. nurse is devoting the day to the educator role.
With which of the following activities would
the nurse be involved? Select all that apply.
Planning seven home visits today
Working on a new curriculum for high-risk
teens
Meeting with colleagues to discuss
organizational changes in the office
Ordering pamphlets over the Internet to be
used in a parenting class
Tabulating data from surveys distributed to
elders during a flu-shot clinic
Going to social services to speak up for a
A)
Planning seven home visits today
Working on a new curriculum for high-risk
teens
Meeting with colleagues to discuss
organizational changes in the office
Ordering pamphlets over the Internet to be
used in a parenting class
Tabulating data from surveys distributed to
elders during a flu-shot clinic
Going to social services to speak up for a
family in his or her caseload
B, D
Feedback:
In the educator role, the nurse would work on
a new curriculum for high-risk teens and
order pamphlets for use in a parenting class.
Planning seven home visits would be part of
the clinician role. Meeting with colleagues to
discuss organizational changes would be part
of the manager role. Tabulating data from
surveys would be part of the researcher role.
Speaking up for a family in the nurse's
caseload would be an example of the advocate
role.
B)
C)
D)
E)
F)
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A community health nurse is devoting the day
to being a manager. Which activities would
23. the nurse expect to perform? Which of the
following activities are part of this role?
Select all that apply.
Orienting three new community health nurses
in the agency
Attending a strategy meeting for a new
service the community will be offering
Working with a team to direct a smoking
cessation program in public areas
Investigating an outbreak of Salmonella in the
community
Tabulating the findings of exploring
immunization practices among teens
Reviewing the staff evaluations to assist with
planning future in-services
A, B, F
Feedback:
As a manager, a community health nurse
would be involved in orienting new nurses in
the agency, attending meetings for new
services to be offered, and reviewing staff
evaluations. Working with a team to direct a
smoking cessation program in public areas
exemplifies the leadership role. Investigating
an outbreak of Salmonella and tabulating the
findings of immunization practices depict the
D)
E)
F)
Ans:
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A)
E)
immunization practices among teens
Reviewing the staff evaluations to assist with
planning future in-services
A, B, F
Feedback:
As a manager, a community health nurse
would be involved in orienting new nurses in
the agency, attending meetings for new
services to be offered, and reviewing staff
evaluations. Working with a team to direct a
smoking cessation program in public areas
exemplifies the leadership role. Investigating
an outbreak of Salmonella and tabulating the
findings of immunization practices depict the
researcher role.
F)
Of all the nursing roles assumed by
24. community health nurses, which role must be
assumed in every situation?
Researcher
Manager
Leader
Clinician
B
Feedback:
The type and number of roles that are
practiced vary with each set of clients and
each specific situation, but the nurse should
be able to successfully function in each of
these roles as the particular situation
demands. The role of manager is one that the
nurse must play in every situation, because it
involves assessing clients' needs, planning
and organizing to meet those needs, directing
and leading clients to achieve results, and
controlling and evaluating the progress to
ensure that the goals and clients' needs are
met.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
E)
F)
Ans:
Which of the following are core values of
25. professional behavior that are unique to
public health nursing? Select all that apply.
Community/population as client
Prevention
Rehabilitation
Partnership
Healthy environment
Diversity
A, B, D, E, F
Feedback:
Core values of professional behavior
emphasize community/population as client,
A)
B)
C)
D)
E)
F)
Ans:
Community/population as client
Prevention
Rehabilitation
Partnership
Healthy environment
Diversity
A, B, D, E, F
Feedback:
Core values of professional behavior
emphasize community/population as client,
prevention, partnership, healthy environment,
and diversity. Rehabilitation is not population
centered.
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Chapter 3 History and Evolution of Public Health Nursing
A group of students are reviewing the various
historical events associated with the evolution
of community health nursing in preparation
for a test. They identify the time from 1970 to
1.
the present as the era known as community
health nursing based on the understanding
that which of the following influences
contributed most to this change?
The settings and the nurses delivering health
A)
care in the community
Decisions made by the American Nurses
B)
Association
Decisions made by physicians in a variety of
C)
community settings
The demand to eliminate the word “public”
D)
from health services
Ans:
A
Feedback:
The numbers, increasing variety of settings,
and many nurses coming to work in the
community settings since the 1970s have
contributed most significantly to the change.
As a result, professional associations
supported the broader term of community
health nursing. Physician decisions played no
role in the change. The term public health
nursing still remains.
Before the mid-1800s, early home care
2. nursing was best recognized by which of the
following?
Technical advances with the Industrial
Revolution making major changes
Care provided by family members, friends,
and religious groups in the home
Accomplishments stemming from the work of
Florence Nightingale
Formal organization of visiting nursing to
provide care to the sick poor
B
Feedback:
Before the mid-1800s, early home care was
characterized by care of the sick in the home
by family members, friends, and religious
groups. Technical advances came after 1850,
as did the work of Florence Nightingale and
the formal organization of visiting nurses to
provide care to the sick poor.
A)
B)
C)
D)
C)
D)
Ans:
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B)
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Ans:
Community health nursing has a long history
of contributing to the health of populations.
3. Which of the following forms of service
would the nurse identify as being most
recent?
Voluntary home nursing care for the sick poor
via district nursing
Care provided termed public health nursing
Lay and religious groups providing care to the
sick poor in their homes
Focus on populations with community health
nursing seen as a specialty field
D
Feedback:
The four stages of community health nursing
followed from lay and religious groups
providing care in the early years before 1850,
the more specialized “health nurses” or
district nursing after the mid-1800s, concern
for the health of the general public from
1900s to 1970, and finally community health
nursing as a specialty with a focus on
populations since 1970.
C)
sick poor in their homes
Focus on populations with community health
nursing seen as a specialty field
D
Feedback:
The four stages of community health nursing
followed from lay and religious groups
providing care in the early years before 1850,
the more specialized “health nurses” or
district nursing after the mid-1800s, concern
for the health of the general public from
1900s to 1970, and finally community health
nursing as a specialty with a focus on
populations since 1970.
Ans:
4.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
Which factor was the most significant feature
associated with district nursing?
Caring for the sick
Teaching hygiene and cleanliness
Preventing illness
Gathering statistical data
B
Feedback:
Although district nurses primarily cared for
the sick, they also taught cleanliness and
wholesome living to their clients. This early
emphasis on prevention and health became
one of the distinguishing features of district
nursing and later of public health nursing.
Preventing illness and gathering statistical
data were key contributions of Florence
Nightingale during the Crimean War of the
early 1850s.
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D)
5.
In their early stages, district nursing was
sponsored by which of the following?
Religious organizations
Private philanthropy
Contributions
Public funding
A
Feedback:
Early district nursing services were founded
by religious organizations that served as their
sponsors. Later sponsorship shifted to private
philanthropy. Funding came from
contributions and fees charged to clients on an
ability-to-pay basis. Finally, visiting nursing
began to be supported by public money.
Private philanthropy
Contributions
Public funding
A
Feedback:
Early district nursing services were founded
by religious organizations that served as their
sponsors. Later sponsorship shifted to private
philanthropy. Funding came from
contributions and fees charged to clients on an
ability-to-pay basis. Finally, visiting nursing
began to be supported by public money.
Which of the following would characterize
6. the public health stage of community health
nursing?
Voluntary health agencies emphasizing
disease prevention
Family considered as the primary unit of care
Service provision to the sick poor population
Primary health care as the key to health for all
B
Feedback:
The public health nursing stage was
characterized by service to the public, with
the family targeted as a primary unit of care.
Official health agencies, which placed a
greater emphasis on disease prevention and
health promotion, provided the chief
institutional base. Primary health care as the
key to health for all characterizes the
community health nursing stage.
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B)
C)
D)
Ans:
A)
A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
At which time did the focus of district nursing
7. broadened to include the health and welfare of
the general public?
Beginning of 20th century
In the late 19th century
Prior to the 1850s
By the early 1970s
A
Feedback:
The focus of district nursing broadened to
include the health and welfare of the general
public by the beginning of the 20th century or
the early 1900s. In the late 19th century,
district nurses were ill-prepared to cope with
their clients' multiple health and social
problems resulting from widespread
immigration and filled tenement housing that
led to inadequate sanitation, unsafe and
unhealthy working condition, and barriers
In the late 19th century
Prior to the 1850s
By the early 1970s
A
Feedback:
The focus of district nursing broadened to
include the health and welfare of the general
public by the beginning of the 20th century or
the early 1900s. In the late 19th century,
district nurses were ill-prepared to cope with
their clients' multiple health and social
problems resulting from widespread
immigration and filled tenement housing that
led to inadequate sanitation, unsafe and
unhealthy working condition, and barriers
adding to poverty and disease. District
nursing did not develop until after 1850. The
early 1970s is associated with the emergence
of community health nursing.
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B)
C)
D)
Ans:
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A student is planning a presentation about the
evolution of public health nursing. As part of
8. the presentation, the student would identify
which person as being the first one to use the
term “public health nursing”?
Jessie Sleet
Lillian Wald
Lina Rogers
Margaret Sanger
B
Feedback:
Lillian Wald, a leading figure in the expansion
of district nursing, was the first to use the
term “public health nursing” to describe the
specialty. Jessie Sleet was credited as being
the first Black public health nurse. Lina
Rogers was credited with being the first
school nurse. Margaret Sanger was the nurse
who opened the first birth control clinic in
America that eventually resulted in the
formation of the International Planned
Parenthood Federation.
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A)
B)
C)
D)
Ans:
A)
B)
Which of the following are important
contributions made by Lillian Wald to the
9.
profession of public health nursing? Select all
that apply.
Demonstrating the effectiveness of placing
school nurses in public schools to reduce
absenteeism and improve follow-up of
problems identified in school children
Promoting the use of birth control
Which of the following are important
contributions made by Lillian Wald to the
9.
profession of public health nursing? Select all
that apply.
Demonstrating the effectiveness of placing
school nurses in public schools to reduce
absenteeism and improve follow-up of
problems identified in school children
Promoting the use of birth control
Convincing the Metropolitan Life Company
that nurse intervention could reduce death
rates
Providing rural “frontier nursing” to serve
mountain families in Kentucky
Founding the National Organization for
Public Health Nursing (NOPHN)
A, C, E
Feedback:
Lillian Wald contributed to the profession of
public health nursing by demonstrating the
effectiveness of placing school nurses in
public schools to reduce absenteeism and
improve follow-up of problems identified in
school children, convincing the Metropolitan
Life Company that nurse intervention could
reduce death rates, and Founding the National
Organization for Public Health Nursing
(NOPHN).
A)
B)
C)
D)
E)
A)
B)
C)
D)
Ans:
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Ans:
After a class discussion about the
contributions of Lillian Wald to the
10. advancement of community health nursing,
which of the following if stated by the class
indicates that the discussion was effective?
Establishment of family-centered nursing and
outreach services in New York City at the turn
of the 20th century
Use of clean and safe nursing care practices to
soldiers during the Crimean War in the 1850s
Assistance to high-risk populations
experiencing tropical diseases in Central
America and the Caribbean in the late 1800s
Creation of home nursing services in London,
marking the beginning of district nursing in
the 1860s
A
Feedback:
Lillian Wald worked with immigrant families
in the Lower East Side of New York City,
providing home visits, a neighborhood center,
and general sanitation improvement for
families and health care services to children in
Creation of home nursing services in London,
marking the beginning of district nursing in
the 1860s
A
Feedback:
Lillian Wald worked with immigrant families
in the Lower East Side of New York City,
providing home visits, a neighborhood center,
and general sanitation improvement for
families and health care services to children in
schools. Florence Nightingale was responsible
for providing clean and safe nursing care
practices to soldiers during the Crimean War.
Mary Seacole helped high-risk populations
who experienced tropical diseases in Central
America and the Caribbean. William
Rathbone was responsible for establishing a
visiting nurse service for the sick in London.
D)
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A group of nursing students are studying for
an examination on influential nursing leaders
involved in the advancement of community
11. health nursing. The students demonstrate that
they are prepared for the examination when
they identify which person as the first
community health nurse in the United States?
Frances Root
Mary Robinson
Mary Seacole
Reba Thelin
A
Feedback:
In the United States, Frances Root was the
first community health nurse who was hired
by the Women's Branch of the New York
Mission in 1877. Mary Robinson was the
nurse who cared for William Rathbone's wife
and was hired by Rathbone to visit the sick
poor in their homes in England. Mary
Seacole, the “Black Nightingale,” practiced
Creole or Afro-Caribbean medicine in
Jamaica and helped populations who
experienced tropical diseases in Central
America, Panama, and the Caribbean. Reba
Thelin was a nurse hired by Johns Hopkins
Hospital to visit the homes of tuberculosis
clients in 1903.
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A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
Which of the following nurses openly defied a
law that she saw as unjust and eventually
12.
resulted in the formation of The International
Planned Parenthood Federation?
Lillian Wald
Florence Nightingale
Margaret Sanger
Mary Brewster
C
Feedback:
Margaret Sanger openly defied a law that she
saw as unjust (the Comstock Act that
prohibited the provision of any information
on contraception to women). This defiance
eventually resulted in the formation of The
International Planned Parenthood Federation.
During the same period that Lillian Wald and
her contemporaries were working to alleviate
the suffering caused by disease and poverty,
Margaret Sanger began a different battle.
Florence Nightingale wrote a series of papers
on the need for “home missioners” and
“health visitors” and endorsed the view that
prevention was better than cure. Mary
Brewster was a nurse and a friend of Lillian
Wald who both together started the Henry
Street Settlement.
A)
B)
C)
D)
E)
Ans:
The community health nurse is preparing a
presentation for a group of nursing students
about the societal influences on the
13. development of community health nursing.
Which factors should the nurse include that
have influenced the growth of community
health nursing? Select all that apply.
Advances in the technology
The recognition that one single agent could be
considered a cause of illness
Access to education being limited to the
privileged few
Continued increase in the number of women
entering nursing because it is recognized as a
choice career for women and not men
Consumer demand for quality services
coupled with community health nurses
provision of holistic care
A, E
A)
Advances in the technology
The recognition that one single agent could be
considered a cause of illness
Access to education being limited to the
privileged few
Continued increase in the number of women
entering nursing because it is recognized as a
choice career for women and not men
Consumer demand for quality services
coupled with community health nurses
provision of holistic care
A, E
Feedback:
Many factors have influenced the growth of
community health nursing, including
advances in technology, progress in causal
thinking (relating disease or illness to its
cause and recognition that many factors might
contribute to a disease or health disorder), and
the consumer movement with consumers
demanding quality services. Education is now
widely available and is considered a basic
right and necessity for a vital society.
Changing demographics and the role of
women have influenced community health
nursing; however, the number of women
entering nursing has decreased.
B)
C)
D)
E)
C)
D)
Ans:
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Ans:
Which of the following actions by the
community health nurse exemplifies the
14.
societal influence of causality on the practice
of community health nursing?
Using computer-based education programs
for client education
Engaging in video conferencing to share
research findings
Identifying multiple factors associated with
promoting wellness
Developing a plan to address the rapid
increase in older adult population
C
Feedback:
Causal thinking relates disease or illness to its
cause and includes areas such as
epidemiology; interactions among an agent,
host, and environment; and recognition of
multiple factors contributing to a disease,
health disorder, or wellness. Using computerbased education programs and engaging in
video conferencing are examples reflecting
the advancement of technology. Developing a
plan to address the rapid increase in the older
adult population involves application of the
C)
promoting wellness
Developing a plan to address the rapid
increase in older adult population
C
Feedback:
Causal thinking relates disease or illness to its
cause and includes areas such as
epidemiology; interactions among an agent,
host, and environment; and recognition of
multiple factors contributing to a disease,
health disorder, or wellness. Using computerbased education programs and engaging in
video conferencing are examples reflecting
the advancement of technology. Developing a
plan to address the rapid increase in the older
adult population involves application of the
change in demographics affecting community
health nursing.
D)
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A community health nurse who is teaching a
group of nursing students about the various
societal influences on community health
nursing is explaining the effects of the
15.
consumer movement. Which of the following
student responses would lead the community
health nurse to determine that the teaching
was successful?
Individuals are considered passive members
of the health care team.
Consumers are demanding more coordinated
comprehensive care.
People are expecting community health
nurses to develop new programs.
Consumers are identifying a greater need for
care by a variety of care providers.
B
Feedback:
The consumer movement has led to changes
in community health nursing. Consumers are
demanding more humane, personalized health
care, seeking more comprehensive
coordinated care. They are viewed as active
members of the health care team. The need to
develop new programs is a response to the
economic forces that have affected the
practice of community health nursing.
Consumers desire more coordinated care, not
care from a variety of care providers.
A)
Ans:
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B)
Which of the following most accurately
16. reflects the response of community health
nursing to economic forces?
Decreased competition with other community
health service providers
Reduction in available programs and services
Development of new services for generating
revenue
Switch to a more illness-oriented philosophy
for service
C
Feedback:
Economic forces have led community health
nursing to respond by developing new
revenue-generating services to augment
depleted budgets. Other responses include
directly competing with other community
health service providers and developing new
programs and service emphases. Although
some public health agencies have been drawn
into more illness-oriented services,
community health nursing continues to be
resourceful in finding ways to foster the
community's optimal health.
A)
B)
C)
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D)
A)
B)
C)
D)
Ans:
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Ans:
A prospective nursing student is interested in
working in community health nursing after
17.
graduation. Which type of education would be
most appropriate for this student to choose?
Diploma program
Associate degree
Baccalaureate degree
Graduate degree
C
Feedback:
Community health nursing is a challenging
specialty in nursing. The demands of this type
of nursing require additional courses in liberal
arts and science, along with courses in
community health nursing practice as a
student. The minimum preparation for
community health nurses in many states is a
baccalaureate degree. The diploma and
associate degree level prepares students for
basic nursing practice. Students can build on
this basic knowledge by entering a BSN
Associate degree
Baccalaureate degree
Graduate degree
C
Feedback:
Community health nursing is a challenging
specialty in nursing. The demands of this type
of nursing require additional courses in liberal
arts and science, along with courses in
community health nursing practice as a
student. The minimum preparation for
community health nurses in many states is a
baccalaureate degree. The diploma and
associate degree level prepares students for
basic nursing practice. Students can build on
this basic knowledge by entering a BSN
completion program, which will prepare them
to enter the specialty of community health
nursing. In order to stay current and to build
skills in this specialty, advanced courses or a
graduate (masters) degree is needed.
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B)
C)
D)
Ans:
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A community health nurse desires to attain a
tenure-track position at a local university to
18.
teach community health nursing. Which of the
following would this nurse need?
Certification
Master's degree
Doctoral degree
Nurse practitioner license
C
Feedback:
A doctoral degree would be the required
education needed to obtain a tenure-track
teaching position at a university. Certification
provides additional education for
specialization and may result in a promotion
or higher salary accompanied by additional
responsibilities and opportunities. A master's
degree can lead to management positions,
private community health ownership, agency
teaching, or research positions. Nurse
practitioners can run well-child clinics and
direct a school-based clinic if a school nurse.
Advanced practice can open doors into
leadership positions in community health
nursing.
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A)
B)
C)
D)
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Chapter 4 Evidence-Based Practice and Ethics in Community/Public Health
A nursing instructor is preparing a teaching
plan for a class comparing evidence-based
1.
practice and critical thinking. Which of the
following would the instructor include?
Evidence-based practice and critical thinking
A)
are polar opposites.
Both involve problem clarification of central
B)
concepts.
Interpretation of accumulated evidence is
C)
unique to evidence-based practice.
Problem exploration is unique to evidenceD)
based practice.
Ans:
B
Feedback:
Evidence-based practice and critical thinking
share commonalities including exploring a
problem, addressing a purpose or goal,
making assumptions, clarifying the problem
around central concepts or indicators,
accessing data, interpreting accumulated
evidence, using reasoning, processing,
defining, planning and documenting, acting
on the problem, and evaluating, adjusting,
generalizing, and applying to a broader
problem set. In addition, critical thinking is an
important component of evidence-based
practice.
A)
B)
C)
D)
E)
Ans:
According to the Institute of Medicine's
2. landmark report, The Future of Nursing,
nurses should: Select all that apply.
work independently from other health
professionals to promote the profession of
nursing.
work collaboratively with other health
professionals to promote health care.
attempt to redesign health care.
improve practices through evidence-based
means.
The Future of Nursing report does not express
the importance of evidence-based nursing.
B, C, D
Feedback:
The Future of Nursing highlights the need for
work collaboratively with other health
professionals to promote health care.
attempt to redesign health care.
improve practices through evidence-based
means.
The Future of Nursing report does not express
the importance of evidence-based nursing.
B, C, D
Feedback:
The Future of Nursing highlights the need for
nursing to work with other health
professionals in “redesigning health care” by
“conducting research” and improving
practices through evidence-based means.
B)
C)
D)
E)
Which of the following statements about
evidence-based practice has been identified
by multiple reports over the past decade, such
as To Err Is Human: Building a Safer Health
3. System (2000), Crossing the Quality Chasm:
A New Health System for the 21st Century
(2001), and Priority Areas for National
Action: Transforming Health Care Quality
(2003)?
We must continue to cling to “the way we've
always done it.”
We have spent billions of dollars each year
researching new treatments and have
translated that knowledge into clinical
practice.
We are not translating the knowledge that we
are gaining into clinical practice.
We have continued to spend more than a
trillion dollars a year providing care and do
translate that capacity into improved clinical
practice.
C
Feedback:
To Err Is Human: Building a Safer Health
System (2000), Crossing the Quality Chasm:
A New Health System for the 21st Century
(2001), and Priority Areas for National
Action: Transforming Health Care Quality
(2003). These reports draw attention to the
fact that we spend billions of dollars each
year researching new treatments, and more
than a trillion dollars are spent annually on
health care, but “we repeatedly fail to
translate that knowledge and capacity into
clinical practice.”
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Ans:
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A)
yn
B)
Ans:
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D)
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C)
Ans:
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B)
yn
C)
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D)
Ans:
Which of the following statements about the
steps of the EBP process is most accurate?
One of the last steps of the EPB process is to
search for and collect the most relevant best
evidence.
One of the earliest steps in the EBP process is
to disseminate the outcomes of the EBP
decision or change.
It is optional to integrate the best evidence
with one's clinical expertise and patient
preferences and values in making a practice
decision or change.
The first step in the EBP process is to
cultivate a spirit of inquiry.
D
Feedback:
The steps of the EBP process in order are
cultivating a spirit of inquiry; asking the
burning question in PICOT format; searching
for and collecting the most relevant best
evidence; critically appraising the evidence
for its validity, reliability, and applicability
and then synthesizing that evidence;
integrating the best evidence with one's
clinical expertise and patient preferences and
values in making a practice decision or
change; evaluating outcomes of the practice
decision or change based on evidence; and
disseminating the outcomes of the EBP
decision or change.
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trillion dollars a year providing care and do
translate that capacity into improved clinical
practice.
C
Feedback:
To Err Is Human: Building a Safer Health
System (2000), Crossing the Quality Chasm:
A New Health System for the 21st Century
(2001), and Priority Areas for National
Action: Transforming Health Care Quality
(2003). These reports draw attention to the
fact that we spend billions of dollars each
year researching new treatments, and more
than a trillion dollars are spent annually on
health care, but “we repeatedly fail to
translate that knowledge and capacity into
clinical practice.”
D)
A)
B)
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C)
Which one of the following statements about
5. cultivating a spirit of inquiry is most
accurate?
It is not very important; research will be
performed anyway.
In order for effective change to occur, current
practices must be continually examined,
questioned, and challenged.
It involves “asking the burning clinical
question.”
The agency does not have an important role in
cultivating a spirit of inquiry.
B
Feedback:
In order for effective change to occur, current
practices must be continually examined,
questioned, and challenged. It is very
important that the spirit of inquiry is
cultivated. “Asking the burning clinical
question” is part of the next step of asking the
question. The agency does have a role in
cultivating a spirit of inquiry. The
organization must be open to a cultural shift
from the status quo. The foundations of this
spirit of inquiry are ongoing curiosity and a
culture that supports it.
D)
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A)
B)
C)
D)
Ans:
A nurse is planning a research study to answer
a clinical question. Which of the following
6.
would be most appropriate for qualitative
research approach?
Evaluating the reported cases of post
vaccination complications after varicella
immunization
Determining the use of complementary and
alternative health care by middle-aged adults
in rural areas
Ascertaining the effect of using calming
music on older adults with dementia in
extended care facilities
Assessing the emotional responses and
feelings of individuals requiring isolation due
to a highly communicable illness
D
Feedback:
Qualitative research is used to study those
B)
alternative health care by middle-aged adults
in rural areas
Ascertaining the effect of using calming
music on older adults with dementia in
extended care facilities
Assessing the emotional responses and
feelings of individuals requiring isolation due
to a highly communicable illness
D
Feedback:
Qualitative research is used to study those
areas that need a broader focus or that do not
lend themselves to objective measurement.
This type of research emphasizes subjectivity
and the meaning of the experiences to
individuals. Thus, qualitative research would
be most appropriate for assessing the
emotional responses and feelings of
individuals who require isolation for a
communicable illness. Quantitative research
would be used to evaluate the reported cases
of post vaccination complications, to
determine the use of complementary and
alternative health care, and to ascertain the
effect of calming music.
C)
D)
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C)
D)
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A)
Which of the following research studies
7. would most likely use a quantitative research
approach?
The relationship of maternal age and history
of parents' vaccine-preventable disease and
parents' efforts to have their children
immunized
The experience of parents whose children
have had serious complications subsequent to
immunization
The experience of parents whose children
were not properly immunized and developed
a vaccine-preventable illness
Reasons that parents who practice a particular
religion do not have their children properly
immunized
A
Feedback:
Quantitative research is helpful in identifying
a problem or a relationship between two or
more variables, such as type of treatment. A
more subjective or qualitative approach is
needed to study those areas that need a
broader focus or that do not lend themselves
to objective measurement. Qualitative
research emphasizing subjectivity asks “how”
or “why.”
Reasons that parents who practice a particular
religion do not have their children properly
immunized
A
Feedback:
Quantitative research is helpful in identifying
a problem or a relationship between two or
more variables, such as type of treatment. A
more subjective or qualitative approach is
needed to study those areas that need a
broader focus or that do not lend themselves
to objective measurement. Qualitative
research emphasizing subjectivity asks “how”
or “why.”
D)
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E)
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A)
B)
C)
D)
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Which of the following statements about the
8. impact of research on community health
nursing are true? Select all that apply.
It is important to conduct research to affect
public policy.
Public policy will continue to have a negative
effect on the community's health.
Research will affect the effectiveness of
community health nursing practice.
Research will affect the status and influence
of nursing as a profession.
The impact that research has on community
health nursing is negligible.
A, C, D
Feedback:
Research has the potential to have a
significant impact on community health
nursing in three ways: by affecting public
policy and the community's health, the
effectiveness of community health nursing
practice, and the status and influence of
nursing as a profession. Community health
nurses have been involved in research
addressing all three of these dimensions.
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Ans:
Application of nursing research results to
community health nursing practice is
9.
essential. Which of the following must occur
first before results can be applied?
Be informed about research findings
Demonstrate skill in examining research
reports
Assess abstracts of relevant research studies
Check if the study was funded by a drug
company
A
Feedback:
9.
A)
B)
C)
D)
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essential. Which of the following must occur
first before results can be applied?
Be informed about research findings
Demonstrate skill in examining research
reports
Assess abstracts of relevant research studies
Check if the study was funded by a drug
company
A
Feedback:
Community health nurses have many
opportunities to apply the results of other
investigator's research, but a necessary
prerequisite is that the nurse must be informed
about research findings. Critically examining
research reports and assessing abstracts are all
part of evaluating relevant research studies.
However, the nurse needs to know what the
research findings are before he or she can
evaluate the research. Checking if the study
was funded by a drug company might indicate
that the results of the study could be
questioned due to a conflict of interest.
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After teaching a class on values, which of the
10. following, if stated by the class, indicates the
need for additional teaching?
Some values are descriptive, while others are
evaluative.
Keeping a promise is an example of a
terminal value.
Values persist, remaining relatively stable
over time.
Certain values have more importance than
others.
B
Feedback:
Terminal values refer to end states of
existence such as spiritual salvation, peace of
mind, or world peace. Instrumental values
refer to modes of conduct such as
confidentiality, keeping promises, and
honesty. Some values are descriptive or
capable of being true or false, while other
values are evaluative, involving judgments of
good and bad. Values remain relatively stable
over time and persist to provide continuity to
personal and social existence. A hierarchical
system of values occurs in which certain
values have more weight or importance than
others.
A)
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C)
over time.
Certain values have more importance than
others.
B
Feedback:
Terminal values refer to end states of
existence such as spiritual salvation, peace of
mind, or world peace. Instrumental values
refer to modes of conduct such as
confidentiality, keeping promises, and
honesty. Some values are descriptive or
capable of being true or false, while other
values are evaluative, involving judgments of
good and bad. Values remain relatively stable
over time and persist to provide continuity to
personal and social existence. A hierarchical
system of values occurs in which certain
values have more weight or importance than
others.
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Which of the following would the community
11. health nurse do first when making an ethical
decision?
Engage in critical thinking
Choose a value
Identify isolated values
Clarify one's values
D
Feedback:
Clarification of a person's values is the first
step in the process of ethical decision making.
Critical thinking is a strategy that can be used
to help clarify values. Choosing a value is the
first step in the process of valuing. Identifying
isolated values are those which are organized
into a hierarchical system where certain
values have more weight or importance than
others.
After a class discussion on moral evaluations,
which characteristic if identified by the class
12.
would lead the instructor to determine that the
discussion has been effective?
There is specificity that applies to an
individual person.
A special place is given to a person's own
welfare.
Other values cannot override the moral
evaluation.
They relate to a matter of individual taste.
C
Feedback:
discussion has been effective?
There is specificity that applies to an
individual person.
A special place is given to a person's own
welfare.
Other values cannot override the moral
evaluation.
They relate to a matter of individual taste.
C
Feedback:
Moral evaluations have distinctive
characteristics: the evaluations are ultimate,
having a preemptive quality, meaning that
other values or human ends cannot, as a rule,
override them; they possess universality or
reflect a standpoint that applies to everyone,
such that everyone in principle ought to be
able to make and understand, even if some
individuals, in fact, do not; moral evaluations
avoid giving a special place to a person's own
welfare, having a focus that keeps others in
view, or at least considers one's own welfare
on a par with that of others. Moral evaluations
are prescriptive–proscriptive beliefs that have
certain characteristics separating them from
other evaluations including matters of taste.
A)
B)
C)
A)
B)
C)
D)
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B)
C)
D)
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D)
Ans:
A group of students are reviewing for an
examination on values. Identification of
13.
which of the following as an instrumental
value indicates the need for continued study?
Spiritual salvation
Confidentiality
Honesty
Promise keeping
A
Feedback:
Spiritual salvation is an example of a terminal
value, which refers to end states of existence.
An instrumental value refers to a mode of
conduct, such as confidentiality, promise
keeping, and honesty.
A community health nurse obtains a client's
informed consent for care demonstrating the
14.
understanding that this is derived from which
value?
Self-interest
Well-being
Equity
Self-determination
D
A community health nurse obtains a client's
informed consent for care demonstrating the
14.
understanding that this is derived from which
value?
Self-interest
Well-being
Equity
Self-determination
D
Feedback:
Informed consent derives from selfdetermination. Self-interest refers to a
deterioration of self-determination in which
the person focuses on fulfilling one's own
desires without regard for the greater good.
Well-being is a state of positive health, the
intent of all therapeutic interventions. Equity
refers to justice or fair and equal treatment.
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B)
C)
D)
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B)
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C)
D)
Which of the following statements about
15. basic values that guide decision making in
community health nursing is true?
Client empowerment means that the provider
must use a paternalistic approach to health
care.
Self-interest does not interfere with selfdetermination.
When matters of well-being are considered,
the client's preferences and needs should not
be considered.
Equity is not possible in times of limited
resources.
D
Feedback:
In times of limited technical, human, and
financial resources, however, it may be
impossible to fully respect the value of equity.
Client empowerment is an approach that
differs from the paternalistic approach to
health care in which decisions are made for,
rather than with, the client; instead, it enables
patients and professionals to work in
partnerships. When self-determination
deteriorates into self-interest, it poses a major
roadblock to equitable health care. Wellintended interventions sometimes fall short if
they are in conflict with clients' preferences
and needs.
be considered.
Equity is not possible in times of limited
resources.
D
Feedback:
In times of limited technical, human, and
financial resources, however, it may be
impossible to fully respect the value of equity.
Client empowerment is an approach that
differs from the paternalistic approach to
health care in which decisions are made for,
rather than with, the client; instead, it enables
patients and professionals to work in
partnerships. When self-determination
deteriorates into self-interest, it poses a major
roadblock to equitable health care. Wellintended interventions sometimes fall short if
they are in conflict with clients' preferences
and needs.
D)
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B)
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D)
E)
Situations in which self-determination should
16. be restricted include which of the following?
Select all that apply.
When some objectives of individuals are
contrary to the public interest or the interests
of others in society
When a person's decision making is so
defective or mistaken that the decision fails to
promote the person's own values or goals
When it interferes with self-interest
Self-determination and personal autonomy
must never be restricted.
When self-determination deteriorates into
self-interest and poses a major roadblock to
equitable care
A, B
Feedback:
There are two situations in which selfdetermination should be restricted: when
some objectives of individuals are contrary to
the public interest or the interests of others in
society (e.g., endangering others with a
communicable disease) and when a person's
decision making is so defective or mistaken
that the decision fails to promote the person's
own values or goals. When self-determination
deteriorates into self-interest, it poses a major
roadblock to equitable health care.
A community health nurse is applying the
value of equity in decision making with
17.
clients. Which of the following best describes
this value?
Forming, revising, and pursuing personal life
plans
Promoting clients' health and a sense of wellbeing
Fulfilling one's desires over those of others
Treating similar cases in the same fair fashion
D
Feedback:
Equity is defined as the value directing like
cases to be treated alike and that all
individuals be treated fairly. Selfdetermination refers to a person's exercise of
the capacity to shape and pursue personal
plans for life. Well-being involves promoting
clients' health and sense of well-being. Selfinterest is the fulfillment of one's own desires
without regard for the greater good.
A)
B)
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B)
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D)
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C)
D)
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When working with clients, a community
health nurse promotes the clients' self-concept
18.
and health promoting behaviors. The nurse is
attempting to achieve which outcome?
A value system
Prescriptive–proscriptive beliefs
Individual autonomy
Values clarification
C
Feedback:
Promoting clients' self-concept and healthpromoting behaviors are associated with the
value of self-determination that promotes
individual autonomy. Value system,
prescriptive–proscriptive beliefs, and values
clarification are not associated with selfdetermination. A value system is an organized
set of beliefs that guide individual behavior.
Prescriptive–proscriptive beliefs are viewed
as desirable or undesirable beliefs. Values
clarification is a process that helps identify
the personal and professional values that
guide actions.
Prescriptive–proscriptive beliefs
Individual autonomy
Values clarification
C
Feedback:
Promoting clients' self-concept and healthpromoting behaviors are associated with the
value of self-determination that promotes
individual autonomy. Value system,
prescriptive–proscriptive beliefs, and values
clarification are not associated with selfdetermination. A value system is an organized
set of beliefs that guide individual behavior.
Prescriptive–proscriptive beliefs are viewed
as desirable or undesirable beliefs. Values
clarification is a process that helps identify
the personal and professional values that
guide actions.
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B)
C)
D)
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A community health nurse discovers that a
bill in the legislature would eliminate a state
law that currently funds child health
19.
promotion services for low-income children.
Which action at the primary level of
prevention would be most appropriate?
Advocate for amendment to the passed law to
allow some funding for children to remain
Once the bill has been passed, seek private
resources to support funding of health
promotion services for low-income children.
Gather a group of health professionals to
volunteer to provide the health promotion
services eliminated by the passed bill
Advocate through active lobbying against the
bill and gather community support
D
Feedback:
Appropriate activities at the primary level of
prevention would include actively lobbying
against the bill, garnering community support
in favor of the revised bill, and advocating for
the clients. Advocating for amendments
would be appropriate at the secondary level.
Seeking private resources and gathering
volunteers to provide the health services
would be appropriate at the tertiary level.
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After teaching a class on ethical principles,
the instructor determines that the class needs
20.
additional instruction when they identify
which of the following as an ethical principle?
Respect
Autonomy
Morality
Justice
C
Feedback:
Morality is the behavior or judgment that
conforms to a standard that is right and good.
When judgments involve moral values,
conflicts are inevitable. There are seven
fundamental ethical principles that guide
decision making. These include respect,
autonomy, beneficence, nonmaleficence,
justice, veracity, and fidelity.
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A)
B)
C)
D)
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B)
C)
D)
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A community health nurse is working to
support programs to encourage preschool
21.
immunizations. The nurse is integrating
which ethical principle in his or her practice?
Beneficence
Autonomy
Nonmaleficence
Justice
A
Feedback:
Beneficence means doing good or benefitting
others, such as supporting programs to
encourage preschool immunizations.
Autonomy means freedom of choice and
exercise of people's rights, such as promoting
individuals' and groups' rights to and
involvement in decision making.
Nonmaleficence means avoiding or
preventing harm to others as a consequence of
a person's own choice and actions, such as
encouraging physicians to prescribe drugs
with the fewest side effects. Justice refers to
treating people fairly, such as ensuring equal
access to health care.
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A)
B)
C)
D)
Ans:
A community health nurse working with a
group of families who come to local
community health care center tells them that
she is going to be setting up child care so that
22. the families can participate in the various
classes being offered by the center. Three
months have passed, and the nurse still has
not instituted the child care program. The
nurse has violated which ethical principle?
Veracity
Fidelity
Justice
Respect
B
Feedback:
Fidelity means keeping promises or
commitments to foster trust and
trustworthiness. By failing to set up the child
care program, the nurse has violated this
fidelity. Nurses who follow through on what
they have said earn their clients' respect and
trust. In contrast, when a commitment is not
kept, community members may lose faith and
interest in participation. Veracity refers to
telling the truth, giving clients accurate
information in a timely manner. Veracity
involves treating clients as equals. Justice
refers to treating people fairly, such as by
ensuring equal access to health care and not
limiting the amount or quality of services due
to income level. Respect involves
acknowledging clients as valued participants
in shaping their own and the community's
health outcomes.
A)
B)
C)
D)
Ans:
A public health nurse is faced with an ethical
dilemma. Which question should the nurse
23.
consider first when deciding how to resolve
the dilemma?
“What exactly is the ethical dilemma?”
“What are the alternative courses of action?”
“What are the consequences of each
alternative courses of action?”
“How should this dilemma be solved?”
A
Feedback:
A framework is applied in public health ethics
23.
A)
B)
C)
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dilemma. Which question should the nurse
consider first when deciding how to resolve
the dilemma?
“What exactly is the ethical dilemma?”
“What are the alternative courses of action?”
“What are the consequences of each
alternative courses of action?”
“How should this dilemma be solved?”
A
Feedback:
A framework is applied in public health ethics
inquiry. Three core functions of this inquiry
include (1) identifying and clarifying the
ethical dilemma, (2) analyzing it in terms of
alternative courses of action and their
consequences, and (3) resolving the dilemma
by deciding which course of action best
incorporates and balances the guiding
principles and values.
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Chapter 5 Transcultural Nursing
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After discussing the meaning of cultural
diversity and its significance for community
health nursing, the nursing instructor
1.
recognizes that some points need to be
clarified when a student makes which of the
following comments?
“Dominant values are those held by the male
head of the household in most American
families.”
“The percentages of White European descent
Americans are rising, while the percentages of
other ethnicities are declining and this is
projected to continue into the year 2050 at
least.”
“Nurses maintain their original culture as they
are socialized throughout the educational
process.”
“America has become an amalgamation of
people who have different values, ideals, and
behaviors, rather than the melting pot that was
once envisioned.”
A
Feedback:
The beliefs and sanctions of the dominant or
majority culture are called dominant values.
The proportion of the population identified as
White is projected to continue to fall below
other ethnicities between 2010 and 2050.
Nurses will still have the same culture as they
did before they were socialized in the nursing
educational process, but they may be able to
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C)
D)
Ans:
people who have different values, ideals, and
behaviors, rather than the melting pot that was
once envisioned.”
A
Feedback:
The beliefs and sanctions of the dominant or
majority culture are called dominant values.
The proportion of the population identified as
White is projected to continue to fall below
other ethnicities between 2010 and 2050.
Nurses will still have the same culture as they
did before they were socialized in the nursing
educational process, but they may be able to
see things differently. America is not the ideal
melting pot once described, but rather an
amalgamation of people who have different
values, ideals, and behaviors.
D)
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The population that community health nurses
serve in the United States is changing.
Because of population shifts, nurses must
2. become sensitive to the cultural differences
and language differences among new
community members. Which minority group
currently represents the largest group?
African Americans
Hispanic Americans
Asian Americans
American Indians
B
Feedback:
Significant minorities include Hispanic
Americans, numbering more than 35 million
in 2000 and over 42 million in 2005 and
currently representing over 14% of the
population; African Americans, numbering
over 37 million or approximately 12.8% of
the population; Asian Americans, numbering
more than 12 million or approximately 4.3%
of the population; and American Indians and
Alaska Natives, numbering 2.8 million or 1%
of the population.
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B)
C)
D)
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A)
B)
C)
D)
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While providing care to a community group, a
community health nurse provides culturally
3.
sensitive care by avoiding which of the
following?
Ethnocentrism
Ethnorelativism
Enculturation
Ethnicity
A
While providing care to a community group, a
community health nurse provides culturally
3.
sensitive care by avoiding which of the
following?
Ethnocentrism
Ethnorelativism
Enculturation
Ethnicity
A
Feedback:
Ethnocentrism is the belief or feeling that
one's own culture is best causing the person to
believe that his or her way of doing things is
right and to judge others' methods as inferior,
ignorant, or irrational. It blocks effective
communication by creating biases and
misconceptions. Ethnorelativism is seeing all
behavior in a cultural context. Enculturation
refers to the process of each person learning
his or her culture through socialization with
the family or significant group. Ethnicity
refers to the group of qualities that mark a
person's association with a particular ethnic
group (collection of people who have
common origins and a shared culture and
identity).
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
As a community health nurse, you overhear a
colleague say, “I don't understand why the
Yang's take their young teenage daughters to
the Hmong New Year celebration and have
4. them play these match-making games. The
girls meet boys every day at school and they
are too young to be looking for husbands.”
Which of the following would be the most
appropriate response?
“The Yang's are very different from us; maybe
in time we can convince them that their
practices are not right.”
“Every culture has its differences; I think it is
valuable that the Yang's are keeping their
cultural practices alive.”
“I know what you mean, I was thinking the
same thing. You wouldn't catch me doing
something similar with my teens.”
“I feel sorry for those girls; they must feel
funny in those cultural costumes. Let's talk to
the parents and tell them how teens in
America feel about such things.”
B
Feedback:
Community health nurses need to develop
B)
valuable that the Yang's are keeping their
cultural practices alive.”
“I know what you mean, I was thinking the
same thing. You wouldn't catch me doing
something similar with my teens.”
“I feel sorry for those girls; they must feel
funny in those cultural costumes. Let's talk to
the parents and tell them how teens in
America feel about such things.”
B
Feedback:
Community health nurses need to develop
cultural sensitivity, becoming aware of own
biases and preconceived values and beliefs.
This would be evidenced by the statement
about every culture having differences. The
celebration is a part of the family's culture,
and the nurses should not attempt to convince
them that it is not right nor should they
attempt to impose their views, feelings, or
beliefs on the family.
C)
D)
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What is the most serious negative effect of a
5. nurse maintaining ethnocentric views but not
recognizing or acknowledging this?
The nurse fails to understand the views of
other cultures because of his or her
ethnocentrism.
The nurse does not communicate effectively
with members of other cultures because of his
or her ethnocentrism.
The nurse's ethnocentrism causes damage to
interpersonal relationships and interferes with
the effectiveness of nursing interventions.
Nurses are immune to the effects of
ethnocentrism.
C
Feedback:
The most negative effect of nurses
maintaining ethnocentric views but not
recognizing or acknowledging this is that the
nurse's ethnocentrism causes damage to
interpersonal relationships and interferes with
the effectiveness of nursing interventions. The
nurse who is ethnocentric and doesn't realize
it will fail to understand the views of other
cultures, but this is not the most serious
negative effect. If the nurse is ethnocentric, he
or she may not communicate effectively
because of his or her ethnocentrism, and this
can lead to impaired relationships and
interference with the effectiveness of nursing
interventions. All nurses hold ethnocentric
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the effectiveness of nursing interventions.
Nurses are immune to the effects of
ethnocentrism.
C
Feedback:
The most negative effect of nurses
maintaining ethnocentric views but not
recognizing or acknowledging this is that the
nurse's ethnocentrism causes damage to
interpersonal relationships and interferes with
the effectiveness of nursing interventions. The
nurse who is ethnocentric and doesn't realize
it will fail to understand the views of other
cultures, but this is not the most serious
negative effect. If the nurse is ethnocentric, he
or she may not communicate effectively
because of his or her ethnocentrism, and this
can lead to impaired relationships and
interference with the effectiveness of nursing
interventions. All nurses hold ethnocentric
views, but it is important for the nurse to be
aware of them and acknowledge them to
avoid having it damage relationships and
interfere with the effectiveness of nursing
interventions.
D)
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Ans:
When describing culture as shared, which of
the following would be most accurate?
It is acquired, not inherited.
It is a product of aggregate behavior.
It is interrelated and interdependent.
It undergoes change.
B
Feedback:
When describing culture as shared, it means
that it is a product of aggregate behavior, not
an individual habit. The customs are
phenomena shared by all members of the
group. Culture is learned; that is, the patterns
of cultural behavior are acquired, not
inherited. Culture is integrated; that is, it is a
functional, integrated whole where all parts
are interrelated and interdependent. Culture is
dynamic; that is, it is changeable and not
entirely static.
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6.
As part of a class presentation, a nursing
instructor describes the characteristics shared
7. by all cultures. Which description of culture
being tacit indicates that the teaching was
successful?
Culture is mostly unexpressed.
Cultures do not remain static.
Culture is a functional and integrated whole.
Patterns of cultural behavior are acquired.
A
Feedback:
Culture is tacit, that is, mostly unexpressed
and at the unconscious level. Culture is
dynamic, undergoing change and never
entirely static. It is integrated and learned.
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B)
C)
D)
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Which of the following statements is an
8. accurate description of the characteristic
shared by all cultures, culture is integrated?
A person's culture is an interrelated and
interdependent web of ideas and practices.
In order to describe a person's culture, it is
necessary to describe each trait independently.
Aspects of a person's culture are best
described as unrelated to other aspects of the
person's culture.
A person's culture is an assortment of various
customs and traits.
A
Feedback:
A person's culture is an integrated web of
ideas and practices. To understand culture,
single traits should not be described
independently. As in any system, all parts of a
culture are interrelated and interdependent.
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D)
A)
B)
C)
D)
E)
Ans:
A community health nurse is working with
several Native American groups in Arizona.
9.
Which of the following would the nurse be
most likely to assess? Select all that apply.
The value of competition
Respect for advancing age and elders
Focus of living in the future
Frequent dialogue and discussion
Each tribe or nation has its own distinct
language, beliefs, customs, and rituals.
B, C, E
Feedback:
9.
A)
B)
C)
D)
E)
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Ans:
Which of the following would the nurse be
most likely to assess? Select all that apply.
The value of competition
Respect for advancing age and elders
Focus of living in the future
Frequent dialogue and discussion
Each tribe or nation has its own distinct
language, beliefs, customs, and rituals.
B, C, E
Feedback:
Although there are differences among Native
American tribes, most have respect for
advancing age and they live in the present and
not the distant future (making primary
prevention activities more difficult). Each
tribe or nation has its own distinct language,
beliefs, customs, and rituals. Competition and
frequent dialogue and discussion are not
values held by Native Americans.
te
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A community health nurse working a large
metropolitan city has a large Asian American
10. client base. Which of the following would the
nurse be least likely to assess in this
population?
Belief that illness results from a body
imbalance
Reliance on Western medical practices
Use of traditional self-care practices
A focus on patriarchal family structures
B
Feedback:
Asian Americans believe illness results from
an imbalance of yin and yang forces. They
use traditional healers and also exercise
traditional self-care practices before using
Western medical practices.
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D)
Ans:
While visiting an Asian American family in
their home, the community health nurse
inspects the skin of the 3-year-old child and
11. notices a bruise-like lesion on the child's
abdomen. The mother states that the child has
been experiencing diarrhea for 2 days. Which
of the following would the nurse do next?
Report the family to the local child abuse
agency
Recognize this as a normal skin variation
Question the family about the use of cupping
Obtain a blood test for clotting function
C
Feedback:
abdomen. The mother states that the child has
been experiencing diarrhea for 2 days. Which
of the following would the nurse do next?
Report the family to the local child abuse
agency
Recognize this as a normal skin variation
Question the family about the use of cupping
Obtain a blood test for clotting function
C
Feedback:
The nurse needs to gather additional
information about the lesion. Practicing
transcultural nursing would require the nurse
to perform a cultural assessment and question
the family about their use of dermabrasive
techniques such as cupping that would leave a
bruise-like lesion on the skin and be mistaken
for physical abuse. The nurse would report
the family to the local child abuse agency if
further investigation provides additional
information to support that decision. The
lesion is not a normal skin variation.
Obtaining a blood test for clotting function
would be warranted only if further assessment
reveals additional bruising or other signs of
clotting problems.
A)
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B)
C)
D)
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B)
C)
D)
Ans:
The community health nurse is working in the
health department of a major city that has a
large Hispanic/Latino population. Which of
12.
the following would the nurse need to
integrate into the plan of care for this
population?
View of the female as superior to the male
Importance of an extended, cohesive family
Males as the binding force of the family
Adherence to strict time schedules
B
Feedback:
Hispanic people value extended, cohesive
families. Families have been patriarchal, with
male members perceived as superior and
female members seen as a family-bonding life
force. Many Latinos tend to be oriented to the
present and are not as concerned as the
mainstream culture about keeping time
schedules or preparing for the future.
A group of nursing students are studying for a
test about various cultural communities. The
13. students demonstrate that they understand the
material when they identify which cultural
group as believing in predestination?
Hispanic/Latinos
African Americans
Muslims
Native Americans
C
Feedback:
Muslims believe in predestination, that life is
determined beforehand, and they attribute the
occurrence of disease to the will of Allah.
Hispanic/Latinos believe that illness may be a
form of punishment for sins. Some African
Americans believe that illness is evidence of
disharmony possibly due to evil spirits,
punishment of God, or a hex placed on a
person. Native Americans believe that health
reflects living in total harmony with nature.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A community health nurse is developing
health promotion programs for a local
community that consists predominantly of
14.
African Americans. Which of the following
areas would be a priority for health promotion
with this group?
Cardiac health
Respiratory care
Mental health
Skin care
A
Feedback:
Leading causes of death for African
Americans include heart disease, cancer, and
stroke. Heart disease is also a major health
problem. Thus programs emphasizing cardiac
health would be a priority. African Americans
show a lower incidence in suicide and chronic
obstructive pulmonary disease. They may
experience skin problems such as keloids and
melasma. However, all of these conditions
would be of lesser importance than cardiac
health.
Respiratory care
Mental health
Skin care
A
Feedback:
Leading causes of death for African
Americans include heart disease, cancer, and
stroke. Heart disease is also a major health
problem. Thus programs emphasizing cardiac
health would be a priority. African Americans
show a lower incidence in suicide and chronic
obstructive pulmonary disease. They may
experience skin problems such as keloids and
melasma. However, all of these conditions
would be of lesser importance than cardiac
health.
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B)
C)
D)
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D)
Ans:
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B)
C)
D)
Ans:
A community health nurse is providing care to
a family in the community who are Muslim.
15. Which of the following would be most
important for the nurse to integrate when
providing care for this family?
Rules are stricter for boys than for girls.
Modest dressing is key for both men and
women.
Most Arabic women work outside the home.
Most adhere to the three tenets of Islam.
B
Feedback:
For Muslims, modesty in dress is a core value
for both men and women, although it is
expressed more evidently by women. Rules
are stricter for girls than for boys and most
Arabic women stay at home and are not in the
workplace. All practicing Muslims adhere to
the five tenets of Islam.
A community health nurse is providing care to
an Asian American family who believes that a
member's current illness is due to an excess of
16.
yin. The nurse integrates knowledge of this
belief, expecting the family to avoid which
foods?
Rice
Eggs
Chicken
Fruits
D
Feedback:
If the imbalance is an excess of yin, then
“cold” foods, such as vegetables and fruits,
are avoided, and “hot” foods, such as rice,
foods?
Rice
Eggs
Chicken
Fruits
D
Feedback:
If the imbalance is an excess of yin, then
“cold” foods, such as vegetables and fruits,
are avoided, and “hot” foods, such as rice,
chicken, eggs, and pork, are offered.
A)
B)
C)
D)
Ans:
17.
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A)
What is the most important reason for the
nurse to conduct a cultural assessment?
Because it is often assigned by nursing faculty
Because usually there is some culturally
based reason that causes clients to engage in
or avoid certain actions
To meet the nurse's professional learning
needs
Because understanding the values, beliefs,
and practices of a designated cultural group is
critical to effective nursing action
D
Feedback:
The most important reason for the nurse to
conduct a cultural assessment is that because
understanding the values, beliefs, and
practices of a designated cultural group is
critical to effective nursing action. There is
usually some culturally based reason that
causes clients to engage in or avoid certain
actions but that is not the most important
reason for the nurse to conduct a cultural
assessment. The nurse does not necessarily
collect a cultural assessment to meet his or
her own needs primarily.
B)
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A)
B)
C)
D)
Ans:
When developing an in-service program for a
group of community health nurses about
18.
culture, which of the following would the
presenter expect to include?
All members of a cultural group are alike.
Intraethnic variations underscore a
population's cultural diversity.
Ethnicity has a major impact on the
effectiveness of health care.
Ethnocentric attitudes are key to working with
different cultures.
B
Feedback:
Intraethnic variations, differences within
A)
All members of a cultural group are alike.
Intraethnic variations underscore a
population's cultural diversity.
Ethnicity has a major impact on the
effectiveness of health care.
Ethnocentric attitudes are key to working with
different cultures.
B
Feedback:
Intraethnic variations, differences within
microcultures, underscore the range of
culturally diverse clients served by
community health nurses. Subcultures and
microcultures have their own distinctive
characteristics even within fairly homogenous
cultural groups. Culture, not ethnicity, has a
major impact on the effectiveness of health
care. Ethnocentric attitudes are to be avoided.
All members of a cultural group are not alike.
In general, individuals who are members of a
specific culture are more alike than unlike but
still not totally alike.
B)
C)
D)
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When applying the principles of transcultural
19. nursing, which of the following must the
nurse do first?
Cultivate cultural sensitivity
Develop cultural awareness
Learn the client's group culture
Demonstrate respect for culture
B
Feedback:
Applying the principles of transcultural
nursing involves the following: (1)
developing cultural self-awareness, (2)
cultivating cultural sensitivity, (3) assessing
the client group's culture, (4) showing respect
and patience while learning about other
cultures, and (5) examining culturally derived
health practices.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse implements a plan
of care that combines aromatherapy and
20. acupuncture with medication therapy and
surgery. The nurse is applying which of the
following?
Holistic health care
Folk medicine care
Herbalistic health care
Integrated health care
D
Feedback:
of care that combines aromatherapy and
20. acupuncture with medication therapy and
surgery. The nurse is applying which of the
following?
Holistic health care
Folk medicine care
Herbalistic health care
Integrated health care
D
Feedback:
Integrated health care is defined as the
combination of complementary therapies such
as aromatherapy and acupuncture with
biomedical or Western health care such as
medication therapy and surgery. Holistic
health care vies the world as being in
harmonious balance in which all facets of the
individual's natures (physical, mental,
emotional, and spiritual) must be in balance.
Folk medicine involves treatment practices
that have been handed down from generation
to generation. Herbalism is the use of
medicinal herbs.
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A)
B)
C)
D)
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A community health nurse is providing care to
several cultural groups in the community.
21.
When providing transcultural nursing, which
of the following would be the priority?
Examining one's own culture carefully and
recognizing that alternative viewpoints are
possible
Recognizing that cultural values, beliefs, and
practices influence people's health and
lifestyles
Obtaining health-related information about a
cultural group concerning their values,
beliefs, and practices
Actively and attentively listening to
demonstrate respect while learning about
other cultures
A
Feedback:
The first step in providing transcultural
nursing is to develop cultural self-awareness
by examining one's own culture carefully and
recognizing that alternative viewpoints are
possible. Next, the nurse would need to
cultivate cultural sensitivity by recognizing
that cultural values, beliefs, and practices
influence people's health and lifestyle. Then
the nurse would assess the client group's
culture by obtaining health-related
information and actively and attentively
D)
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A)
Actively and attentively listening to
demonstrate respect while learning about
other cultures
A
Feedback:
The first step in providing transcultural
nursing is to develop cultural self-awareness
by examining one's own culture carefully and
recognizing that alternative viewpoints are
possible. Next, the nurse would need to
cultivate cultural sensitivity by recognizing
that cultural values, beliefs, and practices
influence people's health and lifestyle. Then
the nurse would assess the client group's
culture by obtaining health-related
information and actively and attentively
listening to demonstrate respect.
D)
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A community health nurse is assessing a
family during a home visit. The nurse is
examining the mother who is pregnant with
her second child. The nurse asks the mother to
22. raise her arms above her head. The mother
replies, “I can't do this because it will cause
the umbilical cord to strangle the baby.” The
nurse interprets this statement as reflective of
which of the following?
Home remedy
Herbalism
Folk medicine
Alternative therapy
C
Feedback:
The mother's statement reflects folk medicine,
a body of preserved treatment practices that
has been handed down verbally from
generation to generation. One example is not
reaching above your head if you are pregnant,
because doing so will cause the umbilical
cord to strangle the baby. Home remedies are
caregiving practices passed down between
families, for example, ice on a cold sore,
baking soda paste on a bee sting. Herbalism
involves the use of medicinal herbs.
Alternative therapy or complementary therapy
is designed to promote comfort, health, and
well-being and includes, for example,
aromatherapy, music therapy, acupuncture,
and yoga.
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A)
B)
C)
D)
Ans:
Herbalism
Folk medicine
Alternative therapy
C
Feedback:
The mother's statement reflects folk medicine,
a body of preserved treatment practices that
has been handed down verbally from
generation to generation. One example is not
reaching above your head if you are pregnant,
because doing so will cause the umbilical
cord to strangle the baby. Home remedies are
caregiving practices passed down between
families, for example, ice on a cold sore,
baking soda paste on a bee sting. Herbalism
involves the use of medicinal herbs.
Alternative therapy or complementary therapy
is designed to promote comfort, health, and
well-being and includes, for example,
aromatherapy, music therapy, acupuncture,
and yoga.
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B)
C)
D)
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When working with different cultural groups
in the area of health care practices, the nurse
23. acts as an effective advocate for the client.
Which of the following must the nurse do
first?
Prepare to teach clients about the limits and
benefits of cultural health practices
Assess the client or family adequately to
ascertain their belief system and choices
Individualize caregiving for the client within
his or her culture
Be knowledgeable about health care practices
and choices
D
Feedback:
When working with different cultural groups
in the area of health care practices, the
community health nurse can be an effective
advocate for the client. First, however, the
nurse must be prepared to speak
knowledgeably about health care practices
and choices. The nurse also must be able to
assess the client or family adequately so as to
know what belief system motivates their
choices. Finally, the nurse must be prepared to
teach clients about the limits and benefits of
cultural health care practices. The community
health nurse should always individualize
assessment and caregiving for the client
within his or her culture and should not
generalize about the client based on cultural
group norms.
A)
Ans:
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B)
C)
his or her culture
Be knowledgeable about health care practices
and choices
D
Feedback:
When working with different cultural groups
in the area of health care practices, the
community health nurse can be an effective
advocate for the client. First, however, the
nurse must be prepared to speak
knowledgeably about health care practices
and choices. The nurse also must be able to
assess the client or family adequately so as to
know what belief system motivates their
choices. Finally, the nurse must be prepared to
teach clients about the limits and benefits of
cultural health care practices. The community
health nurse should always individualize
assessment and caregiving for the client
within his or her culture and should not
generalize about the client based on cultural
group norms.
D)
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When working with immigrant groups in
community health care, which of the
24.
following would be least appropriate for the
community health nurse to do?
Permit ample time for interviewing to allow
time to evaluate beliefs
Develop educational programs to correct
misconceptions
Assume that the client has a basic
understanding of health issues
Ensure an appropriate interpreter for
communication if needed
C
Feedback:
When working with immigrant groups in the
community, do not make assumptions about a
client's understanding of health care issues;
permit more time for interviewing; allow time
to evaluate beliefs and provide appropriate
interventions; provide educational programs
to correct any misconceptions about health
issues; provide an appropriate interpreter to
improve communication with immigrants
who do not speak English well.
A)
Ans:
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Chapter 6 Structure and Economics of Community/Public Health Services
After a class on important historical
influences on community health care, the
students are asked to describe the impact of
1.
the Shattuck Report. Which response
indicates that the students have understood
the information?
“It influenced the speed with which healthA)
focused bills pass the legislature.”
“The report set up the organizational structure
B)
of the U.S. Public Health Service.”
“It emphasized sanitary progress forming the
C)
basis for current public health practice.”
“It de-emphasized the issues addressed in the
D)
Hebrew hygienic code.”
Ans:
C
Feedback:
The Shattuck Report, a landmark document,
made a tremendous impact on sanitary
progress addressing public health concepts
and methods that form the basis of public
health practice today. It had no effect on
getting bills passed by the legislation nor was
it involved in setting up the organizational
structure of the U.S. Public Health Service.
The Hebrew hygienic code, probably the first
written code, was the prototype for personal
and community sanitation.
A)
B)
C)
D)
E)
F)
Ans:
Over the past century, many health-related
changes have occurred affecting morbidity
and mortality. As community health nurses
2. assess and plan for services in the community,
an understanding of which of the following
changes would the nurses need to integrate
into their plans? Select all that apply.
High levels of chronic disease
Shortened life spans
Increased teen pregnancies
Abuse of multiple substances
Increased maternal mortality
Multidrug-resistant diseases
A, C, D, F
Feedback:
Issues today include high levels of chronic
into their plans? Select all that apply.
High levels of chronic disease
Shortened life spans
Increased teen pregnancies
Abuse of multiple substances
Increased maternal mortality
Multidrug-resistant diseases
A, C, D, F
Feedback:
Issues today include high levels of chronic
disease, increase in teen pregnancies, abuse of
multiple substances, and multidrug-resistant
disease. Shortened life spans and increased
maternal mortality were real issues in the
1900s but are significantly different today.
With the shortened life span over 100 years
ago, people were not living long enough to
develop a long history of chronic disease.
Maternal mortality was high 100 years ago as
prenatal care and the technology of today did
not exist.
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A)
B)
C)
D)
E)
F)
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B)
C)
D)
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During a presentation at a local health
department, a community health nurse
discusses how society has changed over the
3. past 100 years and the influence that these
changes have had on the community's health
care needs. Which of the following would the
nurse include as a current societal event?
Large disparity in male/female wages
Rural to urban migration
Rampant child labor
Widespread violence
D
Feedback:
Today, society is faced with widespread
violence and terrorism. Populated urban areas
continue to loose people to the suburbs, while
100 years ago, people were leaving rural areas
for urban areas. A century ago child labor
laws were just forming and child labor was
rampant.
A)
B)
C)
D)
Ans:
When seeking employment, a community
health nurse decides to focus the search on
4.
official health care agencies, based on the
understanding that these agencies are
voluntary.
tax supported.
proprietary.
privately funded.
B
When seeking employment, a community
health nurse decides to focus the search on
4.
official health care agencies, based on the
understanding that these agencies are
voluntary.
tax supported.
proprietary.
privately funded.
B
Feedback:
Official health care agencies, later called
public health agencies, are tax supported;
thus, they must provide services determined
by the federal, state, or local government.
Voluntary or private agencies are privately
funded. Proprietary health services are
privately owned and managed and may be for
profit or nonprofit.
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A)
B)
C)
D)
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B)
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D)
Ans:
After describing the Public Health Service to
5. a group of students, which description would
indicate the need for additional discussion?
It offers consultation through national
advisory health councils and special advisory
committees made up of lay experts.
The Secretary of Health and Human Services
is ultimately responsible for it.
The Secretary of Health and Human Services
is an elected position.
A major function is to administer grants and
contracts with other government agencies.
C
Feedback:
The Secretary of Health and Human Services
is a cabinet position. Cabinet positions are
appointed by the President. The Public Health
Service does offer consultation through
national advisory health councils and special
advisory committees made up of lay experts.
The Secretary of Health and Human Services
is ultimately responsible for the Public Health
Service. A major function of the Public Health
Service is to administer grants and contracts
with other government agencies.
A community health nurse is engaged in
provision of care to clients in a clinic setting
6. at the local health department. This nurse is
engaging in which core public health
function?
Clinical
Assessment
Policy development
Assurance
D
Feedback:
The three core public health functions are
assessment, policy development, and
assurance. Assessment would involve
assessing the community, policy development
would involve helping to establish policies
that will address the problems assessed, and
assurance would involve making sure that the
services indicated by policies (following
assessment) are available to the community.
Clinical is not a core public health function.
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A)
B)
C)
D)
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7.
D)
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A)
Which of the following statements about the
core public health functions are true?
Public health nurses practice as partners with
other public health professionals within these
core functions.
Assessment involves the actual provision of
services.
Policy development relates to assessment.
Assurance means that the public health
agency must directly provide the needed
services.
A
Feedback:
Public health nurses practice as partners with
other public health professionals within these
core functions. Assessment does not involve
the actual provision of services (assurance
does). Public policy development builds on
data from the assessment function. Assurance
is the process of translating established
policies into services. This function ensures
that population-based services are provided,
whether by public health agencies or private
sources.
Assurance means that the public health
agency must directly provide the needed
services.
A
Feedback:
Public health nurses practice as partners with
other public health professionals within these
core functions. Assessment does not involve
the actual provision of services (assurance
does). Public policy development builds on
data from the assessment function. Assurance
is the process of translating established
policies into services. This function ensures
that population-based services are provided,
whether by public health agencies or private
sources.
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Which one of the following groups of actions
8. fulfills the three core public health functions
in their proper order?
Counting the number of kindergarten students
who are fully immunized, encouraging the
school officials to exclude children who are
not fully immunized, and offering
immunization clinics at the school
Identifying a source of pollution in the
community, educating local residents about
precautions that should be taken when the
pollution exceeds minimum standards, and
asking legislators to apply sanctions to the
responsible party for the source of pollution
Providing prenatal care for pregnant
adolescents, determining how many pregnant
adolescents currently attend the school, and
encouraging school officials to provide an
alternative school setting for the pregnant
adolescents
Lobbying for a citywide ban on smoking in
public, providing smoking cessation services
in the community, and reviewing mortality
data to determine the number of people in the
community who die each year from lung
cancer
A
Feedback:
The three core public health functions are
assessment, policy development, and
assurance. Assessment is data collection, the
policy development would be based on the
assessment, and assuring is the process of
translating established policies into services.
Counting the number of kindergarten students
who are fully immunized would be
assessment, encouraging the school officials
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B)
D)
Ans:
D)
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Ans:
data to determine the number of people in the
community who die each year from lung
cancer
A
Feedback:
The three core public health functions are
assessment, policy development, and
assurance. Assessment is data collection, the
policy development would be based on the
assessment, and assuring is the process of
translating established policies into services.
Counting the number of kindergarten students
who are fully immunized would be
assessment, encouraging the school officials
to exclude children who are not fully
immunized would be policy development, and
offering immunization clinics at the school
would be assurance. Identifying a source of
pollution in the community would be
assessment, educating local residents about
precautions that should be taken when the
pollution exceeds minimum standards would
be assurance, and asking legislators to apply
sanctions to the responsible party for the
source of pollution would be policy
development. Providing prenatal care for
pregnant adolescents would be assurance,
determining how many pregnant adolescents
currently attend the school would be
assessment, and encouraging school officials
to provide an alternative school setting for
pregnant adolescents would be assurance.
Lobbying for a citywide ban on smoking in
public would be policy development,
providing smoking cessation services in the
community would be assurance, and
reviewing mortality data to determine the
number of people in the community who die
each year from lung cancer would be
assessment.
A)
B)
C)
D)
E)
F)
Ans:
A community health nurse primarily works
with mothers and their high-risk children,
often referring them to various voluntary
9.
agencies for services. Which of the following
would be examples of voluntary health
agencies? Select all that apply.
American Diabetes Association
The U.S. Public Health Service
The National Institutes of Health
Women, Infant, and Children Program (WIC)
National Society for Autistic Children
Planned Parenthood Federation of America
A, E, F
9.
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B)
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D)
Ans:
A)
B)
Which of the following most well describes a
public health care agency?
The agency most often has a very specific
focus.
The agency is responsible for promoting and
protecting the health of all within their
jurisdiction.
The agency only employs nurses and
environmental health practitioners.
The agency is able to perform its work
independently with complete autonomy.
B
Feedback:
Unlike private organizations that tend to have
a specific focus, government health agencies
exist to accomplish a broad goal of protecting
and promoting the health of the total
population under their jurisdiction. Public
health requires interdisciplinary and
interorganizational collaboration.
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A)
B)
C)
D)
E)
F)
Ans:
agencies for services. Which of the following
would be examples of voluntary health
agencies? Select all that apply.
American Diabetes Association
The U.S. Public Health Service
The National Institutes of Health
Women, Infant, and Children Program (WIC)
National Society for Autistic Children
Planned Parenthood Federation of America
A, E, F
Feedback:
The American Diabetes Association, National
Society for Autistic Children, and Planned
Parenthood Federation are examples of
voluntary agencies supported by nonfederal
funds and are nonprofit organizations. The
U.S. Public Health Service, the National
Institutes of Health, and the WIC program are
federal agencies or receive federal funds to
operate; thus they are not voluntary agencies.
Which of the following statements best
describes the difference between the function
11.
of public sector health care agencies and
private sector health care agencies?
Private sector health services are
complementary and supplementary to
government health agencies.
Public sector health care agencies usually
meet the needs of people with special needs.
Private sector health agencies usually are
A)
B)
C)
D)
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Ans:
Which of the following statements best
describes the difference between the function
11.
of public sector health care agencies and
private sector health care agencies?
Private sector health services are
complementary and supplementary to
government health agencies.
Public sector health care agencies usually
meet the needs of people with special needs.
Private sector health agencies usually are
constrained in developing innovations in
health care.
Public health sector agencies generally satisfy
the health care needs of a community.
B
Feedback:
Private sector health services are
complementary and supplementary to
government health agencies, but this is not a
difference between the two types of agencies.
Private sector health care agencies usually
meet the needs of people with special needs
(rather than public sector health care agencies
that focus on the entire population within their
jurisdiction). Private sector health care
agencies are less constrained than public
sector health care agencies in developing
innovations in health care. A part of the
reason for the development of private sector
health care agencies is the impatience or
dissatisfaction with government (public
health) programs.
A)
B)
C)
D)
Ans:
Which of the following statements best
describes the difference between the function
12.
of public sector health care agencies and
private sector health care agencies?
Public sector health care agencies are more
likely to pilot or subsidize demonstration
projects.
Private sector health care agencies are more
likely to promote health legislation.
Public sector health care agencies are more
likely to generate new research and
innovation.
Private sector health care agencies usually
focus on needs that are met.
B
Feedback:
Private sector health agencies are more likely
to promote health legislation, whereas public
sector health care agencies are more likely to
Public sector health care agencies are more
likely to generate new research and
innovation.
Private sector health care agencies usually
focus on needs that are met.
B
Feedback:
Private sector health agencies are more likely
to promote health legislation, whereas public
sector health care agencies are more likely to
be responsible for carrying out health
legislation. Private sector health care agencies
(not public) are more likely to pilot or
subsidize demonstration projects and generate
new research and innovation. Private sector
health care agencies strive to detect unmet
needs rather than met needs.
C)
D)
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13. international health organization is most
accurate?
PAHO is completely separate from the WHO.
UNICEF promotes child and maternal health
and welfare globally.
WHO focuses primarily on developing
countries.
WHO and UNICEF are agencies of the
United Nations.
B
Feedback:
United Nations International Children's
Emergency Fund (UNICEF) promotes child
and maternal health and welfare globally. The
Pan American Health Organization (PAHO) is
the oldest continually functioning
international health organization in the world
and predates the World Health Organization
(WHO). Initially, the PAHO was independent
from the WHO but is now the WHO regional
office for the Americas and receives part of its
funding from WHO. WHO focuses on the
promotion of health worldwide, not just
developing countries. The United States
Agency for International Development
(USAID) focuses on developing countries.
WHO and UNICEF are both agencies of the
United Nations.
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An instructor is preparing a class presentation
on landmark health legislation. Which of the
14. following would the instructor include as the
most significant legislation that attempts to
ensure access to health care for Americans?
Social Security Act
Hill-Burton Act
Patient Protection and Affordable Care Act
Omnibus Budget Reconciliation Act
C
Feedback:
Patient Protection and Affordable Care Act is
expected to provide access to health care for
30 million Americans when fully enacted. The
Social Security Act had tremendous
consequences for public health with
revolutionary welfare insurance and
assistance programs, the provision of
financial assistance to form state and local
health agencies. The Hill-Burton Act (1946),
Occupational Health and Safety Act (1970),
and the Omnibus Budget Reconciliation Act
(1981) are important acts that brought about
changes in health care planning, safety, and
funding.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
E)
A group of students are preparing for an
examination on the various events serving as
landmarks for health care legislation. The
15. students demonstrate understanding of these
events by identifying which of the following
statements about particular landmark health
legislation are true? Select all that apply.
The Occupational Safety and Health Act
provided protection to workers against
personal injury or illness resulting from
hazardous working conditions.
The Shepard-Towner Act provided funds to
states for hospital construction.
The Hill-Burton Act provided funds to states
for administration of programs to support the
health and welfare of mothers and infants.
The Social Security Act Amendments of 1965
addressed a concern for some version of
national health insurance.
The Omnibus Budget Reconciliation Act
attempted to shift more power to states by
B)
C)
D)
E)
F)
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Ans:
The Shepard-Towner Act provided funds to
states for hospital construction.
The Hill-Burton Act provided funds to states
for administration of programs to support the
health and welfare of mothers and infants.
The Social Security Act Amendments of 1965
addressed a concern for some version of
national health insurance.
The Omnibus Budget Reconciliation Act
attempted to shift more power to states by
consolidating categorical grants into four
block grants.
The Patient Protection and Affordable Care
Act attempted to ensure the privacy of
medical records.
A, D, E
Feedback:
The Occupational Safety and Health Act
provided protection to workers against
personal injury or illness resulting from
hazardous working conditions. The HillBurton Act provided funds to states for
hospital construction. The Shepard-Towner
Act provided federal funds to states for
administration of programs to support the
health and welfare of mothers and infants.
The Social Security Act Amendments of 1965
addressed a concern for some version of
national health insurance. The Omnibus
Budget Reconciliation Act attempted to shift
more power to states by consolidating
categorical grants into four block grants. The
Health Insurance Portability and
Accountability Act attempted to ensure the
privacy of medical records.
A)
B)
C)
D)
A community health nurse working at the
local level is attending an in-service program
about health care economics. The nurse asks
16. the presenter, “Why do I need to know this
information? My focus is my clients.” Which
response by the presenter would be most
appropriate?
“You are required to know this information
because your agency receives government
funding.”
“You might be in management one day and
have to deal with cost control and
reimbursement.”
“Although it seems foreign to you, it's an
important topic that you might have to deal
with someday.”
“This knowledge is important to the success
of your practice and for the agency's
response by the presenter would be most
appropriate?
“You are required to know this information
because your agency receives government
funding.”
“You might be in management one day and
have to deal with cost control and
reimbursement.”
“Although it seems foreign to you, it's an
important topic that you might have to deal
with someday.”
“This knowledge is important to the success
of your practice and for the agency's
survival.”
D
Feedback:
At the local level (the community health nurse
and the employing agency), health care
economics is very important for survival.
Resourceful use of time, talent, and materials
will ensure that the services will be able to
continue and that the agency stays viable.
Government funding, a future role in
management, and dealing with the issue in the
future are inappropriate and do not emphasize
the importance of the effect of health care
economics.
A)
B)
C)
D)
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B)
C)
D)
Ans:
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When discussing the economics of health care
with colleagues, the community health nurse
17.
addresses macroeconomic theory. Which of
the following would the nurse include?
Quantity of services available
Consumer's willingness to buy services
Aggregate perspective of economic stability
Allocation of the available resources
C
Feedback:
Macroeconomic theory is concerned with the
broad variables that affect the status of the
economy as a whole, such as factors affecting
aggregate consumptions, production,
investment, and international trade. The focus
is on the larger view of economic stability and
growth, providing a global or aggregate
perspective. Microeconomic theory addresses
supply (quantity of services available) and
demand (consumer's willingness to buy
services) and study how allocation and
distribution affect consumer demand for
goods and services.
Consumer's willingness to buy services
Aggregate perspective of economic stability
Allocation of the available resources
C
Feedback:
Macroeconomic theory is concerned with the
broad variables that affect the status of the
economy as a whole, such as factors affecting
aggregate consumptions, production,
investment, and international trade. The focus
is on the larger view of economic stability and
growth, providing a global or aggregate
perspective. Microeconomic theory addresses
supply (quantity of services available) and
demand (consumer's willingness to buy
services) and study how allocation and
distribution affect consumer demand for
goods and services.
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B)
C)
D)
Ans:
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As part of a community wide education
program, a community health nurse is
18. developing a teaching plan about Medicare.
Which of the following would the nurse
include in the plan? Select all that apply.
It is a state health insurance program for
elderly and the disabled.
Medicare Part A covers medically necessary
hospitalization, home care, hospice services,
and limited-skilled nursing services.
Medicare Part D covers prescription drug
costs.
Medicare Part A is supplementary and
voluntary.
Medicare beneficiaries can make changes to
their coverage at any time.
B, C
Feedback:
Medicare is a federal health insurance
program and covers citizens and some legal
aliens who are over 65 years old (not a State
program). It also covers people with
permanent disabilities or chronic renal disease
at any age. Medicare Part A covers medically
necessary hospitalization, home care, hospice
services, and limited-skilled nursing service.
Prescriptions are covered under Medicare Part
D. Medicare Part B is supplementary and
voluntary. Medicare beneficiaries can make
changes to their coverage during open
enrollment periods.
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B)
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D)
voluntary.
Medicare beneficiaries can make changes to
their coverage at any time.
B, C
Feedback:
Medicare is a federal health insurance
program and covers citizens and some legal
aliens who are over 65 years old (not a State
program). It also covers people with
permanent disabilities or chronic renal disease
at any age. Medicare Part A covers medically
necessary hospitalization, home care, hospice
services, and limited-skilled nursing service.
Prescriptions are covered under Medicare Part
D. Medicare Part B is supplementary and
voluntary. Medicare beneficiaries can make
changes to their coverage during open
enrollment periods.
E)
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After teaching a community group about the
Medicaid program, which of the following
19.
would indicate to the nurse that additional
teaching is necessary?
Medicaid has a monthly fee that recipients
must pay.
Medicaid is administered individually by each
state.
Medicaid focuses on preventative services.
It is possible to be on both Medicare and
Medicaid.
A
Feedback:
Medicaid monies come to the states from the
federal government. Each state determines
who will receive what kinds of health care
services. This makes it a uniquely different
program in each state. Medicaid is a free
program available to individuals on the basis
of financial need and legal residency status.
Medicaid has a major focus on preventative
services, namely, infant, childhood, and elder
immunization programs. Eligibility is
determined on the basis of financial need and
residency status. Finally, some low-income
Medicare eligible people also receive
Medicaid.
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C)
D)
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Which of the following would the community
20. health nurse identify as a drawback to
retrospective reimbursement?
Spending was limited to the most necessary
tests and treatments.
Services for sickness were encouraged rather
than wellness.
Consumers had to bear the increased
accountability for cost containment.
Payments for services were based on rates
calculated from predictions.
B
Feedback:
Retrospective payment is associated with
encouraging sickness care rather than
wellness services. Physicians and other
providers were rewarded financially for
treating illness and providing for additional
tests and services. Patients and providers
often insisted on expensive or unnecessary
tests and treatment. Neither consumers nor
providers were accountable for containing
costs. Retrospective payment involves
reimbursement for a service after it has been
rendered with payment of a fee occurring
after the fact.
A)
B)
C)
D)
A)
B)
C)
D)
E)
Ans:
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Which of the following statements about
trends and issues influencing health care
21.
economics and community health services
delivery are true? Select all that apply.
The United States has the most cost effective
health care system in the world.
One explanation for the high cost of US
Health Care System is the need to practice
defensive medicine by ordering excessive
tests and x-rays.
In the United States, the health-related quality
of life is lower than for most other countries.
The United States ranks first among all WHO
countries on a measure of how respectfully
clients are treated.
In a survey published in 2009, most US
physicians identified that their health care
system worked well.
B, C, D
Feedback:
The United States has one of the least cost
effective health care systems in the world.
In the United States, the health-related quality
of life is lower than for most other countries.
The United States ranks first among all WHO
countries on a measure of how respectfully
clients are treated.
In a survey published in 2009, most US
physicians identified that their health care
system worked well.
B, C, D
Feedback:
The United States has one of the least cost
effective health care systems in the world.
One explanation for the high cost of US
Health Care System is the need to practice
defensive medicine by ordering excessive
tests and x-rays. In the United States, the
health-related quality of life is lower than for
most other countries. The United States ranks
first among all WHO countries on a measure
of how respectfully clients are treated. In a
survey published in 2009, most US physicians
did not identify that their health care system
worked well.
C)
D)
E)
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Which of the following statements about
Health Care Rationing is most accurate?
It will not occur in the United States because
of our country's values.
A danger of rationing is compromising quality
and effectiveness.
Rationing in health care has never been
practiced.
Advances in knowledge and technological
capabilities will eliminate the need for
rationing in the future.
B
Feedback:
A danger of rationing is compromising quality
and effectiveness. Rationing is already
practiced in this country to some extent and
for many years. Advances in knowledge and
technological capabilities compound rationing
decisions.
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When describing managed competition as a
potential solution to resolve the health care
23.
crisis, which of the following would be
included? Managed competition would
promote cost containment and universal
access to health care.
eliminate burdensome government
regulations.
reduce state and federal control over health
care delivery.
discourage consumers from making
responsible choices.
A
Feedback:
Managed competition ideally would promote
cost containment and universal access to
health care. Governmental regulations and
control would still be present as would
insurance companies. Managed care would
encourage consumers to make responsible
choices.
A)
B)
C)
D)
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C)
D)
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Which statement regarding the potential
24. impact of health care reform on community
health nursing is most accurate?
Health care reform does not affect community
health nursing.
Community health nurses know that outcomes
research is unnecessary.
Public health nurses can lead the effort in
making health care more accessible to all
citizens.
Community health nurses will only be able to
work in public health agencies.
C
Feedback:
Public health nurses can lead the effort in
making health care more accessible to all
citizens. Health care reform definitely affects
community health nursing. Community health
nurses recognize the importance of outcomes
research to document the value of nursing
interventions with at-risk populations.
Community health nursing has important ties
to both private and public health agencies.
D)
Ans:
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citizens.
Community health nurses will only be able to
work in public health agencies.
C
Feedback:
Public health nurses can lead the effort in
making health care more accessible to all
citizens. Health care reform definitely affects
community health nursing. Community health
nurses recognize the importance of outcomes
research to document the value of nursing
interventions with at-risk populations.
Community health nursing has important ties
to both private and public health agencies.
Chapter 7 Epidemiology in the Community
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An instructor is discussing the worldwide
1. distribution of AIDS. Which term would the
instructor use to describe this situation?
Epidemic
Pandemic
Endemic
Pathogenicity
B
Feedback:
Pandemic is the term used to describe an
epidemic that is distributed worldwide. An
epidemic refers to a disease occurrence that
clearly exceeds the normal or expected
frequency in a community or region. Endemic
is used to describe the continuing presence of
a disease or infectious agent in a given
geographic area. Pathogenicity refers to an
agent's capacity to cause disease in a host.
After a class describing the contributions of
Florence Nightingale to epidemiology, the
instructor determines that the class needs
2.
additional instruction when they state which
of the following is associated with
Nightingale?
Establishment of the need for a clean
environment
A sophisticated coding system for medical
conditions
Proper wound cleansing and bandaging
techniques
Separation of infected individuals from those
injured
B
Nightingale?
Establishment of the need for a clean
environment
A sophisticated coding system for medical
conditions
Proper wound cleansing and bandaging
techniques
Separation of infected individuals from those
injured
B
Feedback:
Nightingale's colleague, William Farr, is
credited for developing a more sophisticated
system for coding medical conditions.
Nightingale's contributions included
establishing the need for a clean environment,
properly cleaning wounds and bandaging
them, and separating infected soldiers from
those who were injured.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When applying the epidemiologic triad model
to a community's plan of care, which of the
3.
following would the community health nurse
address?
Incidence, prevalence, and case fatality
Health, illness, and injury
Host, agent, and environment
Immunity, causation, and risk
C
Feedback:
The purpose of this model is to demonstrate
the relationship among host, agent, and
environment. Each component has to be
present to a certain degree in order for any
disease, illness, or injury to exist or happen. If
one component is missing, illness or injury
will not occur. Incidence, prevalence, case
fatality, health, illness, injury, immunity,
causation, and risk are terms used in
epidemiology but do not refer to the
epidemiologic triad model.
Which of the following would the community
4. health nurse identify as a key component of
the host?
Infectivity
Antigenicity
Virulence
Inherent resistance
D
Feedback:
The host, a susceptible human or animal, can
Which of the following would the community
4. health nurse identify as a key component of
the host?
Infectivity
Antigenicity
Virulence
Inherent resistance
D
Feedback:
The host, a susceptible human or animal, can
sometimes have an ability to resist pathogens.
This is called inherent resistance. Infectivity,
antigenicity, and virulence are characteristics
of the agent.
5.
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A)
B)
C)
D)
Ans:
Which of the following statements apply to
the concept of causality? Select all that apply.
Causality is the relationship between cause
and effect.
The chain of causation is the most recent
theory of causality.
The web of causation theory is the most
recent theory of causality.
The chain of causation clearly explains
causation in noninfectious disease.
Epidemiology has changed its view of
causality over time.
A, C, E
Feedback:
Causality is the relationship between cause
and effect. The web of causation theory is the
most recent theory of causality. Epidemiology
has changed its view of causality over time.
The chain of causation was the first theory of
causality. The chain of causation could not
sufficiently explain causation in noninfectious
disease because the chain of causation is too
linear.
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A)
B)
C)
D)
Ans:
A community health nurse is explaining the
chain of causation to a family that includes a
child who has developed Lyme disease. The
6.
nurse correctly describes the opening in the
child's skin caused by the actual tick bite as
the
reservoir.
mode of transmission.
portal of entry.
host.
C
Feedback:
The opening in the child's skin caused by the
6.
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A)
B)
C)
D)
Ans:
nurse correctly describes the opening in the
child's skin caused by the actual tick bite as
the
reservoir.
mode of transmission.
portal of entry.
host.
C
Feedback:
The opening in the child's skin caused by the
actual tick bite is the portal of entry in the
chain of causation. The mode of transmission
would be the tick biting the child. The
reservoir would refer to the tick. The host
would be the child who has been bitten by the
tick.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is integrating the
epidemiology of wellness into practice.
7.
Which of the following would the nurse
include?
Lifestyle with its self-created risks
Communicable disease control
The natural history of disease
Vital statistics and reportable diseases
A
Feedback:
Today there is an increased focus on lifestyle
behaviors and how they relate to a person's
state of wellness or illness. It is a basic
component of a wellness model.
Communicable disease control focuses on an
illness state, not a wellness state, and is not
part of a wellness model. The four states of
the natural history of a disease or health
condition is not part of the wellness model.
Vital statistics and reportable diseases are not
part of the wellness model.
The nurse is examining the possibility that
multiple factors are involved in the
8.
development of a disorder. The nurse is
applying which of the following?
Chain of causation
Web of causation
Strength of association
Temporality
B
Feedback:
The web of causation is being used to apply
the concept of multiple causes to explain the
existence of health and illness states. It was a
applying which of the following?
Chain of causation
Web of causation
Strength of association
Temporality
B
Feedback:
The web of causation is being used to apply
the concept of multiple causes to explain the
existence of health and illness states. It was a
refinement of the chain of causation, such that
it looked at the combination of multiple
factors as implicated in the development of
poor outcomes. The chain of causation
focuses on one factor in the development of a
condition. The strength of association is an
element of causation in noninfectious disease
that refers to the ratio of disease rates in those
with and without the causal factor.
Temporality, also involved with the causation
of noninfectious disease, is an element in
which the exposure to the suspected factor
must precede the onset of the disease.
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A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
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The nurse is reviewing a research article that
describes the use of the bacille CalmetteGuerin (BCG) vaccine to prevent tuberculosis
that was given to individuals who were
9.
exposed to leprosy. The individuals did not
develop the leprosy. The nurse interprets this
as most accurately demonstrating which type
of immunity?
Herd immunity
Passive immunity
Cross-immunity
Active immunity
C
Feedback:
Cross-immunity refers to a situation in which
a person's immunity to one agent provides
immunity to a related agent as well. This
immunity can be active or passive. Herd
immunity describes the immunity level
present in a population group. Passive
immunity refers to short-term resistance
acquired naturally or artificially. Active
immunity is long-term and can be acquired
naturally or artificially.
A)
B)
C)
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D)
The nurse educator knows that a nursing
10. student understands the basics of immunity
when the student nurse states
herd immunity only pertains to cows.
active immunity can be attained via the use of
vaccines.
passive immunity can be attained via the use
of vaccines.
cross-immunity is immunity that causes a
person who is immune to one disease to be
also immune to a completely different
infectious agent.
B
Feedback:
Active immunity can be attained via the use
of vaccines. Passive immunity is immunity
that is given to a person, either by maternally
provided protection for newborn infants or
from antibody products that provide
temporary resistance. Herd immunity
describes the immunity level that is present in
a population group. Cross-immunity is
immunity that causes a person who is immune
to one disease to be also immune to a related
infectious agent.
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A)
B)
C)
D)
Ans:
When assessing several populations, the nurse
notes each population's relative risk. Using
11. the relative risk ratios below, which
population would require a major emphasis
for risk reduction intervention?
0.59
1.13
1.79
2.45
D
Feedback:
A relative risk >1.0 indicates that those with
the risk factor have a greater likelihood of
acquiring the disease than do those without it.
For example, a relative risk ratio of 2.45
means that the exposed group is 2.45 times
more likely to acquire the disease than the
unexposed group. Therefore, interventions to
reduce this population's risk would be most
important.
1.13
1.79
2.45
D
Feedback:
A relative risk >1.0 indicates that those with
the risk factor have a greater likelihood of
acquiring the disease than do those without it.
For example, a relative risk ratio of 2.45
means that the exposed group is 2.45 times
more likely to acquire the disease than the
unexposed group. Therefore, interventions to
reduce this population's risk would be most
important.
12.
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A)
Which of the following statements about risk
is true? Select all that apply.
Risk is the probability that a disease or
unfavorable health condition will develop.
Risk means that the person who has the most
negative influences will definitely develop the
disease or unfavorable health condition.
Risk refers to positive and negative influences
on a person's likelihood of developing a
specific disease.
Risk can be measured using the relative risk
ratio, which is based on the ratio of incidence
in an exposed group to incidence rate in
unexposed group.
Risk is unimportant when determining the
most effective points for community health
intervention.
A, C, D
Feedback:
Risk is the probability that a disease or
unfavorable health condition will develop.
Risk also refers to positive and negative
influences on a person's likelihood of
developing a specific disease. Relative risk
ratio is a calculation of risk consisting of the
ratio of incidence in an exposed group to
incidence rate in unexposed group. Risk does
not mean that the person who has the most
negative influences will definitely develop the
disease or unfavorable health condition, but it
refers to the probability that the person will
develop the disease or unfavorable health
condition. The relative risk ratio assists in
determining the most effective points for
community health intervention in regard to
particular health problems.
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B)
C)
D)
Ans:
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B)
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C)
D)
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w
w
w
Ans:
yn
E)
Risk is unimportant when determining the
most effective points for community health
intervention.
A, C, D
Feedback:
Risk is the probability that a disease or
unfavorable health condition will develop.
Risk also refers to positive and negative
influences on a person's likelihood of
developing a specific disease. Relative risk
ratio is a calculation of risk consisting of the
ratio of incidence in an exposed group to
incidence rate in unexposed group. Risk does
not mean that the person who has the most
negative influences will definitely develop the
disease or unfavorable health condition, but it
refers to the probability that the person will
develop the disease or unfavorable health
condition. The relative risk ratio assists in
determining the most effective points for
community health intervention in regard to
particular health problems.
E)
st
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re
p
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om
Ans:
yn
.m
w
w
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A)
B)
C)
D)
Ans:
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si
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te
While visiting a family's home, the
community health nurse finds out that the two
children in the home were exposed to
13. chickenpox. Assessment of the children
reveals no signs of fever or lesions. The nurse
determines that the children may be in which
stage of the disease?
Susceptibility
Subclinical disease
Clinical disease
Resolution
B
Feedback:
The children have been exposed but have not
yet developed the signs of chickenpox.
Therefore, they are in the subclinical disease
stage. During the susceptibility stage, the
disease is not present and individuals have not
been exposed. During the clinical stage, signs
and symptoms are beginning to develop.
During the resolution stage, the disease causes
sufficient anatomic or functional changes to
produce recognizable signs and symptoms.
During which stage of the natural history of a
14. communicable disease would quarantine be
most effective?
Susceptibility stage
Subclinical disease stage
Clinical disease stage
Resolution stage
A
Feedback:
Quarantine is the isolation of persons who are
susceptible to a communicable disease and
have been exposed to that communicable
disease until the incubation period of the
subclinical disease stage has passed.
Quarantining persons during the susceptibility
stage itself is not indicated as individuals have
not been exposed. The proper action for
persons who are in the clinical disease stage
and beyond is isolation until the danger of
spreading the communicable disease has
passed.
.m
w
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w
A)
B)
C)
D)
Ans:
yn
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st
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A)
B)
C)
D)
Ans:
The nurse is reviewing actual census data for
information for use in an epidemiologic study.
15.
Which of the following would the nurse be
least likely to find?
Occupational status
Housing quality
Births recorded
Educational level
C
Feedback:
Vital statistic data provides information about
the number of births recorded. Census data
includes information about age, sex, race,
ethnic background, type of occupation,
income gradient, marital status, educational
level, and other standards such as housing
quality. If the nurse is reviewing actual census
data, the nurse would be least likely to find
births recorded, which is vital statistics.
A community health nurse is looking for data
on the use of nursing home services and the
common diagnoses of those using these
16.
services. Which source of information would
be most appropriate for the nurse to
investigate?
National Center for Health Statistics
Consumer Product Safety Commission
Environmental Protection Agency
Cancer disease registries
A
Feedback:
The National Center for Health Statistics
furnishes valuable health prevalence data
from surveys of Americans. Among the
information available is the National Nursing
Home Survey, which provides information on
those who are using these services and the
diagnoses and other characteristics. The
Consumer Product Safety Commission and
Environmental Protection Agency would
provide information about environmental
issues. Cancer disease registries would
provide information specific to the diagnosis
of cancer.
B)
C)
D)
E)
Ans:
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w
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A)
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yn
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st
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A)
B)
C)
D)
Ans:
Which of the following is true about
17. incidence and prevalence? Select all that
apply.
Prevalence is the number of new cases of a
disease or health condition.
Incidence is the number of new cases of a
disease or health condition.
Prevalence refers to all of the people with a
particular health condition existing in a given
population at a given point in time.
Incidence refers to all of the people with a
particular health condition existing in a given
population at a given point in time.
When determining if a disease is endemic in a
specific area, the statistic that is most helpful
is prevalence.
B, C, E
Feedback:
Incidence is the number of new cases of a
disease or health condition. Prevalence refers
to all of the people with a particular health
condition existing in a given population at a
given point in time. When determining if a
When determining if a disease is endemic in a
specific area, the statistic that is most helpful
is prevalence.
B, C, E
Feedback:
Incidence is the number of new cases of a
disease or health condition. Prevalence refers
to all of the people with a particular health
condition existing in a given population at a
given point in time. When determining if a
disease is endemic in a specific area, the
statistic that is most helpful is prevalence.
E)
A)
re
p
B)
st
p
C)
te
D)
w
w
w
.m
yn
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si
ng
Ans:
A)
B)
C)
D)
A community health nurse is preparing to
carry out an experimental epidemiologic
18.
study. Which of the following would be most
important for the nurse to do?
Focus the study on evaluating the cause of a
disease
Ensure carefully controlled conditions during
the study
Expose both groups to the same factor or
condition
Ensure that there are a substantial number of
subjects
B
Feedback:
Experimental studies are carried out under
carefully controlled conditions. In human
populations, experimental studies should
focus on disease prevention or health
promotion rather than testing the cause of
disease. The investigator exposes an
experimental group to some factor and
simultaneously observes a control group
similar in characteristics to the experimental
group but without the exposure factor. An
experimental study need not be elaborate to
provide important data.
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om
Ans:
A community health nurse is participating in a
case–control observational study. Which of
19.
the following would most likely explain this
type of study?
Description of patterns of occurrence of
illness and injury in a population
Investigation of development of health–illness
conditions over a long period of time
Studying of a cohort with evaluation of
variables associated with the disease or injury
Comparison of persons with and without a
health–illness condition
19.
A)
B)
C)
D)
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Ans:
case–control observational study. Which of
the following would most likely explain this
type of study?
Description of patterns of occurrence of
illness and injury in a population
Investigation of development of health–illness
conditions over a long period of time
Studying of a cohort with evaluation of
variables associated with the disease or injury
Comparison of persons with and without a
health–illness condition
D
Feedback:
Comparing persons with and without a certain
condition is known as a case–control study. A
study that describes patterns of occurrence in
a population is a descriptive study. Following
people over a long period of time is a
longitudinal study. And cohorts are groups
studied over time.
ur
si
ng
te
st
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After teaching a group of students about the
various types of epidemiologic research
studies that can be done, the instructor
20.
determines that the teaching was effective
when the students describe a community trial
as which of the following?
A type of experimental study conducted at the
community level
An inexpensive type of analytic research
study
A study that gathers volunteers for the
experimental group
A way to locate health problems in a variety
of communities
A
Feedback:
A community trial is conducted as an
experimental study design with large
populations. Some of the community receives
a treatment, while the other part does not.
This is probably the most expensive type of
experimental study. It involves a great number
of subjects, the support of the governmental
forces as well as the population involved, a
large number of staff over a long period of
time, and the cost of the intervention itself.
When a whole community is involved,
individuals are not approached to be
volunteers. What makes it a community study
is that the entire community is part of the
study. The health problem is identified prior
to the implementation of the study. The
A)
Ans:
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D)
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C)
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B)
C)
experimental group
A way to locate health problems in a variety
of communities
A
Feedback:
A community trial is conducted as an
experimental study design with large
populations. Some of the community receives
a treatment, while the other part does not.
This is probably the most expensive type of
experimental study. It involves a great number
of subjects, the support of the governmental
forces as well as the population involved, a
large number of staff over a long period of
time, and the cost of the intervention itself.
When a whole community is involved,
individuals are not approached to be
volunteers. What makes it a community study
is that the entire community is part of the
study. The health problem is identified prior
to the implementation of the study. The
introduction of an intervention in one
community with no introduction in a similar
community forms the study population, and
the health problem being studied is then
monitored between the two populations. The
health problem has to be identified first in this
type of study.
D)
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A)
B)
C)
D)
Ans:
yn
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Ans:
When using descriptive epidemiology, which
21. type of study would the community health
nurse expect to include?
Prevalence study
Case–control study
Cohort study
Count study
D
Feedback:
Descriptive epidemiology includes
investigations that seek to observe and
describe patterns of health-related conditions
that occur naturally in a population. The
simplest measure of a description is a count.
Prevalence, case–control, and cohort studies
are types of studies involved with analytical
research.
Organize the following steps in the
epidemiologic study from the first step to the
last.
A) Collect the data.
B) Identify the problem.
22.
C) Analyze the findings.
D) Disseminate the findings.
E) Review the literature.
F) Develop conclusions and applications.
G) Design the study.
B, E, G, A, C, F, D
Feedback:
The proper order of the steps in the
epidemiologic study from the first step to the
last is to identify the problem, review the
literature, design the study, collect the data,
analyze the findings, develop conclusions and
applications, and disseminate the findings.
st
p
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om
Ans:
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.m
w
w
w
A)
B)
C)
D)
Ans:
ur
si
ng
te
When implementing an epidemiologic
research study, which of the following would
23.
the community health nurse complete as the
final step?
Analyze the data
Design the study
Disseminate findings
Review the literature
C
Feedback:
The last step in the research process is to
disseminate the findings. After identifying the
problem and reviewing the literature, the
researcher designs the study, collects the data,
analyzes the findings, and develops
conclusions and applications.
Chapter 8 Communicable Disease
A)
B)
C)
D)
Ans:
When reporting the identification of a
communicable disease and need for
1.
investigation, which of the following must be
notified first?
Centers for Disease Control (CDC)
State health department
Local health department
National Reported Disease list
C
When reporting the identification of a
communicable disease and need for
1.
investigation, which of the following must be
notified first?
Centers for Disease Control (CDC)
State health department
Local health department
National Reported Disease list
C
Feedback:
The local health department is the initial point
of notification of a communicable disease
investigation. Each local health department or
agency will investigate the specific disease.
The CDC is the federal agency that provides
guidance and recommendations for each state
health department. The state health
department may be the primary agency or the
guiding agency for local disease control
policies. States use the National Reported
Disease list as the guidance for State
reportable diseases.
st
p
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A)
B)
C)
D)
Ans:
E)
F)
Ans:
yn
.m
w
D)
w
w
A)
B)
C)
ur
si
ng
te
Which of the following are appropriate
communicable disease prevention
2. interventions that may be implemented by
community health nurses? Select all that
apply.
Immunization of children and adults
Disease investigation and case/contact finding
Diagnosing cases of communicable diseases
Prescribing treatment for communicable
diseases
Environmental interventions
Community Education
A, B, E, F
Feedback:
Appropriate interventions that may be
implemented by community health nurses
include immunizations of children and adults,
environmental interventions, community
education, screening programs, and disease
investigation and case/contact finding.
A)
B)
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C)
Which of the following statements accurately
describes important steps that a community
3. health nurse must take prior to contacting an
individual for an interview regarding
communicable disease? Select all that apply.
Review the information received from the
news media reporter for completeness
Review disease information including the
reservoir, incubation period, infectious period,
symptoms, and treatment
Take all appropriate treatments to the
interview site
Investigate only laboratory confirmed
communicable diseases
Eradicate the disease
A, B
Feedback:
Steps to take prior to contacting an individual
regarding communicable disease include
reviewing the information received from the
reporters for completeness (this refers to the
individual reporting the communicable
disease to the public health agency and not
the news media reporter); clarifying that the
disease is suspect or lab confirmed (some
infections can be reported if they meet a set of
clinical criteria or are part of a larger outbreak
for which the case definition has been
identified even without laboratory
confirmation); review the case definition;
review the disease information (including
reservoir, incubation period, infectious period,
symptoms, and treatment); and identifying the
specific questionnaire for the reported disease
or using a generic disease investigation form
and reviewing the questionnaire. It is not
appropriate for the community health nurse to
take all treatments to the interview site as the
goal of this interview is to assess. Community
health nurses may investigate laboratory
confirmed or suspected diseases. Eradication
of the disease is the last step in investigating a
disease, and interviewing an individual
regarding communicable disease is one of the
first steps in the process of investigation.
D)
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te
st
p
re
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E)
Ans:
D)
w
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yn
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te
st
p
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E)
Ans:
Investigate only laboratory confirmed
communicable diseases
Eradicate the disease
A, B
Feedback:
Steps to take prior to contacting an individual
regarding communicable disease include
reviewing the information received from the
reporters for completeness (this refers to the
individual reporting the communicable
disease to the public health agency and not
the news media reporter); clarifying that the
disease is suspect or lab confirmed (some
infections can be reported if they meet a set of
clinical criteria or are part of a larger outbreak
for which the case definition has been
identified even without laboratory
confirmation); review the case definition;
review the disease information (including
reservoir, incubation period, infectious period,
symptoms, and treatment); and identifying the
specific questionnaire for the reported disease
or using a generic disease investigation form
and reviewing the questionnaire. It is not
appropriate for the community health nurse to
take all treatments to the interview site as the
goal of this interview is to assess. Community
health nurses may investigate laboratory
confirmed or suspected diseases. Eradication
of the disease is the last step in investigating a
disease, and interviewing an individual
regarding communicable disease is one of the
first steps in the process of investigation.
A)
B)
C)
D)
E)
Ans:
Which of the following entities would the
community health nurse know are required to
4. report known or suspected cases of reportable
diseases in every state in the United States?
Select all that apply.
Physicians, dentists, and nurses
Laboratory directors
Any individual who knows of or suspects the
existence of a reportable disease
Medical examiners
Administrators of schools and child care
centers
A, D, E
Feedback:
In most states, reporting known or suspected
cases of a reportable disease is generally
considered to be an obligation of physicians,
dentists, nurses, and other health
professionals; medical examiners;
administrators of hospitals, clinics, nursing
D)
Medical examiners
Administrators of schools and child care
centers
A, D, E
Feedback:
In most states, reporting known or suspected
cases of a reportable disease is generally
considered to be an obligation of physicians,
dentists, nurses, and other health
professionals; medical examiners;
administrators of hospitals, clinics, nursing
homes, schools, and child care centers. Some
states also require or request reporting from
laboratory directors; and any individual who
knows of or suspects the existence of a
reportable disease.
E)
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Ans:
st
p
re
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A community health nurse is presenting a
program about hepatitis prevention and risk
reduction to a local community group. The
5. nurse determines that the group has
understood the program when they identify
which method as the major mode of
transmission for hepatitis B?
Oral–fecal route
Exposure to contaminated blood
Airborne droplet nuclei
Infected rodents, such as mice and rats
B
Feedback:
Hepatitis B can occur in certain high-risk
groups, including injected drug users,
heterosexuals with multiple partners, and
homosexual men. Hepatitis A is transmitted
by the fecal–oral route. TB is transmitted by
airborne droplet nuclei. Hantavirus is
transmitted via infected rodents.
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te
A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When reviewing the trends in communicable
diseases for a county, the community health
nurse notes that there was an increased
6. incidence of Lyme's disease. The nurse
develops a plan for prevention and control
integrating the understanding that this disease
is most likely transmitted by which mode?
Vector
Airborne
Vehicle-borne
Direct
A
Feedback:
In the United States, vector-borne illnesses
develops a plan for prevention and control
integrating the understanding that this disease
is most likely transmitted by which mode?
Vector
Airborne
Vehicle-borne
Direct
A
Feedback:
In the United States, vector-borne illnesses
have received renewed attention with
accumulating information about Lyme's
disease, transmitted to humans by a tick
vector. Airborne transmission occurs through
droplet nuclei, such as sneezing or coughing.
Indirect or vehicle-borne transmission occurs
when the infectious agent is transported via
contaminated inanimate objects such as air,
water, or food. Direct transmission occurs via
the immediate transfer of infectious agents
from a reservoir to a new susceptible host
such as through touching, biting, kissing, or
sexual intercourse.
st
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A)
B)
C)
D)
Ans:
ur
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ng
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After a community health nurse implements
an educational program for a local community
7.
group about food safety, which statement
indicates that the teaching was successful?
“Handwashing is unnecessary if we use
gloves.”
“After cooking the meat, we'll put it on the
same platter that we used for the raw meat.”
“Our cooked foods should be cooled quickly.”
“If we peel the carrots, we don't need to wash
them before eating.”
B
Feedback:
Cooked foods should be cooled quickly.
Surfaces, hands, and utensils should be
washed in warm soapy water (even when
gloves are used as gloves do not prevent
cross-contamination by themselves). Foods
when cooked should not come in contact with
dishes, utensils, or containers used when the
foods were raw and uncooked. Foods that are
to be eaten raw and uncooked should be
washed thoroughly in clean water. This
includes foods (e.g., carrots) that are to be
peeled that grow on the ground or come in
contact with soil.
yn
A)
Ans:
w
D)
w
w
C)
.m
B)
C)
“Our cooked foods should be cooled quickly.”
“If we peel the carrots, we don't need to wash
them before eating.”
B
Feedback:
Cooked foods should be cooled quickly.
Surfaces, hands, and utensils should be
washed in warm soapy water (even when
gloves are used as gloves do not prevent
cross-contamination by themselves). Foods
when cooked should not come in contact with
dishes, utensils, or containers used when the
foods were raw and uncooked. Foods that are
to be eaten raw and uncooked should be
washed thoroughly in clean water. This
includes foods (e.g., carrots) that are to be
peeled that grow on the ground or come in
contact with soil.
D)
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om
Ans:
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st
p
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A community health nurse is teaching a group
of clients about infection control and
mentions the role of vectors in transmitting
8.
diseases. Which of the following would be
examples of some common vectors? Select all
that apply.
Chemicals
Mosquitoes
Salmonella
Fleas
Roaches
B, D, E
Feedback:
A vector is a nonhuman carrier of disease
organisms that can transmit diseases directly
to humans. Examples would include
mosquitoes, fleas, and roaches. Various
chemicals are not vectors and Salmonella is
an infectious agent.
w
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.m
yn
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A)
B)
C)
D)
E)
Ans:
A)
B)
C)
D)
E)
Which of the following statements about
9. modes of transmission are true? Select all that
apply.
Direct transmission requires contact with a
contaminated inanimate material.
Indirect transmission is also known as
vehicle-borne illness.
Food- and water-related illnesses are
considered to be spread by indirect
transmission.
Vector transmission requires contact with a
nonhuman carrier such as an animal or insect.
Airborne transmission commonly occurs from
apply.
Direct transmission requires contact with a
contaminated inanimate material.
Indirect transmission is also known as
vehicle-borne illness.
Food- and water-related illnesses are
considered to be spread by indirect
transmission.
Vector transmission requires contact with a
nonhuman carrier such as an animal or insect.
Airborne transmission commonly occurs from
coughing and sneezing.
B, C, D, E
Feedback:
Direct transmission occurs by immediate
transfer of infectious agents from a reservoir
to a new susceptible host. Indirect
transmission requires contact with a
contaminated inanimate material and is also
known as vehicle-borne illness. Food- and
water-related illnesses are considered to be
spread by indirect transmission. Vector
transmission requires contact with a
nonhuman carrier such as an animal or insect.
Airborne transmission commonly occurs from
coughing and sneezing.
A)
B)
C)
D)
E)
B)
C)
D)
E)
F)
Ans:
w
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A)
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st
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Ans:
Community health nurses practice within the
three levels of prevention. Which of the
following would the community health nurse
10.
engage in at the primary level of prevention
for communicable disease control? Select all
that apply.
Providing TB skin test to children entering
kindergarten
Administering immunizations to senior
citizens
Teaching kindergarten students to wash their
hands
Encouraging parents to complete their
children's immunizations
Providing chest x-rays to people with positive
TB skin tests
Administering prompt treatment for the
symptoms of gonorrhea
B, C, D
Feedback:
Primary prevention interventions include
administering immunizations, teaching about
hand washing, and encouraging adherence to
the recommended schedule for childhood
immunizations. Providing TB skin testing and
chest x-rays, and promptly treating symptoms
E)
TB skin tests
Administering prompt treatment for the
symptoms of gonorrhea
B, C, D
Feedback:
Primary prevention interventions include
administering immunizations, teaching about
hand washing, and encouraging adherence to
the recommended schedule for childhood
immunizations. Providing TB skin testing and
chest x-rays, and promptly treating symptoms
of gonorrhea are examples of interventions at
the secondary level of prevention.
F)
The nurse educator has just discussed
education of aggregates using mass media
with targeting health messages. Which of the
11.
following statements by the nursing student
would demonstrate the student's ability to
analyze and apply the information?
Television would be the most important venue
of mass media to educate the aggregate as
everyone has a television.
The target audience must be assessed for
educational level, salience of the issue,
involvement in the issue, and access to the
media channel used.
Pamphlets should be assessed to make sure
they are at a twelfth grade reading level.
It is unnecessary to consider culture when
planning the health message.
B
Feedback:
To effectively deliver a health promotion and
disease-prevention message, the message
must reach the target (at-risk) population.
This requires correct identification of the
characteristics of the target audience in terms
of educational level, salience of the issue,
involvement of the target audience with the
issue, and access of the target audience to the
media channels used. Cultural issues affect
people's interpretation of messages and must
be considered in the presentation of a diseaseprevention message to ethnic and racial
minority groups. Television may not be the
most important venue of mass media to
educate the aggregate. Pamphlets may not be
the best way to educate the aggregate, and the
reading level of any literature must be specific
for the target audience. Cultural issues affect
people's interpretation of messages and must
be considered in the presentation of a diseaseprevention message to ethnic and racial
re
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Ans:
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A)
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B)
C)
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D)
w
w
w
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Ans:
C)
they are at a twelfth grade reading level.
It is unnecessary to consider culture when
planning the health message.
B
Feedback:
To effectively deliver a health promotion and
disease-prevention message, the message
must reach the target (at-risk) population.
This requires correct identification of the
characteristics of the target audience in terms
of educational level, salience of the issue,
involvement of the target audience with the
issue, and access of the target audience to the
media channels used. Cultural issues affect
people's interpretation of messages and must
be considered in the presentation of a diseaseprevention message to ethnic and racial
minority groups. Television may not be the
most important venue of mass media to
educate the aggregate. Pamphlets may not be
the best way to educate the aggregate, and the
reading level of any literature must be specific
for the target audience. Cultural issues affect
people's interpretation of messages and must
be considered in the presentation of a diseaseprevention message to ethnic and racial
minority groups.
D)
.m
w
w
w
A)
B)
C)
D)
Ans:
yn
ur
si
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te
st
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Ans:
A community health nurse has identified the
12. index case. The nurse is involved in which of
the following?
Contact investigation
Screening
Isolation
Quarantine
A
Feedback:
The index case (diagnosed person) results
from contact investigation and partner
notification. Screening describes programs
that deliver a testing procedure to detect
disease in groups of asymptomatic apparently
health individuals. Isolation refers to the
separation of the infected person from others
for a period of communicability to limit
transmission; quarantine refers to restrictions
placed on healthy contacts of an infectious
case for the duration of the incubation period.
Contact investigation and notification is one
of two approaches to secondary prevention of
communicable diseases.
Screening
Isolation
Quarantine
A
Feedback:
The index case (diagnosed person) results
from contact investigation and partner
notification. Screening describes programs
that deliver a testing procedure to detect
disease in groups of asymptomatic apparently
health individuals. Isolation refers to the
separation of the infected person from others
for a period of communicability to limit
transmission; quarantine refers to restrictions
placed on healthy contacts of an infectious
case for the duration of the incubation period.
Contact investigation and notification is one
of two approaches to secondary prevention of
communicable diseases.
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B)
C)
D)
Ans:
st
p
The three main approaches to the tertiary
13. prevention of communicable disease include
which of the following?
Education, immunization, and screening
Screening, immunization, and isolation and
quarantine
Case and contact investigation, notification,
and treatment
Care and treatment, isolation and quarantine,
and safe handling and control of infectious
wastes
D
Feedback:
The three main approaches to the tertiary
prevention of communicable disease include
care and treatment, isolation and quarantine,
and safe handling and control of infectious
wastes. The primary prevention techniques
for communicable disease include education,
immunization, and screening. The secondary
prevention techniques for communicable
disease include case and contact investigation,
notification, and treatment.
A)
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B)
C)
yn
D)
w
w
w
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Ans:
A)
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om
B)
If an agency discards used needles and
syringes in plastic milk jugs, which of the
four key elements of an infectious waste
14.
management program that are applicable to
community practice would the agency be
violating?
Health professionals must be able to correctly
distinguish biohazardous waste from
biomedical waste.
The waste management program must have
administrative support and authority to
institute practice guidelines.
Handling of the infectious wastes must be
minimized. Containers should be rigid, leak
resistant, and impervious to moisture.
An enforcement or evaluation mechanism
must be in place to ensure that the potential
for exposure to infectious waste is met.
C
Feedback:
Handling of the infectious wastes must be
minimized. Containers should be rigid, leak
resistant, and impervious to moisture; they
should have sufficient strength to prevent
rupture or tearing under normal conditions;
and they should be sealed to prevent leakage.
Containers for sharps must also be puncture
resistant. Other key elements of an infectious
waste management program that are
applicable to community practice include that
health professionals must be able to correctly
distinguish biohazardous waste from
biomedical waste; the waste management
program must have administrative support
and authority to institute practice guidelines;
and an enforcement or evaluation mechanism
must be in place to ensure that the potential
for exposure to infectious waste is met.
re
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C)
D)
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Ans:
A)
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B)
The community health nurse determines that
the adult population in the community has an
increased incidence of vaccine preventable
15.
disease. Which of the following are factors
that may contribute to low vaccination levels
among adults? Select all that apply.
Lack of comprehensive vaccine delivery
systems to the public and private sectors for
adults (similar to the Vaccines for Children
program for children)
Lack of statutory requirements for vaccination
of adults
Health care providers may lack current
information about recommended adult
immunizations and may miss opportunities to
vaccinate adults during contacts in offices,
outpatient clinics, and hospitals.
Adults fear injections for immunizations but
do not worry about adverse effects after
vaccination.
A multitude of comprehensive vaccination
programs exist in settings where healthy
adults congregate such as workplaces and
other locations.
A, B, C
Feedback:
Low vaccination levels among adults are
associated with several factors: limited
comprehensive vaccine delivery systems that
are available; lack of statutory requirements
for vaccination of adults; and frequently
missed opportunities for vaccinating adults
during contacts in offices, outpatient clinics,
and hospitals. Additionally there is a lack of
comprehensive vaccination programs in
settings where healthy adults congregate; and
clients and providers may fear adverse
reactions after vaccination.
re
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C)
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D)
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E)
w
w
w
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Ans:
16.
A)
B)
C)
D)
Ans:
A community health nurse would recommend
pneumococcal vaccine for which group?
1-year-old children
30-year-old adults who have simple
respiratory tract infections
Adults over age 65 who have COPD
Healthy adults in their 50s
C
Feedback:
16.
A)
B)
st
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C)
D)
Ans:
A community health nurse would recommend
pneumococcal vaccine for which group?
1-year-old children
30-year-old adults who have simple
respiratory tract infections
Adults over age 65 who have COPD
Healthy adults in their 50s
C
Feedback:
Primary prevention includes a pneumococcal
vaccine, especially for the high-risk groups,
ages 2 years old and up, including those with
chronic diseases, immune-suppressing health
conditions, or those who are asplenic.
Reimmunization is recommended only for
high-risk children, or adults over 65 years old
who had their first vaccination before age 65.
The vaccine is not effective in children
younger than 2 years of age and is not
recommended for the healthy population
between the ages of 2 and 65 years.
te
Which of the following statements about
immunization is most accurate?
Immunization is helpful in the spread of all
communicable diseases.
Immunization cannot provide herd immunity.
Immunization is the process of introducing a
form of a disease-causing organism into a
person's system to promote the development
of antibodies that will resist the disease.
Immunization is the process of administering
antibodies to a person.
C
Feedback:
Immunization is the process of introducing a
form of a disease-causing organism into a
person's system to promote the development
of antibodies that will resist the disease. There
are many communicable diseases that a
vaccine is not known for. Immunization can
help to promote herd immunity. Immunization
does not involve the administration of
antibodies to a person.
ur
si
ng
17.
A)
yn
B)
Ans:
w
w
w
D)
.m
C)
A family member has developed tuberculosis
(TB) and the remainder of the family
members are undergoing tuberculosis skin
18. testing to determine their status. The nurse
assesses the indurations and determines that a
family member with which size induration is
positive for TB?
2 mm
3 mm
4 mm
5 mm
D
Feedback:
An induration of 5 mm or more is considered
positive for individuals in close contact with
others who have TB. Indurations <5 mm are
not considered positive.
st
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A)
B)
C)
D)
Ans:
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The community health nurse observes an
increase in the development of multidrug19. resistant tuberculosis. The nurse understands
that a major reason for this occurrence for
individual clients would most likely be
political and social response to declining rates
of TB over the past decade.
a reduction in funding for surveillance and
research.
noncompliance with the therapy for the full,
recommended period.
a premature sense that TB has been defeated.
C
Feedback:
On an individual case basis, the most
common means by which resistant organisms
are acquired is by noncompliance with
therapy for the full, recommended period.
Factors that seem to contribute to the overall
increase in multidrug-resistant tuberculosis
include the political and social response to
declining rates of TB over past decades,
which has resulted in funding cuts for
surveillance, treatment, and research, and a
premature sense that TB was defeated.
yn
A)
w
D)
Ans:
w
w
C)
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B)
A)
B)
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C)
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D)
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E)
w
w
w
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yn
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ng
Ans:
A)
B)
Which of the following statements about the
20. prevention of sexually transmitted diseases is
true? Select all that apply.
Many persons who have HIV infection can
stave off AIDS by the use of medications
during the HIV stage of the spectrum.
Screening programs have actually reduced the
incidence of Chlamydia as infected persons
are identified and treated.
The proper use of condoms prevents
transmission of all sexually transmitted
infections.
Expedited partner treatment can prevent the
spread of Chlamydia and gonorrhea.
It is not possible for a person who has a
HSV-2 infection to transmit the infection to
other sex partners if sexual contact is only
practiced when the person does not have any
visible sores.
A, B, D
Feedback:
Many persons who have HIV infection can
stave off AIDS by the use of medications
during the HIV stage of the spectrum.
Screening programs have actually reduced the
incidence of Chlamydia as infected persons
are identified and treated. Expedited partner
treatment can prevent the spread of
Chlamydia and gonorrhea. The proper use of
condoms reduces the risk of sexually
transmitted infection transmission but does
not eliminate the transmission of all sexually
transmitted infections. It is possible for a
person who has HSV-2 infection to transmit
the infection to other sex partners if sexual
contact is practiced even when the infected
partner does not have a visible sore.
Which one of the following statements is true
21. about the consequences of biologic terrorism
with anthrax and smallpox?
Anthrax is not usually spread by person to
person contact and so is not a good agent of
biological terrorism.
Smallpox is globally eradicated and therefore
does not present a problem.
Which one of the following statements is true
21. about the consequences of biologic terrorism
with anthrax and smallpox?
Anthrax is not usually spread by person to
person contact and so is not a good agent of
biological terrorism.
Smallpox is globally eradicated and therefore
does not present a problem.
Most adults are immune to smallpox due to
routine immunization.
As many as one in five persons who become
ill with cutaneous anthrax die and inhalation
anthrax can cause death in 3 to 5 days.
D
Feedback:
The case–fatality rate for cutaneous anthrax is
5% to 20%. Inhalation anthrax initial
symptoms are mild and nonspecific but
progress to respiratory distress, fever, shock,
and expected death within a matter of days.
Anthrax is not usually spread by person to
person contact, but it has been demonstrated
to be an agent of biologic terrorism via spores
that were placed in mail right after the 2001
terrorist attacks. Many adults are not immune
to smallpox as it has not been used for routine
immunization for 40 years.
A)
B)
C)
D)
B)
C)
D)
Ans:
w
w
A)
w
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yn
ur
si
ng
te
st
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om
Ans:
Which of the following statements about
22. confidentiality, privacy, and discrimination is
the most accurate?
It is permissible for a community health nurse
to reveal the name and any other personal
health information of a person who has a
communicable disease to the public health
authorities.
It is permissible for a community health nurse
to tell the contacts of a person who is infected
with a communicable disease which disease
they have been exposed to and the name of
the source.
It is permissible for any health care provider
to report any cases of known or suspected
communicable diseases to the news media.
Only the identity of the index case of a
communicable disease needs to be protected.
A
Feedback:
It is permissible and necessary for a
community health nurse to reveal the name
and any other personal health information of a
It is permissible for any health care provider
to report any cases of known or suspected
communicable diseases to the news media.
Only the identity of the index case of a
communicable disease needs to be protected.
A
Feedback:
It is permissible and necessary for a
community health nurse to reveal the name
and any other personal health information of a
person who has a communicable disease to
the public health authorities. It is important
that the contacts of a person who is infected
with a communicable disease which disease
they have been exposed to but is not
acceptable for the community health nurse to
reveal the identity of the source. It is
permissible and often helpful for a
community health nurse to involve the news
media in informing the public of information
about the specific disease including mode of
transmission, prevention, and treatment
options but not the identity(ies) of the cases. It
is important to assure the individual being
interviewed that the information will be
maintained in a confidential manner, and the
goal is care and treatment.
C)
D)
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Ans:
A)
B)
C)
D)
Ans:
w
w
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yn
Chapter 9 Environmental Health & Safety
A community health nurse is presenting an inservice for a group of other community health
nurses about ecological perspective of
1.
environmental health. Which of the following
would the nurse incorporate into the program
when describing this concept?
The study of governmental and private sector
regulations of the environment
A technological view of strategies for
preventing illness and injury
Identification of not only the physical
environment but also the social and cultural
factors that exist for populations
The role of the community health nurse in
preventing injury, disease, and illness
C
Feedback:
The ecological perspective identifies not only
the physical environment but also the social
and cultural factors that exist for populations.
Nurses who display this type of approach
provide a more comprehensive level of care.
It is not a study of the governmental and
factors that exist for populations
The role of the community health nurse in
preventing injury, disease, and illness
C
Feedback:
The ecological perspective identifies not only
the physical environment but also the social
and cultural factors that exist for populations.
Nurses who display this type of approach
provide a more comprehensive level of care.
It is not a study of the governmental and
private sector regulations, a technological
view, or the nurse's role in preventing injury,
disease, and illness.
D)
re
p
A)
B)
st
p
C)
te
D)
w
w
w
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yn
ur
si
ng
Ans:
A)
B)
C)
D)
Ans:
When applying the ecological perspective to
environmental health, a community health
2.
nurse integrates which of the following
concepts as most essential?
Primary prevention is limited in this area.
The need for foresight in designing
innovations
No one factor can be viewed in isolation.
Implications of scientific advances are fully
understood.
C
Feedback:
With the ecological perspective, no one factor
can be viewed in isolation. The preventive
approach involves all three levels of
prevention, of which primary prevention is
the most important. This approach also
requires foresight in designing innovations
and involves implications associated with the
unprecedented advances in science and
technology.
.c
om
Ans:
Which of the following concepts is used by
public health professionals to illustrate that
3.
the determinants of health interact to affect
health?
Precautionary principle
Ecological perspective
Sustainability
Upstream focus
B
Feedback:
The ecological perspective is used by public
health professionals to illustrate that the
determinants of health interact to affect
health. The precautionary principle states that
in the absence of clear data that indicates the
4.
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ng
te
B)
C)
D)
w
w
w
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yn
Ans:
A)
B)
C)
D)
Ans:
Which of the following statements about an
upstream focus is the most accurate?
The upstream approach does not focus on
socioeconomic factors and the environmental
origins of disease and health problems.
The focus of an upstream approach is the
institution and system level.
The upstream approach pertains to the purity
of water supplies.
The focus of an upstream approach is healthy
lifestyle issues.
B
Feedback:
The focus of an upstream approach is the
institution and system level, and not just
healthy lifestyle issues. The upstream
approach does focus on socioeconomic
factors and the environmental origins of
disease and health problems. The upstream
approach does not pertain to the purity of
water supplies.
st
p
A)
.c
om
Ecological perspective
Sustainability
Upstream focus
B
Feedback:
The ecological perspective is used by public
health professionals to illustrate that the
determinants of health interact to affect
health. The precautionary principle states that
in the absence of clear data that indicates the
safety of an action, chemical or material that
poses a threat to human health, it should not
be used. Sustainability is “the ability to meet
the needs of the present without
compromising the ability of future
generations to meet their own needs.”
Upstream focus identifies the root causes of
disease and manufacturers of illness.
re
p
B)
C)
D)
Ans:
When the public health nurse uses an
upstream approach to improve heart health,
5.
the nurse would examine which one of the
following factors?
Unhealthy diets
Decreased physical activity
Smoking tobacco
Lack of safe places to exercise
D
Feedback:
The upstream approach focuses on the factors
5.
.c
om
A)
B)
C)
D)
Ans:
upstream approach to improve heart health,
the nurse would examine which one of the
following factors?
Unhealthy diets
Decreased physical activity
Smoking tobacco
Lack of safe places to exercise
D
Feedback:
The upstream approach focuses on the factors
at the institutional and system level rather
than looking at healthy lifestyle issues.
Healthy diets, increased physical activity, and
smoking cessation are all healthy lifestyle
issues. The root causes of the decreased
physical activity would include lack of safe
places to exercise.
st
p
re
p
A public health nurse who uses the upstream
approach would likely focus on which one of
6.
the following contributors to unhealthy diets
in the community?
Consumer preference for sweet, greasy, and
salty foods
Marketing strategies of fast food businesses
Busy lifestyles within the community
Individual acceptance of obesity
B
Feedback:
A public health nurse who uses the upstream
approach would likely focus on factors that
are at the institutional and system level rather
than looking solely at healthy lifestyle issues.
Consumer preference for sweet, greasy, and
salty foods; busy lifestyles within the
community and individual acceptance of
obesity are lifestyle issues. The marketing
strategies of fast food businesses are one root
cause of unhealthy diets in the community.
A)
w
w
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te
B)
C)
D)
Ans:
A)
B)
C)
The nursing student is preparing a report for
class relating to Healthy People 2020 and
7. environmental health. Which of the following
should be included in this report? Select all
that apply.
The agency that prepared this initiative is the
World Health Organization.
The overall goal is to “promote health for all
through a healthy environment.”
The document provides instructions for
persons in the community regarding how to
protect their own health.
7. environmental health. Which of the following
should be included in this report? Select all
that apply.
The agency that prepared this initiative is the
World Health Organization.
The overall goal is to “promote health for all
through a healthy environment.”
The document provides instructions for
persons in the community regarding how to
protect their own health.
One of the six focus areas is global
environmental health.
The document provides guidance for nurses to
identify targets for health.
B, D, E
Feedback:
The overall goal of Healthy People 2020 is to
“promote health for all through a healthy
environment.” The document does provide
guidance for nurses to identify targets for
health (not instructions for individuals). The
six areas that are focused on include outdoor
air quality, surface and ground water quality,
toxic substances and hazardous wastes, homes
and communities, infrastructure and
surveillance, and global environmental health.
The agency that prepared this initiative is the
U.S. Department of Health and Human
Services.
A)
B)
C)
D)
E)
B)
C)
D)
Ans:
w
w
A)
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Ans:
Which one of the following statements about
assessment (one of the core public health
8.
functions) and how it can be applied to
environmental health is most accurate?
Assessment includes the investigation of
health hazards, surveillance of health issues,
examining causes, and assessing needs.
Assessment is least valuable when related to
where the person attends school.
It is not necessary for nurses to have a
background in the environmental health
sciences.
Assessment should be limited to the general
population and should not include the
increased vulnerability of certain groups.
A
Feedback:
Assessment includes the investigation of
health hazards, surveillance of health issues,
examining causes, and assessing needs. With
assessment, priority should be given to
locations where people spend the majority of
their time (home, work, school). Where
Assessment should be limited to the general
population and should not include the
increased vulnerability of certain groups.
A
Feedback:
Assessment includes the investigation of
health hazards, surveillance of health issues,
examining causes, and assessing needs. With
assessment, priority should be given to
locations where people spend the majority of
their time (home, work, school). Where
persons attend school is too limiting as many
people do not go to school and the priority
should be given to home and work. The
ability to perform critical assessments for
environmental health requires background in
the environmental health sciences. Public
health nurses must also be aware of the
increased vulnerability of certain groups.
D)
re
p
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om
Ans:
st
p
The core public health function of policy
9. development related to environmental health
includes which one of the following?
Policy development is best left to legislators.
To be an effective advocate for change, it is
only necessary that the nurse speak out.
There are many ways for public health nurses
to participate in policy development related to
environmental health.
Public health nurses are public servants and
therefore cannot advocate for public policy.
C
Feedback:
There are many ways for a public health
nurses to participate in policy development
related to environmental health that start with
the nurse being informed about the hazards in
the community, existing legislation that
protects people in the community, and
governmental and nongovernmental groups in
communities that can be partners in the efforts
to protect health. They may write letters to
their legislators, inform community members,
and write letters to the editors of local
newspapers and periodicals. Nurses can also
present testimony at public forums or
hearings. Policy development is not best left
to legislators. It is important for nurses to
advocate for policy development to care for
the environment. Public health nurses are
public servants and that is why they must
advocate for policy development that favors
the environment.
A)
ur
si
ng
te
B)
C)
yn
D)
w
w
w
.m
Ans:
environmental health.
Public health nurses are public servants and
therefore cannot advocate for public policy.
C
Feedback:
There are many ways for a public health
nurses to participate in policy development
related to environmental health that start with
the nurse being informed about the hazards in
the community, existing legislation that
protects people in the community, and
governmental and nongovernmental groups in
communities that can be partners in the efforts
to protect health. They may write letters to
their legislators, inform community members,
and write letters to the editors of local
newspapers and periodicals. Nurses can also
present testimony at public forums or
hearings. Policy development is not best left
to legislators. It is important for nurses to
advocate for policy development to care for
the environment. Public health nurses are
public servants and that is why they must
advocate for policy development that favors
the environment.
D)
te
st
p
re
p
.c
om
Ans:
C)
D)
E)
Ans:
w
B)
w
w
A)
.m
yn
ur
si
ng
A community health nurse is enacting policy
development by preparing a presentation for a
group of state health officials about the issue
10.
of water pollution in the United States. Which
of the following would the nurse include?
Select all that apply.
Globally, the availability of clean water is
becoming a very serious threat to human
survival.
Water pollutants consist solely of chemicals.
Recently, there has been an increase in the
concern about pharmaceuticals contaminating
water supplies.
All water that is to be consumed is regulated
through the EPA.
The people most vulnerable to serious health
problems are the very young, the very old,
and the immune-compromised.
A, C, E
Feedback:
Globally, the availability of clean water is
becoming a very serious threat to human
survival. Recently, there has been an increase
in the concern about pharmaceuticals
contaminating water supplies. The people
most vulnerable to serious health problems
are the very young, the very old, and the
immune-compromised. Water pollutants
The people most vulnerable to serious health
problems are the very young, the very old,
and the immune-compromised.
A, C, E
Feedback:
Globally, the availability of clean water is
becoming a very serious threat to human
survival. Recently, there has been an increase
in the concern about pharmaceuticals
contaminating water supplies. The people
most vulnerable to serious health problems
are the very young, the very old, and the
immune-compromised. Water pollutants
consist of organic and inorganic chemicals,
contamination with microbes,
pharmaceuticals, pesticides and insecticides,
and radionuclides. The EPA only regulates
public water systems.
E)
.c
om
Ans:
te
st
p
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A community health nurse is working with the
local health departments to educate the
citizens about the effects of radon exposure
11.
and its link to possible illness. Which of the
following would the nurse identify as being a
major health concern associated with radon?
Skin cancer
Lung cancer
Diarrhea
Cardiovascular disease
B
Feedback:
Radon is a leading cause of death from lung
cancer. Skin cancer is associated with sun
exposure. Diarrhea and cardiovascular disease
are not associated with radon exposure.
w
w
w
.m
yn
ur
si
ng
A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
During a community program about food
safety, a participant asks, “I know it is
important to use safe food practices to avoid
12. microbial contamination, but what other
possible risks are there with our food
supply?” Which response by the nurse would
be most appropriate?
“Nothing is more of a problem than foodborne illness.”
“Risks occur only at food production and not
handling or consumption.”
“Radiating food is something that really
doesn't occur in the United States.”
“A recent concern has been raised about
genetically modified foods being marketed.”
D
be most appropriate?
“Nothing is more of a problem than foodborne illness.”
“Risks occur only at food production and not
handling or consumption.”
“Radiating food is something that really
doesn't occur in the United States.”
“A recent concern has been raised about
genetically modified foods being marketed.”
D
Feedback:
There are many possible risks to the food
supply, some even having more serious
effects than food-borne illness. Risks occur at
all points from food production to food
consumption. Radiating food does occur in
the United States. A recent concern has been
raised about genetically modified foods being
marketed. Genetically modified foods may
interfere with the safety of food for human
consumption and also questions about the
ecological impact and sustainability have
been raised.
A)
B)
C)
D)
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Which of the following groups of persons
have increased vulnerability to environmental
13.
hazards to human health related to food?
Select all that apply.
Pregnant women are likely to transmit their
exposure to chemicals, pesticides, and toxins
to the unborn fetus.
Persons who have altered immunity are more
likely to be affected by food exposures.
Middle-aged males
Children are more susceptible to hazards due
to their immature gastrointestinal systems and
increased food intake per size.
Adult women who are nonchildbearing
A, B, D
Feedback:
Pregnant women are likely to transmit their
exposure to chemicals, pesticides, and toxins
to the unborn fetus. Persons who have altered
immunity are more likely to be affected by
food exposures. Children are more susceptible
to hazards due to their immature
gastrointestinal systems and increased food
intake per size. Middle-aged males and adult
women who are nonchildbearing are not
especially vulnerable to environmental
hazards to human health.
D)
E)
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D)
to their immature gastrointestinal systems and
increased food intake per size.
Adult women who are nonchildbearing
A, B, D
Feedback:
Pregnant women are likely to transmit their
exposure to chemicals, pesticides, and toxins
to the unborn fetus. Persons who have altered
immunity are more likely to be affected by
food exposures. Children are more susceptible
to hazards due to their immature
gastrointestinal systems and increased food
intake per size. Middle-aged males and adult
women who are nonchildbearing are not
especially vulnerable to environmental
hazards to human health.
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E)
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Which of the following are variables that
14. occur in nature and could have a negative
impact on humans? Select all that apply.
The effect of climate change upon weather
extremes (droughts, floods, and storms)
Changes in rainfall and water supply for soil
Ecology of microbial growth
Risks for waterborne and food-borne
pathogens in drinking water, seafood, and
fresh produce because of climate variability
There is adequate food supply and always will
be.
A, B, C, D
Feedback:
The variables related to the food supply that
occur in nature and could have a negative
impact on humans include the effect of
climate change upon weather extremes
(droughts, floods, and storms); changes in
rainfall and water supply for soil; ecology of
microbial growth; risks for water-borne and
food-borne pathogens in drinking water,
seafood, and fresh produce because of climate
variability. There are currently food shortages
in parts of the world, and this is likely to
continue and may worsen.
A)
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C)
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E)
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An instructor is reviewing the evolution of
environmental health and the development of
various agencies designed to protect health.
15. As part of the review, the instructor includes
the Environmental Protection Agency (EPA),
describing its primary goal as which of the
following?
Identify and address world health issues
Protect occupational safety and health
Monitor food and drug production and
availability
Set standards and monitor and enforce
environmental protection
D
Feedback:
The EPA was established for the purpose of
standard setting, monitoring, and enforcement
of environmental protection. The World
Health Organization (WHO) identifies and
addresses world health issues. The
Occupational Safety and Health
Administration (OSHA) protects occupational
safety and health. The Food and Drug
Administration (FDA) is responsible for
monitoring food and drug production and
availability.
A)
B)
C)
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Chapter 10 Communication, Collaboration, and Technology
When educating clients, which of the
following parts of the communication process
1.
would be most important for the nurse to
ensure?
A)
Limit setting
B)
Feedback loop
C)
Goal direction
D)
Nonverbal expression
Ans:
B
Feedback:
A major component of the communication
process is the feedback loop, which allows
both the sender and the receiver to check on
the success of the transference of meaning
and to renegotiate the message to allow for
clarity and better understanding. Limit setting
may or may not be appropriate. Although
Feedback loop
Goal direction
Nonverbal expression
B
Feedback:
A major component of the communication
process is the feedback loop, which allows
both the sender and the receiver to check on
the success of the transference of meaning
and to renegotiate the message to allow for
clarity and better understanding. Limit setting
may or may not be appropriate. Although
therapeutic communication is goal directed
and involves nonverbal expressions, these are
not parts of the communication and they are
not as important as making sure the message
has been understood correctly.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
E)
F)
Ans:
A community health nurse sends an e-mail
stating a request to the local health
2.
department. This is an example of which part
of communication?
Sender
Message
Decoding
Channel
D
Feedback:
A channel is the medium through which the
sender conveys the message. It may be
written, spoken, or nonverbal. Sending an email is an example. The sender is the person
conveying the message. The message is the
expression of the purpose of the
communication. Decoding is the translation of
the message into an understandable form by
the receiver.
Which of the following steps of the
communication process does the community
3.
health nurse who is serving as the sender have
the most control of? Select all that apply.
The receiver
The decoding
The message
The channel
The feedback loop
The encoding
C, D, F
Feedback:
The community health nurse who is serving
as the sender in the communication process
The receiver
The decoding
The message
The channel
The feedback loop
The encoding
C, D, F
Feedback:
The community health nurse who is serving
as the sender in the communication process
has the most control over the sender, the
message, the channel (the medium through
which the sender conveys the message), and
the encoding (the sender decides which
specific signals or codes such as language,
words, gestures, and body language to use).
The community health nurse does not have
much control over the receiver, the decoding
(the receiver's interpretation of the message),
or the feedback loop (a way for the sender and
receiver to check on the success of the
transference of meaning and to renegotiate the
message to allow for clarity and better
understanding), all of which are controlled by
the receiver.
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A)
B)
C)
D)
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A)
B)
C)
D)
E)
F)
Ans:
A)
B)
C)
Which of the following would a community
4. health nurse identify as most important to
sending skills involved with communication?
Active listening
Paraphrasing
Nonverbal messages
Rapport
C
Feedback:
Sending skills involve the ability to transmit
the messages effectively. Two main channels
to send messages are nonverbal and verbal
messages. Active listening and paraphrasing
are involved with receiving skills. Rapport is
an interpersonal skill.
When communicating with a group of clients,
which of the following would the nurse
5.
identify as a barrier to the communication
process?
The nurse's sharing of complete and accurate
information with the clients
The clients' use of medical terminology in the
discussion
The clients' offering of feedback to allow the
nurse to learn what the client understands
When communicating with a group of clients,
which of the following would the nurse
5.
identify as a barrier to the communication
process?
The nurse's sharing of complete and accurate
information with the clients
The clients' use of medical terminology in the
discussion
The clients' offering of feedback to allow the
nurse to learn what the client understands
The clients' interpretation of the message
through their own perceptions
D
Feedback:
Selective perception is the interpretation of a
message through their own perceptions, and
projects this onto the communication process
as they decode a message. Sharing complete
and accurate information, client's use of
medical terminology, and the clients' offering
of feedback to allow the nurse to learn what
the client understands are important skills of
effective communication.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A community health nurse is dealing with a
family in crisis. The nurse remains calm and
6. firmly reassuring when communicating with
them. This nurse is avoiding which barrier to
communication?
Filtering information
Emotional influence
Language barrier
Selective perception
B
Feedback:
The nurse is avoiding emotional influence,
that is, how a person feels at the time a
message is sent or received, which can
influence its meaning. Senders can distort
messages and receivers can interpret
messages incorrectly when emotions cloud
their perception. Emotions can interfere with
rational and objective reasoning, thus
blocking communication. Filtering
information means manipulating information
by the sender to influence the receiver's
response. Language barriers involve the
different interpretations of words by people.
Selective perception involves the receivers
interpreting a message through their own
perceptions, which are influenced by their
own experiences, interests, values,
Emotional influence
Language barrier
Selective perception
B
Feedback:
The nurse is avoiding emotional influence,
that is, how a person feels at the time a
message is sent or received, which can
influence its meaning. Senders can distort
messages and receivers can interpret
messages incorrectly when emotions cloud
their perception. Emotions can interfere with
rational and objective reasoning, thus
blocking communication. Filtering
information means manipulating information
by the sender to influence the receiver's
response. Language barriers involve the
different interpretations of words by people.
Selective perception involves the receivers
interpreting a message through their own
perceptions, which are influenced by their
own experiences, interests, values,
motivations, and expectations.
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B)
C)
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A)
B)
C)
D)
Ans:
Which of the following statements about
filtering messages is most accurate?
Filtering is always intentional.
Filtering is never intentional.
Only clients use filtering.
Filtering leads to miscommunication and
misinterpretation.
D
Feedback:
Filtering leads to miscommunication and
misinterpretation. Filtering can be intentional
or unintentional and may be used by clients or
nurses.
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B)
C)
D)
Ans:
During an interview with several clients, the
community health nurse assumes
8. responsibility for and strives to understand the
feelings and thoughts of the client. The nurse
is demonstrating which of the following?
Reflection
Respect
Empathy
Active listening
D
Feedback:
Active listening is the skill of assuming
responsibility for and striving to understand
the feelings and thoughts in a sender's
is demonstrating which of the following?
Reflection
Respect
Empathy
Active listening
D
Feedback:
Active listening is the skill of assuming
responsibility for and striving to understand
the feelings and thoughts in a sender's
message. The nurse actively works to
discover what the clients mean. Reflection
involves restating what clients or others have
said to clarify the received meaning. Respect
involves conveying an attitude that clients and
others have importance, dignity, and worth.
Empathy is the ability to communicate
understanding and to vicariously experience
the feelings and thoughts of others.
9.
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A)
B)
Which action by a community health nurse
demonstrates respect to the client?
Feeling the same emotion that the client has
Addressing the client as “Mr.” or “Mrs.”
Being open and genuine with the client
Having self-awareness
B
Feedback:
Showing respect means conveying the attitude
that clients and others have importance,
dignity, and worth, such as by the manner in
which the nurse addresses people—for
instance, by using the courtesy titles of “Mr.”
or “Mrs.” until it is determined how the client
wants to be addressed. Putting one's self in
the client's shoes demonstrates empathy; this
is not the same as feeling the same emotion
that the client has. Being open and genuine
establishes rapport. Having self-awareness is
a part of empathy that allows an individual to
accurately demonstrate this understanding to
the client.
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A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
Which one of the following statement about
10. health literacy and health outcomes is most
accurate for clients who have low literacy?
It is important to make the message as basic
and simple as possible because the client
likely has low intelligence.
It is best to use written materials for clients
who have low literacy.
It is very important for clients who have low
Which one of the following statement about
10. health literacy and health outcomes is most
accurate for clients who have low literacy?
It is important to make the message as basic
and simple as possible because the client
likely has low intelligence.
It is best to use written materials for clients
who have low literacy.
It is very important for clients who have low
literacy to have ample opportunity to provide
feedback.
Health literacy is not a very important factor
in mortality and morbidity.
C
Feedback:
It is very important for clients who have low
literacy to have ample opportunity to provide
feedback that will demonstrate understanding.
Communication with low-literacy, high-risk
groups should be simplified and easy-to-read
materials. At the same time, there is the
danger of making the communication so
simple that the reader feels insulted. It has
been well documented that most health
information pamphlets, brochures, and other
materials cannot be read or comprehended by
adults who have low literacy. Those who have
the lowest literacy levels have the highest
mortality and morbidity.
A)
B)
C)
D)
B)
C)
D)
E)
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11.
Which of the following are key issues related
to health literacy? Select all that apply.
Health literacy is characterized as critical to
health promotion and disease prevention.
Limited health literacy only affects those who
have low educational levels.
Poor health literacy skills can contribute to
increased health care costs.
Health literacy involves the ability to read,
understand, and act on health information.
Health literacy goes beyond the basic
definitions of literacy.
A, C, D, E
Feedback:
Health literacy is characterized as critical to
health promotion and disease prevention.
Limited health literacy affects people of all
races, incomes, ages, and educational levels.
Poor health literacy skills have been
associated with poorer health status and
increased health care costs because people
D)
understand, and act on health information.
Health literacy goes beyond the basic
definitions of literacy.
A, C, D, E
Feedback:
Health literacy is characterized as critical to
health promotion and disease prevention.
Limited health literacy affects people of all
races, incomes, ages, and educational levels.
Poor health literacy skills have been
associated with poorer health status and
increased health care costs because people
with a low-literacy level are less
knowledgeable about their health conditions
and are less likely to seek preventative care.
Health literacy involves the ability to read,
understand, and act on health information.
Health literacy goes beyond the basic
definitions of literacy and includes cultural
literacy, computer literacy, scientific, media,
and technological literacy.
E)
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While working with a community group, a
community health nurse observes the group
12. sharing ideas and opinions and being creative.
The nurse determines that the group is in
which stage?
Forming
Storming
Norming
Performing
C
Feedback:
During the norming stage, trust and openness
are more apparent, and there is a sharing of
ideas and opinions and creativity. The
forming stage is characterized by members
becoming oriented to each other. The
storming stage involves conflict and
competition with the group getting down to
sharing more sensitive issues. The performing
stage is characterized by the ability to work as
a total group, in subgroups, or independently.
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A)
B)
C)
D)
Ans:
A)
B)
C)
Which of the following descriptions of the
13. five stages in group development are
accurate? Select all that apply.
All groups eventually reach the performing
stage.
The storming stage is detrimental to group
development.
Loss of group affiliation often occurs with
Which of the following descriptions of the
13. five stages in group development are
accurate? Select all that apply.
All groups eventually reach the performing
stage.
The storming stage is detrimental to group
development.
Loss of group affiliation often occurs with
adjourning.
The group begins to focus more on
maintenance rather than just tasks during the
norming stage.
Conflict is inherent in the forming stage.
C, D
Feedback:
During the adjourning stage, the group must
disengage, and this may cause feelings of
loss. The group begins to focus more on
maintenance rather than just tasks during the
norming stage. Not all groups do reach the
performing stage. The storming stage is
necessary to allow group members to identify
roles, expectations, and get a feel of how the
group will work together. Conflict is to be
avoided at the forming stage but must occur at
the storming stage.
A)
B)
C)
D)
A)
B)
C)
D)
Ans:
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E)
Ans:
A community health nurse is part of a group
dealing with health issues. During one of the
meetings, the nurse states, “Let's all take
14. about 5 minutes to share ideas so that
everybody will have a chance to be heard.”
The nurse is demonstrating which of the
following?
Encouraging
Gatekeeping
Blocking
Mediating
B
Feedback:
The nurse is demonstrating the maintenance
role behavior of gatekeeping, by trying to
make it possible for another member to make
a contribution to the group such as by saying,
“We haven't heard from Jim yet” or
suggesting limited talking time for everyone
so that all will have a chance to be heard.
Encouraging is demonstrated by being
friendly, warm, and responsive to others,
praising others and their ideas, and agreeing
with and accepting the contributions of others.
Gatekeeping
Blocking
Mediating
B
Feedback:
The nurse is demonstrating the maintenance
role behavior of gatekeeping, by trying to
make it possible for another member to make
a contribution to the group such as by saying,
“We haven't heard from Jim yet” or
suggesting limited talking time for everyone
so that all will have a chance to be heard.
Encouraging is demonstrated by being
friendly, warm, and responsive to others,
praising others and their ideas, and agreeing
with and accepting the contributions of others.
Blocking is demonstrated by going off on a
tangent, citing personal experiences unrelated
to the problem, arguing too much on a point,
or rejecting ideas without consideration.
Mediating involves attempts to harmonize,
conciliate differences in point of view, or
suggest compromises.
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B)
C)
D)
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B)
C)
D)
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A community health nurse working as part of
group uses the group as a sounding board,
15. often expressing personal, nongroup-related
feelings. This nurse is demonstrating which of
the following nonfunctional behaviors?
Self-confession
Aggression
Competition
Sympathy seeking
A
Feedback:
Self-confession involves using the group as a
sounding board, expressing personal,
nongroup-oriented feelings or points of view.
Aggression involves working for status by
criticizing or blaming others, showing
hostility toward the group or some individual
and deflating egos or status of others.
Competition involves vying with others to
produce the best idea, talk the most, play the
most roles, and gain favor with the leader.
Sympathy seeking involves trying to induce
other group members to be sympathetic to
one's problems or misfortunes, for example,
deploring one's own situation, or disparaging
one's own ideas to gain support.
Aggression
Competition
Sympathy seeking
A
Feedback:
Self-confession involves using the group as a
sounding board, expressing personal,
nongroup-oriented feelings or points of view.
Aggression involves working for status by
criticizing or blaming others, showing
hostility toward the group or some individual
and deflating egos or status of others.
Competition involves vying with others to
produce the best idea, talk the most, play the
most roles, and gain favor with the leader.
Sympathy seeking involves trying to induce
other group members to be sympathetic to
one's problems or misfortunes, for example,
deploring one's own situation, or disparaging
one's own ideas to gain support.
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B)
C)
D)
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B)
C)
D)
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When the community health nurse encourages
the group members of a collaborative
partnership of interdisciplinary teams to
effectively share ideas and frustrations on an
16.
equal, reciprocal basis, the community health
nurse is focusing on which of the five
characteristics of collaboration in community
health?
Maximized use of resources
Clear responsibilities
Shared goals
Mutual participation
B
Feedback:
When the community health nurse encourages
the group members of a collaborative
partnership of an interdisciplinary team to
effectively share ideas and frustrations on an
equal, reciprocal basis, the community health
nurse is focusing on the mutual participation
characteristic. The characteristic of
maximized use of resources involves
designing the collaborative partnership of
those who are most knowledgeable and in the
best positions to influence a favorable
outcome. The characteristic of clear
responsibilities involves each member in the
partnership plays a specific role with related
tasks. The characteristic of shared goals
involves each member of the team entering
the collaborative relationship with broad
needs or purposed to be met and specific
objectives to accomplish.
Clear responsibilities
Shared goals
Mutual participation
B
Feedback:
When the community health nurse encourages
the group members of a collaborative
partnership of an interdisciplinary team to
effectively share ideas and frustrations on an
equal, reciprocal basis, the community health
nurse is focusing on the mutual participation
characteristic. The characteristic of
maximized use of resources involves
designing the collaborative partnership of
those who are most knowledgeable and in the
best positions to influence a favorable
outcome. The characteristic of clear
responsibilities involves each member in the
partnership plays a specific role with related
tasks. The characteristic of shared goals
involves each member of the team entering
the collaborative relationship with broad
needs or purposed to be met and specific
objectives to accomplish.
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B)
C)
D)
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B)
C)
D)
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A collaborative community health group
working with the teenage population to
improve health draws on the expertise of
17. school nurses and others working with
adolescents to develop a plan. The group is
demonstrating which characteristic of
collaboration?
Shared goals
Mutual participation
Maximized use of resources
Clear responsibilities
C
Feedback:
Maximizing the use of community resources
involves drawing on the expertise of those
who are most knowledgeable and in the best
positions to influence a favorable outcome. In
this case, it would be school nurses and others
working with adolescents. Shared goals are
demonstrated by recognition of the specific
reasons for entering into the relationship, that
is, the improved health of adolescents. Mutual
participation involves the reciprocal exchange
among team members, with all team members
contributing and receiving mutual benefit.
Clear responsibilities involve each member
playing a specific role with related tasks.
Mutual participation
Maximized use of resources
Clear responsibilities
C
Feedback:
Maximizing the use of community resources
involves drawing on the expertise of those
who are most knowledgeable and in the best
positions to influence a favorable outcome. In
this case, it would be school nurses and others
working with adolescents. Shared goals are
demonstrated by recognition of the specific
reasons for entering into the relationship, that
is, the improved health of adolescents. Mutual
participation involves the reciprocal exchange
among team members, with all team members
contributing and receiving mutual benefit.
Clear responsibilities involve each member
playing a specific role with related tasks.
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C)
D)
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Several community health agencies are
collaborating on health promotion strategies.
The community health nurse observes that the
18.
team is working on assessment, planning,
implementation, and evaluation. The nurse
correctly concludes that
the team is made up solely of nurses.
the team is in the beginning phase.
the team is determining the goals they will
work toward.
the team is working together to accomplish
desired goals.
D
Feedback:
The three phases common to the collaboration
process are the beginning phase when the
team relationship is being established and are
identifying the project needs and determine
the goals toward which they will work. The
second phase occurs when team members
start working together to accomplish desired
goals. The work of the second phase may
include assessment, planning,
implementation, and evaluation that will recur
cyclically until the goals are satisfactorily
accomplished. The third phase occurs when
the need for team members to work together
has ended.
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The student nurse correctly identifies the four
19. characteristics of contracting as: Select all
that apply.
format.
partnership and mutuality.
negotiation.
commitment.
legal fees.
A, B, C, D
Feedback:
The four features of contracting in community
health nursing are partnership and mutuality,
commitment, format, and negotiation. Legal
fees are not involved as contracting in
community health nursing is not legally
binding.
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A)
B)
C)
D)
E)
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A)
B)
C)
D)
Ans:
When the nurse and client enter a contract in
community health nursing and the nurse and
20. client share participation and agreement
between them, which characteristic of
contracting is being enacted?
Partnership and mutuality
Commitment
Format
Negotiation
A
Feedback:
The four features of contracting in community
health nursing are partnership and mutuality
(the nurse and the client share participation
and agreement), commitment (the involved
parties make a decision that binds them to
fulfilling the purposed of the contract), format
(outlining of specific terms of the
relationship), and negotiation (the parties
propose to accept certain responsibilities that
are agreed upon by both parties).
A community health nurse determines that
contracting would be effective to use with
21. client groups based on the understanding that
this method is beneficial for which of the
following?
Encouraging client participation in the
decision-making process
Contributing to a trusting nurse–client
relationship
Decreasing client stress during home visits
Reducing client visit time by over 50%
A
Feedback:
The nurse and the client contribute to the
formulation of the contract, thus fostering
client participation in decisions regarding the
direction and activities within the contract.
Contracting also involves commitment,
format, and negotiation. Contributing to trust,
decreasing client stress, and reducing visit
time are not considered benefits associated
with contracting.
A)
B)
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C)
D)
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A community health nurse is contracting with
a client receiving services in the home. The
nurse and client are negotiating the activities
22.
for which each will be responsible. This
correlates with which phase of the nursing
process?
Assessment
Nursing diagnosis
Planning
Evaluation
C
Feedback:
Dividing responsibilities via negotiation
would be part of the planning/intervention
phase of the nursing process. The assessment
phase would involve exploration of needs.
The nursing diagnosis phase would correlate
with goal establishment. Evaluation would
involve formative and summative assessments
of progress toward goals and renegotiation or
termination.
After teaching a group of students about the
23. process of contracting, which statement by the
group indicates successful teaching?
The process is dynamic as it moves through
various phases.
Contracting involves a unidirectional client–
nurse relationship.
The process must move backward before it
can move forward.
Once the contract is developed, it remains
relatively stable.
A
Feedback:
Contracting is a dynamic process that moves
through phases. It forms a reciprocal
relationship between clients, nurse, and other
persons. The process moves forward, focused
on meeting clients' needs, and enables the
collaborating group to facilitate ultimate
achievement of clients' goals.
A)
B)
C)
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B)
C)
D)
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Chapter 11 Health Promotion Through Education
After teaching a class about the stages of
change, the instructor determines that the
1. class understands the information when they
identify the following as the proper sequence
of stages?
Unfreeze, plan, and integrate
Plan, organize, and coordinate
Plan, relearn, and integrate
Unfreeze, change, and refreeze
D
Feedback:
According to Lewin, change occurs in the
following stages: unfreezing the old behavior,
implementing the change, and then refreezing
the new change in place to integrate it into the
system. Planning, relearning, integrating, and
coordinating are not stages of change.
When implementing a program for teaching
parenting to a group of teenagers, the
community health nurse determines that the
2.
group is in the changing/moving stage of
change when the group demonstrates which
of the following?
Motivation for change
Integration of the change
Lack of resistance to the change
Beginning adoption of the change
D
Feedback:
During the changing or moving stage, people
experience a series of attitude
transformations, ranging from early
questioning to full acceptance and
commitment to accomplishing the change.
They examine, accept, and try the innovation
and the nurse helps them see the value of the
change, encourages them to try it, and assists
them in adopting it. Motivation for the change
is part of the unfreezing stage. Showing a lack
of resistance to the change and integration of
the change characterize the refreezing stage.
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A)
B)
C)
D)
Ans:
A)
B)
C)
A client who needs to lose weight as part of
an overall plan to become healthier has
contracted with a nurse for behavior change.
The client is working on increasing fruits and
3. vegetables in his or her diet and currently
consumes less than one fruit or vegetable per
day. The nurse knows that the client is in the
unfreezing stage of change when the client
stated:
“I have been reading a lot about the healing
powers of many fruits and vegetables. I never
ate many fruits and vegetables as a child so I
am not sure how to prepare them. Can you
refer me to some sources of information?”
“I have started to try one serving of fruits and
one serving of vegetables at each meal. I am
starting to discover some of my favorites.”
“I still hate fruits and vegetables and I don't
think I will be successful at integrating them
into my diet.”
“Today I ate a total of 10 servings of fruits
A)
B)
C)
D)
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Ans:
“I have been reading a lot about the healing
powers of many fruits and vegetables. I never
ate many fruits and vegetables as a child so I
am not sure how to prepare them. Can you
refer me to some sources of information?”
“I have started to try one serving of fruits and
one serving of vegetables at each meal. I am
starting to discover some of my favorites.”
“I still hate fruits and vegetables and I don't
think I will be successful at integrating them
into my diet.”
“Today I ate a total of 10 servings of fruits
and vegetables. I really do like them and I feel
great!”
A
Feedback:
In the first stage, a disequilibrium develops
and the system is more vulnerable to change.
People in this stage have a sense of
dissatisfaction and have a void that they
would like to fill. When the client stated, “I
have been reading a lot about the healing
powers of many fruits and vegetables…,” he
or she was expressing disequilibrium. When
the client stated, “I have started to try one
serving of fruit and one serving at vegetables
at each meal…,” he or she was indicating that
he or she is changing. When the client stated,
“I still hate fruits and vegetables…,” he or she
was expressing opposition to change which is
not a part of the change process. When the
client stated, “Today I ate a total of 10
servings of fruits and vegetables…,” the client
was expressing that the change has become
established as an accepted and permanent part
of the system.
A)
B)
C)
D)
Ans:
A community health nurse is applying the
normative–reductive strategy of change when
working with clients. In doing so, the nurse
4.
engages them into changing their behavior in
addition to providing education, based on
which assumption?
Information alone is not enough, and
behaviors change through persuasion.
Compliance by the client system will occur
through the use of power to effect change.
People are rational and will adopt a new
practice because it is in their best interest.
The clients can assume a high degree of
responsibility for their own help.
A
Feedback:
which assumption?
Information alone is not enough, and
behaviors change through persuasion.
Compliance by the client system will occur
through the use of power to effect change.
People are rational and will adopt a new
practice because it is in their best interest.
The clients can assume a high degree of
responsibility for their own help.
A
Feedback:
Normative–reductive strategies not only give
information but also directly influence people
to change attitudes and behaviors through
persuasion. Use of power or coercion is
associated with the power–coercive change
strategy. The Empiric–rational change
strategy is based on the assumption that
people are rational and, when presented with
empiric information, will adopt new practices
that appear to be in their best interest. The
empiric–rational strategy is best used with
clients who can assume a relatively high
degree of responsibility for their own health.
A)
B)
C)
D)
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B)
C)
D)
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The community health nurse is presenting
sexuality education to a group of sixth grade
students. The community health nurse tells
the students that they must never have
5.
unprotected sexual intercourse or they will die
from a sexually transmitted infection and
displays pictures of people dying from AIDS.
The nurse is using which change strategy?
Normative–reeducative
Rational–empiric
Power–coercive
Planned change
C
Feedback:
The community nurse in this scenario is using
power–coercive change strategies that are
based on fear. Normative–reeducative change
strategies present new information and
directly influence people's attitudes and
behaviors through persuasion. Empiric–
rational change strategies are based on the
assumption that people are rational and, when
presented with empiric information, will
adopt new practices that appear to be in their
best interest.
Rational–empiric
Power–coercive
Planned change
C
Feedback:
The community nurse in this scenario is using
power–coercive change strategies that are
based on fear. Normative–reeducative change
strategies present new information and
directly influence people's attitudes and
behaviors through persuasion. Empiric–
rational change strategies are based on the
assumption that people are rational and, when
presented with empiric information, will
adopt new practices that appear to be in their
best interest.
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C)
D)
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As part of a community-wide program
addressing the needs of seniors in the county,
the nurse engages the seniors as well as their
6.
families in the program. The nurse is
demonstrating which principle for effecting
positive change?
Participation
Proper timing
Resistance to change
Interdependence
A
Feedback:
The principle of participation requires
involvement of the persons who will be
affected by the change. The principle of
proper timing requires that it be the right time
to introduce the change. The principle of
resistance to change involves responding to
the instinctive nature of the desire to preserve
the status quo because change poses a threat
to stability and security. The principle of
interdependence requires the view that every
system has many subsystems intricately
related such that a change in one part of the
system may affect other parts.
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B)
C)
D)
Ans:
The community health nurse evaluates his or
her own past personal habit of smoking as he
or she prepares to talk to a group of people
about the importance of smoking cessation.
The nurse recalls that he or she had several
unsuccessful attempts before quitting 1 year
7.
ago today. The nurse decides to share this
information with the group and tells them that
all the attempts he or she had made before
stopping smoking were necessary steps for his
or her eventual success. Which principle of
change was the nurse enacting?
Principle of flexibility
Principle of self-understanding
Principle of interdependence
Principle of proper timing
B
Feedback:
The principle of self-understanding relates to
the change agent (the community health
nurse) should be able to clearly define his or
her role and learn how others define it. The
principle of flexibility is the ability of the
change agent to adapt to unexpected events
and make the most of them. The principle of
interdependence is that a change in one part
of a system affects other parts and a change in
one system may affect other systems. The
principle of proper timing relates to the
knowledge that even the right change may not
occur if the timing is not right.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
The community health nurse is talking to a
group of clients about the health importance
of consuming a low-fat diet. The clients are
members of a particular cultural group that
grows their own food and consumes a lot of
animal protein. The clients state that their
forefathers ate a diet that was high in animal
8. protein and they had lived into their 90s. The
community health nurse expects this
argument and points out that their ancestors
did not have the luxury of modern machines
and they had to engage in a lot more activity
than the current generation. This is an
example of which principle of effecting
change?
Principle of participation
Principle of proper timing
Principle of self-understanding
Principle of resistance to change
D
Feedback:
and they had to engage in a lot more activity
than the current generation. This is an
example of which principle of effecting
change?
Principle of participation
Principle of proper timing
Principle of self-understanding
Principle of resistance to change
D
Feedback:
The nurse was aware that all systems
instinctively resist change and was prepared
to discuss aspects of the clients' cultural
background that related to their current state
of health. This is the principle of resistance to
change. The principle of participation means
that persons affected by the proposed change
should participate as much as possible in
every step of the planned change process. The
principle of proper timing requires that it be
the right time to introduce the change. The
principle of self-understanding relates to the
change agent (the community health nurse)
should be able to clearly define his or her role
and learn how others define it.
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A)
B)
C)
D)
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C)
D)
E)
F)
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A)
Which of the following are examples of a
9. community health nurse providing health
promotion teaching? Select all that apply.
The community health nurse teaches a class
of kindergartners how to properly wash their
hands.
The community health nurse is a guest on a
radio talk show to provide information how to
avoid an infection that is endemic.
The community health nurse encourages an
individual whose blood pressure screening
was elevated to have his or her blood pressure
rechecked in 1 week.
The community health nurse teaches a group
of preschoolers about different fruits and
vegetables that they might like to try.
The community health nurse teaches a mother
and baby exercise group.
The community health nurse leads a group of
stroke survivors in soft exercise.
A, D, E
Feedback:
Health promotion is behavior that is
motivated by the desire to increase well-being
and actualize human potential. This is
different from disease prevention/health
protection, which is behavior motivated by a
E)
and baby exercise group.
The community health nurse leads a group of
stroke survivors in soft exercise.
A, D, E
Feedback:
Health promotion is behavior that is
motivated by the desire to increase well-being
and actualize human potential. This is
different from disease prevention/health
protection, which is behavior motivated by a
desire to actively avoid illness, detect it early,
or maintain functioning within the constraints
of illness. The activities of teaching a class of
kindergartners how to properly wash their
hands, teaching a group of preschoolers about
different fruits and vegetables that they might
like to try, and teaching a mother and baby
exercise group are focused on well-being and
not a particular illness. The activities of being
a guest on a talk show to provide information
how to avoid an infection that is endemic,
encouraging an individual whose blood
pressure screening was abnormal to have their
blood pressure rechecked in 1 week, and
leading a group of stroke survivors in soft
exercise are focused on avoiding specific
illnesses and not on improved general health.
F)
B)
C)
D)
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Which of the following statements most
accurately describes the nurse's role as an
10.
educator related to the social determinants of
health?
The nurse must focus on individual behavior
and encourage people to take responsibility
for their own behavior.
The nurse must examine one or two factors
that contribute to our state of health.
The nurse must look at the root causes of
disease and health inequities.
The nurse must lecture people about what is
right and wrong behavior.
C
Feedback:
Community health nurses must look at the
social determinant of health as the root causes
of disease and health inequities. This requires
that nurses look beyond the individual
behavior and have a broader scope of what
underlies illness.
C)
disease and health inequities.
The nurse must lecture people about what is
right and wrong behavior.
C
Feedback:
Community health nurses must look at the
social determinant of health as the root causes
of disease and health inequities. This requires
that nurses look beyond the individual
behavior and have a broader scope of what
underlies illness.
D)
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A community health nurse has been teaching
nutrition to a group of seniors in a local senior
center. After attending the nurse's class on
11.
nutrition, the nurse determines the group's
cognitive level of learning. Which of the
following indicates knowing?
Comparing the nutrient value in foods
Eating well-balanced meals
Planning recipes that are low in fat
Naming three foods high in iron
D
Feedback:
Naming three foods reflect the knowledge
level of the cognitive domain of learning.
Comparing nutrient values reflects analysis;
eating well-balanced meals reflects
application; and planning recipes reflects
synthesis.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A teaching plan for a group of new mothers
has the following objective: “The mothers
will describe the principles that relate to
12.
safety while diapering their newborn.” The
nurse is attempting to achieve learning at
which level of the cognitive domain?
Knowledge
Comprehension
Application
Analysis
C
Feedback:
At the application level, the learner not only
understands the material but can apply it to
new situations, transferring understanding
into practice. This is reflected by words such
as practice, demonstrate, use, illustrate, and
employ. Knowledge level learning would be
reflected by words such as define, repeat, list,
name, or recall. Comprehension level learning
would be reflected by words such as restate,
Comprehension
Application
Analysis
C
Feedback:
At the application level, the learner not only
understands the material but can apply it to
new situations, transferring understanding
into practice. This is reflected by words such
as practice, demonstrate, use, illustrate, and
employ. Knowledge level learning would be
reflected by words such as define, repeat, list,
name, or recall. Comprehension level learning
would be reflected by words such as restate,
describe, explain, identify, and discuss.
Analysis level learning would be reflected by
words such as distinguish, debate, question,
compare, examine, or calculate.
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C)
D)
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Which of the following interventions by the
nurse is most likely to have a positive
13.
influence on the client's adoption of a new
healthy behavior?
Providing feedback about what the client is
doing incorrectly
Providing feedback about what the client is
doing correctly
Not providing feedback
Not providing role modeling of the desired
change
B
Feedback:
The nurse who recognizes clients'
participation in a group praises them for
completing assignments or commends them
for sticking to diet plans will have more
success than the nurse who only criticizes
failures.
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A)
B)
C)
D)
Ans:
To ensure learning in the psychomotor
domain, which of the following would be
14.
most important for the nurse to ensure about
the learner?
Has a sensory image of how to do the skill
Has the ability to perform the necessary skill
Is willing to listen to the information about
the skill
Can continue to practice the skill
independently
B
Feedback:
For psychomotor learning to occur, the nurse
the learner?
Has a sensory image of how to do the skill
Has the ability to perform the necessary skill
Is willing to listen to the information about
the skill
Can continue to practice the skill
independently
B
Feedback:
For psychomotor learning to occur, the nurse
must ensure that the learner is physically,
intellectually, and emotionally capable of
performing the skill. Otherwise, the other two
conditions, having a sensory image and
practicing the skill, would not occur. A
willingness to listen is an important aspect for
all learning, especially learning in the
affective domain.
A)
B)
C)
D)
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A community health nurse develops a written
teaching plan for a community education
15. program about nutrition and salt-reduction.
Which objective would reflect synthesis
learning in the cognitive domain?
The client will create an enjoyable meal using
low-sodium foods.
The client will compare the salt content in a
variety of packaged foods.
The client will practice eating meals that
contain low-sodium foods.
The client will list foods that are low in
sodium.
A
Feedback:
Synthesis, the fifth level of cognitive learning,
is the ability not only to break down and
understand the elements of a situation but also
to form elements into a new whole. Synthesis
combines all of the earlier levels of cognitive
learning to culminate in the production of a
unique plan or solution. The objective with
the verb create demonstrates this level. Being
able to compare foods of varying salt content
reflects analysis. Practicing eating meals
demonstrates application. Listing foods
demonstrates knowledge.
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B)
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D)
A community health nurse has been getting
good attendance and group participation in
her Saturday class on newborn care for young
mothers. The participants receive free
16. transportation and a $10 food voucher for
attending. When they participate, prizes are
distributed. This nurse is using behavioral
theory to encourage clients, focusing the
teaching on which of the following concepts?
Meeting a hierarchy of needs
The learner's self-confidence and personal
mastery
A person's natural tendency to learn
Changes in response to a stimulus
D
Feedback:
Behavioral theory is grounded in stimulus–
response behaviors, and changes occur in
response to stimuli. The nurse is also using
conditioning through reinforcement as
described by Skinner. Meeting a hierarchy of
needs is based upon Maslow, a humanistic
theorist. Self-confidence and personal mastery
reflect social learning theory. A person's
natural tendency to learn is based upon
humanistic theories.
A)
B)
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D)
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A)
B)
C)
D)
Ans:
A 32-year-old wife and mother of two
children was a bank manager before entering
the nursing program. She is finishing a
Baccalaureate nursing program in a few
months. She learns best when she can plan
17.
and carry out her own learning activities, uses
past experiences to help with current learning,
and applies learning immediately. Which
learning theory best fits this woman's learning
style?
Knowles' adult learning theory
Bandura's social learning theory
The Gestalt–Field family of theories
Maslow's Hierarchy of Needs theory
A
Feedback:
The woman's behaviors support the tenets of
Knowles' adult learning theory. She is a selfdirected learner, experienced, ready to learn,
and is problem centered rather than
theoretically oriented. Bandura's social
learning theory attempts to explain behavior
Bandura's social learning theory
The Gestalt–Field family of theories
Maslow's Hierarchy of Needs theory
A
Feedback:
The woman's behaviors support the tenets of
Knowles' adult learning theory. She is a selfdirected learner, experienced, ready to learn,
and is problem centered rather than
theoretically oriented. Bandura's social
learning theory attempts to explain behavior
and facilitate learning. With social learning
theory, learners are benefitted by role models,
building self-confidence, persuasion, and
personal mastery. The Gestalt–Field family of
cognitive theories assumes that people are
neither good nor bad; they simply interact
with their environment and their learning is
related to perception. Maslow's hierarchy of
needs requires lower level basic needs to be
met before working toward self-actualization.
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B)
C)
D)
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B)
C)
D)
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A community health nurse is preparing a
teaching program for a group of elementary
school-aged children about substance abuse
18.
awareness. The nurse would implement
strategies that address which cognitive phase
of development?
Preconceptual
Intuitive thought
Concrete operations
Formal operations
C
Feedback:
Elementary school-aged children would most
likely be in the concrete operations stage of
cognitive development where the child can
solve concrete problems and recognize others'
viewpoints. The preconceptual stage would
apply to children between the ages of 2 to 4
years when language development is rapid
and everything is related to “me.” The
intuitive thought stage would apply to
children between the ages of 4 to 7 years
when egocentric thinking diminishes and
words are used to express thoughts. Formal
operations stage would apply to adolescents
when the child uses rational thinking and can
develop ideas from general principles and
apply them to future situations.
Intuitive thought
Concrete operations
Formal operations
C
Feedback:
Elementary school-aged children would most
likely be in the concrete operations stage of
cognitive development where the child can
solve concrete problems and recognize others'
viewpoints. The preconceptual stage would
apply to children between the ages of 2 to 4
years when language development is rapid
and everything is related to “me.” The
intuitive thought stage would apply to
children between the ages of 4 to 7 years
when egocentric thinking diminishes and
words are used to express thoughts. Formal
operations stage would apply to adolescents
when the child uses rational thinking and can
develop ideas from general principles and
apply them to future situations.
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B)
C)
D)
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When choosing an appropriate model for
health education, community health nurses
19.
often select the PRECEDE–PROCEED model
for which reason?
It emphasizes the desired outcome of the
teaching.
The steps are similar to those of the nursing
process.
The nurse's perception of the problem is the
key to this model.
Evaluation of outcomes is the final step.
B
Feedback:
The steps of the PRECEDE–PROCEED
model are similar to the nursing process, and
thus this model has become a useful tool for
nurses teaching in the community. It does
emphasize outcomes with evaluation of the
outcomes as the final step. But these are not
reasons for nurses selecting this model. The
client's or community's perception of the
problem is key to this model.
A)
B)
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C)
Which of the following statements accurately
20. describe Pender's Health Promotion Model?
Select all that apply.
It has been revised to reflect a number of
major theoretical changes.
It is not effective.
It is unrelated to interpersonal influence of
others.
It allows the community health nurse to
predict health promotion behaviors which
enhances the ability to work with clients.
Individual characteristics and experiences are
seen to interact with behavior-specific
cognitions and affect to influence specific
behavioral outcomes.
A, D, E
Feedback:
Pender's Health Promotion Model has been
revised from the earlier framework that was
published in 1980 and has been revised to
reflect a number of major theoretical changes.
It is viewed as an effective model. It focused
on predicting behaviors that influence health
promotion and includes the variable of
interpersonal influence of others.
A)
B)
C)
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D)
E)
B)
C)
D)
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Ans:
Which of the following statements about
21. teaching at three levels of prevention is most
accurate?
Ideally, the community health nurse would
focus at the tertiary level of prevention.
The outcome of focusing on the tertiary level
of prevention is to help diminish years of
morbidity and limit subsequent infirmity.
It is ideal to focus on the primary level of
prevention.
Community health nurses do not spend a
significant share of time teaching at the
secondary level.
C
Feedback:
Ideally, the community health nurse focuses
on the primary level. Because the primary
level of prevention is not possible in all cases,
a significant share of the nurse's time is spent
teaching at the secondary or tertiary level.
Community health nurses do not spend a
significant share of time teaching at the
secondary level.
C
Feedback:
Ideally, the community health nurse focuses
on the primary level. Because the primary
level of prevention is not possible in all cases,
a significant share of the nurse's time is spent
teaching at the secondary or tertiary level.
D)
Ans:
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A)
Which of the following is the best example of
22. a community health nurse focusing on the
secondary level of prevention?
Teaching clients how to navigate the health
care system to receive prompt treatment
Teaching clients about the importance of
immunization
Teaching stroke survivors about the
importance of diet, rest, and exercise to
prevent a secondary health problem
Teaching a class on sensible nutrition for
adolescents
A
Feedback:
The secondary level of prevention would be
exemplified by the community health nurse
when teaching clients how to navigate the
health care system to receive prompt
treatment. Teaching clients about the
importance of immunization is focused on the
primary level of prevention. Teaching stroke
survivors about the importance of diet, rest,
and exercise to prevent a secondary health
problem is focused on the tertiary level of
prevention. Teaching a class on sensible
nutrition for adolescents is focused on the
primary level of prevention.
B)
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D)
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A)
B)
C)
D)
Ans:
When developing an educational program for
23. the community, which of the following must
the community health nurse do first?
Assess the clients' readiness to learn
Ensure a conducive environment for learning
Assess the client's perception of the problem
Determine the appropriate subject matter
A
Feedback:
Before any teaching can begin, it is essential
to assess the clients' readiness to learn. Once
this is determined, the nurse can determine
the clients' perceptions of the problem and
Assess the clients' readiness to learn
Ensure a conducive environment for learning
Assess the client's perception of the problem
Determine the appropriate subject matter
A
Feedback:
Before any teaching can begin, it is essential
to assess the clients' readiness to learn. Once
this is determined, the nurse can determine
the clients' perceptions of the problem and
identify the appropriate subject matter.
Ensuring a conducive environment occurs
when the teaching begins.
A community health nurse is providing
informal teaching to groups of parents about
24. typical childhood developmental milestones.
Which of the following would the nurse
mostly likely be using?
Lecture
Demonstration
Anticipatory guidance
Visual images
C
Feedback:
Informal teaching such as anticipatory
guidance and counseling requires the teacher
to be prepared, but there is no defined plan of
presentation. Lecture and demonstration are
formal methods of teaching. Visual images
also are often used with formal teaching.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
Which question would the community health
25. nurse use as a guide to determine a client's
participation in a teaching program?
“What does the client know about the current
problem?”
“How does the client view the current
situation?”
“Does the client need special seating?”
“What does the client want to learn?”
D
Feedback:
To determine client participation, one of the
first questions that need to be answered is,
“What does the client want to learn?” This
directly influences the client's participation in
the educational process. Asking the question
about what the client knows about the
problem determines the client's readiness to
learn. Asking about the client's view of the
problem helps identify the client's
situation?”
“Does the client need special seating?”
“What does the client want to learn?”
D
Feedback:
To determine client participation, one of the
first questions that need to be answered is,
“What does the client want to learn?” This
directly influences the client's participation in
the educational process. Asking the question
about what the client knows about the
problem determines the client's readiness to
learn. Asking about the client's view of the
problem helps identify the client's
perceptions. Asking about special seating
helps to ensure that the educational
environment is conducive to the client's
needs.
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C)
D)
Ans:
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Which of the following is the best example of
26. a positive learning environment for a group of
developmentally disabled adults?
A local diner, seated near the door to the
kitchen during lunchtime
A brightly lit conference room with
comfortable chairs
A kindergarten classroom with small chairs
that are low to the ground
A park on a beautiful, sunny day
B
Feedback:
A brightly lit conference room with
comfortable chairs would be the best example
of a positive learning environment among the
choices listed. A local diner, seated near the
door to the kitchen during lunchtime would
not be a good choice as it is likely very noisy.
A kindergarten classroom with small chairs
that are low to the ground would not be a
good choice as the adults could not
comfortably sit in the chairs. A park on a
beautiful, sunny day would not be a good
choice as there would be too many
distractions making it difficult for the clients
to focus.
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C)
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A)
B)
C)
D)
A)
B)
C)
D)
E)
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When a community health nurse is planning
to teach a group of new immigrants from a
27. non-English speaking country about the need
for immunizations, the nurse should include
which in his or her plans?
Using a lot of pictures
Guessing about the native language and
attempting to speak it
Using an interpreter
Talking clearly and slowly, being sure to
enunciate each word
C
Feedback:
Planning to use an interpreter when
presenting information to a group of new
immigrants from a non-English speaking
country is the best option among those listed.
Pictures will not effectively convey the
meanings that the clients need. Guessing
about the native language and attempting to
speak it will not be effective either, as the
nurse should never assume anything and
unless the language is native to the nurse, the
nurse will not be any more effective at
communicating with the clients. Talking
clearly and slowly, being sure to enunciate
each word, might be appropriate for a group
of immigrants from a non-English speaking
country who have been in this country for a
while and have been learning the language.
Which of the following are factors to consider
28. related to the social determinants of health?
Select all that apply.
Being marginalized
Access to safe housing
Safe workplaces
Being related to a politician
Access to social and economic opportunities
B, C, E
Feedback:
Factors that influence an individual's ability to
maintain good health include social factors,
such as access to social and economic
opportunities and equitable social
interactions, and physical factors, such as
access to safe housing and safe workplaces.
Being related to a politician may or may not
have a positive impact on the social
determinants of health.
Safe workplaces
Being related to a politician
Access to social and economic opportunities
B, C, E
Feedback:
Factors that influence an individual's ability to
maintain good health include social factors,
such as access to social and economic
opportunities and equitable social
interactions, and physical factors, such as
access to safe housing and safe workplaces.
Being related to a politician may or may not
have a positive impact on the social
determinants of health.
Which of the following endings to this
sentence most accurately describes the reason
a community health nurse must consider the
29.
social determinants of health? The community
health nurse must consider the social
determinants of health
because the social determinants of health
affect a wide range of health, functioning, and
quality-of-life outcomes and risks.
because in our country all people are treated
equally.
because it is the right thing to do.
because the community health nurse believes
in social justice.
A
Feedback:
The social determinants of health affect a
wide range of health, functioning, and
quality-of-life outcomes and risks. There is a
growing inequity in the distribution of
disease, illness, and wellness across our
society and not all people are treated equally.
It is not enough to do this because it is the
right thing to do. If the community health
nurse believes in social justice, this is one
thing but really implementing social justice in
considering outcomes and risks is more
accurate.
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C)
D)
E)
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C)
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Chapter 12 Planning, Implementing, and Evaluating Community/Public Health Programs
Which of the following would be least
appropriate source of information for the
1. nurse to investigate when attempting to
determine the importance of an issue for a
community-based intervention?
Special interest groups
Client's concern
State health department
Local community priorities
B
Feedback:
A client's concern may be the initial spark that
leads the nurse to identify a need, but this
would be most restrictive source of
information and thus would be limited in
scope. Therefore, when determining the
feasibility of a community-based intervention,
several methods can be used to determine the
importance of the issue including federal
agencies, special interest groups, state health
departments, and local community priorities.
These sources would provide information
about whether or not a problem has affected a
sufficient percent of the population to warrant
intervention.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A community health nurse is attempting to
identify a target group for a program using
2. geographic information system (GIS). Which
type of information would the nurse be able to
obtain?
Family status
Past interventions used
Previous health problems
Areas needing more study
A
Feedback:
GIS information includes information about
race, age, and family status. Information
about past interventions used or previous
health problems can be obtained from talking
with other nurses and health professionals.
Areas needing more study can be obtained
from the Guide to Community Preventive
Services: Systematic Reviews and evidencebased recommendations, a federally
sponsored initiative that provides
recommendations about population-based
interventions.
Past interventions used
Previous health problems
Areas needing more study
A
Feedback:
GIS information includes information about
race, age, and family status. Information
about past interventions used or previous
health problems can be obtained from talking
with other nurses and health professionals.
Areas needing more study can be obtained
from the Guide to Community Preventive
Services: Systematic Reviews and evidencebased recommendations, a federally
sponsored initiative that provides
recommendations about population-based
interventions.
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B)
C)
D)
Ans:
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A community health nurse has just moved to
your community. Which might be good ways
3. for this community health nurse to identify
group and community health problems?
Select all that apply.
Interview health professionals in the agency
and other agencies to determine the needs
Read about it in a national magazine
Refer to the geographic information system
(GIS) data for the community
It is not necessary for the community health
nurse to do so. It is best for the community
health nurse to just pitch in and work to solve
the problems of the community.
A, C
Feedback:
Interviewing health professionals in the area
about the problems, what should be done, and
what has been tried in the past and their input
on why past interventions failed. Referring to
the geographic information system (GIS) data
for the community can look at groups of
people by race, age, and family status.
Reading about it in a national magazine is too
broad of an approach as factors that affect the
nation may or may not reflect what is
happening in your community. It is critical for
the community health nurse to identify group
and community health problems in order to
effectively influence the health of the
community.
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D)
nurse to do so. It is best for the community
health nurse to just pitch in and work to solve
the problems of the community.
A, C
Feedback:
Interviewing health professionals in the area
about the problems, what should be done, and
what has been tried in the past and their input
on why past interventions failed. Referring to
the geographic information system (GIS) data
for the community can look at groups of
people by race, age, and family status.
Reading about it in a national magazine is too
broad of an approach as factors that affect the
nation may or may not reflect what is
happening in your community. It is critical for
the community health nurse to identify group
and community health problems in order to
effectively influence the health of the
community.
D)
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Which of the following change strategies
would be most effective in maximizing the
4.
cooperation of the target population? Select
all that apply.
Use only one strategy that the nurse is most
familiar with
Knowing that as a nurse, the nurse knows
more about the health topic than their
audience
Employ multiple strategies to promote health,
prevent disease, and ensure a safe
environment for populations
Learning about the target population's beliefs
regarding the health topic
Focusing on health promotion and not disease
prevention
C, D
Feedback:
Standard 5B of the Public Health Nursing:
Scope and Standards of Practice calls on the
public health nurse to “employ multiple
strategies to promote health, prevent disease,
and ensure a safe environment for
populations.” It is not enough for the nurse to
use only one strategy that the nurse is most
familiar with. Interventions that fail to engage
the target population by learning about the
target population's beliefs will be
unsuccessful because clients hold just as
strongly to their belief systems as the nurse
does. It is important for the nurse to focus on
health promotion and disease prevention and
ensure a safe environment for populations.
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B)
E)
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D)
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C)
D)
regarding the health topic
Focusing on health promotion and not disease
prevention
C, D
Feedback:
Standard 5B of the Public Health Nursing:
Scope and Standards of Practice calls on the
public health nurse to “employ multiple
strategies to promote health, prevent disease,
and ensure a safe environment for
populations.” It is not enough for the nurse to
use only one strategy that the nurse is most
familiar with. Interventions that fail to engage
the target population by learning about the
target population's beliefs will be
unsuccessful because clients hold just as
strongly to their belief systems as the nurse
does. It is important for the nurse to focus on
health promotion and disease prevention and
ensure a safe environment for populations.
E)
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A community health nurse has identified the
target population and is determining an
5. appropriate intervention. Which of the
following would be most important for the
nurse to do next?
Develop an intervention based on the nurse's
previous experiences
Review the literature for research on
previously attempted interventions
Access the National Center for Health
Statistics Web site for data
Learn about the target population's beliefs and
ideas
D
Feedback:
Nurses may think that they know more about
a topic, and therefore, their solutions are
better than the target population's solutions.
However, if nurses don't learn about the target
population's beliefs and only consider their
own, they will not be able to work out a
solution with the target population that is
acceptable and appropriate for them. Thus,
the interventions will most likely be
unsuccessful. Although reviewing the
literature for research would be helpful on
identifying possible strategies, the nurse
needs input from the target population.
Accessing the NCHS Web site would provide
information about whether a problem has
affected a sufficient percent of the population
to warrant intervention. It would not be
helpful in determining an appropriate
A)
B)
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C)
C)
Statistics Web site for data
Learn about the target population's beliefs and
ideas
D
Feedback:
Nurses may think that they know more about
a topic, and therefore, their solutions are
better than the target population's solutions.
However, if nurses don't learn about the target
population's beliefs and only consider their
own, they will not be able to work out a
solution with the target population that is
acceptable and appropriate for them. Thus,
the interventions will most likely be
unsuccessful. Although reviewing the
literature for research would be helpful on
identifying possible strategies, the nurse
needs input from the target population.
Accessing the NCHS Web site would provide
information about whether a problem has
affected a sufficient percent of the population
to warrant intervention. It would not be
helpful in determining an appropriate
intervention.
D)
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A)
B)
C)
D)
Ans:
In an effort to ensure success of a proposed
community intervention program, the
6.
community health nurse would include which
of the following?
Formal leaders
Advisory group
Target population
Local knowledge
B
Feedback:
A key factor for ensuring the success of any
intervention is to appoint an advisory group
that includes representatives from the target
and service communities. Formal leaders are
important in obtaining information about the
possible target population. The target
population is important in making sure that
the planned intervention is appropriate.
However, it does not ensure that the
intervention will be successful. Local
knowledge provides information about
possible environmental and social factors
influencing the problem. However, it also
does not help to ensure the success of the
planned intervention.
Advisory group
Target population
Local knowledge
B
Feedback:
A key factor for ensuring the success of any
intervention is to appoint an advisory group
that includes representatives from the target
and service communities. Formal leaders are
important in obtaining information about the
possible target population. The target
population is important in making sure that
the planned intervention is appropriate.
However, it does not ensure that the
intervention will be successful. Local
knowledge provides information about
possible environmental and social factors
influencing the problem. However, it also
does not help to ensure the success of the
planned intervention.
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B)
C)
D)
Ans:
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A)
B)
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C)
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A)
B)
C)
D)
Ans:
Which of the following interventions
7. targeting health problems is most likely to be
effective?
Teaching about prenatal care to a group of
men in a men's homeless shelter
Teaching about prenatal care in a home for
unwed mothers
Teaching about prenatal care to a group of
cub scouts
Teaching about prenatal care to a group of
senior citizens
B
Feedback:
It is crucial to analyze the extent to which
individuals and families are affected by the
problem. It would be a waste of resources to
provide teaching about prenatal care to any of
the listed groups except the home for unwed
mothers.
In order to evaluate a health program, which
8. of the following should the community health
nurse focus on when planning the program?
Measurement of goal attainment
Creation of objectives that are specific,
measurable, attainable, relevant, and timely.
Patient satisfaction
Measurement of consistency with standards
B
Feedback:
When planning a health program, the
8. of the following should the community health
nurse focus on when planning the program?
Measurement of goal attainment
Creation of objectives that are specific,
measurable, attainable, relevant, and timely.
Patient satisfaction
Measurement of consistency with standards
B
Feedback:
When planning a health program, the
community health nurse should focus on the
creation of objectives that are specific,
measurable, attainable, relevant, and timely
(acronym SMART). The other options
describe what must be measured in the
evaluation of the health program.
A)
B)
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D)
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A review of factors influencing a population's
behavior related to childhood obesity reveals
9. several reinforcing factors. Which of the
following would the community health nurse
identify?
Children's belief that they like to be similar to
other children of the same age
Children's view of themselves as becoming
independent from adults
Offering of incentives to students' modeling
positive food choices
Proposed monitoring of children's behavioral
changes by the local PTA
C
Feedback:
Reinforcing factors include the knowledge,
values, beliefs, and attitudes of the family and
friends of the target population. It also
includes authority figures such as teachers or
managers, as well as agency and community
decision makers, as these individuals also
influence the target population. In this case, it
would be the offering of incentives to
student's modeling positive food choices. The
children's belief in being similar to others and
view as becoming independent are examples
of predisposing factors. Proposed monitoring
would be an example of enabling factors.
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C)
D)
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10.
A)
B)
C)
D)
A)
B)
C)
D)
Ans:
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Ans:
Which of these behaviors is most likely
changeable?
Smoking cessation among a group of people
who have smoked for 20 or more years
Smoking cessation at a work place where
smoking is common and deeply imbedded
Smoking cessation in a school for students
who have only recently started smoking
Smoking cessation in a public environment
where cigarettes are openly sold and persons
are allowed to smoke
C
Feedback:
The behaviors that are easiest to change
include those that are still in the
developmental stage and have only recently
been established (as would students who have
only recently started smoking and not among
a group of people who have each smoked for
20 or more years or at a work place where
smoking is common); are not deeply
imbedded in cultural patterns or lifestyle (not
in a workplace where smoking is deeply
imbedded nor in a public environment where
cigarettes are openly sold and persons are
allowed to smoke).
The community health nurse is identifying
factors that would influence behavior change.
11.
Which of the following would the nurse
identify as enabling factors?
Attitudes of the target population
Knowledge of the family of the target
population
Availability of resources
Values of the authority figures
C
Feedback:
Enabling factors include the availability of
resources, the accessibility of resources, laws,
and government support for the health
behaviors or for the health program, as well as
skills. Predisposing factors include the
knowledge, beliefs, values, attitudes, and
confidence of the target population that
influence their behavioral choices.
Reinforcing factors include the knowledge,
values, beliefs, and attitudes of the family and
population
Availability of resources
Values of the authority figures
C
Feedback:
Enabling factors include the availability of
resources, the accessibility of resources, laws,
and government support for the health
behaviors or for the health program, as well as
skills. Predisposing factors include the
knowledge, beliefs, values, attitudes, and
confidence of the target population that
influence their behavioral choices.
Reinforcing factors include the knowledge,
values, beliefs, and attitudes of the family and
friends of the target population. It also
includes authority figures such as teachers or
managers, as well as agency and community
decision makers, as these individuals also
influence the target population. These factors
must be addressed as they can interfere with
successful behavioral change and create
barriers to behavioral change.
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C)
D)
Ans:
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B)
C)
D)
Ans:
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When the community health nurse is
examining barriers to successful behavioral
change, the nurse identifies that there are no
laws in the community that prohibit smoking
in public areas, which leads to increased
12. smoking and increased risks to health related
to secondhand smoke. The nurse believes that
a possible solution is to advocate for a
citywide bans on smoking in public locations.
Which type of factor is affecting the behavior
in the community?
Enabling factors
Predisposing factors
Reinforcing factors
Unrelated factors
A
Feedback:
Enabling factors include the availability of
resources, the accessibility of resources, laws,
and government support for the health
behaviors or for the health program, as well as
skills. Predisposing factors include the
knowledge, beliefs, values, attitudes, and
confidence of the target population that
influence their behavioral choices.
Reinforcing factors include the knowledge,
values, beliefs, and attitudes of the family and
friends of the target population. These factors
must be addressed as they can interfere with
successful behavioral change and create
Predisposing factors
Reinforcing factors
Unrelated factors
A
Feedback:
Enabling factors include the availability of
resources, the accessibility of resources, laws,
and government support for the health
behaviors or for the health program, as well as
skills. Predisposing factors include the
knowledge, beliefs, values, attitudes, and
confidence of the target population that
influence their behavioral choices.
Reinforcing factors include the knowledge,
values, beliefs, and attitudes of the family and
friends of the target population. These factors
must be addressed as they can interfere with
successful behavioral change and create
barriers to behavioral change.
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B)
C)
D)
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Several quality management models are
helpful in measuring and improving the
quality of care. They are designed differently
13.
but are developed to enhance care giving.
Which of the following uniquely places the
client within the model?
Quality Health Outcomes model
Donabedian model
Omaha System model
QSEN project
A
Feedback:
The Quality Health Outcomes model includes
the client in the model and proposes a twodimensional relationship among components.
The Donabedian model consists of three
components: environment structure,
processes, and outcomes. The Omaha System
model addresses process indicators, client
outcome measures, and satisfaction with care.
The QSEN project was spurned by the IOM
report To Err is Human and focuses on the
knowledge skills and attitudes for
competencies that include patient-centered
care, teamwork and collaboration, evidencebased practice, quality improvement, safety
and informatics.
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A)
B)
C)
D)
Ans:
A community health nurse is assisting with
the evaluation of outcomes of a program. The
14. client's response to care is being measured
quantitatively. The nurse identifies this as
which of the following?
Benchmarking
Quality indicators
Process
Structure
B
Feedback:
Quality indicators are quantitative measures
of a client's response to care. Benchmarking
uses continuous, collaborative, and systematic
processes for measuring and examining
internal programs' strengths and weaknesses
and includes studying another's processes in
order to improve one's own. Process refers to
activities and behaviors used to improve or
maintain the client's status. Structure refers to
the care environment, such as client mix,
philosophy, facility, and staff.
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When participating in quality improvement
activities, a community health nurse would be
15.
least likely to engage in which of the
following?
Daily prioritizing of care needs for a caseload
of clients
Completing necessary documentation
efficiently
Seeking supervision for a difficult client case
Reviewing organizational personnel
D
Feedback:
Nursing administration would be responsible
for developing a formalized quality
management program that would include a
review organizational structure, personnel,
and environment. Quality improvement
activities for community health nurses include
daily prioritizing of care needs for a caseload
of clients, seeking supervision or skills
development for a difficult case, and
systematizing charting so that needed
documentation is efficiently completed.
efficiently
Seeking supervision for a difficult client case
Reviewing organizational personnel
D
Feedback:
Nursing administration would be responsible
for developing a formalized quality
management program that would include a
review organizational structure, personnel,
and environment. Quality improvement
activities for community health nurses include
daily prioritizing of care needs for a caseload
of clients, seeking supervision or skills
development for a difficult case, and
systematizing charting so that needed
documentation is efficiently completed.
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C)
D)
Ans:
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16. process aspect of quality management when
the nurse does which of the following?
Contribute to the revision of standards
Ensure an adequate amount of resources
Determine additional sources of funding
Review services provided for client needs
A
Feedback:
As part of the process aspect of quality
management, staff is encouraged to contribute
to evaluation of the standards and revise them
as needed. Adequate resources and funding
are components of the structure aspect.
Reviewing services provided is a component
of the outcome aspect.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
After teaching a group of students about the
various models used in program evaluation,
the instructor determines that the students
17.
have understood the teaching when they state
which of the following as the model most
basic?
Quality Health Outcomes model
Donabedian model
Quality and Safety Education for Nurses
Omaha System model
B
Feedback:
The Donabedian model is recognized as a
simplistic and basic method of measuring
quality that has been used widely over the
past 35 years. The Quality Health Outcomes
model takes the Donabedian model a step
further by including the client in the model.
Donabedian model
Quality and Safety Education for Nurses
Omaha System model
B
Feedback:
The Donabedian model is recognized as a
simplistic and basic method of measuring
quality that has been used widely over the
past 35 years. The Quality Health Outcomes
model takes the Donabedian model a step
further by including the client in the model.
The QSEN project was spurned by the IOM
report To Err is Human and focuses on the
knowledge skills and attitudes for
competencies that include patient-centered
care, teamwork and collaboration, evidencebased practice, quality improvement, safety
and informatics. The Omaha System model
focuses on process indicators, client outcome
measures, and satisfaction with care.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
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A community health nurse who is part of a
committee that is deciding on which model to
use for program evaluation reviews the
18. Omaha System model. The nurse needs
additional review of this model after
identifying which of the following as an
aspect for rating outcomes?
Client knowledge
Client behavior
Client status
Client ownership of problem
D
Feedback:
Ownership of the problem is component of
the community, the group that shares a
physical environment and ownership of a
health-related problem. Knowledge, behavior,
and status are how outcomes are rated in this
model.
A)
B)
C)
D)
Ans:
A community health nurse is participating in
an agency program evaluation using the
Quality Practice Settings Attributes model.
19.
The nurse is assisting with evaluation of the
professional system. Which of the following
would the nurse need to address?
Communication with clients
Staffing ratios
Safety of practice
Continuing education
D
an agency program evaluation using the
Quality Practice Settings Attributes model.
19.
The nurse is assisting with evaluation of the
professional system. Which of the following
would the nurse need to address?
Communication with clients
Staffing ratios
Safety of practice
Continuing education
D
Feedback:
Using the Quality Practice Settings Attributes
model, evaluation of the professional system
would address hiring, orientation, training,
and continuing education. Communication
with clients, families, and professionals are
areas evaluated in the communication system.
Staffing ratios are addressed in the care
delivery process. Collaboration is addressed
with the leadership element.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
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One community health agency has developed
a clinical pathway that has proved useful with
clients with heart failure. After review,
20. another community health agency providing
care to similar clients decides to implement
that pathway. This reflects which of the
following?
Structure
Process
Outcomes
Benchmarking
D
Feedback:
Benchmarking uses continuous, collaborative,
and systematic processes for measuring and
examining internal programs' strengths and
weaknesses and includes studying another's
processes in order to improve one's own. The
example reflects external benchmarking
which occurs between similar agencies
providing like services. Structure is reflected
in the agency's organization, facility,
personnel, and philosophy. Process reflects
the standards, attitudes, and activities.
Outcomes reflect the expected results, goals,
efficiency, and satisfaction.
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A)
B)
C)
D)
Ans:
A group of students are reviewing material in
preparation for test on program evaluation
models. The students demonstrate
21. understanding of the material when they
identify which model as dynamic with
interventions always acting through the
system and client?
Donabedian model
QSEN project
Quality Health Outcomes model
Quality Practice Setting Attributes model
C
Feedback:
The Quality Health Outcomes model includes
the client in the model and proposes a twodimensional relationship among components.
Interventions always act through the system
and the client, creating a dynamic model. The
Donabedian model is recognized as a
simplistic and basic method of measuring
quality. Structure, process, and outcome can
be depicted in a box-shaped model. The
QSEN (Quality and Safety Education in
Nursing) project was spurned by the IOM
report To Err is Human and focuses on the
knowledge skills and attitudes for
competencies that include patient-centered
care, teamwork and collaboration, evidencebased practice, quality improvement, safety
and informatics. The Quality Practice Setting
Attributes model is used as a tool to assist in
ensuring the quality of nursing practice and
the nursing profession by promoting
continuing competence.
A)
B)
C)
D)
Ans:
When devising a social marketing strategy for
a community health issue, which of the
22. following concepts is being integrated when
the selection of one option inherently requires
giving up on another option?
Self-interest
Competition
Consumer orientation
Exchange
B
Feedback:
The concept of competition is being
22. following concepts is being integrated when
the selection of one option inherently requires
giving up on another option?
Self-interest
Competition
Consumer orientation
Exchange
B
Feedback:
The concept of competition is being
integrated by selecting one option that
inherently involves the giving up of another
option. Self-interest is demonstrated when
people act in their own interests. Consumer
orientation is reflected in the problem-solving
process directed at the target. Exchange is
demonstrated when an individual gives
something to get something.
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A)
B)
C)
D)
Ans:
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A community health nurse is seeking seed
money to set up a health promotion program
23.
for pregnant adolescents. The nurse would
seek which type of grant?
Planning
Start-up
Management
Facility
B
Feedback:
The type of grant would be a start-up grant,
for example, seed money. Other types of
grants include planning grants (i.e., initial
project development), management or
technical assistance grants (e.g., for fund
raising or marketing), and facilities or
equipment grants (e.g., money for a building,
computer, or van).
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When composing a letter of inquiry, which of
24. the following would a community health
nurse include?
Names and academic credentials of all the
personnel who will be involved in
implementing the program
An extensive literature review of the evidence
that supports the planned interventions
Other funding sources for the project or
program (prospective and committed)
Lengthy description of the organization
C
Feedback:
The letter of inquiry is normally only two to
Names and academic credentials of all the
personnel who will be involved in
implementing the program
An extensive literature review of the evidence
that supports the planned interventions
Other funding sources for the project or
program (prospective and committed)
Lengthy description of the organization
C
Feedback:
The letter of inquiry is normally only two to
three pages in length and includes a concise
overview of the project. For example, it
would likely include an overview of the
organization and its purpose, the reason for
the funding request, clearly stated need or
problem to be addressed, overview of the
proposed project or program, and other
funding sources for your project or program
(prospective and committed). The letter is
brief, yet clearly lays out your plan. Names
and academic credentials of all the personnel
who will be involved in implementing the
program, an extensive literature review of the
evidence that supports the planned
interventions, and a lengthy description of the
organization would make the letter of inquiry
unnecessarily long when it should be concise.
A)
B)
C)
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D)
Ans:
Ans:
As the community health nurse engages in the
process of seeking grant funding, the nurse
ensures that the appropriate steps are
followed. Place the following in their proper
sequence.
25.
A) Contact funders
B) Acquire proposal guidelines
C) Define the project
D) Identify the proper funding source
E) Be aware of submission deadline
C, D, A, B, E
Feedback:
When seeking grant funding, define the
project, identify the right funding sources,
contact the funders (think of the funder as a
resource), acquire proposal guidelines, and
know the submission deadline.
Chapter 13 Policy Making and Advocacy
When developing a teaching plan for a class
that describes health policy, which of the
1.
following would the instructor include as an
example of a regulatory health policy?
Licensure of health professionals
Federal subsidies for nursing education
Benefits for needy groups
Allocating resources among groups
A
Feedback:
Regulatory health policy regulates or licenses
services or people providing services in the
community. Distributive health policy
subsidizes nursing education, benefits the
needy, and allocates resources among and
between groups.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
Which of the following is an example of a
distributive health policy?
Reporting of communicable disease
Federal funds for nursing education
Medicare
Arms control agreement
B
Feedback:
Distributive health policy promotes
nongovernmental activities that are thought to
be beneficial to society as a whole. An
example of a distributive policy is the Nurse
Training Act, Title VIII of the Public Health
Service Act, which was established in 1965
and provided federal subsidies for nursing
education in an effort to address the need for a
more nurses. Reporting of communicable
diseases and arms control agreement are
examples of regulatory health policy at the
national and international levels respectively.
Medicare is an example of a redistributive
health policy.
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2.
A)
B)
C)
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D)
Ans:
Which of the following effects of a health
system in disarray have the most direct
3.
influence for a public health nurse at this
present time?
The United States is often touted as having
the best health care system in the world.
Fewer jobs for nurses
Crisis in public health related to underfunding
and underappreciation of the core functions of
public health leading to substantial reduction
in public health programs
Changes in the Medicare payment system
C
Feedback:
Currently, there is serious underfunding and
underappreciation of the core functions of
public health, which has led to massive
layoffs of staff and substantial reduction in
public health programs. The United States is
often touted as having the best health care
system in the world. However, this may be in
question related to the expense of our current
health problems and the lack of benefit to the
health of all Americans. There is currently a
serious nursing shortage that is projected to
only get worse in the coming decades. There
are changes in the Medicare payment system
and this does affect health care in general but
most public health programs do not receive
Medicare support.
A)
B)
C)
D)
Ans:
Community health nurses are attending an inservice program about health policy. Which of
4.
the following would the nurses expect to be
included in the description?
Reflection of a community's values
Creation for several influential people
Development by those outside of the
community
Indication of needs of the community's poor
A
Feedback:
Health policy should reflect a community's
values and should not only be created for
certain groups such as the influential or the
poor. It needs to come from the people within
the community and be for all of them.
Development by those outside of the
community
Indication of needs of the community's poor
A
Feedback:
Health policy should reflect a community's
values and should not only be created for
certain groups such as the influential or the
poor. It needs to come from the people within
the community and be for all of them.
C)
D)
Ans:
A group of community health nurses are
discussing health care policy in the United
5.
States. Which of the following reflects the
consensus view?
Market forces should solve the problem.
The government should assume responsibility.
Health care policy needs to change.
Health care policy is flawed but adequate.
C
Feedback:
Most people agree that health care policy in
the United States must change, but there is
little agreement among policy makers and
citizens about how this should occur. Some
believe market forces should be allowed to
work this problem out; others believe the
government should assume responsibility.
Health care policy is not viewed as being
adequate.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When describing public health nursing to a
group of community health nurses, which of
6.
the following would be identified as its
foundation?
Social marketing
Social justice
Social disparities
Advocacy
B
Feedback:
The concept of social justice is seen as the
very foundation of public health nursing.
Social marketing is the means to influence
behavior of target populations for program
development. Addressing social disparities or
inequalities are one component of public
health nursing. Advocacy involves pleading
the case of another and pursuing influencing
outcomes.
Social justice
Social disparities
Advocacy
B
Feedback:
The concept of social justice is seen as the
very foundation of public health nursing.
Social marketing is the means to influence
behavior of target populations for program
development. Addressing social disparities or
inequalities are one component of public
health nursing. Advocacy involves pleading
the case of another and pursuing influencing
outcomes.
A)
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E)
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Ans:
A)
B)
C)
D)
Ans:
Which of the following statements about
7. special interest groups and policy making are
true? Select all that apply.
Others will be persuaded by facts alone.
Power is wielded by special interest groups,
business, and industry.
Nurses need to provide input to policy circles
through advocacy.
Nurses need to provide leadership at decisionmaking tables.
There are power struggles behind all
legislation and health care regulation.
B, C, D, E
Feedback:
Nurses need to provide input to policy circles
through advocacy and leadership at decisionmaking tables. It is naïve to believe that
others will be persuaded by facts alone.
Power is wielded by special interest groups,
business, and industry. There are power
struggles behind all legislation and health care
regulation.
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B)
C)
D)
Ans:
The community health nurse is reviewing
how managed care today has changed from its
8. initial proposal. Which of the following
would the nurse identify as an important
change?
Current emphasis on cost containment
Focus on choosing a practitioner
Expansion in types of care provided
Increase in nonprofit agencies
A
Feedback:
Managed care has evolved and the emphasis
has shifted from prevention to cost
containment. Reductions in reimbursement
change?
Current emphasis on cost containment
Focus on choosing a practitioner
Expansion in types of care provided
Increase in nonprofit agencies
A
Feedback:
Managed care has evolved and the emphasis
has shifted from prevention to cost
containment. Reductions in reimbursement
particularly for disadvantaged patients (e.g.,
those covered under Medicaid and Medicare),
reductions in the choice of practitioners, and
limitations on the types of care available
transformed this system as originally
envisioned. Most managed care today is for
profit, setting up a dichotomy between the
insured and the owners/investors.
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A)
B)
C)
D)
Ans:
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Which of the following statements about
9. professional organizations and public policy
is the most accurate?
Professional organizations increase
polarization and cause a group to be more
united and strong.
Professional organizations encourage
selfishness and self-interest.
Professional organizations focus solely on
“protecting their turf.”
A united voice on public policy is more
powerful than individuals pleading with
legislators.
D
Feedback:
A united voice on public policy is more
powerful than individuals pleading with
legislators. The other statements about
professional organizations are not true. They
do not increase polarization and if they did, it
would not cause the group to be more united
and strong. Professional organizations do not
increase selfishness and self-interest, and
professional nursing organizations do not
focus solely on “protecting their turf.”
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B)
C)
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D)
A)
B)
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C)
Which of the following statements reflect
progress in public policy that can be attributed
10.
to professional nursing organizations? Select
all that apply.
Professional nursing organizations have
elevated nursing professionalism.
Professional nursing organizations have given
voice to the inequalities that affect our
society.
Professional nursing organizations have
developed the paradigms that influence and
affect public health.
Nursing is regarded as a major player in
Washington when discussing health care
policy.
Professional nursing organizations have a
long and consistent relationship with public
policy.
A, B, C
Feedback:
Professional nursing organizations have
elevated nursing professionalism, have given
voice to the inequalities that affect our
society, and have developed the paradigms
that influence and affect public health.
Despite nursing's early history of political
activism and the fact that nurses are the
largest group of health care providers in the
United States, widespread political
involvement has yet to be fully realized.
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D)
E)
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A)
B)
C)
D)
Ans:
11.
Which is the best way for any nurse to
advocate for change and exert power?
Pursuing an advanced degree
Running for state congressional seat
Actively participating in a professional
nursing organization
Becoming a member of a local not-for-profit
agency board of directors
C
Feedback:
A major way in which nurses have been
successful with advocacy is through
membership in their professional
organization. Influencing policy may be
achieved by obtaining advanced education,
which would be helpful in pursuing higher
level positions, and political office whether at
C)
nursing organization
Becoming a member of a local not-for-profit
agency board of directors
C
Feedback:
A major way in which nurses have been
successful with advocacy is through
membership in their professional
organization. Influencing policy may be
achieved by obtaining advanced education,
which would be helpful in pursuing higher
level positions, and political office whether at
the local or state level. Influencing policy is
not the same as advocating.
D)
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B)
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D)
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Ans:
A)
B)
After a class on nursing and political
activism, which statement by the nursing
12.
student would indicate that the teaching was
successful?
“Nurses have just now become increasingly
active in the political arena.”
“Nurses are the smallest group of providers
with the largest voice.”
“Nurses are considered major political players
in Washington.”
“The ANA provides nurses with a collective
political voice.”
D
Feedback:
A professional nursing association such as the
ANA builds a collective voice for nurses.
Despite nursing's early history of political
activism and the fact that nurses are the
largest group of health care providers in the
United States, widespread political
involvement has yet to be realized. Nursing
also is not thought of as a major player in
Washington when discussing health care
policy.
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Ans:
Which of the following statements about
13. power and empowerment are true accurate?
Select all that apply.
Power is the ability to act or produce an effect
and possess control, authority, or influence
over others.
Empowerment is a process of assisting
communities to come together to express their
values and ideas to those outside the
community.
If power is the ability to control, predict, and
participate in one's environment, then
A)
B)
C)
D)
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E)
13. power and empowerment are true accurate?
Select all that apply.
Power is the ability to act or produce an effect
and possess control, authority, or influence
over others.
Empowerment is a process of assisting
communities to come together to express their
values and ideas to those outside the
community.
If power is the ability to control, predict, and
participate in one's environment, then
empowerment is the process whereby
individuals and communities take power and
transform their lives.
All of the power belongs to the legislators.
Nurses have a responsibility to ensure
community participation in issues affecting
them, and they must continually examine the
relationship and position they hold within
these communities.
A, B, C, E
Feedback:
Power is the ability to act or produce an effect
and possess control, authority, or influence
over others. Empowerment is a process of
assisting communities to come together to
express their values and ideas to those outside
the community. If power is the ability to
control, predict, and participate in one's
environment, then empowerment is the
process whereby individuals and communities
take power and transform their lives.
Professionals hold the power and authority by
virtue of their place in the bureaucracy.
Nurses have a responsibility to ensure
community participation in issues affecting
them, and they must continually examine the
relationship and position they hold within
these communities.
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A)
B)
C)
D)
Ans:
A community health nurse integrates
understanding of power and empowerment
14.
when working with clients by demonstrating
which of the following?
Partnership with clients
Hierarchical relationship
Authority over clients
Client autonomy
A
Feedback:
The various definitions of empowerment and
the expansion of the definition of health,
which now includes the social, political, and
which of the following?
Partnership with clients
Hierarchical relationship
Authority over clients
Client autonomy
A
Feedback:
The various definitions of empowerment and
the expansion of the definition of health,
which now includes the social, political, and
economic determinants of health, have
changed our thinking on how best to interact
with the communities we serve. This also
suggests a change in the relationship between
professionals and communities; a change
from the customary hierarchical patient/
provider relationship to one of a partnership.
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A)
B)
C)
D)
Ans:
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How can nursing fulfill the potential to
transform nursing and take the power to
15.
influence policy development? Select all that
apply.
Practicing to the full extent of their education
and training
Achieving higher levels of education and
training through an improved education
system that promotes seamless academic
progression
Act as full partners, with physicians and other
health professionals, in redesigning health
care in the United States
Improve data collection and an improved
information infrastructure to ultimately
influence effective workplace planning and
policy making
Most nurses are already involved in the
regulatory framework development.
A, B, C, D
Feedback:
The four key messages from The Future of
Nursing: Leading Change, Advancing Health
include the following:
1. Nurses should practice to the full extent
of their education and training.
2. Nurses should achieve higher levels of
education and training through an improved
education system that promotes seamless
academic progression.
3. Nurses should be full partners, with
physicians and other health professionals, in
redesigning health care in the United States.
4. Effective workforce planning and policy
making require better data collection and an
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C)
policy making
Most nurses are already involved in the
regulatory framework development.
A, B, C, D
Feedback:
The four key messages from The Future of
Nursing: Leading Change, Advancing Health
include the following:
1. Nurses should practice to the full extent
of their education and training.
2. Nurses should achieve higher levels of
education and training through an improved
education system that promotes seamless
academic progression.
3. Nurses should be full partners, with
physicians and other health professionals, in
redesigning health care in the United States.
4. Effective workforce planning and policy
making require better data collection and an
improved information infrastructure.
It is not yet true that most nurses are already
involved in the regulatory framework
development.
E)
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Ans:
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Organize the following stages in the policy
process in the order they should be
considered.
16. A) Policy Adoption
B) Policy Evaluation
C) Policy Formulation
D) Policy Implementation
C, A, D, B
Feedback:
The order of the stages in the policy process is
formulation, adoption, implementation, and
evaluation.
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A)
B)
C)
D)
Ans:
Which stage in the policy process is
exemplified by the activities of identifying the
17.
health problem and/or using a goal-oriented
approach?
Policy adoption
Policy evaluation
Policy formulation
Policy implementation
C
Feedback:
Policy formulation involves identifying goals,
problems, and potential solutions. Policy
adoption involves the authorized selection and
specification of means to achieve goals,
resolve problems, or both. Policy
B)
C)
D)
Ans:
Policy evaluation
Policy formulation
Policy implementation
C
Feedback:
Policy formulation involves identifying goals,
problems, and potential solutions. Policy
adoption involves the authorized selection and
specification of means to achieve goals,
resolve problems, or both. Policy
implementation follows adoption and occurs
when the policy is put to use. Policy
evaluation compares policy outcomes or
effects with the intended or desired effects.
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When involved in the policy process, the
community health nurse must keep in mind
18.
that which of the following should be the
strongest influence?
Social conditions
Political conditions
Public need
Health planning
C
Feedback:
The social and political conditions that affect
policy formulation are limitless, but public
need and public demand should be the
strongest influences. Health planning may be
an approach to policy formulation.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse identifies a
problem of increased infant mortality with
adolescent pregnancies. The nurse decides to
19.
address this problem with a health policy. The
nurse is engaging in which stage of the policy
process?
Formulation
Adoption
Implementation
Evaluation
A
Feedback:
Health policy formulation is the stage at
which a policy is conceptualized and
ultimately defined. Policy adoption involves
the authorized selection and specification of
means to achieve goals, resolve problems, or
both. Implementation follows adoption and
occurs when the policy is put to use. Policy
evaluation means comparing policy outcomes
or effects with the intended or desired effects.
Adoption
Implementation
Evaluation
A
Feedback:
Health policy formulation is the stage at
which a policy is conceptualized and
ultimately defined. Policy adoption involves
the authorized selection and specification of
means to achieve goals, resolve problems, or
both. Implementation follows adoption and
occurs when the policy is put to use. Policy
evaluation means comparing policy outcomes
or effects with the intended or desired effects.
A community health nurse is involved in
assessing the community's capacity to define
20. strategies to enhance compliance with a
policy. The nurse is working in which stage of
the policy process?
Formulation
Adoption
Implementation
Evaluation
C
Feedback:
Implementation of health policy occurs when
an individual, group, or community puts the
policy into use. It involves overt behavior
changes as the policy is put into nursing
practice. As an implementer, the community
health nurse assesses the capacity of the
community to formulate and define strategies
that will enhance the community's compliance
with the policy. Health policy formulation is
the stage at which a policy is conceptualized
and ultimately defined. Policy adoption
involves the authorized selection and
specification of means to achieve goals,
resolve problems, or both. Policy evaluation
means comparing policy outcomes or effects
with the intended or desired effects.
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B)
C)
D)
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B)
C)
D)
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A)
B)
C)
D)
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When engaging in the policy process, which
21. of the following would the community health
nurse do last?
Define the problem
Gather information
Look for alternatives
Choose the approach
D
Feedback:
When engaging in the policy process, which
21. of the following would the community health
nurse do last?
Define the problem
Gather information
Look for alternatives
Choose the approach
D
Feedback:
Policy analysis involves the following
sequential steps: define the problem,
information gathering, looking for alternatives
to the approach, and choose the most
appropriate approach.
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A)
B)
C)
D)
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B)
C)
D)
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When analyzing health policy, which question
22. would be most important for the community
health nurse to ask?
“How much does it cost?”
“What is the result?”
“Why is it in place?”
“Who benefits from it?”
D
Feedback:
When analyzing policy, nurses need to answer
two general questions: Who benefits from this
policy? and who loses from this policy?
Whether the policy should be advocated by
the community as a whole depends on the
degree to which the policy benefits the
community without being detrimental to
individuals or the country. Cost, results, and
reasons why are not key elements to address
in policy analysis.
A)
B)
C)
D)
E)
Ans:
Which of the following statements about
23. advocacy and lobbying and the influence of
both on policy are true? Select all that apply.
Advocacy can be defined as pleading the case
of another or championing a cause.
Lobbying is the act of influencing legislators.
Nurses can gain access to legislators
individually or through the services of a
professional lobbyist or PAC.
Policy and politics are not related to each
other.
Public policy is a rational process.
A, B, C
Feedback:
Advocacy can be defined as pleading the case
of another or championing a cause. Lobbying
Nurses can gain access to legislators
individually or through the services of a
professional lobbyist or PAC.
Policy and politics are not related to each
other.
Public policy is a rational process.
A, B, C
Feedback:
Advocacy can be defined as pleading the case
of another or championing a cause. Lobbying
is the act of influencing legislators. Nurses
can gain access to legislators individually or
through the services of a professional lobbyist
or PAC. Policy and politics go hand in hand;
neither exists without the other. Public policy
is not a rational process.
C)
D)
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E)
Ans:
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Which of the following would be important
24. for a politically involved nurse to do? Select
all that apply.
Communicate ideas effectively
Get to know local representatives
Avoid involvement with community boards
Be firm and unyielding in approach
Stay current about health care issues
A, B, E
Feedback:
The politically involved nurse should aim to
accomplish three primary goals: (1) generate
support for one's views by communicating
ideas effectively and getting to know and
influence representatives at local, state, and
national levels; (2) create professional
legitimacy by keeping abreast of current
issues in health care and nursing and
becoming involved in professional nursing
organizations, community boards or
committees, or political office at the local,
state or national level; and (3) resolve conflict
and effectively negotiate and compromise.
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B)
C)
D)
E)
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Chapter 14 Family as Client
Which of the following would be most
appropriate for the community health nurse to
1.
do first when planning an initial home visit to
a family?
Obtain the basic supplies that will be needed
Gather appropriate educational materials
Contact the family via telephone
Review the referral information
D
Feedback:
The first step is to obtain the referral and
review it to gather information about the
possible needs of the family and the reason
for the visit. Once this is done, then the nurse
would obtain the basic supplies and education
materials that might be needed and contact the
family to arrange the visit.
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B)
C)
D)
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When planning for a home visit, which of the
2. following would be most helpful to ensure a
successful home visit?
Documentation in a timely manner
Summarizing the main visit points
Providing incidental teaching
Scheduling an appropriate visit time
D
Feedback:
As part of planning the community health
nurse would contact the family to set up an
appropriate time for the visit. Documenting in
a timely manner ensures successful
evaluation. Providing incidental teaching and
summarizing the main visit points help to
ensure successful implementation.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse arrives at a
family's home. Which of the following would
3.
behaviors by the nurse would be
nontherapeutic?
Maintaining eye contact with the family
members
Paging through paperwork for information
Sitting on the furniture near the family
members
Placing car keys in the nurse's carryall bag
B
Feedback:
3.
A)
B)
C)
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D)
Ans:
behaviors by the nurse would be
nontherapeutic?
Maintaining eye contact with the family
members
Paging through paperwork for information
Sitting on the furniture near the family
members
Placing car keys in the nurse's carryall bag
B
Feedback:
Community health nurses, like all nurses,
need to be aware of their own body language.
Fidgeting with car keys during the entire visit,
noisily chewing gum, giving minimal eye
contact, continuously looking at or paging
through paperwork, appearing rushed, and
refusing to sit on any of the furniture are
behaviors that tell the family a great deal
about the nurse, including how he or she feels
about being in their home. These actions are
nontherapeutic. Sitting on the furniture near
family members demonstrates interest in the
family. Placing car keys in the carryall bags
prevents inadvertent distractions.
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A community health nurse is about to make
the first home visit to a family based on a
referral from the hospital where the high-risk
infant was born to an adolescent mother about
6 days ago. The nurse plans to assess the
family and home environment and provide
anticipatory guidance. On arrival, the mother
4.
sleepily answers the door after the nurse rings
the bell and knocks several times. The mother
lets the nurse in but is not happy to see the
nurse. She gets the infant and places him in
the nurse's arms, then sits across the room and
turns on the TV. Which response by the nurse
would be most appropriate?
“You must be very tired caring for a newborn
baby.”
“I wasn't planning to hold the baby. You
should hold him, you are the mother.”
“I need to talk to you, so please turn off the
TV.”
“How do you feel being a mother at 17?”
A
Feedback:
It is always best to acknowledge a client's
feelings, and from the scenario, observations
and referral information, being fatigued 6
days after having a baby is very possible. The
option about holding the baby is not the best
A)
B)
C)
D)
Ans:
C)
A)
B)
C)
D)
Ans:
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D)
Ans:
“I need to talk to you, so please turn off the
TV.”
“How do you feel being a mother at 17?”
A
Feedback:
It is always best to acknowledge a client's
feelings, and from the scenario, observations
and referral information, being fatigued 6
days after having a baby is very possible. The
option about holding the baby is not the best
way to respond to the mother or the first
comment to make, but holding the baby gives
the nurse an opportunity to role model infant
interaction and caring and assess his or her
cleanliness and clothing appropriateness.
However, the nurse may want to say that he or
she would like to wash his or her hands before
holding the baby. This gives the nurse an
additional opportunity to teach and assess
another room when washing hands. Asking to
turn off the TV might be appropriate after a
few moments of introductory conversation. It
would be best to ask the mother to turn the
TV down because of difficulty hearing her.
The nurse will win the mother's favor with
this approach better than by asking her to turn
off the TV. Asking how she feels being a
mother at 17 might be information to gather,
but asking it directly as a first comment
sounds like a put-down. There are better ways
to obtain this information a bit later in the
visit.
While making a family health visit, an older
relative who is visiting has been drinking and
5. becomes verbally abusive and increasingly
loud. Which action by the community health
nurse would be best?
Continue the visit with caution
Suggest the relative go in another room and
take a nap
Ask the sober family members to take the
visitor home
Terminate the visit, making plans for another
visit
D
Feedback:
Terminating the visit is the best choice. It
appears the problem is escalating, and the
nurse's safety should always come first.
Continuing the visit puts the nurse and
possibly the other family members at risk.
Making a suggestion to go into another room
and take a nap may agitate the relative and
C)
visitor home
Terminate the visit, making plans for another
visit
D
Feedback:
Terminating the visit is the best choice. It
appears the problem is escalating, and the
nurse's safety should always come first.
Continuing the visit puts the nurse and
possibly the other family members at risk.
Making a suggestion to go into another room
and take a nap may agitate the relative and
make a deteriorating situation worse. Making
a suggestion for a family member to take the
visitor home may agitate the relative and
make a deteriorating situation worse.
Additionally, this is the client's home and the
suggestion should be the client's.
D)
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D)
E)
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A)
B)
C)
D)
Which of the following things does a nurse
6. who is traveling by automobile to make a
home visit need? Select all that apply.
A full gas tank and well-operating vehicle
A map that includes the geographic location
where the home visit will be made
A cellular telephone
A bus schedule
Exact change
A, B, C
Feedback:
A nurse who is traveling by automobile to
make a home visit needs the following: a full
gas tank and well-operating vehicle, a map
that includes the geographic location where
the home visit will be made, and a cellular
telephone. If the nurse is not using public
transportation, the nurse does not need exact
change for each bus trip or a bus schedule.
Which of the following are specific safety
7. measures the nurse should apply when
making a home visit? Select all that apply.
Plan to reschedule the visit if you find a large
group of people assembled between you and
the client's door.
Immediately leave the home when family
members begin to physically fight with one
another.
Enter the residence before you determine that
the family you are intending to visit does live
there and is home.
Travel only in pairs for all home visits.
A)
B)
C)
D)
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E)
7. measures the nurse should apply when
making a home visit? Select all that apply.
Plan to reschedule the visit if you find a large
group of people assembled between you and
the client's door.
Immediately leave the home when family
members begin to physically fight with one
another.
Enter the residence before you determine that
the family you are intending to visit does live
there and is home.
Travel only in pairs for all home visits.
If someone approaches you and indicates that
they want your nursing bag, throw your bag
away from where you are and run in the
opposite direction.
Leave an itinerary of your planned travels, the
telephone numbers of families you will
attempt to visit and your cellular phone
number at your base of operation.
A, B, E, F
Feedback:
It is most important to leave an itinerary of
your planned travels, the telephone numbers
of families you will attempt to visit, and your
cellular phone number at your base of
operation. Specific safety measures the nurse
should apply when making a home visit
include planning to reschedule the visit if you
find a large group of people assembled
between you and the client's door;
immediately leaving the home when family
members begin to physically fight with one
another; and if someone approaches you and
indicates that they want your nursing bag,
throw your bag away from where you are and
run in the opposite direction. It is not
appropriate for the nurse to enter the
residence before determining that the family
that is to be visited does live there and is
home. It is not necessary to travel only in
pairs for all home visits.
F)
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A)
B)
C)
Which one of the following has a negative
8. influence on family health and individual
health?
The level at which a family functions
significantly affects the individual's level of
health.
A healthy family fosters individual growth
and sustains members during times of crisis.
Family patterns dictate whether members
participate in their own health care.
Which one of the following has a negative
8. influence on family health and individual
health?
The level at which a family functions
significantly affects the individual's level of
health.
A healthy family fosters individual growth
and sustains members during times of crisis.
Family patterns dictate whether members
participate in their own health care.
Individuals can obstruct the family's health
and families can obstruct individual family
members' health.
D
Feedback:
A negative influence on family health and
individual health is that individuals can
obstruct the family's health and families can
obstruct individual family members' health.
The level at which a family functions
significantly affects the individual's level of
health; that a healthy family fosters individual
growth and sustains members during times of
crisis; and the influence of families that
dictate whether members participate in their
own health care are all positive influences.
A)
B)
C)
D)
D)
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B)
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When assessing a family, which of the
9. following would lead the nurse to question the
health of a family?
Role relationships are inflexible.
Coping is actively attempted.
Family members communicate regularly.
The family lacks regular links with the
broader community.
D
Feedback:
In a healthy family, role relationships are
structured effectively so that they can change
with changing family needs. Active coping,
regular family communication, and regular
links with the broader community reflect a
healthy family.
During a home visit, a client asks the
community health nurse to take his or her
shopping to purchase some of the food items
10.
he or she needs for his or her diet. Which
response by the nurse would be most
appropriate?
“I can't, I'm going in a totally different
direction.”
“You need to find some other way to get to
the store.”
“I'll help you find a way to get to the store.”
“Use the foods you have in the house and
shop next week.”
C
Feedback:
The nurse needs to empower the client and
helping the client find a way to get to the
store promotes the skill of planning so that the
client can begin to manage her own needs
effectively. Telling the client that the nurse is
going in a different direction, telling him or
her to find some other way to get to the store,
and telling him or her to use the foods in the
house are neither therapeutic nor do they
promote empowerment.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A community health nurse, visits an 81-yearold newly diagnosed insulin-dependent
diabetic who lives alone. The nurse has
visited the family three previous times and is
visiting early in the morning to observe his
11. client's insulin administration technique. The
nurse finds the client depressed over his or
her situation one morning. The nurse suggests
that together they list positive points about his
or her situation and discuss his or her feelings.
This is an example of which of the following?
Strengthening
Data collection
Goal-directed questioning
Measuring family functioning
A
Feedback:
The nurse is demonstrating a communication
technique called strengthening which is used
to assist the family in becoming independent
of the nurse's services. Data collection, goaldirected questioning, and measurement of
family function are methods used for
assessment.
B)
C)
D)
Ans:
Data collection
Goal-directed questioning
Measuring family functioning
A
Feedback:
The nurse is demonstrating a communication
technique called strengthening which is used
to assist the family in becoming independent
of the nurse's services. Data collection, goaldirected questioning, and measurement of
family function are methods used for
assessment.
12.
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A)
Which one of the following is a principle that
guides and enhances family nursing practice?
The nurse should expect that the family will
be normal and will not change.
The nurse should start where the family is at
the present time and not the ideal level of
functioning.
The nurse should focus on each family
member individually.
The nurse should evaluate the family based on
consistency with traditional family patterns.
B
Feedback:
When working with families, community
health nurses begin at the present, not the
ideal level of functioning. This is
accomplished after the nurse views the family
collectively, not individually. The nurse
should expect that what is normal for one
family is not necessarily normal for another
and that families are constantly changing. The
nurse should recognize the validity of family
structure variations.
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B)
C)
D)
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A community health nurse is attempting to
empower a family to become independent.
13.
Which of the following would be most
appropriate?
Focus attention on the problem areas
Do for the family what they cannot
Emphasize the family's strengths
Reinforce positive traits
C
Feedback:
To help empower families, the community
health nurse needs to emphasize the family's
strengths. It is the nurse's job to recognize the
strengths in families and to help families
recognize them as well. Focusing on problem
Do for the family what they cannot
Emphasize the family's strengths
Reinforce positive traits
C
Feedback:
To help empower families, the community
health nurse needs to emphasize the family's
strengths. It is the nurse's job to recognize the
strengths in families and to help families
recognize them as well. Focusing on problem
areas portrays a negative view and can
undermine the nurse's efforts. Doing for the
family what they cannot fosters dependency.
Reinforcing positive traits may be appropriate
if those positive traits are strengths. Not all
positive traits are strengths.
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B)
C)
D)
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A)
B)
C)
A community health nurse is applying an
interactional framework to assess a family's
14.
health. Which of the following would the
nurse do?
View them in terms of the family's internal
relationships
Look at them from a life-cycle perspective
Evaluate the members' changing roles and
tasks
Assess them as a social system relating to
other social systems
A
Feedback:
An interactional framework describes the
family as a unit of interacting personalities
and emphasizes communication, roles,
conflict, coping patterns, and decision-making
processes. A developmental framework
studies the family from a life-cycle
perspective by examining the members'
changing roles and tasks in each progressive
stage. A structural–functional framework
describes the family as a social system
relating to other social systems in the
environment.
A community health nurse constructs an eco15. map for a family based on the understanding
that this tool is useful for which reason?
Family relationships over three or more
generations are depicted.
The ecological system of a family's
neighborhood is charted.
It was originally devised to depict the
complexity of the client's story.
A community health nurse constructs an eco15. map for a family based on the understanding
that this tool is useful for which reason?
Family relationships over three or more
generations are depicted.
The ecological system of a family's
neighborhood is charted.
It was originally devised to depict the
complexity of the client's story.
Directions for gathering data about
neighborhoods are provided.
C
Feedback:
An eco-map depicts the complexity of the
client's story. Lines are drawn to indicate
connections to other systems with arrows
signifying the direction of energy or flow of
resources, and the absence of lines indicates a
lack of connections. The family's
neighborhood is one component, but not the
central focus of the eco-map. A genogram
displays family information about complex
family patterns such as family relationships
over three or more generations, arrows signify
the direction of energy or flow of resources,
and absence of lines indicates a lack of
connections.
A)
B)
C)
D)
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B)
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D)
E)
F)
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A community health nurse is collecting data
about the family's demographics. Which of
16.
the following would the nurse include? Select
all that apply.
Dietary patterns
Housing
Climate
Socioeconomic status
Education of members
Ethnicity
D, E, F
Feedback:
Family demographics refer to such descriptive
variables as a family's composition, its
socioeconomic status, and the ages,
education, occupation, ethnicity, and religious
affiliations of members. Dietary patterns,
housing, and climate are variables assessed
with the physical environment.
Socioeconomic status
Education of members
Ethnicity
D, E, F
Feedback:
Family demographics refer to such descriptive
variables as a family's composition, its
socioeconomic status, and the ages,
education, occupation, ethnicity, and religious
affiliations of members. Dietary patterns,
housing, and climate are variables assessed
with the physical environment.
A)
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A)
B)
C)
When a community health nurse is
conducting a family assessment on an
17.
assigned family, which of the following
would be most appropriate?
Use quantitative data only to maintain and
preserve objectivity
Interview one family member to avoid
confusion and repeated information
Use a checklist format, completing the tool in
the family's presence
Make several visits and accumulate data from
all family members
D
Feedback:
Completing a family assessment takes time. It
is better to keep notes from several visits with
the family and observe the family as a group
during some family activity. The nurse should
not use obtrusive questionnaire techniques or
take notes in the family's presence.
Quantitative data will give a one-sided view
of family data. It is best to interview all
family members over time. The nurse should
collect both quantitative and qualitative data,
which will provide a rich family assessment.
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D)
E)
F)
Ans:
During a home visit and assessment of an
infant and new mother, the nurse determines
that the infant looks healthy. The mother asks
18. several questions and listens attentively. One
question she asks is whether the nurse is
going to visit her again. Which response
would be most appropriate?
“Your baby looks healthy. You should not
have any further questions.”
“The agency limits the number of visits I can
make; I will let you know.”
“I plan to visit again. What would you like to
accomplish at the next visit.”
A)
B)
C)
D)
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Ans:
that the infant looks healthy. The mother asks
18. several questions and listens attentively. One
question she asks is whether the nurse is
going to visit her again. Which response
would be most appropriate?
“Your baby looks healthy. You should not
have any further questions.”
“The agency limits the number of visits I can
make; I will let you know.”
“I plan to visit again. What would you like to
accomplish at the next visit.”
“I can come weekly for the next 16 weeks,
and then a staff nurse will visit.”
C
Feedback:
The response about what the client wants to
accomplish together represents a mutual
approach, giving power to the client and hints
at accomplishing things together on
subsequent visits. Noting that the infant looks
good and that the mother should not have
further questions is closed-ended and nursefocused and does not promote open
communication between the client and the
nurse. The option about limiting visits is
inaccurate; the nurse has more control over
the number of visits than this response
implies, unless the visit is part of a special
and very limited program. Even then it would
not be phrased this way. The final option
about 16 weekly visits followed by a staff
nurse sounds overwhelming and unrealistic.
Very few clients receive this much service
from public health agencies.
A)
B)
C)
D)
Ans:
A community health nurse determines that it
is time for teaching a family about health
19.
promotion activities when they say which of
the following?
“Is there a place we can go for the medicine?”
“It's time we do something about eating
right.”
“When are you coming back to visit?”
“Our grandchildren visit every summer.”
B
Feedback:
Teaching health promotion activities should
begin only after family members express an
interest and recognize a need, such as the
statement about eating right. Asking about
where to get medicine and when the nurse is
coming back do not reflect an interest or need.
The statement about grandchildren reflects
right.”
“When are you coming back to visit?”
“Our grandchildren visit every summer.”
B
Feedback:
Teaching health promotion activities should
begin only after family members express an
interest and recognize a need, such as the
statement about eating right. Asking about
where to get medicine and when the nurse is
coming back do not reflect an interest or need.
The statement about grandchildren reflects
information about the family structure and
demographics.
C)
D)
Ans:
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Which of the following would a community
20. health nurse use when conducting an outcome
evaluation?
Organization
Family progress
Timing
Performance
B
Feedback:
Outcome evaluation involves determining the
change in the family's health status or
progress. Organization and timing are
components of the structure–process
evaluation. Performance is part of selfevaluation.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
The nurse educator knows that the nursing
student has grasped the concept of self21.
evaluation when the nursing student makes
which one of the following statements?
It is important for the family to evaluate itself.
It is important for the nurse's growth and
effectiveness as a community health nurse.
Evaluations by others are not helpful.
Individuals can always see their own
strengths or flaws.
B
Feedback:
Self-evaluation is important for the nurse's
growth and effectiveness as a community
health nurse. Self-evaluation is referring to
the nurse's growth and not the family's.
Sometimes, we cannot see our own strengths
or flaws, and evaluations by others are
helpful.
C)
Evaluations by others are not helpful.
Individuals can always see their own
strengths or flaws.
B
Feedback:
Self-evaluation is important for the nurse's
growth and effectiveness as a community
health nurse. Self-evaluation is referring to
the nurse's growth and not the family's.
Sometimes, we cannot see our own strengths
or flaws, and evaluations by others are
helpful.
D)
Ans:
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Chapter 15 Community as Client
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Which of the following statements about
1. competent communities are accurate? Select
all that apply.
A competent community is able to collaborate
effectively identifying community needs and
problems.
A competent community is able to achieve a
working consensus on goals and priorities.
A competent community is able to agree on
ways and means to implement the agreedupon goals.
A competent community has no problems.
A competent community is able to collaborate
effectively to take the required actions.
A, B, C, E
Feedback:
A competent community is able to collaborate
effectively identifying community needs and
problems. A competent community is able to
achieve a working consensus on goals and
priorities. A competent community is able to
agree on ways and means to implement the
agreed-upon goals. A competent community
is able to collaborate effectively to take the
required actions. All communities have
problems.
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B)
C)
D)
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E)
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A)
B)
Which of the following are overarching goals
2. for the health of the nation presented in
Healthy People 2020? Select all that apply.
To attain high-quality, longer lives free of
preventable disease, disability, injury, and
premature death
To achieve health equity, eliminate disparities,
and improve the health of all groups
A)
B)
C)
D)
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E)
Which of the following are overarching goals
2. for the health of the nation presented in
Healthy People 2020? Select all that apply.
To attain high-quality, longer lives free of
preventable disease, disability, injury, and
premature death
To achieve health equity, eliminate disparities,
and improve the health of all groups
To create social and physical environments
that promote good health for all
To promote quality of life, healthy
development, and healthy behaviors across all
life stages
Healthy People 2020 does not address the
health of the nation but does address the
health of individuals.
A, B, C, D
Feedback:
The four overarching goals for the health of
the nation are the following:
To attain high-quality, longer lives free of
preventable disease, disability, injury, and
premature death
To achieve health equity, eliminate disparities,
and improve the health of all groups
To create social and physical environments
that promote good health for all
To promote quality of life, healthy
development, and healthy behaviors across all
life stages
A)
B)
C)
D)
Ans:
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Ans:
When the nursing student identifies the three
dimensions of the health of a community, the
3.
nurse educator is aware that the student has
grasped which of the following concepts?
Status/people, structure, and process
Assessment, policy development, and
assurance
Primary, secondary, and tertiary
Function, structure, and process
A
Feedback:
The three dimensions of the health of the
community are status/people, structure, and
process. Assessment, policy development, and
assurance are the three core public health
functions. Primary, secondary, and tertiary are
the levels of prevention. Function, structure,
and process are the descriptions of Human
Anatomy and Physiology.
assurance
Primary, secondary, and tertiary
Function, structure, and process
A
Feedback:
The three dimensions of the health of the
community are status/people, structure, and
process. Assessment, policy development, and
assurance are the three core public health
functions. Primary, secondary, and tertiary are
the levels of prevention. Function, structure,
and process are the descriptions of Human
Anatomy and Physiology.
A community health nurse is working as part
of a health planning team to determine the
needs of pregnant teenagers in the
4.
community. Which of the following
population variables would be important to
assess? Select all that apply.
Rate of growth or decline among those in
need
Health needs and practices of subculture
groups
Geographic placement of proposed health
services
Functions of community organizations
Social class of the community
Level of agreement on community goals
A, B, E
Feedback:
Population variables include size, density,
composition, rate of growth or decline,
cultural characteristics, social class structure,
and mobility. Pregnant teens are a subculture
of teenagers. Cultural differences are
population variables along with the numbers,
social class, and mobility. Health needs vary
among subculture and ethnic populations.
Geographic placement reflects location.
Functions of community organizations and
social class reflect the social system.
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C)
D)
Ans:
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B)
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C)
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D)
E)
F)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse avoids focusing
5. care on illness and health problems,
considering clients as which of the following?
Aggregate
Agent
Community
Total system
D
Feedback:
A community health nurse avoids focusing
5. care on illness and health problems,
considering clients as which of the following?
Aggregate
Agent
Community
Total system
D
Feedback:
It was proposed by Mundinger and Jauron
that the use of nursing diagnoses in the
community could be formulated by
substituting the terms, client, family, group, or
aggregate for the word patient. Community
health nurses look for evidence of all kinds of
needs that relate to or influence a client's
levels of wellness. Needs cover the whole
span of the health–illness continuum and the
total person, family, group, aggregate,
population, or community—the total system.
Not all clients are communities. They may be
individuals or families. Not all clients are in
the category of groups, aggregates, or
populations. A client can be an individual or a
family. When using the epidemiological triad,
there are three components: host, agent, and
environment. A client would be considered
the host. An agent is a factor that causes or
contributes to a health problem or condition.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When the nursing student identifies the
concept of community as client as which of
6.
the following the instructor knows that the
student has grasped this concept?
The community is comprised of individual
clients.
The community is comprised of families.
The community is a group or population of
people as the focus of nursing service.
The community cannot be a client. Persons
who are hospitalized are patients.
C
Feedback:
The concept of community as client refers to
a group or population of people as the focus
of nursing service.
A)
B)
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C)
Which of the following statements about the
7. structural dimension of the community as
client are accurate? Select all that apply.
Structure of a community refers to its services
and resources.
Community associations, groups, and
organizations provide a means for accessing
needed services.
Adequacy and appropriateness of health
services can be determined by examining
patterns of use, number and types of health
and social services, and quality measures.
Demographic data, such as socioeconomic
and racial distribution, age, gender, and
educational level, are important indicators of
community structure.
Structure is the most common measure of the
health of a community.
A, B, C, D
Feedback:
Structure of a community refers to its services
and resources. Community associations,
groups, and organizations provide a means for
accessing needed services. Adequacy and
appropriateness of health services can be
determined by examining patterns of use,
number and types of health and social
services, and quality measures. Demographic
data, such as socioeconomic and racial
distribution, age, gender, and educational
level, are important indicators of community
structure. Status/people is the most common
measure of the health of a community.
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D)
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E)
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Ans:
A)
B)
C)
D)
Ans:
The community health nurse is determining
the health of a community by examining
8.
status. Which of the following would the
nurse examine?
Leading causes of death and illness
Adequacy of health services
Socioeconomic distributions
Strengths of the community
A
Feedback:
Status typically comprises morbidity and
mortality data identifying the physical,
emotional, and social determinants of health.
nurse examine?
Leading causes of death and illness
Adequacy of health services
Socioeconomic distributions
Strengths of the community
A
Feedback:
Status typically comprises morbidity and
mortality data identifying the physical,
emotional, and social determinants of health.
Physical and social indices include vital
statistics, leading causes of death and illness,
suicide rates, and rates of drug and alcohol
addiction. Social determinants can be
identified by crime rates and functional ability
level, or by high school dropout rates or
average income levels. Adequacy of health
services and socioeconomic distributions
reflect structure. Strengths of the community
involve process.
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A)
B)
C)
D)
Ans:
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The community health nurse is assessing the
health of a community by reviewing the
9.
dimension of process. Which of the following
is true of this dimension?
Process of a community refers to its services
and resources.
Process reflects the community's ability to
function effectively.
It usually consists of morbidity and mortality
data.
It refers to the physical, emotional and social
determinants of health.
B
Feedback:
Process reflects the community's ability to
function effectively. Structure of a community
refers to its services and resources. Status/
people dimension usually refers to the
morbidity and mortality data and the physical,
emotional, and social determinants of health.
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A)
B)
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Ans:
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D)
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C)
A)
B)
C)
D)
Ans:
As part of an orientation for a group of newly
hired nurses for a community agency, a
10.
community health nurse emphasizes which of
the following as crucial?
Cyclic nature
Client focus
Interaction
Flexibility
C
Feedback:
As part of an orientation for a group of newly
hired nurses for a community agency, a
10.
community health nurse emphasizes which of
the following as crucial?
Cyclic nature
Client focus
Interaction
Flexibility
C
Feedback:
Although the nursing process is cyclical,
deliberative, flexible (adaptable), client
focused, and need oriented, interaction is an
essential first consideration for community
health nursing. All steps of the nursing
process depend on interaction.
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A)
B)
C)
D)
Ans:
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When building a coalition, which of the
11. following would the community health nurse
do first?
Conduct a community assessment
Identify key players
Identify potential members
Define goals and objectives
D
Feedback:
Steps to coalition building include defining
goals and objectives, conducting a community
assessment, identifying key players or leaders,
and identifying potential coalition members.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When assessing a community's needs, which
12. of the following would the nurse most likely
complete first?
Familiarization assessment
Problem-oriented assessment
Community subsystem assessment
Comprehensive assessment
A
Feedback:
A familiarization assessment is a common
starting place in evaluation of a community. It
involves studying data already available on a
community and then gathering a certain
amount of firsthand data in order to gain a
working knowledge of the community. A
problem-oriented assessment begins with a
single problem and assesses the community in
terms of that problem. It is commonly used
when familiarization is not sufficient and a
comprehensive assessment is too expensive. A
community subsystem assessment focuses on
Problem-oriented assessment
Community subsystem assessment
Comprehensive assessment
A
Feedback:
A familiarization assessment is a common
starting place in evaluation of a community. It
involves studying data already available on a
community and then gathering a certain
amount of firsthand data in order to gain a
working knowledge of the community. A
problem-oriented assessment begins with a
single problem and assesses the community in
terms of that problem. It is commonly used
when familiarization is not sufficient and a
comprehensive assessment is too expensive. A
community subsystem assessment focuses on
one dimension of community life. It is a
useful way for a team to conduct a more
thorough community assessment. A
comprehensive assessment seeks to discover
all relevant community health information.
st
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B)
C)
D)
Ans:
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When completing a community assets
assessment, the community health nurse
13.
would gather information about which of the
following?
Key informants
Strengths of the community
Specific problem of the community
Overall life of the community
B
Feedback:
An assets assessment focuses on the strengths
and capacities of a community rather than its
problems. Key informants are important
sources of information with a comprehensive
assessment. Information about a specific
health problem is gathered during a problemoriented assessment. Information about an
overall view of the community and its life is
gathered with a familiarization or windshield
survey.
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A)
B)
C)
D)
Ans:
Nursing students in a community health
nursing course identified toxic waste disposal
to be a major problem in their community.
14. The most cost-effective type of community
assessment to determine the extent of the
problem and the resources available to handle
it would be a
familiarization assessment.
community subsystem assessment.
problem-oriented assessment.
comprehensive community assessment.
C
Feedback:
The problem-oriented assessment is
commonly used when familiarization is not
sufficient and a comprehensive assessment is
too expensive and not needed and a
subsystem assessment is too narrow to
determine the extent of the problem.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
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A community health nurse involved in
assessing community health needs is planning
to get a group of approximately 10 similar
15.
individuals together to obtain information
about opinions on first pregnancies. The nurse
is using which assessment method?
Survey
Community forum
Focus group
Descriptive epidemiology
C
Feedback:
The nurse is using a focus group, similar to
the community forum or town hall meeting in
that it is designed to obtain grassroots
opinion. Focus groups usually have only a
small group of participants, usually 5 to 15
people and the members chosen for the group
are homogeneous with respect to specific
demographic variables. A survey involves a
series of questions, often to provide a broad
range of data. Community forum is a
qualitative method to obtain community
opinions; the members typically represent all
segments of the community involved with the
issue. Descriptive epidemiologic studies
examine the amount and distribution of a
disease or health condition in a population by
Community forum
Focus group
Descriptive epidemiology
C
Feedback:
The nurse is using a focus group, similar to
the community forum or town hall meeting in
that it is designed to obtain grassroots
opinion. Focus groups usually have only a
small group of participants, usually 5 to 15
people and the members chosen for the group
are homogeneous with respect to specific
demographic variables. A survey involves a
series of questions, often to provide a broad
range of data. Community forum is a
qualitative method to obtain community
opinions; the members typically represent all
segments of the community involved with the
issue. Descriptive epidemiologic studies
examine the amount and distribution of a
disease or health condition in a population by
person, place, and time.
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B)
C)
D)
Ans:
te
A community health nurse obtains data about
16. the community from primary sources,
including which of the following?
World Health Organization
Community members
State health department
Other community health nurses
B
Feedback:
Primary sources of information include
community members, including formal
leaders, informal leaders, and community
members, and can frequently offer the most
accurate insights and comprehensive
information. Information gathered by talking
to people provides primary data, because the
data are obtained directly from the
community. The World Health Organization is
an international source of information. State
health department is a state source of data.
Other community health nurses as well as
health team members, client records,
community health (vital) statistics, census
bureau data, reference books, and research
reports are secondary sources of information.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
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Ans:
When developing community diagnoses,
17. which of the following would the community
health nurse do?
Focus primarily on deficits of the community
Use broad statements to guide a range of
interventions
Employ a revised nursing diagnosis format
Substitute the terms client, family, group, or
aggregate for the word patient
D
Feedback:
Community diagnoses should include
statements about the strengths of the
community and possible sources for
community solutions, as well as the
community's weaknesses or problem areas. In
addition, they should portray a community
focus, include the community response, and
identify any related factors that have potential
for change through community health
nursing. These may also include wellness
diagnoses, which indicate maintenance or
potential change responses (due to growth and
development), when no deficit is present.
Diagnoses statements should be narrow
enough to guide interventions and use the
standard nursing diagnosis format.
A)
B)
C)
D)
Ans:
During which stage of the health planning
18. process would the community health nurse
create a plan?
Assessment
Analysis and design
Implementation
Evaluation
B
Feedback:
During the health planning process, a
community health nurse creates a plan during
the analysis and design stage, which
correlates to the planning phase of the nursing
process. Assessment involves data collection,
interpretation, and goal setting.
Implementation involves how to
operationalize the plan and a design for
monitoring progress. Evaluation involves
Analysis and design
Implementation
Evaluation
B
Feedback:
During the health planning process, a
community health nurse creates a plan during
the analysis and design stage, which
correlates to the planning phase of the nursing
process. Assessment involves data collection,
interpretation, and goal setting.
Implementation involves how to
operationalize the plan and a design for
monitoring progress. Evaluation involves
examining the costs and benefits, judging the
potential outcomes, modifying the plan,
presenting the plan to the sponsoring group or
agency, and obtaining acceptance.
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B)
C)
D)
Ans:
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A community health nurse is engaged in
evaluation of a health plan using a formative
19.
evaluation. The nurse would focus on which
of the following?
Process during the actual intervention
Outcomes of the interventions
Development of performance standards
Impact on the clients' health
A
Feedback:
The focus of formative evaluation is on
process during the actual interventions. It uses
performance standards that are developed to
determine what is working and not working.
Summative evaluation focuses on the
outcome of the interventions and examines
the programs' impact on clients' health.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When applying community development
20. theory, which of the following would most
likely be considered the agent of change?
Clients
Nurse
Families
Community leaders
B
Feedback:
When applying community development
theory, the agent of change is most often the
community health nurse who is considered a
partner rather than an authority figure
responsible for the community's health.
Clients, families, and community leaders
B)
C)
D)
Ans:
Nurse
Families
Community leaders
B
Feedback:
When applying community development
theory, the agent of change is most often the
community health nurse who is considered a
partner rather than an authority figure
responsible for the community's health.
Clients, families, and community leaders
would be the care recipients.
Chapter 16 Global Health Nursing
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When describing the global framework,
1. which of the following would the community
health nurse be least likely to include?
Population
Provider
Procedure
Physician
D
Feedback:
The global framework is bounded by a
context and includes three parts, the three
“Ps.” These are the population, the provider,
and the procedure. Physician would be
included as a provider.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When applying the Universal Imperatives of
2. Care, which of the following would be the
priority?
Mortality
Daily functioning
Decision making
Cost
A
Feedback:
The Universal Imperatives of Care include
mortality, morbidity, daily functioning,
decision making, and cost. This paradigm
underscores the notion of first things first.
That is, one must be alive and well before
interventions focus on functioning or decision
making.
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A)
A nursing student is considering a career in
international community health nursing.
Which of the following statements are
3.
accurate regarding the context of international
community health nursing? Select all that
apply.
Global community health care is complex and
is affected by multiple factors relating to
geography, history, politics, culture, religion,
and economy.
The types of services that can be provided
include a range from providing clinical
services to policy making at an international
level.
People's conception of health, wellness, and
illness are static from culture to culture.
By looking through a computer window, the
student is able to see almost anyplace,
connect to about any person, and access
information about almost any concept.
The ways in which people view nurses and
other health care providers are affected by
their attitudes toward women, their culture,
and belief systems.
A, B, D, E
Feedback:
The following statements are true: Global
community health care is complex and is
affected by multiple factors relating to
geography, history, politics, culture, religion,
and economy; The types of services that can
be provided include a range from providing
clinical services to policy making at an
international level; By looking through a
computer window, the student is able to see
almost anyplace, connect to about any person,
and access information about almost any
concept; The ways in which people view
nurses and other health care providers are
affected by their attitudes toward women,
their culture, and belief systems. The
statement that people's conceptions of health
are static from culture to culture is false.
Indeed, people's conceptions of health,
wellness, and illness vary from culture to
culture.
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B)
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C)
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D)
E)
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Ans:
other health care providers are affected by
their attitudes toward women, their culture,
and belief systems.
A, B, D, E
Feedback:
The following statements are true: Global
community health care is complex and is
affected by multiple factors relating to
geography, history, politics, culture, religion,
and economy; The types of services that can
be provided include a range from providing
clinical services to policy making at an
international level; By looking through a
computer window, the student is able to see
almost anyplace, connect to about any person,
and access information about almost any
concept; The ways in which people view
nurses and other health care providers are
affected by their attitudes toward women,
their culture, and belief systems. The
statement that people's conceptions of health
are static from culture to culture is false.
Indeed, people's conceptions of health,
wellness, and illness vary from culture to
culture.
E)
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Ans:
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A community health nurse is preparing a
presentation for a community group about
tuberculosis (TB) and its current epidemic
4.
status. Which of the following would the
nurse include in the presentation about this
disease?
TB kills about 1.7 million people each year.
All persons who are infected by the causative
organism become ill and can spread the
causative organism to others throughout the
remainder of their lifetime.
Three fourths of the world's population is
thought to be currently infected by the
causative organism.
The highest number of deaths is in Eastern
Europe.
A
Feedback:
TB kills approximately 1.7 million people
each year. Only 5 to 10 of those infected
become ill or can spread the causative
organism to others within their lifetime. One
third of the world's population is thought to be
currently infected by the causative organism
(tubercle bacillus). The highest number of
deaths occur in Africa.
C)
D)
Ans:
causative organism.
The highest number of deaths is in Eastern
Europe.
A
Feedback:
TB kills approximately 1.7 million people
each year. Only 5 to 10 of those infected
become ill or can spread the causative
organism to others within their lifetime. One
third of the world's population is thought to be
currently infected by the causative organism
(tubercle bacillus). The highest number of
deaths occur in Africa.
D)
A community health nurse has identified
noise as an environmental hazard. Using the
5.
Blumenthal classification, the nurse would
identify this as which of the following class?
Infectious agents
Asphyxiates
Poison
Physical agents
D
Feedback:
The Blumenthal classification lists classes of
environmental hazards. They include
infectious agents (e.g., bacteria and viruses),
respiratory fibrotic agents (e.g., coal dust),
asphyxiates (e.g., carbon monoxide), poison
(e.g., pesticides), physical agents (e.g., noise),
psychological agents (stressful synergisms
such as crowding combined with noise),
mutagens (e.g., dioxin), teratogens (e.g.,
cadmium), and carcinogens (e.g., cigarette
smoke).
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Which one of the following factors has
6. resulted in the Era of Chronic Long-Term
Health Conditions?
Decreased usage of tobacco by young
populations
Despite programs of control, many infectious
diseases persist with many people surviving
to experience chronic, long-term conditions
secondary to the infectious disease.
Shorter life expectancies due to chronic
diseases
Death from infectious diseases results in a
decrease in degenerative diseases.
B
Feedback:
Despite the programs of control, many
diseases persist with many people surviving
to experience chronic, long-term conditions
secondary to the infectious disease.
Shorter life expectancies due to chronic
diseases
Death from infectious diseases results in a
decrease in degenerative diseases.
B
Feedback:
Despite the programs of control, many
infectious diseases persist. However,
populations now survive and also experience
chronic, long-term conditions. These
conditions affect mortality and morbidity,
daily functioning, decision making, and cost.
Thus, the longevity that has resulted from
meeting the challenges of the Era of
Infectious Diseases compounds the more
recent emergence of chronic diseases in the
many countries. The emergence of multidrug
resistant diseases, continued persistence of
infectious disease, and urbanization with
deforestation have resulted in new and
emerging infectious diseases and conditions.
B)
C)
D)
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A)
B)
C)
D)
Ans:
When reviewing statistics about illnesses
worldwide, which of the following would the
7.
nurse identify as the most common and a
leading cause of mortality?
Tuberculosis
Smallpox
Acute respiratory tract infection
Infectious diarrheal disease
C
Feedback:
The most common illness in the world and a
leading cause of mortality is acute respiratory
tract infection (ARI). Three million deaths
annually are attributed to ARI among children
younger than 5 years of age, usually from
pneumonia. Tuberculosis is considered
epidemic today. Smallpox has been
eradicated. Infectious diarrheal disease has
been reduced due to oral rehydration therapy
and improvements in water and sanitation.
A)
B)
B)
C)
D)
Ans:
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C)
D)
Ans:
Which of the following interventions would a
community health nurse be involved with to
8.
help achieve a reduction in the number of
measles deaths worldwide?
Integrated Management of Childhood Illness
(MCI)
Global Alliance for Vaccine and
Immunization
Oral rehydration therapy
Geographical information systems
A
Feedback:
The MCI is the intervention considered to
have the greatest impact in reducing measles.
It provides wide immunization coverage,
rapid referral of serious cases, prompt
recognition of secondary conditions, and
improved nutrition and vitamin A
supplementation. The Global Alliance for
Vaccine and Immunization is an interagency
initiative that seeks to protect every child
against vaccine-preventable diseases. This
initiative addresses all of these types of
diseases. Oral rehydration therapy has been
used to reduce mortality associated with
diarrheal diseases. Geographical information
systems is not a program but a means to
monitor diseases.
9.
Which one of the following statements about
poliomyelitis is the most accurate?
Polio is not endemic in any countries at
present.
Polio has been eliminated worldwide.
Rotary International has contributed no funds
but many hours of manpower to eradicate
polio.
Polio has been eliminated from the Western
hemisphere.
D
Feedback:
Polio has been eliminated from the Western
Hemisphere. It is now almost eliminated
worldwide. Polio is endemic in Afghanistan,
India, Pakistan, and Nigeria. Rotary
International has contributed over $900
million dollars to help eradicate this disease.
polio.
Polio has been eliminated from the Western
hemisphere.
D
Feedback:
Polio has been eliminated from the Western
Hemisphere. It is now almost eliminated
worldwide. Polio is endemic in Afghanistan,
India, Pakistan, and Nigeria. Rotary
International has contributed over $900
million dollars to help eradicate this disease.
D)
A community health nurse is reading a journal
article about global health and communicable
10. diseases. The article states that elimination is
the goal. The nurse interprets this to mean
which of the following?
There are no further cases of the disease
anywhere.
No further preventive efforts are necessary.
The disease is no longer a public health threat.
The disease has been interrupted in a
geographic area.
D
Feedback:
The term elimination is used when a disease
has been interrupted in a defined geographic
area. In 1991, WHO defined elimination as a
reduction of prevalence to less than one case
per 1 million population in a given area.
Eradication means interruption of person-toperson transmission and limitation of the
reservoir of infection so that no further
preventive efforts are required; it indicates a
status whereby no further cases of a disease
occur anywhere. The term control indicates
that a specific disease has ceased to be a
public health threat.
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A)
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A)
B)
C)
D)
Ans:
A community health nurse instructs a local
community group on how to prepare
11. homemade oral rehydration solution. Which
of the following ingredients would the nurse
include?
Sea water
Table salt
Baking soda
Crushed bananas
B
Feedback:
Oral rehydration solution consists of 1 L of
safe water to which is added half small
of the following ingredients would the nurse
include?
Sea water
Table salt
Baking soda
Crushed bananas
B
Feedback:
Oral rehydration solution consists of 1 L of
safe water to which is added half small
teaspoon of salt, and four large spoons of
sugar. In addition, bananas or green coconut
water are encouraged to compensate for the
loss of potassium.
Communicable disease is a global health
concern with a primary goal of eradicating
12.
communicable diseases worldwide.
Achievement of this goal would involve
interrupting disease in a limited, defined
geographic area.
reducing the incidence and/or prevalence of
communicable diseases.
establishing primary health care services for
all people on the globe.
interrupting transmission and reservoir of
infection to prevent further cases.
D
Feedback:
Eradication is an ambitious and expensive
goal and has occurred with smallpox in 1977
and is under way with other diseases such as
poliomyelitis, guinea worm, leprosy, and
measles so that many diseases can be
eradicated early in the 21st century. One
major means of eradicating communicable
diseases is to interrupt the transmission and
reservoir, thereby preventing the development
of new cases. Interrupting disease in a limited
area may be a starting point, but more
widespread involvement is needed. Reducing
the incidence or prevalence would provide
indications about the effects of attempting to
eradicate the disease. Establishing primary
health care services is the goal of Alma-Ata
“health for all.”
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B)
C)
D)
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13.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
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Ans:
Which one of the following statements about
immunization is true?
The World Health Organization estimates that
a billion more lives could be saved each year
with immunizations.
Vaccines are one of the most cost-effective
interventions found in public health.
Half of the world's children are being reached
with essential vaccines.
In the United States, toddlers are thoroughly
vaccinated.
B
Feedback:
Vaccines are one of the most cost-effective
interventions found in public health. The
World Health Organization estimates that 3
million more lives could be saved each year
with immunizations. Three fourths of the
world's children are being reached with
essential vaccines. In the United States, only
10% of toddlers are protected against measles,
mumps, and rubella via vaccinations.
A community health nurse is working with an
international agency in Australia. The nurse
14.
would most likely encounter which type of
health care system?
Entrepreneurial
Welfare-oriented
Comprehensive
Socialist
B
Feedback:
Australia subscribes to a welfare-oriented
health care system in which statutory
programs drive these systems to support the
cost of health care for all, or almost all, of the
population through their “national health
insurance.” An Entrepreneurial Health Care
System, found in the United States, is one in
which the country's health care system is
based, in part, on its political economy. A
Comprehensive Health Care System is a step
away from the welfare-oriented type in that
substantial modifications exist in delivery and
financing that result in universal entitlements.
These systems are found in Scandinavian
countries, Great Britain, and New Zealand.
Socialist Health Care Systems came about
Welfare-oriented
Comprehensive
Socialist
B
Feedback:
Australia subscribes to a welfare-oriented
health care system in which statutory
programs drive these systems to support the
cost of health care for all, or almost all, of the
population through their “national health
insurance.” An Entrepreneurial Health Care
System, found in the United States, is one in
which the country's health care system is
based, in part, on its political economy. A
Comprehensive Health Care System is a step
away from the welfare-oriented type in that
substantial modifications exist in delivery and
financing that result in universal entitlements.
These systems are found in Scandinavian
countries, Great Britain, and New Zealand.
Socialist Health Care Systems came about
through social revolutions that abolished freemarket economies and replaced them with
socialism where the health care system is also
socialized. They are found in countries such
as Russia, Eastern Europe, Albania, Bulgaria,
Czechoslovakia, East Germany, Hungary,
Poland, Romania, Yugoslavia, and China.
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B)
C)
D)
E)
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B)
C)
D)
Ans:
Which of the following are factors that
influence populations' perceptions of health
15. and health status and their receptivity to
community health nursing programs? Select
all that apply.
Their perceptions of healthy food
Their attitudes toward women
Their culture
Their belief systems
Their geographic location
B, C, D
Feedback:
The factors that influence populations'
perceptions of health and health status and
their receptivity to community health nursing
programs include their attitudes toward
women, their culture, and their belief systems.
Their perceptions of healthy food or their
geographic location would not have a direct
bearing on their perception of health and
health status or receptivity to community
health nursing programs.
Their culture
Their belief systems
Their geographic location
B, C, D
Feedback:
The factors that influence populations'
perceptions of health and health status and
their receptivity to community health nursing
programs include their attitudes toward
women, their culture, and their belief systems.
Their perceptions of healthy food or their
geographic location would not have a direct
bearing on their perception of health and
health status or receptivity to community
health nursing programs.
A community health nurse is preparing to
work in a country in which women are
16.
viewed as weak and ineffectual. Which of the
following would the nurse need to do first?
Determine his or her own position and beliefs
about this view
Develop a basic plan to change the view of
women
Become aware of possible areas that might
impact care
Avoid situations involving the care of women
A
Feedback:
Community health nurses first, need to
determine their own position on this issue and
come to terms with it, realizing that it may
impact their care. Once aware, the nurses can
then prepare appropriately for situations in
which their care may be affected. It would be
inappropriate and probably impossible to
attempt to change the view or avoid situations
involving the care of women.
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C)
D)
E)
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A)
B)
C)
Which of the following statements about the
personal and professional perceptions that
17. nurses bring to providing community health
nursing interventions within an international
context is most accurate?
Community health nurses are not susceptible
to preconceived perceptions and biases.
It is not necessary for community health
nurses to face their own beliefs.
Community health nurses are universally
opposed to female circumcision, the use of
nonlicensed personnel to carry out medical
treatments, and the use of Western
A)
B)
C)
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D)
17. nurses bring to providing community health
nursing interventions within an international
context is most accurate?
Community health nurses are not susceptible
to preconceived perceptions and biases.
It is not necessary for community health
nurses to face their own beliefs.
Community health nurses are universally
opposed to female circumcision, the use of
nonlicensed personnel to carry out medical
treatments, and the use of Western
interventions used simultaneously with other
methods of treatment.
It is critical for community health nurses to
face their own beliefs when confronting
female circumcision, the use of nonlicensed
personnel to carry out medical treatments, and
the use of Western interventions used
simultaneously with other methods of
treatment.
D
Feedback:
It is critical for community health nurses to
face their own beliefs when confronting
female circumcision, the use of nonlicensed
personnel to carry out medical treatments, and
the use of Western interventions used
simultaneously with other methods of
treatment. Community health nurses are as
susceptible as any other group of people to
preconceived perceptions and biases.
Community health nurses may not be
universally opposed to female circumcision,
the use of nonlicensed personnel to carry out
medical treatments, and the use of Western
interventions used simultaneously with other
methods of treatment.
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A)
B)
C)
D)
Ans:
Community health nurses need to be
knowledgeable about the World Health
18.
Organization because its mission reflects
which of the following?
Collaboration in health development to free
the world from poverty
Service as an independent agency providing
economic and humanitarian assistance
overseas
Representation of the global interests and
concerns of the nursing profession
Global health promotion by supporting
development efforts of governments,
organizations, and universities throughout the
world
D
Collaboration in health development to free
the world from poverty
Service as an independent agency providing
economic and humanitarian assistance
overseas
Representation of the global interests and
concerns of the nursing profession
Global health promotion by supporting
development efforts of governments,
organizations, and universities throughout the
world
D
Feedback:
WHO's mission reflects global health
promotion by supporting development efforts
of governments, organizations, and
universities throughout the world.
Collaboration to free the world from poverty
reflects the mission of the World Bank.
Service as an independent agency for
economic and humanitarian assistance
describes the mission of the United States
Agency for International Development
(USAID). Representation of global interests
and concerns of nurses describes the mission
of the International Council of Nurses (ICN).
A)
B)
C)
D)
A)
B)
C)
D)
Ans:
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An instructor in community health nursing
teaches a group of students about the role of
the World Health Organization and global
health, reviewing the importance of the
19.
Declaration of Alma-Ata. The instructor
determines that the students have grasped the
importance when they describe it as which of
the following?
The beginning of the Carter Center's work in
disease prevention and agriculture
A formal document written by 134 nations in
1978 to achieve “health for all”
Participatory development activities, working
in partnership with voluntary organizations
Alliance building and communicating best
practices for global health development
B
Feedback:
The declaration represents the work of 134
nations during a WHO/UNICEF conference
in 1978 to achieve primary health care for all.
The Carter Center was founded in 1986 and is
not related to the work at Alma-Ata.
Participatory development activities describe
the work of the United States Agency for
International Development (USAID). Alliance
C)
in partnership with voluntary organizations
Alliance building and communicating best
practices for global health development
B
Feedback:
The declaration represents the work of 134
nations during a WHO/UNICEF conference
in 1978 to achieve primary health care for all.
The Carter Center was founded in 1986 and is
not related to the work at Alma-Ata.
Participatory development activities describe
the work of the United States Agency for
International Development (USAID). Alliance
building and communicating best practices
describe the Global Health Council, which is
a leading private, voluntary, American
nongovernmental organization.
D)
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Which of the following statements about the
20. International Council of Nurses (ICN) are
accurate? Select all that apply.
ICN represents the global interests and
concerns of the nursing profession.
The mission of ICN is to maintain the role of
nursing in health care through its global
voice.
ICN has, as members, nursing organizations
from 130 countries representing 13 million
nurses.
ICN is a governmental organization.
ICN employs Regional Nursing Advisors.
A, B, C
Feedback:
The following statements about ICN are
accurate: ICN represents the global interests
and concerns of the nursing profession; the
mission of ICN is to maintain the role of
nursing in health care through its global
voice; and ICN has, as members, nursing
organizations from 130 countries representing
13 million nurses. ICN is a nongovernmental
organization. Regional Nursing Advisors are
employed at the international level of the
World Health Organization.
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E)
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After teaching a class of community health
nursing students about the World Health
Organization, the instructor determines that
21.
the teaching was successful when the class
identifies which of the following as the
highest governing body?
World Health Assembly
WHO Collaborating Centers
The European Union
U.S. Agency for International Development
A
Feedback:
The World Health Assembly is the highest
governing body within WHO. WHO
Collaborating Centers are networks of centers
focusing on specific areas of expertise and
carry out the work of the member countries in
these areas. The European Union is an
organization that provides funding for many
projects including health. The U.S. Agency
for International Development is an
independent bilateral agency of the executive
branch that works to enhance long-term and
equitable economic growth.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A group of students are reviewing for an
examination on nongovernmental
organizations that provide global
22.
interventions. The students demonstrate the
need for additional study when they identify
which of the following as an example?
Global Health Council
CARE
Carter Center
World Bank
D
Feedback:
The World Bank is an agency that focuses on
economic development. It partners with
countries, WHO, and other organizations. It is
not a nongovernmental organization.
Examples of nongovernmental organizations
include Global Health Council, The Center
for International Health and Cooperation,
CARE, and the Carter Center.
B)
C)
D)
Ans:
CARE
Carter Center
World Bank
D
Feedback:
The World Bank is an agency that focuses on
economic development. It partners with
countries, WHO, and other organizations. It is
not a nongovernmental organization.
Examples of nongovernmental organizations
include Global Health Council, The Center
for International Health and Cooperation,
CARE, and the Carter Center.
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Which organization would be most
appropriate for the community health nurse to
23. contact for assistance when dealing with
countries shattered by war and ethnic
violence?
Center for International Humanitarian
Cooperation
CARE
Global Health Council
International Council of Nurses
A
Feedback:
The Center for International Humanitarian
Cooperation (CIHC), founded in 1992,
promotes healing and peace in countries
shattered by war, regional conflicts, and
ethnic violence. CARE intervenes by
responding to famines and disasters
worldwide with emergency food, supplies,
and rehabilitative efforts. The GHC advocates
for needed policies and resources, builds
networks and alliances among those working
to improve health, and shares innovative
ideas, knowledge, and best practices in health.
The ICN represents the global interests and
concerns of the nursing profession.
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B)
C)
D)
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24.
A)
B)
Which of the following statements about the
World Health Organization is accurate?
The World Health Organization does not
provide technical support for interventions or
provide assistance developing nursing
knowledge and skills.
The World Health Organization can help a
member state determine the drugs that are
essential and will assist in developing health
policy, project plans, and programs.
The World Health Organization provides
24.
A)
B)
C)
D)
A)
B)
C)
D)
Ans:
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World Health Organization is accurate?
The World Health Organization does not
provide technical support for interventions or
provide assistance developing nursing
knowledge and skills.
The World Health Organization can help a
member state determine the drugs that are
essential and will assist in developing health
policy, project plans, and programs.
The World Health Organization provides
medicines and other tangible resources to its
member states.
The World Health Organization focuses on
professional issues to support the
development of particular health-related
practitioners, such as nurses.
B
Feedback:
The World Health Organization can help a
member state determine the drugs that are
essential and will assist in developing health
policy, project plans, and programs. The
World Health Organization does focus on
providing technical support related to the
interventions and provides assistance
developing nursing knowledge and skills. The
World Health Organization does not provide
medicines and other tangible resources to its
member states but does help member states
determine the drugs that are essential and
assist in developing health policy, project
plans, and programs.
25.
Which of the following statements regarding
WHO Collaborating Centers is most accurate?
One or two Regional Nursing Advisors carry
out the work of a region that might be the
home to thousands of nursing personnel.
The World Health Organization Collaborating
Centers in Nursing and other fields focus on
specific areas of expertise and carry out the
work of the member countries in these areas.
It is referred to a philosophy, a movement, a
way of thinking, a setting for health services,
or a set of principles.
It focuses on professional issues to support
the development of particular health-related
practitioners.
B
Feedback:
The World Health Organization Collaborating
Centers in Nursing and other fields focus on
specific areas of expertise and carry out the
C)
way of thinking, a setting for health services,
or a set of principles.
It focuses on professional issues to support
the development of particular health-related
practitioners.
B
Feedback:
The World Health Organization Collaborating
Centers in Nursing and other fields focus on
specific areas of expertise and carry out the
work of the member countries in these areas.
Regional Nursing Advisors work in
collaboration with WHO Collaborating
Centers to accomplish the work within each
region. Primary Health Care is referred to a
philosophy, a movement, a way of thinking, a
setting for health services, or a set of
principles.
D)
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Ans:
Chapter 17 Disasters and Their Impact
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A community health nurse is working with
people who experienced a tornado and have
1. been forced to leave their homes to escape the
effects of a disaster. The nurse would identify
these people as which of the following?
Indirect victims
Refugees
Displaced persons
Casualties
C
Feedback:
Displaced persons are those who have been
forced to leave their homes to escape the
effects of a disaster. Indirect victims are the
relatives and friends of direct victims.
Refugees are direct victims who are forced to
leave their homeland, usually due to war,
religious persecution, or political turmoil. A
casualty is a human being who is injured or
killed by or as a direct result of an accident.
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A)
B)
C)
D)
Ans:
A community health nurse working as a part
of a disaster response team is told that the
2. disaster is classified as a multiple-casualty
incident. The nurse would interpret this to
mean which of the following?
There is more than 1 but less than 10
casualties.
The number of casualties is between 2 and
100.
Casualties number over 100.
There are too many casualties to count.
B
Feedback:
If casualties number more than two people but
fewer than 100, the disaster is characterized
as a multiple-casualty incident. A masscasualty incident involves100 or more
casualties.
A)
B)
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C)
D)
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B)
C)
D)
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A community health nurse is part of a disaster
response team that is first to respond to an
3. earthquake. The team evaluates the level of
destruction and devastation, identifying this
as which of the following?
Intensity
Scope
Casualty
Range of effect
A
Feedback:
The intensity of a disaster is the level of
destruction and devastation it causes. The
scope of a disaster is the range of its effect,
either geographically or in terms of the
number of victims. Casualty refers to the
human being(s) injured or killed by or as a
direct result of an accident.
4.
A)
B)
C)
D)
Which of the following examples of disasters
are natural disasters? Select all that apply.
The Earthquake and tsunami in Japan in 2011
The 2008 shootings at Virginia Tech
The terrorist attacks on the United States on
September 11, 2001
Wildfires that affected California in October
2007
The oil spill in the gulf coast in 2010 that
4.
A)
B)
C)
D)
E)
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Ans:
Which of the following examples of disasters
are natural disasters? Select all that apply.
The Earthquake and tsunami in Japan in 2011
The 2008 shootings at Virginia Tech
The terrorist attacks on the United States on
September 11, 2001
Wildfires that affected California in October
2007
The oil spill in the gulf coast in 2010 that
threatened hundreds of species of wildlife
A, D
Feedback:
Examples of natural disasters include the
earthquake and tsunami in Japan in 2011 and
wildfires that affected California in October
2007. The following disasters are man-made:
the 2008 shootings at Virginia Tech; the
terrorist attacks on the United States on
September 11, 2001; and the oil spill in the
gulf coast in 2010 that threatened hundreds of
species of wildlife.
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B)
C)
D)
Ans:
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After teaching a class about the factors that
contribute to disasters, the instructor
5. determines that the teaching was successful
when the students identify which of the
following as the agent?
Population's age
Radiation
Level of preparedness
Flood-prone location
B
Feedback:
The agent is the natural or technologic
element that causes the disaster. For example,
the high winds of a hurricane and the lava of
an erupting volcano are agents, as are
radiation, industrial chemicals, biologic
agents, and bombs. The population's age is an
example of host factor. The level of
preparedness and flood-prone location are
examples of environmental factors.
Which of the following federal agencies
would a community health nurse expect to be
6.
contacted to assist with a disaster in the
United States?
American Red Cross
Federal Emergency Management Agency
(FEMA)
WHO's Emergency Relief Operations
Pan American Health Organization
B
Feedback:
The Federal Emergency Management Agency
(FEMA) is the federal agency responsible for
assessing and responding to disaster events in
the United States. The American Red Cross is
authorized to provide disaster assistance free
of charge across the country through its more
than 1 million volunteers. It is not supported
by the federal government. The World Health
Organization's Emergency Relief Operations
provide disaster assistance internationally, and
the Pan American Health Organization works
to coordinate relief efforts in Latin America
and the Caribbean.
A)
B)
A)
B)
C)
D)
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D)
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The nurse is using the epidemiological triad to
explain the factors contributing the disaster.
7. Which one of the following statements about
the environment factors that contribute to
disasters is most accurate?
The environment is the natural or technologic
element that causes the disaster.
The environment is the human being who
experiences the disaster.
Factors that could potentially contribute to or
mitigate a disaster are environmental.
Examples of environmental factors that cause
a disaster are high winds of a hurricane and
the lava of an erupting volcano.
C
Feedback:
Factors that could potentially contribute to or
mitigate a disaster are environmental. The
agent factor is the natural or technologic
element that causes the disaster, for example
the high winds of a hurricane and the lava of
an erupting volcano. The host is the human
being who experiences the disaster.
Examples of environmental factors that cause
a disaster are high winds of a hurricane and
the lava of an erupting volcano.
C
Feedback:
Factors that could potentially contribute to or
mitigate a disaster are environmental. The
agent factor is the natural or technologic
element that causes the disaster, for example
the high winds of a hurricane and the lava of
an erupting volcano. The host is the human
being who experiences the disaster.
D)
A community health nurse is working with a
community that is involved with identifying
8. risk factors for program development in case
of a disaster. This community is in which
phase of disaster management?
Prevention
Preparedness
Response
Recovery
A
Feedback:
During the prevention phase, no disaster is
expected or anticipated. The task during this
phase is to identify community risk factors
and to develop and implement programs to
prevent disasters from occurring. Disaster
preparedness involves improving community
and individual reaction and responses so that
the effects of a disaster are minimized. The
response phase begins immediately after the
onset of the disastrous event. During the
recovery phase, the community takes actions
to repair, rebuild, or relocate damaged homes
and businesses and restore health and
economic vitality to the community.
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B)
C)
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Ans:
A)
B)
C)
D)
Ans:
A community health nurse is working with a
community that is involved with improving
community and individual reaction and
9.
responses, so that the effects of a disaster are
minimized. This community is in which phase
of disaster management?
Prevention
Preparedness
Response
Recovery
B
Feedback:
Disaster preparedness involves improving
9.
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B)
C)
D)
Ans:
responses, so that the effects of a disaster are
minimized. This community is in which phase
of disaster management?
Prevention
Preparedness
Response
Recovery
B
Feedback:
Disaster preparedness involves improving
community and individual reaction and
responses so that the effects of a disaster are
minimized. During the prevention phase, no
disaster is expected or anticipated. The task
during this phase is to identify community
risk factors and to develop and implement
programs to prevent disasters from occurring.
The response phase begins immediately after
the onset of the disastrous event. During the
recovery phase, the community takes actions
to repair, rebuild, or relocate damaged homes
and businesses and restore health and
economic vitality to the community.
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When would the nurse expect the response
phase of a disaster to occur?
When no disaster is expected or anticipated
Immediately after the onset of the disastrous
event
Long-term phase occurring after the
disastrous event
Prior to the disastrous event
B
Feedback:
The response phase of disaster occurs
immediately after the onset of the disastrous
event. During the prevention phase no disaster
is expected or anticipated. Long-term phase
occurring after the disastrous event is the
recovery phase. Prior to the disastrous event
is the preparedness phase.
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B)
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11.
A)
B)
C)
D)
Which of the following statements about
disaster planning is most accurate?
Disaster planning is essential for a
community, business, or hospital.
A disaster plan must be lengthy and detailed.
A disaster plan should be created by the
person responsible for the emergency
management of the community.
It is assumed that all professionals have
addressed their personal preparation.
11.
A)
B)
C)
D)
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Which of the following statements about
disaster planning is most accurate?
Disaster planning is essential for a
community, business, or hospital.
A disaster plan must be lengthy and detailed.
A disaster plan should be created by the
person responsible for the emergency
management of the community.
It is assumed that all professionals have
addressed their personal preparation.
A
Feedback:
Disaster planning is essential for a
community, business, or hospital. A disaster
plan need not be lengthy. A disaster plan
should be created by all involved, including
community leaders, health and safety
professionals, and lay people. All nurses
should address their own personal
preparedness to respond in a disaster, but this
may not be assumed.
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Which of the following are necessary
12. components of a nurse's personal
preparedness? Select all that apply.
Workplace and community disaster plans
have been reviewed by the nurse.
An individual disaster plan for the nurse's
own family has been developed.
The nurse participated in disaster drills at the
workplace and had a family disaster drill to
practice what actions to take in the event of a
disaster.
It is not necessary for the nurse to bring
copies of their nursing license and driver's
license.
In the case of an actual disaster, the nurse will
be able to use equipment made available to
them.
A, B, C
Feedback:
To be personally prepared, a nurse should
have read and understood workplace and
community disaster plans, should have
developed a disaster plan for his or her own
family, and should have participated in
disaster drills. Nurses preparing to work in
disaster areas should bring copies of their
nursing license and driver's license and bring
basic equipment.
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In the case of an actual disaster, the nurse will
be able to use equipment made available to
them.
A, B, C
Feedback:
To be personally prepared, a nurse should
have read and understood workplace and
community disaster plans, should have
developed a disaster plan for his or her own
family, and should have participated in
disaster drills. Nurses preparing to work in
disaster areas should bring copies of their
nursing license and driver's license and bring
basic equipment.
E)
As part of secondary prevention, the
community health nurse engages in crisis
13.
intervention to achieve which of the
following?
Reestablish equilibrium to the lives of those
involved
Prevent the crisis altogether
Involve as many people as possible in the
resolution
Triage clients during the recovery phase of
the crisis
A
Feedback:
The stated goal of crisis intervention is to
reestablish equilibrium. Prevention is the best
approach, but some crises, such as natural
disasters, cannot be prevented. They can,
however, be prepared for to decrease the
negative effects of the crisis as much as
possible. It is important to have an adequate
number of people needed to come to
resolution. However, too many people
involved in resolution may cause additional
confusion, chaos, and unnecessary delays.
Triage decisions need to be made during the
response phase of the disaster or crisis and not
deferred until the recovery phase. Triage is an
ongoing process throughout the response
phase.
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A community health nurse is engaged in
primary prevention activities related to
14. disasters. Which of the following would be
examples of appropriate activities? Select all
that apply.
Providing anticipatory guidance
Practicing an escape plan
Providing emergency assistance
Planning disaster drills
Providing immediate response
Reducing the degree of disability
A, B, D
Feedback:
Anticipatory guidance, practicing escape
plans, and planning disaster drills all
constitute primary prevention activities.
Providing emergency assistance and
immediate response reflect secondary
prevention activities. Reducing the degree of
disability or damage resulting from the
disaster reflects tertiary level prevention
activities.
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B)
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B)
C)
D)
E)
F)
Ans:
When describing primary prevention
activities that would occur in the preparedness
phase of a terrorist attack involving biologic
15.
weapons like smallpox or anthrax to a local
community group, which of the following
would the nurse include?
Investigating outbreaks to determine source
Administering vaccines
Screening suspected cases
Treating persons who have been infected
B
Feedback:
Primary prevention activities that would occur
in the preparedness phase of a terrorist attack
involving biologic weapons like smallpox or
anthrax would include administering
vaccines. Investigating outbreaks to determine
the source, screening suspected cases, and
treating persons who have been infected
would be secondary prevention activities.
A community health nurse is assisting the
local community in preparing a disaster plan.
16.
Which of the following would the nurse
expect to be addressed? Select all that apply.
Chain of command
Routes for transportation
Triage
Basic equipment
Copies of licenses
A, B, C
Feedback:
A disaster plan should address the chain of
command, routes and modes of transportation,
and triage methods. Basic equipment and
licenses are items that a nurse should bring
along when preparing to work in a disaster
area.
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B)
C)
D)
E)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is responding to a
disaster. Which of the following would most
17.
likely be the least appropriate area for the
nurse to be located?
The disaster site
Triage
Victim treatment area
Local hospitals
A
Feedback:
Usually, the immediate disaster site is not the
best place for the disaster nurse, who can be
far more effective in triage and treatment of
victims. One of the lessons of the World
Trade Center bombing was that the greatest
need for medical professionals was at the
local hospitals, not at the disaster site.
When performing triage during a disaster,
18. which color would indicate that the victim is
in urgent need of care?
Red
Yellow
Green
Black
A
When performing triage during a disaster,
18. which color would indicate that the victim is
in urgent need of care?
Red
Yellow
Green
Black
A
Feedback:
During triage, red indicates that the victim has
injuries or medical problems that will likely
lead to death if no treated immediately.
Yellow indicates that the person has injuries
that require medical attention but time to
treatment is not yet critical. Green indicates
that the victim has minor injuries or are
presenting with minimal signs of illness.
Black indicates that the victim is dead or has
suffered mortal wounds.
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A)
B)
C)
D)
Ans:
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B)
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A community health nurse responding to a
disaster is involved with caring for the bodies
19. of the casualties who have died. Which of the
following would be an appropriate method for
documentation?
Making a note on the triage tag
Using a toe tag for identification
Placing the name on a casualty list
Recording the name on the victim's body
B
Feedback:
Toe tags make documentation visible and
accessible and are the most appropriate means
for documentation. Making a note on the
triage tag, placing the name on a casualty list
and recording the name on the victim's body
are inappropriate.
20.
A)
B)
C)
D)
Ans:
Which time after the disaster would be the
ideal time for this to occur?
Within 18 hours
1 to 3 days
4 to 6 days
7 to 10 days
B
Feedback:
The ideal time for CISD is between 24 and 72
hours after the disaster event.
20.
A)
B)
C)
D)
Ans:
When providing secondary prevention
activities for individuals experiencing
21. psychological consequences of a disaster,
which of the following would the nurse do as
a generic approach?
Providing situational support for stress relief
Conveying warmth and concern for the client
Teaching about expected emotional reactions
Reunifying family members who were
separated
C
Feedback:
The generic approach is designed to reach
high-risk individuals and large groups who
have experienced the same disaster, teaching
them about the expected emotional reactions
to the type of disaster they have experienced
and promoting adaptive responses.
Environmental manipulation results in the
change of a person's physical or interpersonal
situation, providing situational support to
relieve stress. An example of environmental
manipulation is when a community health
nurse coordinates the reunification of family
members separated by the disaster. General
support is defined as the caring, warmth, and
concern the community health nurse conveys
to the client as she or he delivers services.
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A)
B)
C)
ideal time for this to occur?
Within 18 hours
1 to 3 days
4 to 6 days
7 to 10 days
B
Feedback:
The ideal time for CISD is between 24 and 72
hours after the disaster event.
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A)
B)
C)
D)
E)
Ans:
A community health nurse suspects that a
client who was a victim of a disaster 3 months
22. ago is experiencing post-traumatic stress
disorder. Which of the following would the
nurse expect to find? Select all that apply.
Diminished startle response
Hypervigilance
Feelings of detachment
Flashbacks
Full range of affect
B, C, D
Feedback:
Signs and symptoms of post-traumatic stress
disorder. Which of the following would the
nurse expect to find? Select all that apply.
Diminished startle response
Hypervigilance
Feelings of detachment
Flashbacks
Full range of affect
B, C, D
Feedback:
Signs and symptoms of post-traumatic stress
disorder include increased startle response,
hypervigilance, feelings of detachment,
flashbacks, and restricted affect.
A group of ten people from the commune in
the hills come into town dressed in robes and
have their faces covered. They have weapons
23. hidden in their clothing and begin entering the
three banks in town to rob them. These
actions can be classified as which of the
following?
Natural disaster
Terrorism
Casualty
Adventitious crisis
B
Feedback:
The actions resemble terrorism, the unlawful
use of force and violence against persons or
property to intimidate or coerce a
government, the civilian population or any
segment thereof in furtherance of political or
social objectives. The actions are not a natural
disaster. Casualty refers to the person who is
injured or killed by or as a direct result of an
accident. An adventitious crisis is an event
that is out of the ordinary in magnitude and
personal experience.
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B)
C)
D)
E)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
After teaching a group of students about
agents associated with chemical warfare, the
24. instructor determines that additional teaching
is needed when the students identify which as
an example?
Explosives
Nerve agents
Anthrax
Jet fuel
C
Feedback:
Anthrax is considered a bioweapon.
Explosives, nerve agents, and jet fuel are
is needed when the students identify which as
an example?
Explosives
Nerve agents
Anthrax
Jet fuel
C
Feedback:
Anthrax is considered a bioweapon.
Explosives, nerve agents, and jet fuel are
considered agents of chemical warfare.
Which of the following would be most
appropriate for community health nurses to
25.
encourage when helping communities cope
with the anxiety associated with terrorism?
Maintaining high levels of alertness and fear
Spending time with children and young
people
Spending more time indoors
Keeping a fear journal
B
Feedback:
Most young people carry a charge of positive
energy that is infectious. Maintaining high
levels of alertness and fear are not healthy.
Instead individuals should be a little afraid
because a certain level of fear is healthy if the
person learns to use it as positive energy.
Spending more time outdoors is helpful
remedy. Individuals should keep a courage
journal; fear immobilizes and courage takes
action.
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B)
C)
D)
Ans:
A)
B)
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B)
C)
D)
E)
Ans:
A community health nurse is preparing a
presentation for a community group about
possible agents of terrorism. Which of the
26.
following would the nurse include as an
example of a bioweapon? Select all that
apply.
Mustard gas
Sarin
VX gas
Nerve agents
Bombs
A, B, C
Feedback:
Bioweapons include mustard gas, sarin, VX
gas, and anthrax. Nerve agents and bombs are
examples of chemical warfare agents.
B)
C)
D)
E)
Ans:
Sarin
VX gas
Nerve agents
Bombs
A, B, C
Feedback:
Bioweapons include mustard gas, sarin, VX
gas, and anthrax. Nerve agents and bombs are
examples of chemical warfare agents.
Chapter 18 Violence & Abuse
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B)
A community health nurse is reviewing the
medical records of several families in the
community who have experienced varying
1.
crises. The nurse identifies which of the
following as developmental crises? Select all
that apply.
A windstorm that damaged 20 homes in a
community
Grandpa Jones dying at age 82 years
A couple getting engaged
The Smiths getting a divorce
The Jones experiencing a home invasion
Seven people dying in an automobile crash
B, C, D
Feedback:
Developmental crises are periods of
disruption that occur at transition points
during normal growth and development.
Developmental crises, as a rule, do not occur
suddenly. They are more evolutionary than
revolutionary. Even the advancing, age,
illness, or death of a grandparent or parent is a
developmental expectation. However, the
actual event may occur suddenly.
Experiencing damage from a windstorm, a
home invasion, or an automobile crash are
situational crises.
A community health nurse is preparing a
presentation for a community center group
2. about crisis. Which of the following concepts
about situational crises should be included in
the presentation? Select all that apply.
A situational crisis is a stressful, disrupting
event arising from external circumstances that
occur suddenly to a person, group, aggregate,
or community.
Situational crises can be predicted, expected,
and planned.
A community health nurse is preparing a
presentation for a community center group
2. about crisis. Which of the following concepts
about situational crises should be included in
the presentation? Select all that apply.
A situational crisis is a stressful, disrupting
event arising from external circumstances that
occur suddenly to a person, group, aggregate,
or community.
Situational crises can be predicted, expected,
and planned.
Situational crises are never positive.
Situational crises often occur without
warning.
Situational crises occur to people because of
where they are in time and space.
A, D, E
Feedback:
A situational crisis is a stressful, disrupting
event arising from external circumstances that
occur suddenly to a person, group, aggregate,
or community. Situational crises often occur
without warning. Situational crises occur to
people because of where they are in time and
space. Situational crises cannot be predicted,
expected, or planned. Some situational crises
arise from positive events such as significant
job promotion or sudden acquisition of great
wealth because the change makes increased
demands on individuals who must make
major life adjustments.
A)
B)
C)
D)
E)
A)
B)
C)
D)
Ans:
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Which one of the following statements about
3. primary prevention for family violence is
most accurate?
The cycle of violence within the family
cannot be interrupted.
Persons who have been victims of family
violence will repeat the behavior with others.
Primary prevention includes planned
activities undertaken by the nurse to prevent
an unwanted event from occurring.
It is not possible for the community health
nurse to foster healthful practices that will
counteract unhealthful influences.
C
Feedback:
Primary prevention includes planned
activities undertaken by the nurse to prevent
an unwanted event from occurring. The cycle
of violence within the family can be
interrupted, and persons who have been
victims of family violence can learn to use
It is not possible for the community health
nurse to foster healthful practices that will
counteract unhealthful influences.
C
Feedback:
Primary prevention includes planned
activities undertaken by the nurse to prevent
an unwanted event from occurring. The cycle
of violence within the family can be
interrupted, and persons who have been
victims of family violence can learn to use
more appropriate coping strategies. It is
possible for the community health nurse to
foster healthful practices that will counteract
unhealthful influences.
D)
The nursing student reads the textbook in
preparation for a class meeting about primary,
secondary, and tertiary prevention related to
4.
families in crisis. The student determines
which one of the following statements as most
accurate regarding the levels of prevention?
Often people in crisis are temporarily helpless
and unable to cope on their own but are
receptive to outside influence.
Secondary prevention interventions include
taking action to prevent the unwanted event
from occurring.
Tertiary prevention focuses on moving past
the crisis and returning to the precrisis state.
Primary prevention is the least effective level
of intervention in terms of promoting client's
health and containing costs.
A
Feedback:
Often people in crisis are temporarily helpless
and unable to cope on their own, but
understand the need for outside help and are
receptive to other people's suggestions.
Primary prevention, not secondary
prevention, involves actions that help to
prevent an unwanted event from occurring.
Tertiary prevention focuses on moving past
the crisis, although returning to the precrisis
state may not be possible. Primary prevention
is the most effective level of intervention in
terms of promoting client's health and
containing costs.
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B)
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B)
After teaching a class about family and
domestic violence directed toward children as
5. a community health problem, which of the
following if stated by the class indicates to the
instructor that the teaching was effective?
Family violence is new and occurs as a result
of our fast-paced technological society.
Family violence has occurred in most
countries for centuries as children have been
thought of as the property of their parents.
Family violence occurs mostly in the
urbanized areas of the United States mostly in
the urbanized areas where exposure to crime
is more prevalent.
Family violence is decreasing in
industrialized countries in the world as a
result of more public awareness.
B
Feedback:
The history of family and domestic violence
is long. For centuries, children were thought
of as the property of their parents, and any
treatment doled out by the parents was their
prerogative. It is only fairly recently in history
(early 1900s) that groups have become
concerned and begun to do something about
family violence. Family violence is brought to
the attention of officials more frequently
today than in yesteryear, especially in urban
areas where more people live, but it occurs
throughout the world—in urban, rural, and
remote areas with no signs of decreasing.
Family violence in the United States occurs
mostly in the urbanized areas where exposure
to crime is more prevalent. Family violence is
decreasing in industrialized countries in the
world as a result of more public awareness.
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After teaching a group of students about
abuse and families, the instructor determines
6.
that the students have an understanding of this
issue when they state which of the following?
Less than 10% of women worldwide reported
being physically abused by an intimate
partner at some point in their lives.
A woman's risk of intimate partner violence
decreases during pregnancy, but increases
once the baby is born.
Intimate partner violence is a leading cause of
morbidity and mortality in women worldwide.
Intimate partner violence is a private matter
and not a public health issue
C
Feedback:
Intimate partner violence is a leading cause of
morbidity and mortality in women worldwide
and is a public health issue. It is estimated
that between 10% and 52% of women report
being physically abused by an intimate
partner at some point in their lives worldwide.
A woman's risk of intimate partner violence
increases during pregnancy with 44% to 48%
of all women being abused at least once
during the pregnancy.
A)
B)
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C)
D)
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A)
B)
C)
D)
Ans:
In preparation for an examination on the
history of family violence, a group of students
reviews the various laws enacted for
7. protection. The students demonstrate
understanding when they identify which of
the following as one of the earliest laws
enacted?
Child Abuse Prevention and Treatment Act
Family Violence Prevention and Services Act
Keeping Children and Families Safe Act
Child Abuse Prevention and Treatment and
Adoption Reform Act
D
Feedback:
In 1974, the Child Abuse Prevention and
Treatment Act was passed, becoming Public
Law 93-247 (PL 93-247). The Child Abuse
Prevention and Treatment and Adoption
Reform Act of 1978 was followed by the
Family Violence Prevention and Services Act
of 1984. Later, all three acts were
Keeping Children and Families Safe Act
Child Abuse Prevention and Treatment and
Adoption Reform Act
D
Feedback:
In 1974, the Child Abuse Prevention and
Treatment Act was passed, becoming Public
Law 93-247 (PL 93-247). The Child Abuse
Prevention and Treatment and Adoption
Reform Act of 1978 was followed by the
Family Violence Prevention and Services Act
of 1984. Later, all three acts were
consolidated into the Child Abuse Prevention,
Adoption, and Family Services Act of 1988
(Public Law 100-294), and most recently, the
Act was amended and reauthorized as the
Keeping Children and Families Safe Act.
D)
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A)
B)
C)
D)
E)
F)
A community health nurse suspects
Munchausen syndrome by proxy when a child
experiences “seizures” only when a parent is
present, not if a third party is present.
has stunted growth and shortened limbs that
have been noticeable since birth.
has a noticeable limp when wearing shoes but
not in bare feet.
has periods of “acting out” and misbehaving,
especially when there is company.
A
Feedback:
Experiencing seizures only when a parent is
present would be a “red flag” for this
syndrome if it were occurring in a child.
Stunted growth, limp, or acting out are not
associated with Munchausen syndrome by
proxy.
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C)
Which of the following would lead a
9. community health nurse to suspect possible
child neglect? Select all that apply.
15-year-old Lucy misses school once a week
to watch her baby sister while mom works.
6-year-old Sam plays in the yard with a
sweater on when it is 60 degrees outside.
Twins, Bobby and Billy arrive at school in
dirty and smelly clothing most school days.
11-year-old Samantha comes to school
without lunch or lunch money each day.
9-year-old Tommy misses school two or three
times a month due to asthma attacks.
14-year-old Jennifer watches her neighbor's 2year-old every Saturday.
A)
to watch her baby sister while mom works.
6-year-old Sam plays in the yard with a
sweater on when it is 60 degrees outside.
Twins, Bobby and Billy arrive at school in
dirty and smelly clothing most school days.
11-year-old Samantha comes to school
without lunch or lunch money each day.
9-year-old Tommy misses school two or three
times a month due to asthma attacks.
14-year-old Jennifer watches her neighbor's 2year-old every Saturday.
A, C, D
Feedback:
Educational neglect involves Lucy missing
school to watch her baby sister and general
neglect is evident for the twins and Samantha.
Sam may be appropriately dressed based on
how hard and long he is playing—he may be
comfortable. Although Tommy is missing a
number of days of school, he has a legitimate
excuse. Fourteen is an appropriate and legal
age to babysit.
B)
C)
D)
E)
F)
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Which of the following would the community
10. health nurse identify as an act of sexual
exploitation of a child?
Child pornography
Child molestation
Fondling of child's genitals
Vaginal penetration with an object
A
Feedback:
Sexual exploitation of children includes
conduct or activities related to pornography
that depict minors in sexually explicit
situations and promotion of prostitution by
minors. Sexual assault includes rape, gang
rape, incest, sodomy, lewd, or lascivious acts
with a child younger than 14 years of age (in
most states), oral copulation, fondling of the
child's genitals, penetration of the genital or
anal opening by a foreign object, and child
molestation.
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A)
B)
C)
D)
Ans:
A community health nurse assesses a child
during a home visit. Which of the following
11.
would lead the nurse to suspect that the child
is a victim of sexual abuse?
Bruising of the arms and back
Evidence of numerous dental caries
Complaints of pain on urination
Burns on the hands and feet
C
Feedback:
A sign of sexual abuse would be complaints
of pain on urination or defecation. Bruising
on the arms and back and burns on the hands
and feet would suggest physical abuse.
Numerous dental caries may suggest neglect.
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B)
C)
D)
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A group of families are attending a local
community group for a class on Internet
12. safety and children. Which of the following
statements by the group indicates effective
teaching?
“It's not so much the time they spend but the
sites they use.”
“We'll move the computer to the family room
so we can easily observe the child's internet
use.”
“We'll set the Internet browser feature to
medium.”
“The firewall program that we have from 2
years ago should still be good.”
B
Feedback:
To promote Internet safety with children, the
computer should be placed in a high traffic
area in the home so that others can easily
observe what is going on. Parents need to
monitor the time as well as the sites that the
child uses. The Internet security browser
should be set to high. With the advances in
technology, a firewall program that is 2 years
old may not be adequate to protect the child.
However, it would be better than no firewall
program at all.
A)
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B)
While visiting a family in their home, a
community health nurse hears a parent
13. screaming who says, “Everything you do is
wrong. Can't you do anything right ever?”
The nurse suspects which of the following?
Neglect
Emotional abuse
Sexual abuse
Physical abuse
B
Feedback:
Emotional abuse involves psychological
mistreatment or neglect and may involve
verbal abuse such as statements like,
“Everything you do is wrong. Can't you do
anything right?” Neglect occurs when
physical, emotional, medical, educational
resources necessary for healthy growth and
development are withheld or unavailable.
Sexual abuse involves acts of sexual assault
or sexual exploitation of a minor. Physical
abuse is intentional harm that results in pain,
physical injury, or death.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
When describing the cycle of violence to a
group of students, the instructor includes
14.
which of the following as occurring as the
cycle continues?
Frequency of the cycle slows
Tension-building occurs less often
Loving reconciliation lasts longer
Acute battering occurs more often
D
Feedback:
As the cycle of violence continues, the
frequency of the cycle increases, with the
tension-building phase and the acute battering
incident occurring more often, and
elimination of the loving reconciliation phase.
Without intervention, this shorter, more
violent cycle becomes increasingly risk-filled,
for outcomes that may lead to injury or
maiming of a partner, incarceration, or death
of a partner.
Tension-building occurs less often
Loving reconciliation lasts longer
Acute battering occurs more often
D
Feedback:
As the cycle of violence continues, the
frequency of the cycle increases, with the
tension-building phase and the acute battering
incident occurring more often, and
elimination of the loving reconciliation phase.
Without intervention, this shorter, more
violent cycle becomes increasingly risk-filled,
for outcomes that may lead to injury or
maiming of a partner, incarceration, or death
of a partner.
Which of the following would a community
15. health nurse expect to assess in a perpetrator
of intimate partner violence?
Occasional marijuana use
High academic achievement
Belief in male dominance
Desire for complacency
C
Feedback:
Characteristics of perpetrators of intimate
partner violence include a belief in strict
gender roles, such as male dominance, heavy
alcohol and drug use, low academic
achievement, and desire for power and control
in relationships.
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B)
C)
D)
Ans:
A)
B)
C)
D)
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B)
C)
D)
Ans:
When discussing elder abuse with a senior
16. citizen group, which of the following would
the community health include?
Older men experienced abuse at a higher rate
than elderly women.
Types of elder abuse include physical abuse,
emotional abuse, neglect, and exploitation.
The majority of cases of elder abuse are
perpetrated by persons unknown to the victim.
Elders with dementia are less likely to be
abused since they have less social
interactions.
B
Feedback:
Types of elder abuse include physical abuse,
emotional abuse, neglect, and exploitation.
Older women experienced abuse at a higher
rate than elderly men. The perpetrators of
elder abuse may be either known or unknown
to the elder. Some elders are especially
Elders with dementia are less likely to be
abused since they have less social
interactions.
B
Feedback:
Types of elder abuse include physical abuse,
emotional abuse, neglect, and exploitation.
Older women experienced abuse at a higher
rate than elderly men. The perpetrators of
elder abuse may be either known or unknown
to the elder. Some elders are especially
vulnerable to elder abuse.
D)
A)
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B)
C)
D)
Ans:
A community health nurse is designated as a
17. “mandated reporter.” Which of the following
best describes this designation?
The nurse must witness abuse and neglect
before being mandated to report.
The nurse commands that battered women
report the abuse.
The supervising community health nurse is
responsible for reporting only known cases of
elder abuse.
The nurse must report any case of known or
suspected abuse and neglect in children or
elders.
D
Feedback:
The abuse or neglect simply needs to be
suspected in order for the nurse to report. In
most states the nurse can receive a jail
sentence and a fine for not reporting
suspected abuse. Reporters may never witness
the actual abusive event, but they can often
see the resulting damage. Each nurse follows
through with reporting abuse and neglect
cases she or he suspects according to the
community's laws.
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Ans:
A community health nurse is providing a
community education program about suicide.
18. Which of the following would the nurse
include as a common method used by
women?
Hanging
Firearms
Vehicle crash
Overdose
D
Feedback:
Women usually choose less violent methods,
such as overdosing on medications. Men
include as a common method used by
women?
Hanging
Firearms
Vehicle crash
Overdose
D
Feedback:
Women usually choose less violent methods,
such as overdosing on medications. Men
choose more violent forms of suicide, such as
hanging, use of firearms, or vehicle crashes.
Which of the following would be least
appropriate for a community health nurse to
19. include in a plan of care at the secondary
prevention level for families who may need to
respond in a case of crisis in the future?
Teaching social problem-solving skills
Helping women develop assertiveness skills
Providing parenting classes
Helping to reestablish as sense of safety
D
Feedback:
Helping to reestablish a sense of safety would
be appropriate at the secondary level of
prevention. Teaching social problem-solving
skills, helping women develop assertiveness
skills, and providing parenting classes are
appropriate primary prevention level
activities.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
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B)
C)
D)
Ans:
When assessing a family in crisis, which of
20. the following would the community health
nurse need to do first?
Assess the nature of the crisis
Determine client's perception
Define available supports
Assess coping abilities
A
Feedback:
Initially, the nurse must assess the nature of
the crisis and the client's response to it. Next,
the nurse focuses on the clients' perceptions
of the event. Then the nurse determines who
is available for support to the individual or
family. Finally the nurse assesses the clients'
coping abilities.
Determine client's perception
Define available supports
Assess coping abilities
A
Feedback:
Initially, the nurse must assess the nature of
the crisis and the client's response to it. Next,
the nurse focuses on the clients' perceptions
of the event. Then the nurse determines who
is available for support to the individual or
family. Finally the nurse assesses the clients'
coping abilities.
A community health nurse is developing a
plan of care for families in crisis. Which of
21.
the following would be most appropriate for
the nurse to include?
Encourage clients to suppress feelings to
minimize pain
Avoid correcting distorted facts to reduce
stress
Allow clients to blame others for the crisis
Help clients confront crisis
D
Feedback:
In a crisis, the community health nurse
encourages clients to accept help by
acknowledging the problem. The nurse should
encourage clients to express their feelings
openly, assist them in finding facts
(distortions create additional tension that may
lead to maladaptive responses), and avoid
blaming others to promote responsibility for
problem solving.
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B)
C)
D)
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D)
Ans:
Chapter 19 Maternal-Child Health
A)
B)
C)
D)
E)
Ans:
Critical population health indicators that
affect childbearing women, infant, toddler,
1. and preschool populations globally and in the
United States include which of the following?
Select all that apply.
Maternal mortality rate
Infant mortality rate
HIV/AIDS
Crude mortality rate
Fetal alcohol syndrome
A, B, C, E
Feedback:
Critical population health indicators that
affect childbearing women, infant, toddler,
Select all that apply.
Maternal mortality rate
Infant mortality rate
HIV/AIDS
Crude mortality rate
Fetal alcohol syndrome
A, B, C, E
Feedback:
Critical population health indicators that
affect childbearing women, infant, toddler,
and preschool populations globally and in the
United States include maternal mortality rate,
infant mortality rate, HIV/AIDS, and fetal
alcohol syndrome. Crude mortality rate does
not apply specifically to childbearing women,
infant, toddler, and preschool populations.
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A)
B)
C)
D)
E)
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Which one of the following statements about
2. low-birth-weight and very-low-birth-weight
babies is most accurate?
Low-birth-weight is more common in Whites
and Hispanics than African Americans.
Birth weight is one of the most important
predictors of infant mortality.
The incidence of low-birth-weight in the
United States is decreasing in relation to the
increase in multiple births.
Recent trends in very-low-birth-weight babies
show that they continue to have morbidity
with significant increases in survival.
B
Feedback:
Birth weight is one of the most important
predictors of infant mortality. Low birth
weight is more common in African Americans
than in Whites and Hispanics. The overall
incidence of low-birth-weight is increasing
slightly, which can be explained by increased
multiple births. Recent trends in very-lowbirth-weight babies show that they continue to
have morbidity with no significant increases
in survival.
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D)
A community health nurse is developing a
program that would encourage mothers to use
breast-feeding exclusively for their babies'
3.
nutrition for the first 6 months. The nurse
bases this program on the understanding
about which of the following?
Exclusive breast-feeding promotes better
growth and development.
Its lower cost provides more money for other
needed items.
Infant mortality would significantly decrease.
It would aid in decreasing maternal mortality
rates.
C
Feedback:
Approximately 1.3 million infants would
survive annually if mothers were able to
exclusively breast-feed their infants for 6
months. The lack of breast-feeding is related
to decreased survival and increased morbidity
from infections, lower intelligence test scores,
increased cardiac risk factors, and inadequate
nutrition. The superiority of breast milk and
lower costs would not be factors for
developing a community health program for
breast-feeding. Exclusive breast-feeding is not
associated with decreasing maternal mortality
rates.
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A)
B)
C)
D)
Ans:
A community health nurse is integrating the
Healthy People 2010 goals into suggested
4. programs for a local community. Which of the
following goals would the nurse identify as
having been met?
Reduction in low-birth-weight infants
Reduction in total preterm births
Increase in the number of infants put to sleep
on their backs
Increased proportion of mothers breastfeeding at 6 months
C
Feedback:
After years of working toward improving
maternal–child health, the United States has
made limited progress. One objective,
however, has been met: 70% of infants are
now being put to sleep on their backs (up
from 35% baseline), largely due to public
C)
on their backs
Increased proportion of mothers breastfeeding at 6 months
C
Feedback:
After years of working toward improving
maternal–child health, the United States has
made limited progress. One objective,
however, has been met: 70% of infants are
now being put to sleep on their backs (up
from 35% baseline), largely due to public
health educational efforts and reminders.
Objectives for LBW, VLBW, and preterm
births all moved away from their Healthy
People 2010 targets. Breast-feeding is
beneficial to both mother and infant, and in
2005, almost 73% of infants were breast-fed
for some period of time. However, the goal
has not been met.
D)
Which Healthy People 2020 goal that has
been established has been met?
The number of infants being put to sleep on
their backs and the rate for sudden infant
death syndrome
Improving the proportion of infants who are
breast-fed
Reduce the rate of fetal and infant deaths
Reduce the occurrence of fetal alcohol
syndrome
A
Feedback:
After years of working toward improving
maternal–child health, the United States has
made limited progress. One objective,
however, has been met; 70% of infants are
now being put to sleep on their backs, up
from a 35% baseline. The rate for sudden
infant death syndrome (SIDS) had dropped by
over 50% since 1994. The proportion of
infants who are breast-fed and reducing the
rate of fetal and infant deaths and occurrence
of fetal alcohol syndrome have not been met.
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A)
B)
C)
D)
E)
F)
Ans:
A community health nurse is providing a class
for pregnant women about the dangers of
alcohol consumption during pregnancy.
6.
Which of the following would the nurse
include as an effect on the newborn? Select
all that apply.
Intellectual impairment
Low-birth-weight
Leukemia
Respiratory distress
Altered growth and development
Childhood cancers
A, B, E
Feedback:
The health of infants can be dramatically
affected by maternal consumption of alcohol.
The pregnancy itself can be threatened.
However, the most devastating consequence
of alcohol consumption during pregnancy is
fetal alcohol spectrum disorders (FASD) and
fetal alcohol syndrome (FAS), both of which
compromise the intellectual functioning, birth
weight, and altered growth and development
of the infant or child. Respiratory distress,
leukemia, and other childhood cancers are not
associated with maternal alcohol
consumption.
A)
B)
C)
D)
Ans:
A community health nurse is working with a
group of pregnant women in the community
to reduce lifestyle risk factors associated with
7.
low-birth-weight newborns and infant
mortality. Which of the following would the
nurse address?
Multiparity
College level education
Environmental toxins
Single gestation pregnancy
C
Feedback:
Environmental toxins are lifestyle risk factors
associated with low-birth-weight newborns
and infant mortality. Other risk factors include
primiparity, low educational level, and
multiple gestation among others.
College level education
Environmental toxins
Single gestation pregnancy
C
Feedback:
Environmental toxins are lifestyle risk factors
associated with low-birth-weight newborns
and infant mortality. Other risk factors include
primiparity, low educational level, and
multiple gestation among others.
A community health nurse visits a local
women's health center to provide teaching
about the effects of smoking during
pregnancy. After teaching the class, the nurse
8.
determines that the women have understood
the teaching when they identify which of the
following as a possible maternal or infant
effect?
Low-birth-weight newborns
Newborn feeding problems
Genetic malformations
Developmental delays
A
Feedback:
One of the strongest predictors of both LBW
and preterm birth is maternal smoking. Other
studies have shown that there is a greater
incidence of stillbirths, spontaneous
abortions, and perinatal mortality in
pregnancies in which women smoke.
Smoking during pregnancy is not associated
with genetic malformations, developmental
delays, or feeding problems.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A local community health center is providing
classes to childbearing families about the
effects of alcohol use during pregnancy.
During one of the classes, a community health
9.
nurse describes fetal alcohol spectrum
disorder (FASD). Which of the following
would the nurse include as a common finding
in the newborn?
Large for gestational age
Facial abnormalities
Hypoactive behavior
Enhanced intellectual development
B
Feedback:
A newborn with FASD typically exhibits
facial abnormalities, is small for gestational
age, demonstrates hyperactivity and
in the newborn?
Large for gestational age
Facial abnormalities
Hypoactive behavior
Enhanced intellectual development
B
Feedback:
A newborn with FASD typically exhibits
facial abnormalities, is small for gestational
age, demonstrates hyperactivity and
intellectual impairment.
A)
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A)
B)
C)
D)
While providing preconception counseling to
a group of women, the community health
10. nurse emphasizes the need for adequate
weight gain during pregnancy based on the
understanding of which of the following?
Maternal nutritional habits do not affect later
life.
Inadequate weight gain increases the woman's
risk for cesarean birth.
Prolonged labor can occur with too little or
too much weight gain.
Adequate weight gain is positively correlated
with normal birth weight.
D
Feedback:
Research has demonstrated a positive
correlation between weight gain during
pregnancy and normal birth weight in babies.
Inadequate weight gain is related to LBW,
premature births, and perinatal mortality.
Gaining large amounts of weight can also
cause problems at birth, including increased
numbers of cesarean deliveries, large-forgestational-age babies, along with the
mother's retention of excessive weight.
Maternal nutritional habits set gene switches
that affect later life.
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A)
B)
C)
D)
Ans:
After teaching a group of pregnant women
about the need for proper oral health during
11. pregnancy, which of the following statements
by the group indicates the need for additional
teaching?
“We should continue seeing the dentist like
we always do.”
“Chewing sugar-free gum is okay even with
the pregnancy.”
“If we need dental work, we can postpone it
until after the birth.”
“Flossing and brushing are just as important
11. pregnancy, which of the following statements
by the group indicates the need for additional
teaching?
“We should continue seeing the dentist like
we always do.”
“Chewing sugar-free gum is okay even with
the pregnancy.”
“If we need dental work, we can postpone it
until after the birth.”
“Flossing and brushing are just as important
now as before.”
C
Feedback:
Postponing dental work is inappropriate.
Dental health procedures have generally been
found to be effective and safe for pregnant
women, especially during the second
trimester. Statements about the importance of
regular dental health checkups and proper
dental hygiene, along with referrals for dental
treatment when needed, indicate effective
teaching. Sugar-free gums that contain xylitol
and chlorhexidine may be helpful in reducing
the maternal–child transmission of cariescausing bacteria.
A)
B)
C)
D)
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B)
C)
D)
E)
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What are the roles that public and community
health nurses need to enact in order to
12.
maximize the outcome for pregnant
adolescents? Select all that apply.
Clinician
Educator
Counselor
Provider of referrals
Friend
A, B, C, D
Feedback:
Roles that public and community health
nurses need to enact in order to maximize the
outcome for pregnant adolescents include
clinician, educator, counselor, and provider of
referrals. It is not appropriate for the nurse to
enact the role of friend with pregnant
adolescent clients or any other client.
A pregnant woman with hypertensive disease
comes to the community health center for
follow up. Which of the following would be
13.
appropriate to include when teaching the
woman about controlling her blood pressure
at this time?
Ensuring rest periods with legs elevated
Limiting her daily intake of fluid
Restricting intake of fresh fruits
Encouraging additional weight gain
A
Feedback:
Various methods are employed to attempt to
prevent and control hypertension during
pregnancy, namely, a diet rich in fresh fruits
and vegetables, adequate fluid intake, weight
gain limitations, rest, and regular exercise.
These remain the most common preventive
suggestions that community health nurses, in
collaboration with the clients' primary health
care providers, can give to their pregnant
clients. A calm environment, along with
periods of rest with the pregnant woman
either elevating her feet or reclining in a left
side-lying position, is also recommended.
B)
C)
D)
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B)
C)
D)
Ans:
During a home postpartum visit, a community
health nurse suspects that the woman is
14. experiencing depression. Which of the
following responses would be most
appropriate?
“You should try drinking more caffeine to
help you be less tired.”
“Don't worry. Good mothers don't hurt their
babies.”
“Try napping when the baby is napping.”
“You should be able to achieve perfection
with housekeeping tasks while you are still on
maternity leave.”
C
Feedback:
Getting adequate sleep is important, because
sleep deprivation exacerbates psychiatric
symptoms. Napping when the baby naps,
resting when possible throughout the day, and
going to bed early (albeit with the knowledge
that sleep may be interrupted two or more
times to feed the infant) will provide more
hours of rest and sleep. Caffeine can lead to
sleep disturbance, and alcohol is a depressant
“You should be able to achieve perfection
with housekeeping tasks while you are still on
maternity leave.”
C
Feedback:
Getting adequate sleep is important, because
sleep deprivation exacerbates psychiatric
symptoms. Napping when the baby naps,
resting when possible throughout the day, and
going to bed early (albeit with the knowledge
that sleep may be interrupted two or more
times to feed the infant) will provide more
hours of rest and sleep. Caffeine can lead to
sleep disturbance, and alcohol is a depressant
that has been implicated in depression. The
elimination of both is a simple yet helpful
suggestion. The statement about telling the
woman not worry discounts her feelings. In
addition, it also may increase her anxiety
because she may be worried about hurting the
baby. The statement about ability to achieve
perfection with housekeeping tasks while on
maternity leave is counterproductive as it has
been recently identified perfectionism
increases the risk for postpartum depression.
D)
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Ans:
C)
D)
Ans:
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B)
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A)
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After teaching a group of students about
various community nutritional programs, the
instructor determines that the teaching has
15.
been successful when the students identify
which of the following as a result of the WIC
program?
Increased expenditures for health care
Decreased rates of large for gestational age
babies
Reduced rates of infant iron deficiency
anemia
Drop in breast-feeding rates
C
Feedback:
In addition to supporting women and young
children with nutritious foods and achieving
the initial goals of decreasing the rates of
preterm and LBW babies, increasing the
length of pregnancy, and reducing the
incidence of infant and child iron deficiency
anemia, WIC also increases breast-feeding
rates and improves pregnant women's
nutritional status.
Reduced rates of infant iron deficiency
anemia
Drop in breast-feeding rates
C
Feedback:
In addition to supporting women and young
children with nutritious foods and achieving
the initial goals of decreasing the rates of
preterm and LBW babies, increasing the
length of pregnancy, and reducing the
incidence of infant and child iron deficiency
anemia, WIC also increases breast-feeding
rates and improves pregnant women's
nutritional status.
C)
A group of nursing students are studying for a
test on child health statistics. The students
demonstrate that they are prepared for the test
16.
when they identify which of the following as
a major cause of death in the 1- to 4-year-old
population.
Pneumonia
Poverty
Unintentional injuries and homicide
Heart disease
C
Feedback:
Unintentional injuries and homicide cause
most of the deaths for the 1- to 4-year-old
population: motor vehicle crashes, falls,
drowning, fires, and burns. Pneumonia is not
a major cause of death among children.
Poverty contributes to morbidity and
mortality but is not a cause of death in and of
itself. Heart disease is the fourth leading
cause of death among young children.
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D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is developing a
plan to address the nutritional needs of
infants, toddlers, and preschoolers. Which of
17.
the following would the nurse need to
incorporate as a major issue associated with
nutritional problems?
Life in the culture of poverty
Overfeeding of an infant
Cultural food preferences
Rapid growth spurts
B
Feedback:
Overfeeding an infant can lead to childhood
obesity and becomes a risk factor for heart
disease, hypertension, and diabetes. Many
nutritional problems?
Life in the culture of poverty
Overfeeding of an infant
Cultural food preferences
Rapid growth spurts
B
Feedback:
Overfeeding an infant can lead to childhood
obesity and becomes a risk factor for heart
disease, hypertension, and diabetes. Many
parents overfeed infants and toddlers and
allow preschool-aged children to make
inappropriate food choices, which can lead to
a lifetime of nutritional problems. Poverty
may limit food choices and selection of
inappropriate foods; however, poverty itself
does not cause nutritional problems. Although
there are major differences in food
preferences and eating practices among
different cultural groups, they do not account
for nutritional problems. Growth spurts in
young children often are marked by changes
in appetite, but it is the quality of the food that
can cause the nutritional problems rather than
the changes in quantity.
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A)
B)
C)
D)
Ans:
D)
Ans:
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C)
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B)
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A)
A community health nurse implements a
teaching program for new parents about ways
18.
to reduce infant mortality. Which suggestion
would the nurse include as most important?
“Never leave the infant alone on a dressing
table or couch.”
“Check the temperature of the bath water
before bathing.”
“Stay within an arm's length when the baby is
in the tub.”
“Put the infant to sleep on his or her back.”
D
Feedback:
Suffocation is the leading cause of death in
infants. Therefore, the suggestion to put the
baby to sleep on the back is a major
preventive measure and the most important.
Never leaving the infant alone would reduce
the risk for falls, a leading case of nonfatal
injuries for infants. Checking bath water
temperature is appropriate to prevent burns.
Staying within an arm's length while bathing
is a suggestion to prevent drowning.
“Stay within an arm's length when the baby is
in the tub.”
“Put the infant to sleep on his or her back.”
D
Feedback:
Suffocation is the leading cause of death in
infants. Therefore, the suggestion to put the
baby to sleep on the back is a major
preventive measure and the most important.
Never leaving the infant alone would reduce
the risk for falls, a leading case of nonfatal
injuries for infants. Checking bath water
temperature is appropriate to prevent burns.
Staying within an arm's length while bathing
is a suggestion to prevent drowning.
C)
D)
Ans:
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A community health nurse is involved in a
screening program for lead exposure. The
19.
nurse would target this program primarily to
which age group?
Birth to -year-olds
- to 3-year-olds
3- to 5-year-olds
5- to 7-year-olds
B
Feedback:
The critical age of lead exposure (or peak
level) is thought to be between 18 and 36
months. Levels generally begin to decline
after age 3.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
Which of the following issues motivated the
increased doses of certain vaccines and
20.
reformulated vaccines at the start of the 21st
century? Select all that apply.
Increased virulence of the vaccinepreventable disease causative organisms
Pertussis immunity was found to wane with
age so the vaccine was reformulated to
cocoon infants by immunizing the adults
around them to prevent exposure of infants.
Varicella vaccine given in two doses has been
found to increase immunity.
Measles outbreaks were identified in
populations where parents had refused MMR
vaccination for their children and received
personal belief exemptions.
B, C, D
Feedback:
The following issues motivated the increased
doses of certain vaccines and reformulated
vaccines at the start of the 21st century.
C)
found to increase immunity.
Measles outbreaks were identified in
populations where parents had refused MMR
vaccination for their children and received
personal belief exemptions.
B, C, D
Feedback:
The following issues motivated the increased
doses of certain vaccines and reformulated
vaccines at the start of the 21st century.
Pertussis immunity was found to wane with
age so the vaccine was reformulated to
cocoon infants by immunizing the adults
around them to prevent exposure of infants;
varicella vaccine given in two doses has been
found to increase immunity and measles
outbreaks were identified in populations
where parents had refused MMR vaccination
for their children and received personal belief
exemptions. There is no evidence that the
vaccine preventable disease causative
organisms have increased virulence.
D)
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Ans:
C)
D)
Ans:
w
B)
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A)
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A community health nurse is making a family
home visit. The family consists of the mother,
father, 1-year-old, and 4-year-old. The mother
states that the 4-year-old who is in preschool
21. had a cold last week and now the 1-year-old
has it. She asks the nurse if she can use the
over-the-counter cold medication that she
gave to the 4-year-old for the 1-year-old.
Which response would be most appropriate?
“It shouldn't be a problem if you use that
same medication for the 1-year-old.”
“I don't know if the medicine will work, but
you can try it and see.”
“That type of medicine should not be used in
children under age 2.”
“You should use a smaller dose but watch if it
makes him irritable.”
C
Feedback:
Community health nurses need to emphasize
that over-the-counter cough and cold
medications should not be used for children
under age 2. The Food and Drug
Administration (FDA) deemed them unsafe
and ineffective and most manufacturers took
them off the market in fall of 2007 in
response to emergency room visits and deaths
linked to their toxic effects. Therefore, the
nurse would tell the mother not to use the
medicine since the child is only a 1-year-old.
C)
children under age 2.”
“You should use a smaller dose but watch if it
makes him irritable.”
C
Feedback:
Community health nurses need to emphasize
that over-the-counter cough and cold
medications should not be used for children
under age 2. The Food and Drug
Administration (FDA) deemed them unsafe
and ineffective and most manufacturers took
them off the market in fall of 2007 in
response to emergency room visits and deaths
linked to their toxic effects. Therefore, the
nurse would tell the mother not to use the
medicine since the child is only a 1-year-old.
D)
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Ans:
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A community health nurse is working with a
group of parents who have infants and
22. toddlers. Which of the following would the
nurse include in a teaching plan for this group
about reducing dental caries?
Serving sugary foods at mealtimes and not
snacks
Providing juice in a sippy cup between meals
Allowing the older infant to fall asleep with a
bottle
Permitting snacking throughout the day
A
Feedback:
It is recommended that sugary foods be eaten
at mealtimes and not as snacks, and that
regular snack times be established. Betweenmeal drinks should consist of water or milk.
Juice should be given only with meals.
Allowing infants to fall asleep with a bottle
can lead to baby bottle tooth decay or nursing
caries.
A)
te
B)
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D)
Ans:
A)
B)
C)
D)
Ans:
Which of the following would be appropriate
23. as secondary prevention level activities
focusing on child abuse and neglect?
Prenatal parent preparation classes
Public service announcements for positive
parenting
Education to improve family functioning
skills
Respite care for families with special needs
children
D
Feedback:
Providing respite care for families with
A)
Prenatal parent preparation classes
Public service announcements for positive
parenting
Education to improve family functioning
skills
Respite care for families with special needs
children
D
Feedback:
Providing respite care for families with
special needs children is an example of a
secondary prevention action. Prenatal parent
preparation classes, public service
announcements, and education to improve
family functioning skills are examples of
primary prevention level activities.
B)
C)
D)
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As one aspect of ensuring adequate brain
development in a child, a community health
24.
nurse would encourage the intake of which
during the first 2 years of life?
Vitamins
Fats
Protein
Carbohydrates
B
Feedback:
During the first 2 years, when rapid
myelination is taking place, 50% of total
calories should come from fat, but after age 2,
the choice of 1% or 2% milk—should be the
norm. A well-balanced diet including an
adequate intake of vitamins, protein, and
carbohydrates is needed for overall growth
and development.
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A)
B)
C)
D)
Ans:
Chapter 20 School-Age Children and Adolescents
When providing safety education for parents
of school-age children, the community health
1.
nurse would focus interventions on which of
the following as the priority?
A)
Motor vehicle safety
B)
Water safety
C)
Fire safety
D)
Poisoning prevention
Ans:
A
Feedback:
For the 1- to 9-year-old age group, motor
vehicle/traffic injury, drowning, and fire/burn
injuries were the top three causes of injury
the following as the priority?
Motor vehicle safety
Water safety
Fire safety
Poisoning prevention
A
Feedback:
For the 1- to 9-year-old age group, motor
vehicle/traffic injury, drowning, and fire/burn
injuries were the top three causes of injury
death. For the 10- to 19-year-old age group,
motor vehicle/traffic injuries, drowning, and
poisoning are the three leading causes of
injury death. Thus the priority would be to
focus interventions on motor vehicle safety.
Although water and fire safety and poisoning
prevention would be important, motor vehicle
safety would be most important.
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A)
B)
C)
D)
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A community health nurse is presenting a
program to a local elementary parent–teacher
association on the topic of pediculosis. The
2. nurse determines that the group needs
additional teaching when they identify which
of the following as a likely mode of
transmission?
Coming into contact with an animal
Combing hair with another's comb
Using a towel of an infected child
Sleeping in a friend's bed who had lice
A
Feedback:
Head lice are most often transmitted by direct
contact (head-to-head) or may be passed from
infected to uninfected children through shared
items such as combs and brushes, hats,
scarves, sheets, and towels (called fomites).
Contrary to some popular myths, lice do not
fly or jump, and they cannot be contracted
from animals—they live only on humans.
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A)
B)
C)
D)
Ans:
A community health nurse who is
participating in a nutritional screening
program with school-age children measures
3. their body mass index (BMI). The majority of
children fall within the 45th to 65th percentile
for their age. The nurse would classify these
children as which of the following?
Underweight
Healthy weight
At risk for overweight
Overweight
B
Feedback:
A BMI between the 5th and 95th percentile
for age is considered healthy weight.
Underweight refers to a BMI below the 5th
percentile. At risk for overweight refers to
children with a BMI between the 85th and
94th percentile. Overweight refers to children
with a BMI equal to or greater than the 95th
percentile.
C)
D)
Ans:
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B)
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A)
B)
C)
D)
Ans:
Which of the following measures would be
most appropriate for a community health
4.
nurse to include when developing programs to
address childhood obesity?
Encouraging television watching for about 3
hours per day
Suggesting that families eat less meals
together at home
Urging participation in physical activity for
30 minutes per day
Limiting the intake of unsaturated oils in
cooking
C
Feedback:
Research has demonstrated an association
between poor eating habits and physical
inactivity. Low levels of physical activity and
more than 2 hours of watching television per
day were found to be predictors of overweight
status in a large longitudinal study of
children. Therefore, interventions should
focus on increasing levels of physical activity
and encouraging limited television for schoolage children, encouraging families to eat more
meals together at home, advocating for
increased physical education in the school
C)
30 minutes per day
Limiting the intake of unsaturated oils in
cooking
C
Feedback:
Research has demonstrated an association
between poor eating habits and physical
inactivity. Low levels of physical activity and
more than 2 hours of watching television per
day were found to be predictors of overweight
status in a large longitudinal study of
children. Therefore, interventions should
focus on increasing levels of physical activity
and encouraging limited television for schoolage children, encouraging families to eat more
meals together at home, advocating for
increased physical education in the school
setting, and for more safe recreational
opportunities in all neighborhoods. In
addition, healthy eating habits such as using
unsaturated oils in cooking need to be
stressed.
D)
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Which of the following programs would be
least effective to institute for a community of
5.
school-age children who are experiencing
dental caries?
Ensuring that the drinking water is fluoridated
Having the school to institute a fluoride rinse
program
Encouraging the parents to get their children's
teeth sealed
Advising parents to encourage the children to
brush once daily
D
Feedback:
Regular brushing and flossing is important for
dental hygiene. However, once daily is not
enough. Fluoridated drinking water, schoolbased fluoride rinse or gel, and dental sealant
programs are cost-effective, proven methods
of reducing dental caries in school-age
children.
A)
B)
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D)
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C)
A)
B)
C)
D)
Ans:
Which of the following would a community
6. health nurse expect to assess in the adolescent
population with an eating disorder?
High levels of peer support
Clear sense of self
Feelings of being in control
Distorted body image
D
Which of the following would a community
6. health nurse expect to assess in the adolescent
population with an eating disorder?
High levels of peer support
Clear sense of self
Feelings of being in control
Distorted body image
D
Feedback:
Adolescents with eating disorders typically
have a disturbed body image, low levels of
peer support, distorted self-concept and low
self-esteem. In addition, they have issues with
control, such that they used eating as a means
for control.
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A)
B)
C)
D)
Ans:
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A community health nurse is teaching a group
of parents about attention deficit hyperactivity
7. disorder. Which statement by the parents
would indicate the need for additional
teaching?
“We probably will need to give him
medication to help him in school.”
“We need to keep him away from foods that
have additives in them.”
“This condition is most likely due to problems
with genes and nerve receptors.”
“We'll be alert to the possibility of more
injuries and accidents.”
B
Feedback:
While a number of parents feel that sugar and
food coloring or additives may worsen ADHD
symptoms in their children, research shows no
behavioral or learning differences in doubleblind studies with sugar and sugar substitutes.
Medications are commonly used, with the
primary goal of improving academics. New
research is focusing on inherited tendencies
for problems with dopamine receptors and
transporter genes, supporting a neurologic
basis for the condition. Children with ADHD
are more prone to accidents and injuries.
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A)
B)
C)
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Ans:
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D)
A community health nurse is working with
local community agencies to provide services
for children and adolescents with disabilities.
8. Based on the nurse's knowledge of the most
common disabilities affecting this group, the
nurse would advocate for which of the
following to address the largest group?
Special education services
Speech therapy services
Mental health services
Mental retardation services
A
Feedback:
In descending order, the most common
disabilities found in school-age children and
adolescents are learning disorders; speech or
language impairment; mental retardation;
serious emotional disturbances and other
disabilities, such as autism; deaf-blindness;
orthopedic problems; traumatic brain injury;
and other health impairments, such as asthma,
diabetes, and epilepsy. Thus advocating for
special education services would address the
most common disability, learning disorders.
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
Which of the following statements about
9. children's health status and academic
achievement are most accurate?
All health problems that can affect learning
and achievement in school-age children are
preventable.
Physical and emotional health can affect
academic achievement in children and
adolescents.
Only behavioral health problems can affect
learning and achievement in school-age
children.
Poverty is one health problem that does not
affect learning and achievement in school-age
children.
B
Feedback:
Physical and emotional health can affect
academic achievement in children and
adolescents. Not all health problems that can
affect learning and achievement in school-age
children are preventable. Behavioral health
problems can affect learning and achievement
in school-age children, but other types of
health problems can also affect learning and
Poverty is one health problem that does not
affect learning and achievement in school-age
children.
B
Feedback:
Physical and emotional health can affect
academic achievement in children and
adolescents. Not all health problems that can
affect learning and achievement in school-age
children are preventable. Behavioral health
problems can affect learning and achievement
in school-age children, but other types of
health problems can also affect learning and
achievement in school-age children. Poverty
is a health problem that also affects learning
and achievement in school-age children.
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is providing
immunizations to school-age children at a
10. local health department. At which age would
the nurse expect to administer the first dose of
human papilloma virus (HPV) vaccine?
9
11
13
15
B
Feedback:
The current recommendation is to administer
the first dose of HPV vaccine at age 11.
However, the earliest age that the vaccine can
be given is age 9. The HPV vaccine is
administered to females at age 13 to 18 if they
have not been previously vaccinated.
A community health nurse is speaking to a
group of parents of incoming college
freshmen students who will be living in the
dormitories. The focus of the program is on
11. the college health program, health issues, and
immunizations. Which immunization would
the nurse most strongly encourage the
students to receive if they have not received it
previously?
Varicella virus vaccine
Human papilloma virus vaccine
Meningococcal vaccine
Influenza vaccine
C
Feedback:
The meningococcal vaccine is a catch-up
vaccine that is recommended for all
students to receive if they have not received it
previously?
Varicella virus vaccine
Human papilloma virus vaccine
Meningococcal vaccine
Influenza vaccine
C
Feedback:
The meningococcal vaccine is a catch-up
vaccine that is recommended for all
previously unvaccinated college freshmen
living in dormitories. Adolescents who have
not had chickenpox and have not received
prior vaccination should receive the varicella
vaccines. The HPV vaccine is given to
females only. The influenza vaccine should be
given only those who are considered high
risk.
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A)
B)
C)
D)
Ans:
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When preparing a program to address
violence among school-age children and
12. adolescents, the community health nurse
integrates knowledge of which of the
following?
Teen females commit homicide more
frequently than teen males.
Homicide is the second highest cause of death
for all adolescents.
Adolescents account for less than one half of
all firearm injuries treated.
Serious youth violence is unrelated to drugs
and guns.
B
Feedback:
Homicide is the second leading cause of death
for adolescents (ages 10 to 24) and is more
common in males than females. Adolescents
between the ages of 15 and 19 years account
for almost 85% of all firearm injuries treated
in emergency departments or hospitals.
Serious youth violence is part of a
constellation of risk-taking behaviors that also
includes precocious sex, drugs, and guns.
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B)
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C)
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D)
When working with community groups to
develop appropriate programs for adolescent
health promotion, the nurse integrates
13.
knowledge of the Healthy People 2020
objectives, keeping in mind that many of the
objectives address which of the following?
Self-esteem improvement
Risk-taking behaviors
Control of disease
Behavioral issues
B
Feedback:
Healthy People 2020 objectives are geared to
improve the health of all Americans. Twentyone specific objectives have been ranked as
critical for this population. The objectives
focus on issues involving mortality and
morbidity in this age group that stems
primarily from risk-taking behaviors. Many of
the objectives relate to reduction in alcoholrelated unintentional injuries, declines in
violent behaviors, suicide and mental health
issues, as well as more responsible
reproductive health behaviors.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When working with school districts, which of
the following would the community health
14. nurse encourage as the most effective schoolbased approach to solve the problem of
teenage suicide?
Suicide prevention programs with direct
interventions
Teachers assessing suicide risk among
students
Promotion of stronger parental control of
teens
Punitive treatment of teens by the school
administration
A
Feedback:
Programs and interventions by counselors and
school nurses that are focused on determining
adolescent suicide intentions are the most
effective approaches. Teachers do not feel
comfortable or prepared to assess suicide risk,
and this alone will not prevent teen suicide.
Peer pressure is strong, and parent concerns
are not as important to the teen. Teens are
C)
teens
Punitive treatment of teens by the school
administration
A
Feedback:
Programs and interventions by counselors and
school nurses that are focused on determining
adolescent suicide intentions are the most
effective approaches. Teachers do not feel
comfortable or prepared to assess suicide risk,
and this alone will not prevent teen suicide.
Peer pressure is strong, and parent concerns
are not as important to the teen. Teens are
seeking independence, and stronger parental
control is not an effective method of reducing
teen suicide. This approach is inappropriate
for any school-age child or teen behavior.
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is working with
local schools to help address teen pregnancy.
15.
The nurse would focus interventions on which
of the following?
Better use of contraceptives
Decreased sexual activity
Improved parenting skills
Proper nutritional habits
B
Feedback:
Although contraceptives, parenting skills, and
nutrition may be areas of focus for teen
pregnancy, research has shown that the
downward trend for teen pregnancy rates has
been attributed largely to better contraceptive
use rather than less sexual activity. Therefore,
interventions should focus on the area of
decreasing sexual activity.
Which of the following would the community
health nurse most commonly need to address
16.
when planning programs for children with
chronic illness?
Asthma control
Autism education
Diabetes regimens
Seizure control
A
Feedback:
Although autism education, diabetic
regimens, and seizure control are common
issues related to chronic disease in children,
asthma is the most common chronic disease.
Thus asthma control would be a priority.
B)
C)
D)
Ans:
Autism education
Diabetes regimens
Seizure control
A
Feedback:
Although autism education, diabetic
regimens, and seizure control are common
issues related to chronic disease in children,
asthma is the most common chronic disease.
Thus asthma control would be a priority.
A community health nurse is working with a
group of school nurses to develop
17. interventions for a 10-year-old girl exhibiting
signs and symptoms of school refusal. Which
of the following would be most appropriate?
Limiting parent involvement in the school
Exposing the child rapidly to the classroom
Keeping the child at home for a while
Providing relaxation training
D
Feedback:
The most effective interventions for school
refusal include early return to school with
parental involvement in school, systematic
desensitization (gradual exposure to the
classroom), relaxation training, and
counseling.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A community health nurse is working with the
local health department on screening for
18. sexually transmitted infections. Which of the
following would the nurse identify as the
most common?
Syphilis
Gonorrhea
Chlamydia
Herpes simplex virus
C
Feedback:
Chlamydia is the most common STI in
adolescents and should be a major focus of
the screening. Syphilis, gonorrhea, and herpes
simplex virus also are common among
adolescents but less than Chlamydia.
When preparing a program about substance
abuse prevention for adolescents, the
19.
community health nurse would focus on
which substance as the most frequently used?
Marijuana
Alcohol
Ecstasy
Ketamine
B
Feedback:
Alcohol is the most frequently used substance
for adolescents in the United States.
Marijuana is the most commonly used drug
among 14- to 17-year-olds. Ecstasy and
ketamine are other drugs used by adolescents
and young adults.
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A)
B)
C)
D)
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A community health nurse is engaged in a
community-wide program for promoting
20. nutrition in adolescents. Which of the
following would lead the nurse to target the
program to adolescent girls?
Girls eat larger quantities of food than boys.
They are more physically active than boys.
They have a tendency to diet inappropriately.
They are more conscious about food nutrients.
C
Feedback:
Girls are more at risk for problems with
nutrition for several reasons: They tend to diet
inappropriately, to have more finicky eating
habits, and to be less physically active than
teenage boys. Boys typically eat large
quantities of food, which increases the
likelihood of obtaining adequate nutrients,
and they also tend to be more physically
active than girls.
A)
B)
C)
D)
Ans:
A community health nurse is implementing a
family planning program near a local inner
21.
city's schools. The nurse is engaging which
type of health service?
Preventive program
Health protection
Health promotion
Injury prevention
A
A community health nurse is implementing a
family planning program near a local inner
21.
city's schools. The nurse is engaging which
type of health service?
Preventive program
Health protection
Health promotion
Injury prevention
A
Feedback:
A family planning program is an example of a
preventive program that provides birth control
information and counseling. Health protection
programs focus on safety including injury
prevention. Health promotion programs focus
on areas such as nutrition and weight control,
and drug abuse education.
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B)
C)
D)
Ans:
Chapter 21 Adult Health
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A community health nurse is working with
other professionals to develop preventive
1. programs to address the leading cause of
death in men and women. Which of the
following would be appropriate?
Risk reduction for heart disease
Cancer screening
Safety education
Flu vaccine immunization
A
Feedback:
The leading cause of death for men and
women is heart disease. Therefore, risk
reduction for heart disease would be most
appropriate. Cancer screening, safety
education, and flu vaccine immunization
would be appropriate for cancer, the second
leading cause of death; unintentional injuries,
the third leading cause of death in men; and
influenza and pneumonia, the eighth leading
cause of death in men and women
respectively.
When developing teaching programs for a
community of adult men and women, which
of the following would the community health
2.
nurse identify as a key aspect for this
community's ability to follow through with
the teaching?
Life expectancy
Health disparity
Health literacy
Financial ability
C
Feedback:
Health literacy is a critical aspect of managing
health problems and a key to being able to
read and understand health information so
that individuals can follow through and make
appropriate health decisions. Low health
literacy also contributes to health disparities, a
difference in health status due to sex, race, or
ethnicity. Life expectancy is the average
number of years an individual member is
projected to live. It is a standard measurement
unrelated to the ability to follow through with
teaching. Financial ability may impact a
person's ability to obtain needed services, but
it is not a key aspect.
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B)
C)
D)
Ans:
When assessing a population for health
3. disparities, which of the following would the
nurse least likely evaluate?
Race
Education
Age
Sexual orientation
C
Feedback:
A health disparity is defined as a difference in
health status that occurs by sex, race or
ethnicity, education or income, disability,
geographic location, or sexual orientation.
Age would not be used to assess health
disparity.
4.
A)
B)
C)
D)
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Which one of the following statements about
life expectancy is most accurate?
The life expectancy for White women is 4
years greater than for Black women.
The life expectancy for Black men is 6 years
greater than for White men.
In the United States, life expectancy continues
to decline.
There is a gap in life expectancy between
women and men of more than 6 years.
A
Feedback:
The life expectancy for White women is 4
years greater than for Black women. The life
expectancy for White men is 6 years greater
than for Black men. In the United States, life
expectancy continues to increase consistently
over time. The gap in life expectancy between
women and men was 5.0 years in 2007.
A)
B)
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A community health nurse is working with a
grant funded project to address stroke
prevention nationwide. After reviewing
5.
statistics related to stroke, which would the
nurse identify as having the greatest need for
this type of program?
North central
Southeast
Southwest
Pacific northwest
B
Feedback:
The nurse would identify the southeast as the
area of greatest need because here. Known as
the stroke belt, stroke death rates for both
Blacks and Whites are higher than in any
other part of the country.
The nurse educator is aware that the nursing
student has a grasp of the major health
6.
problems of adults when the nursing student
makes which one of the following statements?
“Morbidity and mortality among adults does
not vary much by age, gender, and race/
ethnicity.”
“The six leading causes of death in adults
include suicide, Alzheimer's disease, and
A)
B)
C)
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The nurse educator is aware that the nursing
student has a grasp of the major health
6.
problems of adults when the nursing student
makes which one of the following statements?
“Morbidity and mortality among adults does
not vary much by age, gender, and race/
ethnicity.”
“The six leading causes of death in adults
include suicide, Alzheimer's disease, and
homicide.”
“Diseases of the heart and cerebrovascular
diseases are the first and third causes of death
in adults.”
“Malignant neoplasms, chronic lower
respiratory diseases, unintentional injuries,
and diabetes mellitus are not among the six
leading causes of death in adults.”
C
Feedback:
The following statement is true: “Diseases of
the heart and cerebrovascular diseases are the
first and third causes of death in adults.”
Morbidity and mortality among adults varies
substantially by age, gender, and race/
ethnicity. Malignant neoplasms, chronic lower
respiratory diseases, unintentional injuries,
and diabetes mellitus are among the six
leading causes of death in adults. Causes of
death in adults that are not among the six
leading causes of death include suicide,
Alzheimer's disease, and homicide.
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The following is a list of the top five causes
of unintentional injuries accounting for the
majority of adults deaths due to injury. Order
these in their proper sequence from first to
fifth.
7.
A) Fire arms
B) Suffocation
C) Motor vehicle crashes
D) Poisoning
E) Falls
C, A, D, E, B
Feedback:
The top five causes of unintentional injuries
include motor vehicle crashes, fire arms,
poisoning, falls, and suffocation. Together,
these causes account for approximately 80%
of all injury deaths.
C) Motor vehicle crashes
D) Poisoning
E) Falls
C, A, D, E, B
Feedback:
The top five causes of unintentional injuries
include motor vehicle crashes, fire arms,
poisoning, falls, and suffocation. Together,
these causes account for approximately 80%
of all injury deaths.
Ans:
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B)
C)
D)
Ans:
A community health nurse is preparing a
presentation about drug use and abuse for a
8. group of adults. Which of the following
would the nurse include as the one of the
fastest growing forms of drug abuse?
Cocaine
Alcohol
Prescription drugs
Heroin
C
Feedback:
Illegal use of prescription drugs is one of the
fastest growing forms of drug abuse, and it is
becoming a major public health concern. The
primary illicit drugs used in the United States,
such as cocaine and heroin, have and continue
to be a public health problem. Alcohol abuse
also is a public health problem and is
considered the third leading lifestyle-related
cause of death for people living in the United
States.
A)
B)
C)
D)
Ans:
After teaching a group of students about the
major types of cancer affecting men and
women, the instructor determines that the
9.
teaching was successful when the students
identify which of the following as the number
one cause of cancer deaths among adults?
Colon
Pancreatic
Esophageal
Lung
D
Feedback:
Lung and bronchus cancers are the number
one cause of cancer deaths among adults.
Colon and rectal cancers are the third most
common cancers in adults. Pancreatic and
esophageal cancers are less common causes
of cancer death.
Pancreatic
Esophageal
Lung
D
Feedback:
Lung and bronchus cancers are the number
one cause of cancer deaths among adults.
Colon and rectal cancers are the third most
common cancers in adults. Pancreatic and
esophageal cancers are less common causes
of cancer death.
A patient comes to the community health
clinic with complaints of changes in urination.
Which of the following would lead the
10.
community health nurse to suspect that the
patient has benign prostatic hypertrophy
(BPH)?
Nighttime frequency
Dysuria
Hematuria
Flank pain
A
Feedback:
The symptoms of BPH vary, but the most
common ones involve changes or problems
with urination, such as hesitant, interrupted,
or weak urinary stream; urgency or leaking of
urine; and more frequent urination, especially
at night. Dysuria may indicate a urinary tract
infection. Hematuria could suggest a variety
of problems, such as infection calculi, or
cancer. Flank pain may indicate conditions
such as pyelonephritis or renal calculi.
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C)
D)
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B)
C)
D)
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B)
C)
D)
Ans:
When developing community health
programs target to adult men, which of the
11.
following would the nurse need to integrate
into the plan?
Improved quality of education programs
available for men
Increased access of health services by men as
compared to women
Limited male-gender specific research
Increased awareness of men's health issues
C
Feedback:
The current state of men's health involves a
lack of quality health education programs for
men, health care services that are only
accessed half as much by men when
compared to women, and a lack of male
compared to women
Limited male-gender specific research
Increased awareness of men's health issues
C
Feedback:
The current state of men's health involves a
lack of quality health education programs for
men, health care services that are only
accessed half as much by men when
compared to women, and a lack of male
gender-specific research. In addition,
awareness of men's health issues is lacking.
Currently, there is no Office on Men's Health
in the U.S. Department of Health and Human
Services; legislation to establish such an
office has been introduced; however, the bill
did not progress out of the congressional
subcommittee on health and has not been
reintroduced.
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D)
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A community health nurse is reviewing
research related to women's health. Which of
12. the following would the nurse use to obtain
information about postmenopausal women's
health?
The Women's Health Study
The Women's Health Initiative
The Nurses' Health Study I
The Nurses' Health Study II
B
Feedback:
The nurse would use The Women's Health
Initiative. This study was a major 15-year
research program addressing the most
common causes of death, disability, and poor
quality of life in postmenopausal women—
CVD, cancer, and osteoporosis. The Women's
Health Study evaluated the effects of vitamin
E and low-dose aspirin therapy in primary
prevention of CVD and cancer in apparently
healthy women. The Nurses' Health Study I
investigated the potential long-term
consequences of the use of oral
contraceptives. The Nurses' Health Study II
studied oral contraceptives, diet, and lifestyle
risk factors in a population younger than the
original Nurses' Health Study cohort.
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B)
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D)
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B)
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While working in a community health clinic,
a community health nurse interviews a 2413. year-old client. Which of the following would
lead the nurse to suspect that the client is
binge eating?
Significant weight loss from dieting last year
Participation in excessive exercise
Exaggerated concern about body shape
Severe emaciation
A
Feedback:
Binge eating is an eating disorder that is
characterized by repeated episodes of
uncontrolled eating. It usually starts following
significant weight loss from dieting.
Typically, individuals with this disorder eat
quickly, eat until they are uncomfortably full,
eat when they are not hungry, eat large
amounts of food alone, have difficulty
expressing their feelings, have difficulty
controlling impulses and stress, and feel
depressed about overeating. Participation in
excessive exercise and an exaggerated
concern about body shape is usually
associated with bulimia. Severe emaciation is
associated with anorexia.
A)
B)
C)
D)
Ans:
Which of the following statements by a
women's group indicates that they have
14.
understood the teaching about heart disease
and women?
“More women die of breast cancer than heart
disease.”
“Women experience similar symptoms as
men.”
“Hormone replacement therapy protects the
heart.”
“Heart disease is the number one killer of
women.”
D
Feedback:
Heart disease is the number one killer of
women. One in 2.6 female deaths is from
cardiovascular disease, compared to 1 in 30
from breast cancer. Women have atypical
symptoms or less acute chest pain than men,
often leading them to delay care. Hormone
C)
heart.”
“Heart disease is the number one killer of
women.”
D
Feedback:
Heart disease is the number one killer of
women. One in 2.6 female deaths is from
cardiovascular disease, compared to 1 in 30
from breast cancer. Women have atypical
symptoms or less acute chest pain than men,
often leading them to delay care. Hormone
therapy does not reduce coronary events.
D)
Which one of the following statements about
15. coronary heart disease and stroke are most
accurate?
Cardiovascular disease kills more women
than men.
Stroke kills more men than women.
White persons are more likely to have their
first stroke earlier than Black persons.
Risk factors for cardiovascular disease are not
known.
A
Feedback:
Cardiovascular disease kills more women
than men. Stroke kills more women than men.
Black persons are more likely to have their
first stroke earlier than White persons. Risk
factors for cardiovascular disease are known.
Some are controllable such as lifestyle, and
some are uncontrollable such as heredity.
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B)
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B)
C)
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A community health nurse working in a local
women's health clinic is planning a teaching
16. session for a group of women about
menopause. Which of the following would the
nurse include in the session?
Menopause involves very noticeable and
characteristic symptoms.
The symptoms are usually temporary lasting
for a month or two.
It can occur as early as age 30 but more
commonly ages 45 to 55 years.
Going 6 months without a period signals
menopause.
C
Feedback:
Menopause is a time that marks the
permanent cessation of menstrual activity. It
usually occurs between the ages of 45 and 55
years. However, it can occur as early as age
It can occur as early as age 30 but more
commonly ages 45 to 55 years.
Going 6 months without a period signals
menopause.
C
Feedback:
Menopause is a time that marks the
permanent cessation of menstrual activity. It
usually occurs between the ages of 45 and 55
years. However, it can occur as early as age
30. Symptoms of menopause vary among
women and last from months to years. They
range from hardly noticeable in some women
to very severe in others. Natural menopause is
when a woman has not had a period in 12
months (no other apparent causes).
C)
D)
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B)
C)
D)
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A)
B)
C)
D)
Ans:
During a home visit to a family, a community
health nurse encourages the mother, aged 42,
17.
and grandmother, aged 67, to have a clinical
breast exam at which frequency?
Monthly
Yearly
Every 2 years
Every 3 years
B
Feedback:
Clinical breast exams, performed by a health
care provider should be done every year for
each of these women. They should also
perform breast self-exam every month. The
mother at her current age should have a
physical examination every 2 years. Both the
mother and grandmother should have a pelvic
exam and Pap smear done every 3 years after
three consecutive negative Pap smears.
As part of a health screening program, a
community health nurse determines that a
client is infected with the human papilloma
18.
virus (HPV). The community health nurse
encourages the client to do which of the
following?
Get a mammogram immediately
Have her blood glucose level checked
Undergo testing for a breast cancer gene
Have a pelvic examination and Pap smear
D
Feedback:
Infection with certain types of human
papilloma virus is associated with an increase
risk for developing cervical cancer. Pap
following?
Get a mammogram immediately
Have her blood glucose level checked
Undergo testing for a breast cancer gene
Have a pelvic examination and Pap smear
D
Feedback:
Infection with certain types of human
papilloma virus is associated with an increase
risk for developing cervical cancer. Pap
smears have improved early detection and
prevention of cervical cancer dramatically.
HPV infection is not associated with breast
cancer, so there is no need for a
mammography or testing for a breast cancer
gene. HPV is not associated with diabetes so
blood glucose testing is not indicated.
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B)
C)
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B)
C)
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A nurse is instructing the adult male members
of a family on how to perform testicular self
19.
examination. Which of the following would
the nurse include?
Performing the examination every 3 months
Completing the exam right after a hot shower
Examining both testicles at the same time
Reporting a slight difference in size of one
testicle
B
Feedback:
A testicular self-examination should be
performed monthly right after a hot shower or
bath. One testicle is examined at a time. One
testicle, usually the right one, is normally
slightly larger than the other.
Which one of the following statements best
describes the role of the community health
20.
nurse in promoting the health of adult men 35
to 65 years of age?
Anticipatory guidance to men approaching
each stage and help them with ways to
manage life more effectively.
Men of this age do not need to enhance their
self-care skills.
A positive attitude toward aging is not helpful
to men at this time in their lives.
Men of this age should exercise sporadically.
C
Feedback:
The community health nurse can provide
anticipatory guidance to men approaching this
stage and help them with ways to manage life
Men of this age do not need to enhance their
self-care skills.
A positive attitude toward aging is not helpful
to men at this time in their lives.
Men of this age should exercise sporadically.
C
Feedback:
The community health nurse can provide
anticipatory guidance to men approaching this
stage and help them with ways to manage life
more successfully. Successful navigating this
stage of life can be fulfilling but may require
a man to enhance his self-care skills. This
includes having a positive attitude toward
aging, one that examines the benefits of
maturity, finds a balance between work and
home, and maintains a healthy lifestyle by
eating balanced meals and obtaining regular
exercise.
B)
C)
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When developing a plan of care for a group of
male patients experiencing erectile
21.
dysfunction, which of the following would the
nurse expect to institute first?
Lifestyle changes
Adjustments to current medications
Psychotherapy
Behavior modification
A
Feedback:
Treatment for ED usually proceeds from least
to most invasive. For some men, making a
few healthy lifestyle changes may solve the
problem. Smoking cessation, weight loss, and
increased physical activity may help some
men regain sexual function. Cutting back on
any drugs with harmful side effects is
considered next. For example, drugs for high
blood pressure work in different ways. If a
particular drug is causing problems with
erection, a different class of blood pressure
medicine might work just as well.
Medications, psychotherapy and behavior
modifications would follow.
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B)
C)
D)
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Which of the following would a community
22. health nurse recommend adult men and
women over the age of 50 receive yearly?
Electrocardiogram
Tetanus booster
Flexible endoscopy
Hemoccult stool testing
D
Feedback:
Men and women over the age of 50 should
receive yearly physical exams and hemoccult
stool testing, electrocardiograms every 3
years, tetanus booster every 10 years, and
flexible endoscopy every 3 to 4 years.
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B)
C)
D)
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A community health nurse, who is working
with a program to foster early detection of
23. prostate cancer, recommends prostate-specific
antigen testing and a digital rectal exam for
men with average risk starting at which age?
40 years
45 years
50 years
55 years
C
Feedback:
The American Cancer Society recommends
that screening of men who are at average risk
should begin at age 50 years and should
include a blood test to assess PSA levels and a
digital rectal examination.
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B)
C)
D)
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Chapter 22 Older Adults
A)
B)
C)
D)
Ans:
When describing the changes occurring in the
1. older adult population globally, which of the
following would be most accurate?
The over-80 years age group is the fastest
growing segment of the group.
Males have a longer projected life expectancy
when compared with females.
Most countries have adequate numbers of
social programs for older adults.
Adults over age 65 are expected to account
for about 25% of the population by 2050.
A
following would be most accurate?
The over-80 years age group is the fastest
growing segment of the group.
Males have a longer projected life expectancy
when compared with females.
Most countries have adequate numbers of
social programs for older adults.
Adults over age 65 are expected to account
for about 25% of the population by 2050.
A
Feedback:
In most of the world, the population of those
over 80 years of age is growing faster than
any other population age group. A higher life
expectancy at birth for females compared
with males is almost universal. Many
countries have few or no social programs
available for older adults. By the year 2050,
one tenth of the population is expected to be
over the age of 65 years.
A)
B)
C)
D)
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A community health nurse is working with an
older adult population ranging in age from 75
2.
to 85 years. The nurse correctly classifies this
group as which of the following?
Young-old
Old-old
Oldest-old
Elite-old
B
Feedback:
Those between the ages of 65 and 75 are
classified as “young-old,” while those
between 75 and 85 are labeled “old-old.” The
number of people living into “older” old age
(75 years and older) is increasing. Forty
percent of elderly people in the United States
are among the “oldest-old” (85 to 100 years),
while more than 200,000 are among the eliteold, or centenarians.
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B)
C)
D)
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While working with another group of
community health nurses, a nurse overhears
one of the nurses saying, “That older man
3. should just retire. He's 70 years old. How
productive can he be?” The nurse interprets
this statement as reflecting which of the
following?
Prejudice
Bias
Ageism
Insight
C
Feedback:
The one nurse's statement reflects
stereotyping and a negative image of an older
adult. This is called ageism. It may be due to
negative personal experiences, myths, or a
general lack of information. It is not reflective
of prejudice or bias. Insight would reflect an
understanding of the older adult, which this
statement does not do.
C)
D)
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B)
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D)
Ans:
Which of the following statements are
4. common misconceptions about older adults?
Select all that apply.
It is normal for older adults to become more
confused and childlike, forgetful, and lose
contact with reality as they age. They become
“senile.”
As older adults age, they become more
different and less alike other older adults.
Older people are very capable of learning new
things.
As age increases, older adults withdraw,
become inactive, and cease being productive.
A, D
Feedback:
The misconceptions or myths about older
adults include the following: It is normal for
older adults to become more confused and
childlike, forgetful, and lose contact with
reality as they age. They become “senile”; As
age increases, older adults withdraw, become
inactive, and cease being productive; As older
adults age, they lose their individual
differences and become progressively more
alike; older adults are forgetful, unable to
learn new things, and set in their old ways of
C)
D)
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D)
E)
Ans:
A)
B)
C)
Which of the following are characteristics of
healthy older adults?
They are able to perform functional activities
of daily living.
They are able to adapt, to continue to handle
stress, and to be active in life and living.
They maintain the maximum degree of
physical, mental, and social vigor.
They are likely to be dependent on others.
They reside in institutions.
A
Feedback:
Healthy older adults' ability to function is a
key indicator of health and wellness and is an
important factor in understanding healthy
aging. They are able to adapt, to continue to
handle stress, and to be active in life and
living. They maintain the maximum degree of
physical, mental, and social vigor. The vast
majority of older adults, even those with
chronic diseases or other disabilities, are
living outside institutions and are relatively
independent.
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things.
As age increases, older adults withdraw,
become inactive, and cease being productive.
A, D
Feedback:
The misconceptions or myths about older
adults include the following: It is normal for
older adults to become more confused and
childlike, forgetful, and lose contact with
reality as they age. They become “senile”; As
age increases, older adults withdraw, become
inactive, and cease being productive; As older
adults age, they lose their individual
differences and become progressively more
alike; older adults are forgetful, unable to
learn new things, and set in their old ways of
doing things.
The nurse educator is aware that the nursing
student has a grasp of the primary prevention
6.
needs of older adults when the nursing student
makes which of the following comments?
It is unnecessary for older adults to receive
immunizations.
All older adults must restrict their sodium
intake.
Older adults don't need to drink as much fluid
as they are often less thirsty.
The nurse educator is aware that the nursing
student has a grasp of the primary prevention
6.
needs of older adults when the nursing student
makes which of the following comments?
It is unnecessary for older adults to receive
immunizations.
All older adults must restrict their sodium
intake.
Older adults don't need to drink as much fluid
as they are often less thirsty.
The oral health of older adults is often
neglected and so it is important that they see a
dentist regularly.
D
Feedback:
The oral health of older adults is often
neglected, and so it is important that they see
a dentist regularly. It is necessary for older
adults to receive immunizations. Neither of
these statements is true: All older adults must
restrict their sodium intake and older adults
don't need to drink as much fluid as they are
often less thirsty.
A)
B)
C)
D)
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When visiting a local senior center, a
community health nurse engages several of
7. the older adults in a discussion about
immunizations. Which statement best reflects
the importance of older adult immunization?
“We're at greater risk of dying from the flu or
pneumonia.”
“You don't get the flu from the flu shot.”
“The doctor told us that we should get it.”
“Many of us get the shot here at the center for
free.”
C
Feedback:
Older adults are at risk of not only contracting
influenza or pneumonia but of dying from
them, underscoring the importance of
obtaining the immunizations. The statement
about not getting the flu from the shot
addresses one of the common reasons for not
getting it, the belief that the flu shot will give
them the flu. The statement about the doctor
telling them to get it indirectly reflects
another reason for not getting it, lack of
knowledge about the need. The statement
about getting the shot for free suggests that
finances may be a barrier to obtaining the shot
but not why it is important.
Ans:
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B)
C)
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A)
C)
“The doctor told us that we should get it.”
“Many of us get the shot here at the center for
free.”
C
Feedback:
Older adults are at risk of not only contracting
influenza or pneumonia but of dying from
them, underscoring the importance of
obtaining the immunizations. The statement
about not getting the flu from the shot
addresses one of the common reasons for not
getting it, the belief that the flu shot will give
them the flu. The statement about the doctor
telling them to get it indirectly reflects
another reason for not getting it, lack of
knowledge about the need. The statement
about getting the shot for free suggests that
finances may be a barrier to obtaining the shot
but not why it is important.
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is teaching a group
of older adults at a senior center about
8.
strategies for successful aging. Which of the
following would the nurse include?
“Limit drinking alcohol to once or twice a
month”
“Avoid eating too many fruits and vegetables”
“Keep in touch with friends and family”
“Get up early in the morning”
C
Feedback:
Strategies for successful aging include
maintaining contacts with family and friends
and staying active through work, recreation,
and the community. Moderation in drinking is
key. The older adult should eat a healthy diet
of fruits, whole grains, vegetables, and lean
meat. They also should get as much sleep and
rest as needed. Getting up early in the
morning may or may not be appropriate.
An older adult interested in nutrition asks the
community health nurse about the number of
9. calories that he or she should eat every day.
Which of the following would be most
appropriate?
800 to 1,200 calories
1,200 to 1,600 calories
1,600 to 2,000 calories
2,000 to 2,400 calories
B
Feedback:
community health nurse about the number of
9. calories that he or she should eat every day.
Which of the following would be most
appropriate?
800 to 1,200 calories
1,200 to 1,600 calories
1,600 to 2,000 calories
2,000 to 2,400 calories
B
Feedback:
It is generally believed that older people need
to maintain their optimal weight by eating a
diet that is low in fats, moderate in
carbohydrates, and high in proteins with a
daily calorie count of 1,200 to 1,600.
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A)
B)
C)
D)
Ans:
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D)
Ans:
A)
B)
C)
D)
Ans:
An older adult comes to the community health
center for a checkup. During the visit, he or
10. she mentions that he or she is somewhat
constipated. Which of the following
suggestions would be most appropriate?
Use a laxative about once or twice a week
Increase your intake of fresh fruits and
vegetables
Drink about four 8-oz. glasses of fluid each
day
Walk around the block once a week
B
Feedback:
Older adults should add more fiber and bulk
to their diet with fresh fruits and vegetables
instead of relying on the habitual use of
laxatives. Also inadequate fluid intake can
contribute to bowel and bladder problems.
Consuming a diet that includes eight or more
8-oz. glasses of fluid (water, juices, tea) each
day assists the gastrointestinal and
genitourinary system in their functions.
Increased physical activity and exercise, such
as a daily walk, help keep an older adult's
bowel patterns regular.
A community health nurse meets with a group
of adults at the local senior center. They range
11. in age from 65 to 70 years. The nurse would
recommend vision screening at which
frequency?
Every year
Every 2 years
Every 5 years
Every 10 years
B
A community health nurse meets with a group
of adults at the local senior center. They range
11. in age from 65 to 70 years. The nurse would
recommend vision screening at which
frequency?
Every year
Every 2 years
Every 5 years
Every 10 years
B
Feedback:
Currently, vision screening is recommended
every 2 years for adults aged 65 years and
older. Blood pressure screening should occur
yearly, and total cholesterol evaluation should
occur every 5 years. Tetanus and diphtheria
immunizations should be administered every
10 years.
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A)
B)
C)
D)
Ans:
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A community health nurse is assessing an
older adult's ability to perform activities such
as shopping, doing the laundry, using the
12.
telephone, and handling finances. Which
assessment tool would be most appropriate
for the nurse to use?
Barthel Index
Instrumental Activities of Daily Living Scale
Katz Index of Activities of Daily Living
Modified Rankin Scale
B
Feedback:
The Instrumental Activities of Daily Living
Scale looks at an older adult's ability to
perform such activities as using the telephone,
shopping, doing laundry, and handling
finances. The Barthel Index assesses
functional independence and is often used to
determine levels of disability or dependence
of stroke victims in respect to ADLs. The
Modified Rankin Scale (MRS) is another
common tool used for this purpose. The Katz
Index of Activities of Daily Living is based
on an evaluation of the functional
independence or dependence of clients with
respect to bathing, dressing, toileting, and
related tasks.
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A)
B)
C)
D)
Ans:
A community health nurse is preparing a
teaching program that addresses chronic
13. diseases common among older adults. Which
of the following would be most appropriate to
include?
Forty percent of older adults are diagnosed
with diabetes.
Weight-bearing exercises are related to
increased cases of osteoporosis.
Postural hypotension can be related to falls in
elders.
Older White men have the highest rates of
hypertension.
C
Feedback:
Older adults need to have sufficient cerebral
circulation to avoid dizziness. Dizziness can
lead to falling. A normal to high-normal blood
pressure for the elder should be maintained.
Based on the most current statistics, 15.1% of
men and 13.0% of women report having
diabetes. Weight-bearing exercises are a way
to prevent osteoporosis. Older African
American men have the highest rates of
hypertension.
A)
B)
C)
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D)
A)
B)
C)
D)
Ans:
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Ans:
After teaching a group of older adult women
about preventing osteoporosis, which of the
14.
following if stated by the group indicates the
need for additional teaching?
“We should eat foods that are high in calcium
and vitamin D.”
“We need to get bone density screenings
regularly.”
“We should avoid activities that involve
weight bearing.”
“We need to make sure that maintain a
healthy weight.”
C
Feedback:
Weight-bearing activities are encouraged to
promote strong bones. In addition, individuals
should be encouraged to eat diets that are rich
in vitamin D and calcium, and include
calcium supplements as needed. Not smoking,
maintaining a healthy weight, and receiving
ongoing bone density screenings are positive
health behaviors that can contribute to strong
C)
weight bearing.”
“We need to make sure that maintain a
healthy weight.”
C
Feedback:
Weight-bearing activities are encouraged to
promote strong bones. In addition, individuals
should be encouraged to eat diets that are rich
in vitamin D and calcium, and include
calcium supplements as needed. Not smoking,
maintaining a healthy weight, and receiving
ongoing bone density screenings are positive
health behaviors that can contribute to strong
bones throughout life.
D)
After teaching a group of students about the
most common health problems affecting older
adults in the community, which of the
15.
following if identified by the students would
alert the instructor to the need for additional
teaching?
Arthritis
Hypertension
Emphysema
Peripheral vascular disease
C
Feedback:
Emphysema is not considered a common
health problem of older adults. The most
common health problems of older people in
the community are arthritis, reduced vision,
hearing loss, heart disease, peripheral vascular
disease, and hypertension.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When describing elder abuse to the families
of older adults who are attending a local
16. community presentation, which of the
following would the community health nurse
identify most commonly as the perpetrator?
Elder's adult child
Elder's partner
Elder's neighbor
Elder's grandchild
B
Feedback:
The most common perpetrators of elder abuse
are spouses or partners of elders. The next
most frequent abuser is the adult child of the
elder. Although it may be possible that the
perpetrator is the elder's neighbor or
grandchild, this situation would be quite rare.
B)
C)
D)
Ans:
Elder's partner
Elder's neighbor
Elder's grandchild
B
Feedback:
The most common perpetrators of elder abuse
are spouses or partners of elders. The next
most frequent abuser is the adult child of the
elder. Although it may be possible that the
perpetrator is the elder's neighbor or
grandchild, this situation would be quite rare.
17.
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A)
Which one of the following statements about
elder abuse is most accurate?
Elder abuse is a problem that is under
recognized and underreported.
It is more common for elderly men to be
abused rather than elderly women.
If there is long-term domestic violence in an
elderly couple, it is not considered elder abuse
for the perpetrator to continue to abuse the
victim.
Self-neglect is not considered to be a form of
mistreatment.
A
Feedback:
Elder abuse is a problem that is under
recognized and underreported. It is more
common for elderly women to be abused
rather than elderly men. The most common
perpetrators of elder abuse are spouses or
partners of elders, often in a relationship with
long-term domestic violence. In some states,
self-neglect is also considered a form of
mistreatment.
B)
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C)
D)
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A)
B)
C)
D)
E)
Ans:
Which of the following comprise the primary
18. criteria for effective programs for older
adults?
Coordination
Accessibility
Comprehensive
Complex
Quality
A, B, C, E
Feedback:
The primary criteria for effective programs
for older adults include coordination,
accessibility, comprehensive, and quality.
C)
D)
E)
Ans:
Comprehensive
Complex
Quality
A, B, C, E
Feedback:
The primary criteria for effective programs
for older adults include coordination,
accessibility, comprehensive, and quality.
Which of the following are included in a
19. comprehensive set of services? Select all that
apply.
Adequate financial support
Health education
Encouragement to spend much time alone
Adult day care programs
Access to high quality health care services
In-home services
A, B, D, E, F
Feedback:
A comprehensive set of services for senior
citizens should include the following:
adequate financial support, adult day care
programs, access to high quality health care
services, health education, in-home services,
recreation and activity programs that promote
socialization (not encouragement to spend
much time alone), and specialized
transportation services.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
E)
F)
Ans:
A community health nurse is making a home
visit to a family who is providing care to an
older adult member with Alzheimer's disease
20.
for the past 6 months. During the visit, which
of the following would be most important for
the nurse to assess?
Cognitive status
Medication regimen
Personality changes
Caregiver's status
D
Feedback:
Although assessment of the various aspects of
the patient's status is important, that of the
caregiver is even more important. Often, the
person with AD is cared for at home until
very late in the disease course. The intense
care given to these clients can be a constant
drain on the emotional and physical reserves
of their families. The stress of providing care
puts the caregiver's health at risk, as well.
Medication regimen
Personality changes
Caregiver's status
D
Feedback:
Although assessment of the various aspects of
the patient's status is important, that of the
caregiver is even more important. Often, the
person with AD is cared for at home until
very late in the disease course. The intense
care given to these clients can be a constant
drain on the emotional and physical reserves
of their families. The stress of providing care
puts the caregiver's health at risk, as well.
A group of community health nurses who
work in continuing care retirement centers are
21. asked to talk to a group of seniors about what
they do. Which of the following would the
nurses identify as unique for this setting?
Accept clients who primarily need skilled
nursing services
Are similar to board and care homes
Are respite centers for family members of
older adults
Provide a variety of housing and care options
that elders need as they age
D
Feedback:
Continuing care retirement centers are
comprehensive centers and have become the
last place an older adult needs to live, meeting
independent to dependent needs, including
skilled nursing and Alzheimer's disease
services. They can age in place without
moving to another location as their needs
increase. They accept residents at all stages of
need, from totally independent living to
assisted living to skilled nursing care. In some
settings, residents cannot enter the residence
at the skilled nursing level. These beds are
filled by residents with increasing needs as
they move from independent living, to
assisted living, to skilled nursing care. Skilled
nursing facilities provide skilled nursing care
along with personal care that is considered
nonskilled. Board and care or personal care
homes offer 24 hours basic custodial care but
provide no skilled nursing services. Respite
care centers provide time off for caregivers. It
can take place in an adult day center, home, or
residential setting.
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B)
C)
D)
Ans:
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D)
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Ans:
C)
older adults
Provide a variety of housing and care options
that elders need as they age
D
Feedback:
Continuing care retirement centers are
comprehensive centers and have become the
last place an older adult needs to live, meeting
independent to dependent needs, including
skilled nursing and Alzheimer's disease
services. They can age in place without
moving to another location as their needs
increase. They accept residents at all stages of
need, from totally independent living to
assisted living to skilled nursing care. In some
settings, residents cannot enter the residence
at the skilled nursing level. These beds are
filled by residents with increasing needs as
they move from independent living, to
assisted living, to skilled nursing care. Skilled
nursing facilities provide skilled nursing care
along with personal care that is considered
nonskilled. Board and care or personal care
homes offer 24 hours basic custodial care but
provide no skilled nursing services. Respite
care centers provide time off for caregivers. It
can take place in an adult day center, home, or
residential setting.
D)
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A)
B)
C)
D)
Ans:
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Ans:
Which of the following care options would be
most appropriate for an older adult who
experiences confusion, requires daily insulin
22.
injections and blood glucose monitoring, and
needs assistance with bathing, dressing, and
feeding?
Personal care home
Respite care
Intermediate care facility
Skilled nursing facility
D
Feedback:
Based on the situation, a skilled nursing
facility would be most appropriate. A skilled
nursing facility provides skilled nursing care,
such as injections and blood glucose
monitoring, along with personal care that is
considered nonskilled such as bathing,
dressing, and feeding. A personal care home
offers 24 hours basic custodial care but no
skilled services. Respite care provides time
off for caregivers and can take place in a
variety of settings. An intermediate care
facility provides health care, but the amount
and type of skilled care is less than that
Respite care
Intermediate care facility
Skilled nursing facility
D
Feedback:
Based on the situation, a skilled nursing
facility would be most appropriate. A skilled
nursing facility provides skilled nursing care,
such as injections and blood glucose
monitoring, along with personal care that is
considered nonskilled such as bathing,
dressing, and feeding. A personal care home
offers 24 hours basic custodial care but no
skilled services. Respite care provides time
off for caregivers and can take place in a
variety of settings. An intermediate care
facility provides health care, but the amount
and type of skilled care is less than that
provided in skilled nursing facilities.
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B)
C)
D)
Ans:
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B)
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C)
D)
Which one of the following statements is
23. most accurate when differentiating hospice
from palliative care?
Both palliative care and hospice focus on
cure; however, hospice focuses on terminal
illnesses, and palliative care focuses on
diseases that are more chronic in nature.
Palliative care consists of comfort and
symptom management and is often a part of
hospice care.
Hospice is more of a specific place than a
concept of care, whereas palliative care is
more of a concept of care.
Hospice is intended for people who have a
projected life expectancy of 6 months or
more, and palliative care is intended for
people who are actively dying.
B
Feedback:
Palliative care consists of comfort and
symptom management and is often part of
hospice care. Neither palliative care nor
hospice focuses on cure. Hospice does focus
on care of people who are known to be at end
of life, and palliative care can be provided to
people who have chronic ongoing health
conditions even when death is not imminent.
Hospice is more of a concept of care than a
specific place. Palliative care should be a
major focus of care throughout the aging
process, regardless of whether death is
imminent within 6 months.
projected life expectancy of 6 months or
more, and palliative care is intended for
people who are actively dying.
B
Feedback:
Palliative care consists of comfort and
symptom management and is often part of
hospice care. Neither palliative care nor
hospice focuses on cure. Hospice does focus
on care of people who are known to be at end
of life, and palliative care can be provided to
people who have chronic ongoing health
conditions even when death is not imminent.
Hospice is more of a concept of care than a
specific place. Palliative care should be a
major focus of care throughout the aging
process, regardless of whether death is
imminent within 6 months.
D)
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When working with the older adult population
in the community, which of the following
24.
would be most important for the community
health nurse to do?
Develop case management programs to
channel clients to appropriate services
Place the older adult in skilled nursing
facilities for the best care available
Raise funds to support the needs of the older
adults in the community
Emphasize tertiary prevention at this stage in
the lives of the older adult
A
Feedback:
Services for the older adult should be
proactive. Nurses should design interventions
that maximize nursing resources and provide
the greatest benefit to elderly clients. Skilled
nursing facilities are for people with skilled
needs, not for older adults managing chronic
diseases independently. One's own home is
most often the best place for elders and where
they want to be. This is not something that is
always needed or possible for a community
health nurse to become involved in. Nurses
can identify the needs for additional funding,
advocate for more funding, and facilitate a
community group's efforts to raise funds. This
is how a nurse can best serve the elderly and
support their needs rather than by actually
raising the funds. Prevention should be
proactive and focus on primary prevention
regardless of the client's age.
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B)
C)
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D)
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Ans:
C)
adults in the community
Emphasize tertiary prevention at this stage in
the lives of the older adult
A
Feedback:
Services for the older adult should be
proactive. Nurses should design interventions
that maximize nursing resources and provide
the greatest benefit to elderly clients. Skilled
nursing facilities are for people with skilled
needs, not for older adults managing chronic
diseases independently. One's own home is
most often the best place for elders and where
they want to be. This is not something that is
always needed or possible for a community
health nurse to become involved in. Nurses
can identify the needs for additional funding,
advocate for more funding, and facilitate a
community group's efforts to raise funds. This
is how a nurse can best serve the elderly and
support their needs rather than by actually
raising the funds. Prevention should be
proactive and focus on primary prevention
regardless of the client's age.
D)
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Ans:
D)
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B)
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Chapter 23 Working with Vulnerable Populations
Which of the following would a community
1. health nurse use to define vulnerable
populations?
Those persons with higher mortality rates
Individuals with lower life expectancy
Those with increased risk for adverse health
outcomes
Individuals with chronic illness
C
Feedback:
Vulnerable populations are groups who have a
heightened risk for adverse health outcomes.
They may include various populations such as
those with higher mortality rates, lower life
expectancies, or chronic illnesses. However,
presence of just one of these does not
necessarily indicate that the population is
vulnerable.
When assessing vulnerable populations, a
community health nurse uses a popular model
2. that contains three related concepts. Which of
the following would the nurse include? Select
all that apply.
Resource availability
Relative risk
Health status
Housing
Education
A, B, C
Feedback:
A popular conceptual framework of
vulnerability contains three related concepts:
resource availability, relative risk, and health
status. Housing and education are not one of
the three related concepts in this popular
model.
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A)
B)
C)
D)
E)
Ans:
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A)
B)
C)
D)
Ans:
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A community health nurse is applying the
Behavioral Model for Vulnerable Populations
3. when evaluating a local community. Which of
the following would the nurse include as an
enabling factor?
Insurance
Acculturation
Knowledge of disease
Marital status
A
Feedback:
Enabling factors include personal and family
resources, as well as community resources
(e.g., income, insurance, social support,
region, health services resources, public
benefits, transportation, telephone, crime
rates, social services resources).
Acculturation, knowledge of disease, and
marital status are examples of predisposing
factors.
A community health nurse is evaluating a
population for socioeconomic resources.
4.
Which of the following would the nurse
address?
Quality of care provided
Access to health care services
Educational opportunities
Adequacy of health care providers
C
Feedback:
Socioeconomic resources include such things
as human capital (e.g., jobs, income, housing,
education), social connectedness or
integration (e.g., social networks or ties,
social support or the lack of it characterized
by marginalization), and social status (e.g.,
position, power, role). Environmental
resources deal mostly with access to health
care and the quality of that care, including the
adequacy of health care providers.
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B)
C)
D)
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B)
C)
D)
Ans:
When assessing a population's vulnerability,
5. which of the following would the community
health nurse identify as a predisposing factor?
Social support networks
Crime rates
Transportation
Living conditions
D
Feedback:
Predisposing factors include demographic
variables (e.g., gender, age, marital status),
social variables (e.g., education, employment,
ethnicity, social networks), and health beliefs
(e.g., values and attitudes toward health and
health care services, knowledge of disease).
Social structures (e.g., acculturation and
immigration), sexual orientation, and
childhood characteristics (e.g., mobility,
living conditions, history of substance abuse,
criminal behavior, victimization, or mental
illness) are also considered as predisposing
factors. Enabling factors include personal and
family resources, as well as community
resources (e.g., income, insurance, social
support, region, health services resources,
public benefits, transportation, telephone,
crime rates, social services resources).
Crime rates
Transportation
Living conditions
D
Feedback:
Predisposing factors include demographic
variables (e.g., gender, age, marital status),
social variables (e.g., education, employment,
ethnicity, social networks), and health beliefs
(e.g., values and attitudes toward health and
health care services, knowledge of disease).
Social structures (e.g., acculturation and
immigration), sexual orientation, and
childhood characteristics (e.g., mobility,
living conditions, history of substance abuse,
criminal behavior, victimization, or mental
illness) are also considered as predisposing
factors. Enabling factors include personal and
family resources, as well as community
resources (e.g., income, insurance, social
support, region, health services resources,
public benefits, transportation, telephone,
crime rates, social services resources).
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B)
C)
D)
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B)
C)
D)
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When assessing a vulnerable population's
relative risk, which of the following would
6.
the community health nurse identify most
likely as contributing to this risk?
Well-balanced diet
Up-to-date immunizations
Enabling factors
Exposure to abuse
D
Feedback:
Relative risk refers to exposure to risk factors
identified by a substantial body of research as
lifestyle, behaviors, and choices (e.g., diet,
exercise, use of tobacco, alcohol and other
drugs, sexual behaviors), use of health
screening services (e.g., immunizations,
health promotion, use of seat belts), and
stressful events (e.g., crime, violence, abuse,
firearm use). A well-balanced diet, up-to-date
immunizations, and use of seat belts would
reduce one's risk whereas exposure to abuse
may increase the risk. Enabling factors relate
to the Behavioral Model for Vulnerable
Populations and not to the relative risk.
When describing the causes of vulnerability
7. to a group of students, which of the following
would the instructor include?
Vulnerable populations are fairly similar
across the nation and globally.
Statistics about vulnerable populations are
highly accurate.
The most important causative factor is race or
ethnicity.
Many of the factors and conditions suggest
vulnerability overlap.
D
Feedback:
Many of the factors and conditions contribute
to vulnerability overlap, making it difficult to
obtain accurate data and statistics for each
group or category. Although there are some
similarities and consistencies in terms of
vulnerable populations, the factors vary. They
also are interactive, making it difficult to
determine which factor or cause is considered
most important.
A)
B)
C)
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C)
D)
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8.
Which one of the following statements about
relative risk is most accurate?
Lifestyle, behaviors, and choices do not relate
to relative risk.
Relative risk refers to exposure to risk factors
identified from a substantial body of research.
Relative risk means that if a risk exists, the
illness or adverse event will occur.
Any factor that is likely to cause increased
risk is considered relative risk.
B
Feedback:
Relative risk refers to exposure to risk factors
identified from a substantial body of research.
Lifestyle, behaviors, and choices are risk
factors. Relative risk is not an absolute cause
and effect that if a risk exists, the illness or
adverse event will occur. Only factors that are
identified by a substantial body of research
are considered relative risk.
C)
illness or adverse event will occur.
Any factor that is likely to cause increased
risk is considered relative risk.
B
Feedback:
Relative risk refers to exposure to risk factors
identified from a substantial body of research.
Lifestyle, behaviors, and choices are risk
factors. Relative risk is not an absolute cause
and effect that if a risk exists, the illness or
adverse event will occur. Only factors that are
identified by a substantial body of research
are considered relative risk.
D)
Ans:
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A community health nurse is describing social
capital and its impact on populations to a
group of local community leaders. Which of
9.
the following would the nurse suggest as a
way to improve the social capital of the
community?
Better job training
Improved educational programs
Expanded employment opportunities
More community organizations
D
Feedback:
Social capital consists of marital status,
family structure, social ties and networks, and
membership in voluntary organizations, such
as a church or clubs. Thus suggesting more
community organizations would address
social capital. Better job training, improved
education, and expanded employment
opportunities are examples of human capital,
investments in individuals' capabilities and
skills (e.g., education, job training) that
comprise jobs, income, housing, and
education.
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A)
B)
C)
D)
Ans:
10.
A)
B)
C)
D)
Ans:
Which one of the following statements is true
regarding social capital?
Social capital includes investments in
individuals' capabilities and skills.
Social capital includes marital status and
family structure.
Social capital includes jobs, income, housing,
and education.
Examples of social capital are education and
job training.
B
Feedback:
Social capital consists of marital status,
A)
individuals' capabilities and skills.
Social capital includes marital status and
family structure.
Social capital includes jobs, income, housing,
and education.
Examples of social capital are education and
job training.
B
Feedback:
Social capital consists of marital status,
family structure, social ties and networks, and
memberships in voluntary organizations.
Human capital is linked to investments in
individuals' capabilities in skills (e.g.,
education, job training) and comprises jobs,
income, housing, and education.
B)
C)
D)
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D)
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B)
C)
D)
Ans:
Which of the following would a community
11. health nurse include when describing the
differential vulnerability hypothesis?
Exposure to risk factors affects the
population's social and human capital.
Everyone is at risk because of stressful events
occurring in life.
A risk for a negative outcome increases with
lower education and income levels.
Certain groups are impacted by stressful
events more than others.
D
Feedback:
The differential vulnerability hypothesis
states that everyone is subjected to stressful
events, but that these events hurt some people
more than others, thus they are vulnerable
populations. Although everyone experiences
stresses, not everyone is vulnerable. Deficits
or problems in social and human capital can
increase the population's risk. Lower
education and income are associated with a
higher relative risk, but these alone do not
describe the hypothesis.
After teaching a group of students about
factors associated with vulnerable
12. populations, the instructor determines the
need for additional teaching when the
students identify which as a factor?
Homelessness
Acute illness
Income
Immigrant status
B
After teaching a group of students about
factors associated with vulnerable
12. populations, the instructor determines the
need for additional teaching when the
students identify which as a factor?
Homelessness
Acute illness
Income
Immigrant status
B
Feedback:
Factors associated with vulnerable
populations include income and education,
age and gender, race and ethnicity,
homelessness, chronic illness and disability,
and immigration among others. Chronic, not
acute, illness is considered as a factor.
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B)
C)
D)
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A community health nurse is part of a group
working with local and state legislators to
expand health insurance coverage for those
13.
with inadequate or no insurance. Which
outcome would the nurse hope to achieve if
the group is successful?
Increase use of early screenings
Increase emergency room visits
Increase episodic care
Increase disparities in care
A
Feedback:
Having inadequate or no health insurance
leads to poor health outcomes due to lack of
early screening and preventive measures,
including regular physical exams and
immunizations, delays in getting treatment,
and use of emergency rooms for worsening
conditions with no continuity of care, all as
efforts to save money. Expanding health
insurance hopefully would promote increased
use of early screenings, decreased emergency
room visits, more continuity of care, and
better health outcomes all around with less
disparities.
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A)
B)
C)
D)
Ans:
Which of the following would be most
important for a community health nurse to do
14.
first when working with vulnerable
populations?
Helping them to make choices
Guiding them to think things through
Getting them to interact with the nurse
Providing honest feedback
C
Feedback:
When working with vulnerable populations,
the first step is to open the door and interact
with the clients, engaging them, and
developing rapport. Once this is
accomplished, the community health nurse
can then help them in making choices, guide
them to think through all the issues and
consequences, and provide honest feedback.
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A)
B)
C)
D)
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B)
C)
D)
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A community health nurse is working to
empower clients of a vulnerable population.
15.
Which of the following client behaviors
indicates that the nurse is achieving this goal?
Collaboration with their health care providers
Demonstration of a reactive focus
Hesitancy in the use of resources
Viewing of situations as nonchangeable
A
Feedback:
Empowerment would be manifested by the
clients engaging in collaboration with their
health care providers, becoming more
proactive than reactive, being better able to
seek and use services, and being realistic
about barriers with a view for ways to change
things for the better.
Which of the following would be least helpful
to a novice community health nurse working
with vulnerable populations who is feeling
16.
overwhelmed and somewhat guilty about his
or her personal situation as compared to his or
her clients?
Setting up an community agency clothing
drive collection
Working for changes in community attitudes
Sending a personal donation to an agency in
the area
Remaining grounded
C
Feedback:
Working with disadvantaged populations can
be challenging and exhausting. Often a novice
community health nurse may feel
overwhelmed and suffer compassion fatigue
and guilt about ones one life. To be effective,
it is often helpful to donate money or items on
a group level such as an agency clothing drive
rather than an individual level and to work for
substantial changes in community attitudes. In
addition, the nurse needs to remain grounded
in order to continue to have the necessary
energy and compassion.
A)
B)
C)
A)
B)
C)
D)
Ans:
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D)
Ans:
A community health nurse working with a
group of vulnerable clients is focusing on
17.
empowering them. Which of the following
would be most effective?
Keeping the clients to a firm schedule of
visits
Viewing the clients as active partners in the
process
Having the clients cut through bureaucratic
red tape
Focusing on the clients' limitations
B
Feedback:
Activities that are most effective in promoting
empowerment include viewing the clients as
active partners (shows mutual respect and
helps build a trusting relationship), being
flexible in dealing with the clients
(demonstrates a client-centered approach),
cutting through the bureaucratic red tape
(demonstrates advocacy), and focusing on the
Having the clients cut through bureaucratic
red tape
Focusing on the clients' limitations
B
Feedback:
Activities that are most effective in promoting
empowerment include viewing the clients as
active partners (shows mutual respect and
helps build a trusting relationship), being
flexible in dealing with the clients
(demonstrates a client-centered approach),
cutting through the bureaucratic red tape
(demonstrates advocacy), and focusing on the
clients' strengths rather than limitations (helps
to build client capacity).
C)
A community health nurse is preparing a
presentation for a group of local community
18. nurses about measures to help decrease health
disparities. Which of the following would be
the least effective suggestion?
Avoiding political involvement in issues
Working with schools to reduce the dropout
rate
Organizing task forces to raise community
awareness
Holding community meetings to identify
needs
A
Feedback:
To help decrease health disparities, political
advocacy is necessary to influence health
policy. In addition, working with schools to
reduce the dropout rate helps to address the
connection between education and outcomes.
Organizing task forces, raising community
awareness, and community input for need
identification are all effective methods to
address vulnerable populations and health
disparities.
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A)
B)
C)
D)
Ans:
After teaching a group of students about the
socioeconomic gradient in health, the
instructor determines that the students
19.
understand the concept when they state that
the relationship between social class and
health is which of the following?
Direct
Inverse
Positive
Unequal
B
socioeconomic gradient in health, the
instructor determines that the students
19.
understand the concept when they state that
the relationship between social class and
health is which of the following?
Direct
Inverse
Positive
Unequal
B
Feedback:
The socioeconomic gradient refers to the
inverse relationship between social class or
income and health, such that the lower the
social class or income, the higher the rates of
disease.
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A)
B)
C)
D)
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C)
D)
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A)
B)
C)
D)
E)
Ans:
Which one of the following statements is true
20. regarding the socioeconomic gradient of
health?
The behavior of smoking is lowest among
those who have low income and low
educational levels.
The socioeconomic gradient of health has
been found in populations around the world.
All persons who have a low socioeconomic
status will develop particular health problems.
The socioeconomic gradient of health is
universal.
B
Feedback:
The socioeconomic gradient of health has
been found in populations around the world,
although not always unfailingly. The behavior
of smoking is highest among those who have
low income and low educational levels. Not
all persons who have low socioeconomic
status will develop particular health problems.
Which of the following are types of health
21. disparities that are due to inequities that can
be corrected? Select all that apply.
Patients feel that they are unable to trust the
information given to them and may not follow
it as explained.
Limited access to appropriate level of care
Poor access to quality care
Overt discrimination
Health-damaging behaviors that are chosen by
an individual despite health education and
counseling efforts
A, B, C, D
Patients feel that they are unable to trust the
information given to them and may not follow
it as explained.
Limited access to appropriate level of care
Poor access to quality care
Overt discrimination
Health-damaging behaviors that are chosen by
an individual despite health education and
counseling efforts
A, B, C, D
Feedback:
Health disparities may be unavoidable, such
as health-damaging behaviors that are chosen
by an individual despite health education and
counseling efforts, but most are thought to be
due to inequities than can be corrected.
Reported disparities exist in the areas of
quality of health care, access to care, levels
and types of care, and care settings; they exist
within subpopulations (e.g., elderly, women,
children, rural residents, disabled) and across
clinical conditions. Patients can also react to
providers in a way that promotes disparities;
they may not trust the information given to
them and may not follow it as explained,
leading to inadequate care.
A)
B)
C)
D)
E)
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B)
C)
D)
E)
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Chapter 24 Clients with Disabilities
Which of the following vulnerable
populations have been subjected to perceived
22.
poor quality of care and access to care? Select
all that apply.
HIV-infected persons
Persons who use illicit drugs
People of non-White race/ethnicity
People of White race/ethnicity
Homeless persons
A, B, C, E
Feedback:
Higher perceived discrimination was
associated with HIV infection, homelessness,
drug use, and race/ethnicity, emphasizing the
perceived poor quality of care and difficulties
with access to care.
When working with the community to
develop effective plans to meet the needs of
people with disabilities, the community health
nurse reviews the statistics involving
1.
individuals with disabilities. Which of the
following would the nurse identify as
accurately reflecting the number of persons
with ongoing disability?
10 million people—less than 5% of the US
population
27 million people—about 10% of the US
population
36 million people—about 12% of the US
population
150 million people—almost 50% of the US
population
C
Feedback:
An estimated 36 million people or 12% of the
population is living with some ongoing level
of disability. The other statistics of 10 million,
27 million, and 150 million are inaccurate.
A)
B)
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D)
C)
D)
Ans:
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Ans:
When explaining the concept of disability to a
local community group, which of the
2.
following descriptions would be most
appropriate for the nurse to include?
A disability is a condition someone has, not
something one is.
The plan of care for two persons with the
same disability would be the same.
A disability refers to a person's inability to do
something.
Handicap and disability are two terms that go
hand in hand.
A
Feedback:
Long-held negative views of disabilities are
being replaced with new and more positive
approaches that view individuals and their
challenges from a more holistic standpoint.
Thus, a disability is something that a person
has, not something one is. Even persons with
the same disability but their plan of care can
be quite different. Earlier terminology
equated disability with an inability or
incapacity or handicap that presents a more
negative view of the condition.
C)
something.
Handicap and disability are two terms that go
hand in hand.
A
Feedback:
Long-held negative views of disabilities are
being replaced with new and more positive
approaches that view individuals and their
challenges from a more holistic standpoint.
Thus, a disability is something that a person
has, not something one is. Even persons with
the same disability but their plan of care can
be quite different. Earlier terminology
equated disability with an inability or
incapacity or handicap that presents a more
negative view of the condition.
D)
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In Healthy People 2020, what is the emphasis
of the categories of objectives that relate to
3. the goal of “Disability and Health to promote
the health and well-being of people with
disabilities?”
A growing emphasis on a holistic approach
that recognizes life satisfaction is just as
important to health and well-being as
preventative services
A growing realization that healthy-life years
for persons with disabilities do not equate to
decreased health costs at local, state, and
national levels, unlike they do for persons
without disabilities
Focus on personal responsibility for healthy
lifestyle by persons with disabilities
Concept that persons with disabilities are
always dependent on others
A
Feedback:
In Healthy People 2020, the emphasis of the
categories of objectives that relate to the goal
of “Disability and Health to promote the
health and well-being of people with
disabilities” is a growing emphasis on a
holistic approach that recognizes life
satisfaction is just as important to health and
well-being as preventative services. It also
indicates a growing realization that healthy
life years for persons with disabilities equate
to decreased costs at local, state, and national
levels, just as they do for persons without
disabilities. There is not a focus on personal
responsibility for healthy lifestyle by persons
with disabilities or a concept that persons with
disabilities are always dependent on others.
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Ans:
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B)
C)
lifestyle by persons with disabilities
Concept that persons with disabilities are
always dependent on others
A
Feedback:
In Healthy People 2020, the emphasis of the
categories of objectives that relate to the goal
of “Disability and Health to promote the
health and well-being of people with
disabilities” is a growing emphasis on a
holistic approach that recognizes life
satisfaction is just as important to health and
well-being as preventative services. It also
indicates a growing realization that healthy
life years for persons with disabilities equate
to decreased costs at local, state, and national
levels, just as they do for persons without
disabilities. There is not a focus on personal
responsibility for healthy lifestyle by persons
with disabilities or a concept that persons with
disabilities are always dependent on others.
D)
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Which of the following are the three areas has
Healthy People identified for public health
4. action for the year 2020 using the
International Classification of Functioning,
Disability, and Health? Select all that apply.
Improve the conditions of life for persons
with disabilities
Address the inequitable distribution of
resources among people with disabilities and
those without disabilities
Expand the knowledge base and raise
awareness about determinants of health for
people with disabilities
Ensure the health of people with disabilities
by influencing many social and physical
factors
Public health activities need to focus only on
preventing disability
A, B, C
Feedback:
The three areas that Healthy People has
identified for public health action for the year
2020 using the International Classification of
Functioning, Disability, and Health include
improve the conditions of life for persons
with disabilities; address the inequitable
distribution of resources among people with
disabilities and those without disabilities; and
expand the knowledge base and raise
awareness about determinants of health for
people with disabilities. The plan to ensure
the health of people with disabilities by
A)
D)
E)
Ans:
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C)
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B)
factors
Public health activities need to focus only on
preventing disability
A, B, C
Feedback:
The three areas that Healthy People has
identified for public health action for the year
2020 using the International Classification of
Functioning, Disability, and Health include
improve the conditions of life for persons
with disabilities; address the inequitable
distribution of resources among people with
disabilities and those without disabilities; and
expand the knowledge base and raise
awareness about determinants of health for
people with disabilities. The plan to ensure
the health of people with disabilities by
influencing many social and physical factors
is too broad. Public health activities need to
focus only on preventing disability is a
misconception.
E)
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A)
B)
C)
D)
E)
F)
Ans:
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The community health nurse is invited to
speak to a group of students about clients with
disabilities. As part of the class, the nurse
intends to describe The International
Classification of Functioning, Disabilities,
5.
and Health (ICF) and its attempts at
standardized language. Which of the
following would the nurse include as
terminology that was standardized? Select all
that apply.
Disability impairment issues
Body functions
Handicapping conditions
Activities
Environmental factors
Personal Factors
B, D, E, F
Feedback:
The ICF included definitions for body
functions and structures, activities, and
environmental and personal factors. Terms
such as disability, impairment, and handicap
have been removed from the definition and
replaced with functioning, which is more
holistic and positive.
After teaching a group of students about
leading health risks, the instructor determines
6. that the teaching was successful when the
students identify which of the following as the
#1 leading health risk?
Unsafe sex
High blood pressure
Underweight
Tobacco consumption
C
Feedback:
The ten leading health risks are (1)
underweight; (2) unsafe sex; (3) high blood
pressure; (4) tobacco consumption; (5)
alcohol consumption; (6) unsafe water,
sanitation, and hygiene; (7) iron deficiency;
(8) indoor smoke from solid fuels; (9) high
cholesterol; and (10) obesity.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
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A community health nurse is preparing for a
presentation on disabilities and is planning to
include information about Healthy People
2020 goals. When addressing these goals, the
7.
nurse identifies differences from the goals
addressed by Healthy People 2000. Which of
the following would the nurse identify as
different? Select all that apply.
Rather than individuals with disabilities and/
or chronic illnesses being defined by their
limiting conditions, they are viewed as having
the potential to meet and exceed health
promotion and disease prevention goals set
for the nation's population as a whole.
The approach to disability now emphasizes
the principles of health promotion and disease
prevention for those currently experiencing
disabilities and/or chronic illness.
The goals for Healthy People 2000 have an
entire section on disability and secondary
conditions.
A growing realization that healthy life-years
for persons with disabilities equate to
decreased health costs at local, state, and
national levels, just as they do for persons
without disabilities.
A, B, D
Feedback:
B)
C)
D)
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prevention for those currently experiencing
disabilities and/or chronic illness.
The goals for Healthy People 2000 have an
entire section on disability and secondary
conditions.
A growing realization that healthy life-years
for persons with disabilities equate to
decreased health costs at local, state, and
national levels, just as they do for persons
without disabilities.
A, B, D
Feedback:
A comparison among Healthy People plans
over the last decades underscores the
emergence of new approaches to identifying
priority areas and planning to improve the
health of individuals with disabilities and
chronic illness. In Healthy People 2000, only
one priority was devoted to disability and
chronic illness. Over the past two decades,
interest in disability has accelerated. Areas
that are focused on with Healthy People 2020
include rather than individuals with
disabilities and/or chronic illnesses being
defined by their limiting conditions, they are
viewed as having the potential to meet and
exceed health promotion and disease
prevention goals set for the nation's
population as a whole; the approach to
disability now emphasizes the principles of
health promotion and disease prevention for
those currently experiencing disabilities and/
or chronic illness; and a growing realization
that healthy life-years for persons with
disabilities equate to decreased health costs at
local, state, and national levels, just as they do
for persons without disabilities.
A)
B)
C)
D)
Ans:
A community health nurse is compiling a list
of organizations that serve the needs of
8. persons with disabilities. Which of the
following would the nurse categorize as a
federal agency?
National Organization on Disability
National Council on Disability
National Association of the Deaf
American Foundation for the Blind
B
Feedback:
The National Council on Disability is an
independent federal agency. The National
Organization on Disability, National
Association of the Deaf, and American
National Organization on Disability
National Council on Disability
National Association of the Deaf
American Foundation for the Blind
B
Feedback:
The National Council on Disability is an
independent federal agency. The National
Organization on Disability, National
Association of the Deaf, and American
Foundation for the Blind are private
organizations.
Which of the following is a major difference
between Healthy People 2010 and Healthy
9.
People 2020 with respect to people with
disabilities?
Healthy People 2010 emphasized the
disparities that persons with disabilities
experience.
The emphasis on “secondary conditions” in
Healthy People 2010 has been replaced in
Healthy People 2020 with a concern for
health disparities for people with disabilities.
People with disabilities do not experience
health disparities any more than people in the
general population.
Healthy People 2020 continues to emphasize
secondary conditions.
B
Feedback:
The emphasis on “secondary conditions” in
Healthy People 2010 has been replaced in
Healthy People 2020 with a concern for
health disparities for people with disabilities.
Key to addressing the barriers is for people
with disabilities to “(1) be included in public
health activities; (2) receive well-timed
interventions and services; (3) interact with
their environment without barriers; and (4)
participate in everyday life activities. Without
these opportunities, people with disabilities
will continue to experience health disparities,
compared to the general population.”
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A)
B)
C)
D)
Ans:
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A)
B)
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C)
An instructor is reviewing the principles that
resulted from the 2011 reassessment of global
10. progress on addressing disability with a class.
Which of the following would the nurse
include?
The government must focus solely on seeking
improvement in the lives of individuals and
families living with disability.
Government must play the only role in
addressing disability.
It is unimportant for service providers,
academic institutions, the private sector,
communities, and people with disabilities and
their families to address disability.
The importance of all persons, including those
with disabilities to participate in their
country's development.
D
Feedback:
In 2011, the World Health Organization and
the World Bank reassessed global progress on
addressing disability in light of the 2006
Convention on the Rights of Persons with
Disabilities. It was determined that not only
must governments seek improvements in the
lives of individuals and families living with
disability, but every citizen needs to
participate in their country's development.
Government at every level may play a most
significant role, but there are important roles
for service providers, academic institutions,
the private sector, communities, and
especially people with disabilities and their
families.
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Ans:
A)
B)
C)
D)
When describing the importance of the World
Health Report to a group of students, the
11.
instructor would emphasize which of the
following?
It challenged the world community to focus
more attention on unhealthy behaviors that
lead ultimately to chronic disease, disability,
and early mortality.
Lifestyle choices are not one of the key
contributors to morbidity and mortality levels
in either affluent or poor countries.
Infectious disease is the major threat.
Malnutrition is the only threat.
following?
It challenged the world community to focus
more attention on unhealthy behaviors that
lead ultimately to chronic disease, disability,
and early mortality.
Lifestyle choices are not one of the key
contributors to morbidity and mortality levels
in either affluent or poor countries.
Infectious disease is the major threat.
Malnutrition is the only threat.
A
Feedback:
The World Health Report challenged the
world community to focus more attention on
unhealthy behaviors that lead ultimately to
chronic disease, disability, and early
mortality. It recognized that although
infectious disease and malnutrition require
ongoing vigilance because they continue to
plague many parts of the world, they are not
the only threat. Lifestyle choices are also one
of the key contributors to morbidity and
mortality levels in both affluent and poor
countries.
A)
B)
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C)
D)
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B)
C)
D)
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After teaching a class about the International
Classification of Functioning, Disability, and
Health (ICF), the instructor determines that
12.
the teaching was successful when the students
identify which of the following as a personal
factor?
Problems with ambulation
Working
Coping styles
Amputation
C
Feedback:
Personal factors are the features of an
individual's background, life, and living that
are not part of a health condition or health
status, such as gender, race, age, other health
conditions, fitness, lifestyle habits,
upbringing, coping styles, social background,
education, profession, past and current
experience, overall behavior pattern and
character style, individual psychological
assets, and other characteristics. Problems
with ambulation would be considered an
activity limitation. Working would be an
activity. Amputation would be an impairment.
Working
Coping styles
Amputation
C
Feedback:
Personal factors are the features of an
individual's background, life, and living that
are not part of a health condition or health
status, such as gender, race, age, other health
conditions, fitness, lifestyle habits,
upbringing, coping styles, social background,
education, profession, past and current
experience, overall behavior pattern and
character style, individual psychological
assets, and other characteristics. Problems
with ambulation would be considered an
activity limitation. Working would be an
activity. Amputation would be an impairment.
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B)
C)
D)
Ans:
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A community health nurse is planning to
apply the International Classification of
Functioning, Disability, and Health to clinical
13.
care in the community. The nurse could use
this document as a basis for which of the
following?
Curriculum design
Needs assessment
Quality of life measures
Policy design
B
Feedback:
In clinical care, the ICF document would be
helpful with a needs assessment. Using the
ICF document for curriculum design would
reflect education; using it for quality of life
measures would reflect research; using it for
policy design would reflect social policy.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is working with a
group of visually impaired individuals and is
developing a program to promote self14.
confidence and self-respect. Which of the
following organizations would be a valuable
resource for the nurse?
American Foundation for the Blind
American Council of the Blind
Guide Dogs for the Blind
National Federation of the Blind
D
Feedback:
The nurse would contact the National
Federation of the Blind whose focus is on
following organizations would be a valuable
resource for the nurse?
American Foundation for the Blind
American Council of the Blind
Guide Dogs for the Blind
National Federation of the Blind
D
Feedback:
The nurse would contact the National
Federation of the Blind whose focus is on
helping blind individuals achieve selfconfidence and self-respect. The American
Foundation for the Blind advocates for the
visually impaired through increased state and
federal funding. The American Council of the
Blind provides services such as information
and referral, scholarship assistance, public
education, and industry consultation,
governmental monitoring, consultation, and
advocacy. The Guide Dogs for the Blind
makes guide dogs available for the visually
impaired.
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A)
B)
C)
D)
Ans:
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A community health nurse is making a home
visit to a family. The family has a son with a
disability who requires a motorized
15.
wheelchair. The family asks for the nurse's
assistance. Which response by the nurse
would be most appropriate?
“His disability should automatically cover the
cost of the chair.”
“We'll need to check with the insurance
company about coverage.”
“You'll probably be able to get it if you pay
for half the cost.”
“You might be able to get a regular
wheelchair, but a motorized one is
impossible.”
B
Feedback:
One major obstacle for families with a
disabled or chronically ill member may be
obtaining needed assistive devices and
technology. Just because the technology exists
does not mean that it can be obtained. Often
the insurance carrier, whether private or
governmental, sets limits on which products
can be obtained or which brands are
acceptable. Thus the nurse working with the
family would need to check with the
insurance company first and determine what
if anything is covered and then determine how
to go about obtaining what the son needs.
D)
Ans:
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“You might be able to get a regular
wheelchair, but a motorized one is
impossible.”
B
Feedback:
One major obstacle for families with a
disabled or chronically ill member may be
obtaining needed assistive devices and
technology. Just because the technology exists
does not mean that it can be obtained. Often
the insurance carrier, whether private or
governmental, sets limits on which products
can be obtained or which brands are
acceptable. Thus the nurse working with the
family would need to check with the
insurance company first and determine what
if anything is covered and then determine how
to go about obtaining what the son needs.
D)
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A community health nurse is developing a
plan of care for a family who is providing
round-the-clock care in their home for a
16.
daughter who is chronically ill. Which of the
following would be most important for the
nurse to integrate into the plan?
Insurance limitations
Skill teaching
Flexible visiting
Respite care
D
Feedback:
Respite care is another area of great
importance for families of the disabled and
the chronically ill. It can be emotionally
draining to meet the daily needs of a member
who cannot perform self-care. This often
leads to caregiver fatigue and increased stress.
It is also important to recognize the effect of
the situation on noncaregivers in the family,
particularly nondisabled siblings of a disabled
child. Respite care offers some needed relief
to the family and allows for uninterrupted
attention to the nondisabled children.
Whatever the source, some type of respite
care is often vital to the family's health and
should be a priority in the overall treatment
plan of the family. Although insurance
considerations, teaching, and flexible visiting
would be issues to be addressed, respite care
is a priority.
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A)
B)
C)
D)
Ans:
Skill teaching
Flexible visiting
Respite care
D
Feedback:
Respite care is another area of great
importance for families of the disabled and
the chronically ill. It can be emotionally
draining to meet the daily needs of a member
who cannot perform self-care. This often
leads to caregiver fatigue and increased stress.
It is also important to recognize the effect of
the situation on noncaregivers in the family,
particularly nondisabled siblings of a disabled
child. Respite care offers some needed relief
to the family and allows for uninterrupted
attention to the nondisabled children.
Whatever the source, some type of respite
care is often vital to the family's health and
should be a priority in the overall treatment
plan of the family. Although insurance
considerations, teaching, and flexible visiting
would be issues to be addressed, respite care
is a priority.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When developing programs to assist
individuals with disability and chronic illness,
17.
which of the following would be most
important?
Narrow focus
Holistic practice
Orientation to the present
Episodic care
B
Feedback:
The role of the community health nurse with
respect to disabilities and chronic illness
requires a holistic practice and broad focus.
Strong and sustained efforts are needed to
achieve results. The community health nurse
addresses current needs and plans for the
future.
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A)
B)
C)
D)
Ans:
A community health nurse is providing
information handouts that describe the need
18. for annual gynecologic exams to local health
clinics that provide care for individuals with
disabilities. The nurse is fulfilling which role?
Advocate
Coordinator
Researcher
Educator
D
Feedback:
Providing information handouts is a method
for teaching. Therefore, the nurse is assuming
the role of an educator at the community
level. In the advocate role, the nurse would
assist in arranging for the population to
receive the appropriate screening, ensuring
that any special modifications or adaptations
would be available. In the coordinator role,
the nurse might arrange for screening to be
performed during a routine visit made by a
client to a facility or make arrangements for
transporting the clients to a facility for the
screening. In the researcher role, the nurse
might contact other community health nurses
about their experience in ensuring screening
for this population to discover if they have
similar needs or problems.
A)
B)
C)
D)
Ans:
A community health nurse is reviewing the
effects of the Americans with Disabilities Act
19. of 1990. Which of the following would the
nurse identify as a major result of this
legislation?
Employers with five or more employees must
abide by the American with Disabilities Act.
Architectural barriers must be removed from
pathways so that they are accessible by
wheelchair.
The disabled are eligible to receive telephone
services in their home at no cost to them.
Individuals with disabilities who wish to vote
must be provided transportation to polling
places to vote.
B
Feedback:
A major accomplishment of this law was the
removal of architectural barriers; curbs, stairs,
Architectural barriers must be removed from
pathways so that they are accessible by
wheelchair.
The disabled are eligible to receive telephone
services in their home at no cost to them.
Individuals with disabilities who wish to vote
must be provided transportation to polling
places to vote.
B
Feedback:
A major accomplishment of this law was the
removal of architectural barriers; curbs, stairs,
handicap toilets, etc. so that the disabled in
wheelchairs can freely move about.
Employers with 15 or more employees must
follow this law. Adapted telephone services
are provided for those who are hearing or
physically impaired, but the telephone service
is not free. Polling places must be accessible
to the disabled and absentee ballots and voter
registration can be done from home.
B)
C)
D)
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B)
C)
D)
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When reviewing the concept of universal
design with a group of community
20. developers, the community health nurse
recognizes that the emphasis is on which of
the following as the underlying theme?
Disability needs
Adaptation
Access
Safety
C
Feedback:
The underlying theme of universal design is
ensuring access. Universal design is the
design of products and environments to be
usable by all people, including those with
disability needs as well as chronic illness. The
concept incorporated issues of adaptive
design and safety measures such as
reinforcement in bathroom walls to allow for
installation of grab bars, but the key issue is
accessibility.
A)
Which one of the following statements about
21. the benefits of universal design for all persons
is the most accurate?
It is the right thing to do to allow access to the
built environment for all persons including
persons with disabilities.
A healthier population may be achieved with
attention to the environmental barriers that
Which one of the following statements about
21. the benefits of universal design for all persons
is the most accurate?
It is the right thing to do to allow access to the
built environment for all persons including
persons with disabilities.
A healthier population may be achieved with
attention to the environmental barriers that
impede healthy lifestyles for all persons,
including those with chronic or disabling
conditions.
The built environment refers to the naturally
occurring features of the planet.
Access implies universal design.
B
Feedback:
A healthier population may be achieved with
attention to the environmental barriers that
impede healthy lifestyles for all persons,
including those with chronic or disabling
conditions. Universal design is the right thing
to do for persons with disabilities but is not
the most accurate or best reason to ensure
universal design. The built environment refers
to the physical parts of where we live and
work (e.g., homes, buildings, streets, open
spaces, and infrastructure). Universal design
incorporates access, but access does not
necessarily imply universal design.
A)
B)
C)
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Chapter 25 Behavioral Health in the Community
A)
B)
C)
D)
Ans:
A community health nurse is meeting with a
group of individuals who have been
1. diagnosed with a serious mental illness. The
nurse interprets this to mean which of the
following?
The clients have impaired level of functioning
and quality of life.
The clients' disorder is chronic and persistent.
The clients have issues of impaired control
and dependency.
The clients have a significant behavior
syndrome with present distress.
A
Feedback:
Serious mental illness (SMI) is mental illness
that has compromised both the client's level
of function and his or her quality of life.
Serious and persistent mental illness (SPMI)
The clients have issues of impaired control
and dependency.
The clients have a significant behavior
syndrome with present distress.
A
Feedback:
Serious mental illness (SMI) is mental illness
that has compromised both the client's level
of function and his or her quality of life.
Serious and persistent mental illness (SPMI)
is the preferred term for serious mental illness
of a chronic nature. Impaired control and
dependency are components of addiction. A
significant behavior syndrome with present
distress characterizes a mental illness.
C)
D)
When developing appropriate programs for
adult mental health promotion, the nurse
incorporates knowledge about the most
2.
prevalent mental disorders. Which of the
following would the nurse identify as the
most prevalent?
Major depression
Bipolar disorder
Anxiety disorders
Schizophrenia
C
Feedback:
For American adults, the most prevalent
mental disorders are anxiety disorders,
followed by mood disorders, especially major
depression and bipolar disorders.
Schizophrenia, which affects approximately
the same number of adults as bipolar disorder,
is problematic because it is so persistently
disabling.
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A)
B)
C)
D)
Ans:
A)
B)
C)
After teaching a group of women in the
community about common mental health
disorders affecting them, the community
3.
health nurse determines that the teaching has
been effective when the group identifies
which one of the following?
Anxiety disorders and mood disorders occur
twice as frequently in men as in women.
Women of color, women on welfare, poor
women, and uneducated women are more
likely to experience depression than women
in the general population.
The three main types of eating disorders
affect more men than women.
The three main types of eating disorders
3.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
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Ans:
health nurse determines that the teaching has
been effective when the group identifies
which one of the following?
Anxiety disorders and mood disorders occur
twice as frequently in men as in women.
Women of color, women on welfare, poor
women, and uneducated women are more
likely to experience depression than women
in the general population.
The three main types of eating disorders
affect more men than women.
The three main types of eating disorders
include undereating due to food
unavailability.
B
Feedback:
Women of color, women on welfare, poor
women, and uneducated women are more
likely to experience depression than women
in the general population. Anxiety disorders
and mood disorders occur twice as frequently
in women as in men. The three main types of
eating disorders affect more women than men.
The three main types of eating disorders
(anorexia, bulimia nervosa, and binge eating)
also affect more women than men.
A community health nurse is part of
community discussion group on alcohol. The
4.
nurse recommends that adult males should
have less than
6 standard drinks weekly.
8 standard drinks weekly.
10 standard drinks weekly.
14 standard drinks weekly.
D
Feedback:
For the general male adult population, the
recommended drinking limits are fewer than
five standard drinks daily or 14 weekly. For
the general female adult population, the
recommended drinking limits are fewer than
four standard drinks daily or eight weekly,
and for people age 65 and older,
recommended drinking limits are no more
that one standard drink daily or seven
standard drinks weekly.
When determining a target population for
education about alcohol use, which age group
5.
would the community health nurse most
likely plan to address?
18- to 25-year-olds
30- to 40-year-olds
45- to 55-year-olds
65 years of age and older
A
Feedback:
Trends in alcohol use in the United States
differ across subsets of the population. Young
adults (age 18 to 25) have the highest
incidence of problem drinking. Thus the
community health nurse would most likely
address this age group.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
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After teaching a class about commonly used
illicit substances, the instructor determines
6. that the teaching was successful when the
class identifies which of the following as the
most frequently reported illicit drug?
Heroin
Methamphetamine
Marijuana
Cocaine
C
Feedback:
Although heroin, methamphetamine, and
cocaine are frequently used illicit drugs,
marijuana is the most frequently reported
illicit drug.
A)
B)
C)
D)
E)
Ans:
A community health nurse is discussing
alcohol use disorders and is explaining what
7. is meant by a standard drink. Which of the
following would the nurse include as an
example? Select all that apply.
Two 12-oz. cans of beer
5-oz. glass of wine
1.5 oz. of an 80-proof spirit
3 oz. of a cordial
Two bottles of wine cooler
B, C, D
Feedback:
7. is meant by a standard drink. Which of the
following would the nurse include as an
example? Select all that apply.
Two 12-oz. cans of beer
5-oz. glass of wine
1.5 oz. of an 80-proof spirit
3 oz. of a cordial
Two bottles of wine cooler
B, C, D
Feedback:
A standard drink contains about 14 g of
alcohol (0.6 fluid ounces or 1.2 tablespoons),
which is equivalent to one 12-oz. bottle of
beer or wine cooler; 8 to 9 oz. of malt liquor;
one 5-oz. glass of table wine; 3 to 4 oz. of
fortified wine, 2 to 3 oz. of cordial, liqueur, or
aperitif; 1.5 oz. of brandy; or 1.5 oz. of 80proof distilled spirits.
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A)
B)
C)
D)
E)
Ans:
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When assessing a group of individuals for
factors related to an increased risk for alcohol
8.
use disorders, which of the following would
the nurse expect to find? Select all that apply.
Academic engagement/achievement
Antisocial peer affiliations
Decreased impulsivity
Positive mother–child/father–child
relationships
Stressful life events
A, B, E
Feedback:
Individual factors associated with the
development of AUDs include problems with
academic engagement/achievement, antisocial
peer affiliations, problems in the mother–
child/father–child relationship, and other
stressful life events.
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A)
B)
C)
D)
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Ans:
A)
B)
C)
D)
Which one of the following statements
9. regarding the etiology of substance use
disorders is most accurate?
It is believed that nurture has substantially
more influence on the development of
substance use disorders than nature.
With the mapping of the human genome, hope
has decreased that the genes related to
substance use disorders could be identified.
Alcohol dependence is thought to be a
multigenomic disorder influenced by the
environment (gene–environment interaction).
Only genetic heritability is involved in the
etiology and course of substance use
A)
more influence on the development of
substance use disorders than nature.
With the mapping of the human genome, hope
has decreased that the genes related to
substance use disorders could be identified.
Alcohol dependence is thought to be a
multigenomic disorder influenced by the
environment (gene–environment interaction).
Only genetic heritability is involved in the
etiology and course of substance use
disorders.
C
Feedback:
Alcohol dependence is thought to be a
multigenomic disorder influenced by the
environment (gene–environment interaction).
It is believed that genetics is a risk factor in
the range of 50% to 50%. With the mapping
of the human genome, hope has increased that
the genes related to substance use disorders
could be identified. In addition to genetic
heritability, both personal and environmental
factors are involved comparably in the
etiology and course of substance use
disorders.
B)
C)
D)
C)
D)
Ans:
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Ans:
The community health nurse is using effect
theory to design a prevention program for
10. behavioral health. Which of the following
would be the most likely place for the nurse to
start?
Identifying antecedent factors leading to the
problem
Identifying the specific health problem
Determining the desired health problem
impact
Specifying the health problem outcome
B
Feedback:
When using effect theory to design a
prevention program for behavioral health, a
good place to start is to identify the specific
health problem and then the desired health
problem impact and health problem outcome.
As the program is developed, the community
health nurse starts by identifying the
antecedent factors that lead to behavioral
health problems. This provides a clear
rationale for why the intervention should
provide the desired impact.
Determining the desired health problem
impact
Specifying the health problem outcome
B
Feedback:
When using effect theory to design a
prevention program for behavioral health, a
good place to start is to identify the specific
health problem and then the desired health
problem impact and health problem outcome.
As the program is developed, the community
health nurse starts by identifying the
antecedent factors that lead to behavioral
health problems. This provides a clear
rationale for why the intervention should
provide the desired impact.
C)
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D)
Ans:
st
p
re
p
A community health nurse is providing an inservice program to the agency staff about
effect theory, which will be used to develop
11. behavioral intervention programs. The nurse
determines that the staff needs additional
teaching when they identify which of the
following as a component of the theory?
Determinant theory
Intervention theory
Impact theory
Process theory
D
Feedback:
Process theory is a theoretical framework
used in community/public health science. It is
not a component of effect theory. Effect
theory has four components: determinant
theory, intervention theory, impact theory, and
outcome theory.
w
w
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te
A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A community health nurse is applying the
Institute of Medicine model based on
Gordon's Classification of Disease Prevention
model to address prevention of alcohol use
12.
during pregnancy and prevention of fetal
alcohol syndrome. Which of the following
populations would the nurse target indicated
prevention strategies?
Local women in the community of
childbearing age
Women of childbearing age living in a city
Women of childbearing age considered at risk
Pregnant women who have a child with fetal
alcohol syndrome
D
alcohol syndrome. Which of the following
populations would the nurse target indicated
prevention strategies?
Local women in the community of
childbearing age
Women of childbearing age living in a city
Women of childbearing age considered at risk
Pregnant women who have a child with fetal
alcohol syndrome
D
Feedback:
Indicated prevention strategies would be
designed to prevent the use of alcohol in
pregnant women who had screened positive
for alcohol use during pregnancy or already
had a child diagnosed with FAS or FASD.
Universal prevention strategies would address
the entire population of women of
childbearing age (national, local community,
school, neighborhood), with messages and
programs aimed at preventing the use of
alcohol if pregnancy is a possibility. Selective
prevention strategies would target subsets of
women of childbearing age who are deemed
to be at risk for alcohol use by virtue of their
membership in a particular population
segment.
A)
B)
C)
D)
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w
A)
B)
C)
D)
Ans:
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Ans:
A community implements a plan to enforce
the underage drinking law. The community
13.
health nurse interprets this action as reflecting
which public health model?
Primary prevention
Behavioral prevention
Environmental prevention
Clinical prevention
C
Feedback:
Environmental prevention relies on a societal
commitment for the implementation of the
interventions and aims to alter the
environment by reducing risk (e.g.,
community-wide decrease in availability of
the substance; underage drinking law
enforcement). Primary prevention is
conducted when no disease is present in the
target population with the primary goal being
prevention of disease development.
Behavioral prevention includes a broad array
of strategies aimed at changing lifestyles (e.g.,
exercise, smoking cessation, balanced
nutrition). The goal of the intervention is to
change behaviors that put the person at risk
Behavioral prevention
Environmental prevention
Clinical prevention
C
Feedback:
Environmental prevention relies on a societal
commitment for the implementation of the
interventions and aims to alter the
environment by reducing risk (e.g.,
community-wide decrease in availability of
the substance; underage drinking law
enforcement). Primary prevention is
conducted when no disease is present in the
target population with the primary goal being
prevention of disease development.
Behavioral prevention includes a broad array
of strategies aimed at changing lifestyles (e.g.,
exercise, smoking cessation, balanced
nutrition). The goal of the intervention is to
change behaviors that put the person at risk
for developing the disease or to prevent
consequences of the disease. Clinical
prevention is based on the medical model for
preventive services. It relies on one-to-one,
provider-to-patient interaction and occurs
within the traditional health care delivery
system.
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B)
C)
D)
Ans:
C)
D)
Ans:
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B)
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A)
Which of the following statements about the
14. National Alliance on Mental Illness (NAMI)
is most accurate?
NAMI focuses on the needs of the people
who actually have mental illness.
NAMI is committed to enhance the care of
those with mental illness and improve the
quality of life of those who are affected.
The NAMI Web site contains some
information that is intended to be used
exclusively by care providers.
All services of NAMI are provided at the
main headquarters.
B
Feedback:
NAMI is committed to enhance the care of
those with mental illness and improve the
quality of life of those who are affected.
NAMI focuses on the needs of the families,
peers, and consumers of Mental Health
services. The NAMI Web site contains
extensive information that can be utilized by
both consumer and care providers. NAMI is a
nationwide organization with chapters in each
state and county.
exclusively by care providers.
All services of NAMI are provided at the
main headquarters.
B
Feedback:
NAMI is committed to enhance the care of
those with mental illness and improve the
quality of life of those who are affected.
NAMI focuses on the needs of the families,
peers, and consumers of Mental Health
services. The NAMI Web site contains
extensive information that can be utilized by
both consumer and care providers. NAMI is a
nationwide organization with chapters in each
state and county.
D)
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p
A)
st
p
B)
te
C)
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si
ng
D)
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Ans:
A)
B)
C)
D)
E)
Which one of the following statements about
15. nonprofit organizations that serve those with
mental health issues is most accurate?
They are all associated with the government.
A for-profit organization that promotes mental
health is Mental Health America, which was
established in 1909.
The organization National Mental Health
Association is a scam.
They focus on advocacy, education, service,
and funding research endeavors.
D
Feedback:
Nonprofit organizations focus on advocacy,
education, service, and funding research
endeavors. They are not all associated with
the government. Mental Health America was
formerly known as National Mental Health
Association, which is a leading nonprofit
organization that promotes mental health.
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Ans:
Healthy People 2020 objectives focus on
tobacco, alcohol, and illicit drug use
16. education. Which of the following are steps in
the process to providing this education?
Select all that apply.
Identifying the impact of substance use on the
environment
Identifying trends of substance use to develop
a prevention program
Understanding the consequences of substance
use that affect a community as a whole
Differentiating between legal and illegal
substance use
There are no differences in prevention
programs for different populations
Select all that apply.
Identifying the impact of substance use on the
environment
Identifying trends of substance use to develop
a prevention program
Understanding the consequences of substance
use that affect a community as a whole
Differentiating between legal and illegal
substance use
There are no differences in prevention
programs for different populations
B, C, D
Feedback:
The three steps in the process for providing
tobacco, alcohol, and illicit drug use
education are in order (1) identifying trends,
(2) differentiating legal versus illegal use, and
(3) consequences of use. Identifying the
impact of substance use on the environment is
not one of the steps. There are differences in
prevention programs—if the target population
is young adults, the prevention of binge
drinking might be a top concern; if homeless
adults, the focus will be on chronic alcohol,
cocaine, and heroin use; cultural and ethnic
differences in alcohol and SUDs are noted in
American Indians with increased rates of fetal
alcohol syndrome and increased prevalence in
prison and jail populations.
A)
B)
C)
D)
E)
A)
B)
C)
D)
Ans:
w
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Ans:
A community health nurse is involved in a
screening program for alcohol use with an
17. ethnically diverse population. Which of the
following would be the best instrument to
use?
Alcohol Use Disorders Identification Test
(AUDIT)
CAGE questionnaire
Michigan Alcoholism Screening Test (MAST)
Drug Abuse Screening Test (DAST)
A
Feedback:
For alcohol use, the screening instrument
recommended by the NIAAA is the AUDIT.
WHO developed this instrument for use
across populations, and it has established high
reliability and validity across ethnic groups.
Other tests that can be used include the
CAGE questionnaire and MAST. The DAST
would be appropriate to screen for drug use.
CAGE questionnaire
Michigan Alcoholism Screening Test (MAST)
Drug Abuse Screening Test (DAST)
A
Feedback:
For alcohol use, the screening instrument
recommended by the NIAAA is the AUDIT.
WHO developed this instrument for use
across populations, and it has established high
reliability and validity across ethnic groups.
Other tests that can be used include the
CAGE questionnaire and MAST. The DAST
would be appropriate to screen for drug use.
Which of the following would the community
health nurse identify as a major limitation for
18.
using biological markers for screening for
substance use?
Sensitivity of the test
Cost of the test
Factors influencing the test
Ease of obtaining a specimen
B
Feedback:
Biological screening tests are rarely used in a
community-based screening program due to
the cost and the problems with obtaining
biological specimens. In addition, numerous
factors can influence sensitivity and
specificity of biological markers, including
other metabolic disorders or other diseases,
medication use, and reliability of the method.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Which of the following statements about
Healthy People 2020 and reducing substance
19.
use and addressing mental health needs is
most accurate? Select all that apply.
After a diagnosis is established, the nurse can
decide on an intervention that can address the
specific public health issue identified in the
diagnosis using the Healthy People 2020
objectives.
It could be considered a priority as two of the
top ten health indicators relate to substance
use and mental health.
Target benchmarks and data derivation for
each objective can be used to guide program
development.
Reducing substance abuse and addressing
mental health needs are not priority with
Healthy People 2020.
The goals are to improve mental health
diagnosis using the Healthy People 2020
objectives.
It could be considered a priority as two of the
top ten health indicators relate to substance
use and mental health.
Target benchmarks and data derivation for
each objective can be used to guide program
development.
Reducing substance abuse and addressing
mental health needs are not priority with
Healthy People 2020.
The goals are to improve mental health
through prevention and to reduce substance
abuse to protect the health, safety, and quality
of life for all, especially children.
A, B, C, E
Feedback:
Reducing substance abuse and addressing
mental health needs is a priority with Healthy
People 2020.
B)
C)
D)
E)
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Ans:
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Which of the following would a community
20. health nurse address as a means for enhancing
the life of the public?
Proper nutrition
Healthy sleep patterns
Use of community supports
Creative outlets
D
Feedback:
Life-enhancing activities to enhance public
well-being include meaningful work, whether
through or outside of employment, creative
outlets, interpersonal relationships,
recreational activities, and opportunities for
spiritual and intellectual growth. Proper
nutrition, healthy sleep patterns, and use of
community supports are life-sustaining
activities.
A community health nurse has completed a
21. community assessment. Which of the
following would be next?
Decide on an intervention
Locate an appropriate the specific focus area
in Healthy People 2020
Establish a community diagnosis
Determine the level of prevention
C
Feedback:
After completing a community assessment,
the nurse then establishes a community
following would be next?
Decide on an intervention
Locate an appropriate the specific focus area
in Healthy People 2020
Establish a community diagnosis
Determine the level of prevention
C
Feedback:
After completing a community assessment,
the nurse then establishes a community
diagnosis. Once this is done, the next step is
to decide on an intervention that can address
the specific public health issue identified in
the diagnosis. A good starting point in the
development of community/public health
intervention is to begin with the Healthy
People 2020 objectives, locating the specific
focus area that matches the community
diagnosis. Once the nurse identifies the focus
of the intervention, the next step is to
determine the level of prevention.
A)
B)
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C)
D)
Ans:
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.m
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w
w
A)
B)
C)
D)
Ans:
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st
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A community health nurse is working with a
political group to lobby for changes in
22. funding for a mental health promotion
program. The nurse is functioning in which
role?
Educator
Collaborator
Advocate
Case manager
C
Feedback:
The advocacy role requires being politically
involved by serving on decision-making
boards and committees, lobbying for
legislative changes, and helping to influence
mental health policy development that will
better serve this population. In the educator
role, the community mental health nurse
teaches clients individually and in groups
about their mental health conditions, their
treatment protocols, ways to function more
independently in the community, prevention
and health-promoting strategies, and much
more. In the collaborator role, the nurse works
with others, pooling the groups professional
expertise to enhance the quality and
effectiveness of services. In the case manager
role, the nurse is involved with screening,
assessment, care planning, arranging for
service delivery, monitoring, reassessment,
evaluation, and discharge, often within the
Collaborator
Advocate
Case manager
C
Feedback:
The advocacy role requires being politically
involved by serving on decision-making
boards and committees, lobbying for
legislative changes, and helping to influence
mental health policy development that will
better serve this population. In the educator
role, the community mental health nurse
teaches clients individually and in groups
about their mental health conditions, their
treatment protocols, ways to function more
independently in the community, prevention
and health-promoting strategies, and much
more. In the collaborator role, the nurse works
with others, pooling the groups professional
expertise to enhance the quality and
effectiveness of services. In the case manager
role, the nurse is involved with screening,
assessment, care planning, arranging for
service delivery, monitoring, reassessment,
evaluation, and discharge, often within the
context of a community mental health center
(CMHC). Case management helps the person
with an SMI to access services and live as
independently as possible.
w
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A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
Which one of the following are the primary
roles that the community health nurse must
23.
use to understand and serve populations with
mental illness?
Advocate
Educator
Case manager
Consumer of epidemiologic data
D
Feedback:
The access and use of epidemiologic data to
understand and serve populations with mental
illness are primary.
Which of the following are involved in
accessing and using epidemiologic data to
24.
understand and serve populations with mental
illness? Select all that apply.
Identifying the incidence and prevalence of
mental disorders
Understanding that all data are accurate
Examining the causes and risk factors
associated with mental illness
Identifying the needs of people with mental
disorders
A, C, D
Feedback:
This means identifying the incidence and
prevalence of mental disorders, examining the
causes and risk factors associated with mental
illness, and identifying the needs of
populations with mental illness. However, not
all data are accurate.
A)
B)
C)
D)
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Ans:
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A)
B)
C)
D)
Ans:
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Chapter 26 Homeless Populations
An instructor reviews the definition of
homelessness according to the McKinney
Vento Homeless Assistance Act with a group
1. of community health nursing students. The
instructor determines that the students need
clarification when they include which of the
following as homeless?
Someone living in a public shelter
Someone living in a park
Someone who is incarcerated
Someone who lives in his or her car
C
Feedback:
The McKinney–Vento Homeless Assistance
Act (Title 42 of the U.S. Code) defines a
person as homeless who lacks a fixed, regular,
adequate night time residence including
supervised public or private shelters that
provide temporary accommodations,
institutional settings providing temporary
shelter, or public or private places that are not
designed for or used as a regular sleeping
accommodation for human beings (i.e., cars,
parks, camp grounds). Incarcerated
individuals, however, are not considered
Someone living in a park
Someone who is incarcerated
Someone who lives in his or her car
C
Feedback:
The McKinney–Vento Homeless Assistance
Act (Title 42 of the U.S. Code) defines a
person as homeless who lacks a fixed, regular,
adequate night time residence including
supervised public or private shelters that
provide temporary accommodations,
institutional settings providing temporary
shelter, or public or private places that are not
designed for or used as a regular sleeping
accommodation for human beings (i.e., cars,
parks, camp grounds). Incarcerated
individuals, however, are not considered
homeless under this definition.
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B)
C)
D)
Ans:
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st
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When addressing homeless children and
youth, which of the following situations are
also considered homeless according to the
2.
education subtitle of the McKinney–Vento
Homeless Assistance Act? Select all that
apply.
Children who share housing with others due
to economic hardship or loss of housing
Children who are abandoned in hospitals
Children who are awaiting placement in foster
care
Children who are living in motels, trailer
parks, or camping grounds
Children who are living apart from one or
more of their parents
A, B, C, D
Feedback:
The education subtitle of the McKinney–
Vento Homeless Assistance Act expands on
the definition of homelessness when
addressing homeless children and youth. The
act includes as homeless those children who
share housing with others due to economic
hardship or loss of housing, are abandoned in
hospitals, are awaiting placement in foster
care, or are living in motels, trailer parks, or
camping grounds. Children who are living
apart from one or more of their parents may
not be homeless.
ur
si
ng
A)
B)
yn
C)
w
Ans:
w
w
E)
.m
D)
Which of the following would likely provide
3. the best estimate of the number of persons
who are homeless?
Counting the number of homeless people on a
particular day
Counting the persons who are homeless in a
given week
Counting the number of persons who are
homeless at a specific time on a specific date
The number of people who have been
homeless over the course of a year
D
Feedback:
Rather than trying to count the number of
homeless people on a given day or week
(point in time counts), it may be more prudent
to measure the number of people who have
been homeless over a longer timeframe such
as over the course of a year (period
prevalence counts).
A)
B)
C)
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D)
C)
D)
E)
Ans:
w
B)
w
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A)
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Ans:
Which of the following are reasons why it is
4. difficult to estimate the number of persons
who are homeless? Select all that apply.
It is difficult to estimate the number of people
who are homeless, since homelessness is a
temporary condition.
It is difficult to locate and account for people
who are homeless.
Some people are unable to access shelters
where they would be counted as homeless
because the shelter is already overcrowded
and there is limited capacity.
In rural areas, there are fewer housing options
and resources for the homeless and as a result
people may be forced to live temporarily with
friends or family.
Homelessness is increasing due to poverty
and the growing shortage of affordable rental
housing.
A, B, C, D
Feedback:
The following are reasons: It is difficult to
estimate the number of people who are
homeless, since homelessness is a temporary
condition. It is difficult to locate and account
friends or family.
Homelessness is increasing due to poverty
and the growing shortage of affordable rental
housing.
A, B, C, D
Feedback:
The following are reasons: It is difficult to
estimate the number of people who are
homeless, since homelessness is a temporary
condition. It is difficult to locate and account
for people who are homeless. Some people
are unable to access shelters where they
would be counted as homeless because the
shelter is already overcrowded and there is
limited capacity. In rural areas, there are
fewer housing options and resources for the
homeless, and as a result, people may be
forced to live temporarily with friends or
family. It is true that homelessness is
increasing due to poverty and the growing
shortage of affordable rental housing, but this
is not a reason why it is difficult to estimate
the number of people who are homeless.
E)
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Ans:
yn
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w
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A)
B)
C)
D)
Ans:
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After reviewing statistics on homelessness,
which of the following would a community
5.
health nurse identify as the fastest growing
segment of the homeless population?
Children under age 18 years
Families headed by a female single parent
Families headed by a male single parent
Families with children
D
Feedback:
Families with children are the fastest growing
segment of the homeless population based on
statistics, accounting for approximately 34%
of the homeless population. Single female
parents account for most of the homeless
families. However, because many two-parent
families and families headed by single fathers
are becoming homeless because of the
recession, and most homeless provider
organizations serving families are geared to
serving single women with children, it can be
harder for intact families and families headed
by men to access shelter.
Which of the following are subpopulations
6. that are more likely to be sheltered homeless
in urban areas? Select all that apply
Adult males
African Americans
Veterans
Disabled
Migrant workers
A, B, C, D
Feedback:
When compared to their housed counterparts
nationwide, the sheltered homeless are more
likely to be adult males, African Americans,
veterans, unaccompanied, and disabled. In
rural areas, the homeless are more likely to be
White, Native American, or migrant workers.
st
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A)
B)
C)
D)
E)
Ans:
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Which of the following are reasons for the
7. increase in poverty rates over recent years?
Select all that apply.
Declining wages
Decline in public assistance
Loss of jobs that offer security and carry
benefits
A decline in manufacturing jobs in favor of
lower paying service jobs
Globalization and outsourcing
Homelessness
A, B, C, D, E
Feedback:
The increase in poverty rates over recent
years may be attributed to declining wages,
loss of jobs that offer security and carry
benefits, and increase in temporary and parttime employment, erosion of the true value of
the minimum wage, a decline in
manufacturing jobs in favor of lower paying
service jobs, globalization and outsourcing,
and a decline in public service. As wages
drop, the potential to secure adequate housing
wanes. This does not mean that homelessness
is a cause of poverty. Actually, it is poverty
that is known to cause homelessness.
A)
B)
yn
C)
w
w
w
E)
F)
Ans:
.m
D)
lower paying service jobs
Globalization and outsourcing
Homelessness
A, B, C, D, E
Feedback:
The increase in poverty rates over recent
years may be attributed to declining wages,
loss of jobs that offer security and carry
benefits, and increase in temporary and parttime employment, erosion of the true value of
the minimum wage, a decline in
manufacturing jobs in favor of lower paying
service jobs, globalization and outsourcing,
and a decline in public service. As wages
drop, the potential to secure adequate housing
wanes. This does not mean that homelessness
is a cause of poverty. Actually, it is poverty
that is known to cause homelessness.
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E)
F)
Ans:
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p
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Which one of the following statements
8. regarding mental illness and homelessness is
most accurate?
75% of the sheltered homeless report a severe
mental illness.
Deinstitutionalization or being released from
institutions into the community contributes to
the number of persons who have a severe
mental illness who are homeless.
Mental illness only contributes to
homelessness because poor mental health
adversely affects an individual's ability to
make sound judgments, solve problems, and
make wise decisions.
Mental illness and substance abuse are not
often comorbid conditions that contribute to
homelessness.
B
Feedback:
Deinstitutionalization or being released from
institutions into the community contributes to
the number of severely mentally ill persons
represented in the homeless population.
Twenty-five percent of the sheltered homeless
report a severe mental illness. Mental illness
contributes to homelessness because poor
mental health adversely affects an individual's
ability to make sound judgments, solve
problems, and make wise decisions. Mental
illness and substance abuse are often
comorbid conditions, which, coupled with
poor physical health, make it especially
difficult to secure employment and safe,
affordable housing.
te
A)
ur
si
ng
B)
Ans:
.m
w
w
w
D)
yn
C)
Mental illness and substance abuse are not
often comorbid conditions that contribute to
homelessness.
B
Feedback:
Deinstitutionalization or being released from
institutions into the community contributes to
the number of severely mentally ill persons
represented in the homeless population.
Twenty-five percent of the sheltered homeless
report a severe mental illness. Mental illness
contributes to homelessness because poor
mental health adversely affects an individual's
ability to make sound judgments, solve
problems, and make wise decisions. Mental
illness and substance abuse are often
comorbid conditions, which, coupled with
poor physical health, make it especially
difficult to secure employment and safe,
affordable housing.
D)
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Ans:
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A)
B)
C)
D)
Ans:
A)
B)
C)
Which of the following would a community
9. health nurse expect to assess in the population
of homeless men?
Marital status
Substance abuse
Permanent employment
Frequent use of shelters
B
Feedback:
The majority of homeless men are single
adults. Homeless men are more likely to be
employed than their homeless female
counterparts; yet, they usually hold
temporary, low wage jobs that offer little
security. They are also more likely than
homeless women to have uncontrolled
substance abuse issues. This makes it more
difficult for them to access shelters, which
tend to require abstinence for admission
A community health nurse is preparing a
program for a local community group about
10. homelessness. A portion of the program will
address homeless men. Which of the
following would the nurse include?
Homeless men are not looked down upon less
than other groups.
Homeless men are usually eligible for social
services.
Homeless men are perceived as blameless for
their situation.
A community health nurse is preparing a
program for a local community group about
10. homelessness. A portion of the program will
address homeless men. Which of the
following would the nurse include?
Homeless men are not looked down upon less
than other groups.
Homeless men are usually eligible for social
services.
Homeless men are perceived as blameless for
their situation.
Single, low-income men only qualify for
medical assistance if disabled.
D
Feedback:
Single, low-income men only get medical
assistance if they are disabled. Homeless men
are more likely to be treated with disdain than
other homeless subgroups. Some people
perceive homeless men as largely to blame for
their plight, believing that they are able
bodied and should be able to work. Moreover,
homeless men may suffer from disabilities
that are not severe enough to warrant
eligibility for health and social services. Often
health and social programs give priority to
women and children.
A)
B)
C)
D)
C)
D)
Ans:
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B)
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Ans:
The nurse educator knows the nursing student
understands the effect of homelessness on the
11.
health of children when the nursing student
identifies which of the following?
“Homeless children are four times more likely
to become ill.”
“While approximately 87% of homeless
children are enrolled in school, only about
77% attend regularly.”
“Fewer than 25% of homeless children
graduate from high school.”
“Homeless children are twice as likely as their
housed counterparts to repeat a grade in
school.”
A
Feedback:
Only one of these statements that directly
relates to the effect of homelessness on the
health of children is, “Homeless children are
four times more likely to become ill.”
A)
.c
om
B)
For which reason are homeless youth at
12. higher risk for HIV, hepatitis, and sexually
transmitted infections?
They are not likely to receive treatment for
HIV, hepatitis, and sexually transmitted
infections.
They lack education or job training skills and
may resort to prostitution or survival sex,
which increases their risk for HIV, hepatitis,
and sexually transmitted infections.
Homeless adolescents may have difficulty
accessing emergency shelter because of
shelter policies that prohibit older youth from
the facility.
It is not uncommon for homeless youth to be
arrested for running away, breaking curfews,
or being without supervision.
B
Feedback:
The reason that homeless youth are at higher
risk for HIV, hepatitis, and sexually
transmitted infections is that they lack
education or job training skills and may resort
to prostitution or survival sex. The following
factors do not increase the risk for HIV,
hepatitis, and sexually transmitted infections:
They are not likely to receive treatment for
HIV, hepatitis, and sexually transmitted
infection; they may have difficulty accessing
emergency shelter because of shelter policies
that prohibit older youth from the facility; and
it is not uncommon for homeless youth to be
arrested for running away, breaking curfews,
or being without supervision.
re
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C)
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Ans:
A)
B)
C)
Which one of the following statements about
13. mental health issues and homeless young
people is most accurate?
87% of homeless children has suffered
emotional disturbances due to the effects of
traumatic stress and violence.
Homeless youth suffer disproportionately
from anxiety, depression, conduct disorders,
posttraumatic stress, and low self-esteem.
It is not common for homeless youths to be
arrested for running away, breaking curfews,
13. mental health issues and homeless young
people is most accurate?
87% of homeless children has suffered
emotional disturbances due to the effects of
traumatic stress and violence.
Homeless youth suffer disproportionately
from anxiety, depression, conduct disorders,
posttraumatic stress, and low self-esteem.
It is not common for homeless youths to be
arrested for running away, breaking curfews,
or being without supervision.
Homeless youth are persons under age 18
who lack parental, foster, or institutional care.
B
Feedback:
Homeless youth suffer disproportionately
from anxiety, depression, conduct disorders,
posttraumatic stress, and low self-esteem. One
in six homeless children has suffered
emotional disturbances due to the effects of
traumatic stress and violence. It is not
uncommon for homeless youth to be arrested
for running away, breaking curfews, or being
without supervision. Homeless youth are
persons under age 18 who lack parental,
foster, or institutional care, but this is not
necessarily related to mental health issues.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
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Ans:
The community health nurse is explaining the
reasons for health problems in the homeless
14.
population. Which of the following would the
nurse identify as the most likely reason?
Issues related to storage of medications
Lack of transportation to keep appointments
Time and energy focus on survival needs
Limited access to health care services
C
Feedback:
Although issues related to medication storage,
lack of transportation, and limited access to
health care play a role, many homeless people
expend their time and energy trying to meet
basic survival needs such that health care
takes a backseat to finding food, clothing, or
shelter.
A)
B)
C)
D)
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Ans:
A community health nurse is working with a
community-based organization to develop
programs to provide quality accessible health
15. care to the homeless population. Which of the
following would be the most appropriate
source from which to seek funding for this
program?
Projects for Assistance in Transition from
Homelessness (PATH)
Health Care for the Homeless (HCH)
The Interagency Council on Homelessness
U.S. Department of Housing and Urban
Development
B
Feedback:
The HCH program (a provision of the
McKinney Act) awards grants to communitybased organizations that seek to provide
quality, accessible health care to the homeless
and would be the most appropriate source for
funding. PATH is a grant program created
under the McKinney Act to support the
delivery of services to persons with severe
mental illnesses, including those who are
homeless or at risk of becoming homeless.
The Interagency Council on Homelessness
coordinates the federal response to
homelessness and creates a national
partnership with public and private sectors to
reduce and end homelessness in the United
States. HUD provides funding for supportive
housing for low-income families, as well as
low-income individuals with disabilities, and
low-income elderly.
A)
B)
C)
D)
Ans:
After teaching a group of community health
students about public and private sector
programs and initiatives aimed at combating
16. homelessness, the instructor determines that
they need additional teaching when they
identify which of the following as a private
sector organization?
National Coalition for the Homeless
National Alliance to End Homelessness
National Resource Center on Homelessness
and Mental Illness
National Low Income Housing Coalition
C
Feedback:
The National Resource Center on
they need additional teaching when they
identify which of the following as a private
sector organization?
National Coalition for the Homeless
National Alliance to End Homelessness
National Resource Center on Homelessness
and Mental Illness
National Low Income Housing Coalition
C
Feedback:
The National Resource Center on
Homelessness and Mental Illness is a
federally sponsored public program for
addressing the needs of the homeless. The
National Coalition for the Homeless, the
National Alliance to End Homelessness, and
the National Low Income Housing Coalition
are private sector resources.
A)
B)
C)
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D)
Ans:
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A community health nurse who will be
working with a homeless population is
17.
planning care. Which of the following would
the nurse need to do first?
Develop trust with the population
Clarify personal values and beliefs
Focus on the issue of homelessness
Visit the local shelter where the clients are
B
Feedback:
When working with the homeless population,
it is crucial that the nurse clarify personal
beliefs and values about poverty,
homelessness, addictions, and mental
disorders to ensure nonjudgmental care. Trust
too is essential, but this would need to occur
after the nurse has clarified his or her values
and beliefs. Biases or judgments on the
nurse's part would undermine the
development of trust. The nurse needs to use a
comprehensive, holistic approach or focus,
not just focus on the population's
homelessness. Visiting the local shelter may
be helpful to gather information about what
the nurse might expect, but it isn't the first
thing the nurse would do.
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A)
B)
C)
D)
Ans:
When preparing a plan of care for a group of
women who are victims of intimate partner
violence, the nurse develops interventions
18.
aimed at the primary level of prevention.
Which of the following would be most
appropriate for the nurse to include?
Assisting them to locate a safe shelter
Providing immunizations
Screening for sexually transmitted infections
Teaching about basic hygiene measures
A
Feedback:
For women who are victims of intimate
partner violence, counseling and helping them
locate a safe shelter can assist in preventing
homelessness. Providing immunizations and
teaching about basic hygiene may be
appropriate, but these would not priorities at
this time. Screening for sexually transmitted
disease would be a secondary level of
prevention activity.
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A)
B)
C)
D)
Ans:
C)
D)
Ans:
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A community health nurse is working with a
group of homeless clients with substance
19. abuse problems. Which of the following
would be appropriate for the nurse to do at the
tertiary level of prevention?
Conduct mass screening for common
communicable diseases
Institute a mobile van to assist in early
diagnosis of common illnesses
Advocate for counseling programs to address
high risk behaviors and abuse
Assist in ensuring participation in substance
abuse rehabilitation programs
D
Feedback:
Tertiary prevention level activities include
treatment of complications of advanced
disease, providing rehabilitative care, such as
participation in a substance abuse
rehabilitation program, and offering
counseling and support. Conducting mass
screenings for common communicable
diseases associated with substance abuse and
a mobile van program to assist in early
diagnosis are secondary prevention level
activities. Advocating for counseling
programs to address risk behaviors and abuse
would be a primary prevention level activity.
C)
high risk behaviors and abuse
Assist in ensuring participation in substance
abuse rehabilitation programs
D
Feedback:
Tertiary prevention level activities include
treatment of complications of advanced
disease, providing rehabilitative care, such as
participation in a substance abuse
rehabilitation program, and offering
counseling and support. Conducting mass
screenings for common communicable
diseases associated with substance abuse and
a mobile van program to assist in early
diagnosis are secondary prevention level
activities. Advocating for counseling
programs to address risk behaviors and abuse
would be a primary prevention level activity.
D)
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Ans:
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Chapter 27 Rural, Migrant, and Urban Health Care
When describing the term “frontier area,”
1. which of the following would the nurse
include as the most common description?
A population density of fewer than 1,000
A)
people per square mile
Population density of 1,000 people or more
B)
per square mile
C)
Fewer than 10,000 residents in the community
D)
Fewer than six people per square mile
Ans:
D
Feedback:
Fewer than six people per square mile is one
of the most common descriptions of a
“frontier area.” Fewer than 10,000 residents
or population density of less than 1,000
people per square mile is the definition of
“rural.” A population density of 1,000 or more
people per square mile refers to an urbanized
area or urban cluster.
A)
B)
The nurse educator is aware that the nursing
student needs further instruction on the
2. terminology related to rural, frontier, migrant,
and urban issues when the nursing students
identifies which of the following?
A rural area has six or fewer persons per
square mile.
There are many factors that are considered
when determining if a community is rural or
frontier other than population density.
The nurse educator is aware that the nursing
student needs further instruction on the
2. terminology related to rural, frontier, migrant,
and urban issues when the nursing students
identifies which of the following?
A rural area has six or fewer persons per
square mile.
There are many factors that are considered
when determining if a community is rural or
frontier other than population density.
Urban areas are much more densely populated
than urban areas.
An urban area consists of at least 2,500
people per square mile with at least 1,500 of
those who reside outside institutional group
quarters.
A
Feedback:
If a nursing student would identify that a rural
area has six or fewer persons per square mile,
the student would need further instruction as
it is a frontier area that has six or fewer
persons per square mile. There are many
factors that are considered when determining
if a community is rural or frontier other than
population density. Urban areas are much
more densely populated than rural areas.
Urban areas consist of at least 2,500 people
per square mile with at least 1,500 of them
living outside institutional group quarters.
A)
B)
C)
D)
A)
B)
C)
D)
Ans:
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Ans:
When attempting to describe the
characteristics of a typical rural population to
3.
a group of community health nurses, which of
the following would the nurse include?
Older, White, with a lower income and less
formal education
Young minorities with a lower income and
less formal education
Wealthier, more highly educated, older White
Americans
A reflection of the population as a whole
A
Feedback:
Population characteristics include older adults
as the largest segment of the population,
majority as White, with lower educational
attainment, and, on the average, a lower
income.
Wealthier, more highly educated, older White
Americans
A reflection of the population as a whole
A
Feedback:
Population characteristics include older adults
as the largest segment of the population,
majority as White, with lower educational
attainment, and, on the average, a lower
income.
C)
D)
Ans:
4.
A)
.c
om
B)
Which of the following reasons is most likely
to force a rural hospital to close?
Rural hospitals have a high risk for financial
problems and closures.
Rural hospitals do not have access to high
tech equipment and services.
Rural hospitals are able to attract many
specialty physicians.
Many rural residents depend heavily on
public health department services.
A
Feedback:
Rural hospitals have a high risk for financial
problems and closures. Rural hospitals
usually have less high-tech health care
equipment and services, but this does not
directly influence closure of the hospital.
Rural hospitals are usually not able to attract
many specialty physicians, and indeed
physician and nurse and pharmacist shortages
in rural areas make it difficult to operate a
hospital. Many rural residents depend heavily
on public health department services, but this
is more likely an effect of lack of access to
acute care services than a cause of lack of
access to acute care services.
C)
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D)
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Ans:
A)
B)
C)
D)
E)
Ans:
Which of the following are barriers to access
5. to health care that may be experienced by
rural clients? Select all that apply.
Adequate numbers and types of providers
Unpredictable and hazardous weather
conditions
Lack of transportation
Physical distance between the residence and
the location of health care services
Less high-tech health care equipment and
services available
B, C, D, E
Feedback:
The barriers to access to health care that may
Unpredictable and hazardous weather
conditions
Lack of transportation
Physical distance between the residence and
the location of health care services
Less high-tech health care equipment and
services available
B, C, D, E
Feedback:
The barriers to access to health care that may
be experienced by rural clients include
unpredictable and hazardous weather
conditions, lack of transportation, physical
distance between the residence and the
location of health care services, and less hightech health care equipment and services
available. There are often not adequate
numbers and types of providers of health care
in rural areas.
B)
C)
D)
E)
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Ans:
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B)
C)
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D)
Ans:
Which one of the following statements about
6. migrant workers and their families most
accurately describes their lifestyle?
They are usually paid fairly and treated justly
by their employers.
Often the men are the only ones who perform
the migrant work.
They often work 6 days a week from sunrise
to sunset.
Their earning power is dependent only upon
their skill level.
C
Feedback:
Migrant workers often work 6 days a week
from sunrise to sunset. They are often paid
unfairly and treated unjustly. The entire
family is often involved in performing the
migrant work. Their earning power is variable
depending on the variables of weather and
crop conditions.
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A)
B)
C)
D)
Ans:
When assessing a group of migrant
farmworkers, the community health nurse
notes that the group leaves their home base
for part of the year to travel to the same place
7.
along a route during the agricultural season,
usually returning on yearly basis. The
community health nurse identifies this as
which of the following?
Restricted circuit migration
Point-to-point migration
Nomadic migration
Migrant stream migration
B
Feedback:
Point-to-point migration entails leaving a
home base for part of the year to travel to the
same place or series of places along a route
during the agricultural season, usually
returning on a yearly basis. In a restricted
circuit, many people travel throughout a
season within a small geographic area,
following the crops. Nomadic migration
involves traveling away from home for
several years, working from farm to farm and
crop to crop, relying on word of mouth about
job opportunities. Migrant stream migration
involves following the harvest seasons of
agricultural crops, moving from place to
place, usually along predetermined routes
(migrant streams).
A)
B)
C)
D)
Ans:
A community health nurse is working to
improve the health children of migrant
8. families. Which of the following issues would
be of least importance for the nurse to
address?
Adolescent substance abuse
Exposure to domestic violence
Mental health problems
Participation in chores
D
Feedback:
Many migrant children are called upon by
their families to stay home from school to
work, care for younger children, or attend to
other household chores, thus affecting the
child's academic performance. However,
chores and helping the family are necessary to
Exposure to domestic violence
Mental health problems
Participation in chores
D
Feedback:
Many migrant children are called upon by
their families to stay home from school to
work, care for younger children, or attend to
other household chores, thus affecting the
child's academic performance. However,
chores and helping the family are necessary to
the family's survival and as such would be
something the nurse would focus on at a later
time. Issues such as adolescent substance
abuse, domestic violence, and mental health
problems are common and would need to be
addressed early on.
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B)
C)
D)
Ans:
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Which of the following have a direct and
9. negative influence on the vulnerability of
migrant workers? Select all that apply.
Many are undocumented aliens and live in
fear of deportation.
They are often deprived of safe working
conditions.
Their children are deprived of a quality
education.
They often lack adequate sanitation and
housing.
They often have poor nutrition because of
poverty.
A, B, D, E
Feedback:
Factors that have a direct and negative
influence on the vulnerability of migrant
workers include many are undocumented
aliens and live in fear of deportation; lack of
safe working conditions; lack of adequate
sanitation and housing; and poor nutrition
because of poverty. That their children are
deprived of a quality education is also
significant, but it is not a direct influence on
the vulnerability to health concerns of the
migrant workers themselves.
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B)
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C)
D)
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E)
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A)
B)
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C)
A community health nurse is working to
develop programs to address the health status
of migrant families. Which of the following
10.
would the nurse need to keep in mind when
planning these programs? Select all that
apply.
A greater mortality from injuries, TB,
respiratory diseases, and cerebrovascular
diseases
A dramatic increase in use of immunizations
for migrant children
An infant mortality rate that is 25% to 30%
higher than for other infants in the United
States
Health needs compromised by limited access
to health care and high mobility
A much lower life expectancy than that of the
general population
A, C, D, E
Feedback:
The life expectancy of a migrant worker is
much lower than the general population, with
proportionally increased mortality from
“injuries, tuberculosis, mental disorders,
cerebrovascular disease, respiratory diseases,
ulcers, hypertension, and cirrhosis.” The
migrant infant mortality rate is 25% to 30%
higher than the national average. Migrant
children are delayed for immunizations.
Migrant families have numerous health needs,
but they often face many obstacles to
accessing health care including their frequent
movement from place to place.
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E)
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Ans:
A)
B)
C)
A local community has a significant
population of migrant workers. In response, a
community health nurse plans to prevent a
program to the local community about this
11.
population. As part of the program the nurse
plans to include information about Cesar
Chavez, describing him as which of the
following?
A Mexican president who worked to keep
people from crossing the border illegally
A well-known actor who advocates for
increasing the number of Latinos in
Hollywood
The senator who wrote the Children's Health
11.
A)
B)
C)
D)
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Ans:
program to the local community about this
population. As part of the program the nurse
plans to include information about Cesar
Chavez, describing him as which of the
following?
A Mexican president who worked to keep
people from crossing the border illegally
A well-known actor who advocates for
increasing the number of Latinos in
Hollywood
The senator who wrote the Children's Health
Insurance Program (CHIP) bill
Founder of the United Farm Workers who
spent his life fighting for social justice
D
Feedback:
Cesar Chavez founded the United Farm
Workers (UFW), the first union in agricultural
labor history that successfully organized
migrant farmworkers. Chavez fought for
social justice and is an example of a migrant
hero. He was not a senator, well-known actor,
or Mexican president.
yn
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A)
B)
C)
D)
Ans:
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When providing care for migrant workers,
which of the following would be most
12.
appropriate for the community health nurse to
do?
Maintain existing services
Use standard methods of health care delivery
Employ information tracking systems
Use professionals for community outreach
C
Feedback:
Employing information tracking systems is
necessary due to the mobility of this
population and the need for continuity of care.
The nurse should improve the existing
services, use unique methods of health care
delivery to reach this population, and use lay
personnel for community outreach.
A)
B)
A community health nurse works to offer
increased health care services to meet the
13. needs of a local migrant population. Which of
the following ideas will work well for this
population? Select all that apply.
Providing a mobile van clinic that comes to
the farms during the day
Offering a clinic at the migrant camp from 7
to 10 PM
Asking local doctors to stay open until 6 PM
A community health nurse works to offer
increased health care services to meet the
13. needs of a local migrant population. Which of
the following ideas will work well for this
population? Select all that apply.
Providing a mobile van clinic that comes to
the farms during the day
Offering a clinic at the migrant camp from 7
to 10 PM
Asking local doctors to stay open until 6 PM
during the summer
Offering school-based health services for the
children
Providing a breakfast program for the
children at school
A, B, D, E
Feedback:
The van at the work site, services for children
in school including a breakfast program, a late
evening clinic at the camp would help the
greatest number of migrant family members.
Migrant workers are in the fields until dark. In
the summer that may be 9 PM; thus, a
physician who stays open until 6 PM will not
help.
A)
B)
C)
D)
E)
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A)
B)
C)
D)
E)
Ans:
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Ans:
When dealing with urban populations, which
of the following issues would a community
14.
health nurse most likely face? Select all that
apply.
Health disparities in the population
Lower levels of homelessness
Increased cases of asthma
High levels of poverty
Major transportation issues
A, C, D
Feedback:
Health disparities are very evident in the
populated urban setting. There are increased
levels of asthma and higher levels of poverty.
Homelessness is more evident, yet
transportation issues are not as great as in
suburban or rural areas.
After teaching a group of community health
nursing students about urban sprawl and its
effects, the instructor determines that
15.
additional teaching is needed when the
students identify which of the following as an
effect?
Water pollution
Heat islands
Less exposure to pesticides
Decreased air quality
C
Feedback:
Encroachment of housing areas into natural
habitats or farmlands can lead to wider human
exposure to pesticides, herbicides, and other
things such as mosquito-borne illnesses.
Urban encroachment into agricultural areas
creates problems with air and water pollution,
access to health care, and heat islands.
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A)
B)
C)
D)
Ans:
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D)
E)
Ans:
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A)
B)
C)
Which of the following are livability
principles that have been identified by the
16.
Partnership for Sustainability Communities?
Select all that apply.
Diminish economic competitiveness
Disassemble existing communities
Coordinate and leverage federal policies and
investment
Provide more transportation choices
Promote equitable, affordable housing
C, D, E
Feedback:
The six livability principles include (1)
provide more transportation choices, (2)
promote equitable, affordable housing, (3)
enhance economic competitiveness, (4)
support existing communities, (5) coordinate
and leverage federal policies and investment,
and (6) value communities and
neighborhoods.
After teaching a group of students about the
concept of social justice, which of the
17.
following if stated by the group as a
component indicates effective teaching?
Decreased burden borne by all
Increased benefits obtained for all
Narrow isolated view of health
Diversity viewed as a strength
D
Feedback:
Social justice occurs when a society provides
for the health needs and health care issues of
all people by treating people fairly, regardless
of where they live or who they are. It deals
with concepts of inclusion, participation,
empowerment, and the recognition that
diversity is a strength. Social justice involves
an equal bearing of the burdens and equal
reaping of the benefits. Community health
nurses who practice social justice have broad
and holistic views of health.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A community health nurse working with
urban populations integrates the concept of
18.
social justice into practice by demonstrating
which of the following?
Impartiality
Paternalism
Self-interest
Inflexibility
A
Feedback:
Social justice requires impartiality, that is,
ensuring that interventions are just and the
outcome is fair when viewed by an
uninvolved outsider. Paternalism reflects an
individual focus rather than the population
focus of social justice. Self-interest and
inflexibility would interfere with impartiality
and, subsequently, social justice.
A)
B)
C)
D)
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Ans:
A rural community health nurse is a guest
speaker at a nearby nursing school. The nurse
is describing how rural community health
19. nursing compares with community health
nursing in urban and suburban areas. Which
of the following would the nurse include
about rural community health nurses?
Salaries comparable with the other two areas
More difficulty in initiating planned change
Nurses viewed as active, highly respected
community members
Less physical isolation from professional
opportunities
C
Feedback:
Rural community health nurses are active
members of their community and are highly
respected professionals. Salaries typically are
lower than that of urban nurses in comparable
positions. However, because the system of
health care is smaller, it can be easier to
understand the system and initiate planned
change. Rural community health nurses may
experience the challenge of physical isolation
from personal and professional opportunities
associated with urban areas. Traveling to
cities for basic and continuing education can
be a barrier. In addition, rural nurses may feel
isolated in clinical practice because of the
scarcity of professional colleagues.
A)
B)
C)
D)
Ans:
A community health nurse implements the use
of promotoras to promote health in migrant
20.
communities. Which of the following best
describes a promotora?
Nonprofessional community outreach worker
Trained childbirth assistant
Retired nurses knowledgeable of the area
Language translators
A
Feedback:
The use of promotoras—lay community
outreach workers—or doulas—usually trained
childbirth assistants—have promoted health
in migrant communities. Promotoras are not
retired nurses or language translators.
B)
C)
D)
Ans:
Trained childbirth assistant
Retired nurses knowledgeable of the area
Language translators
A
Feedback:
The use of promotoras—lay community
outreach workers—or doulas—usually trained
childbirth assistants—have promoted health
in migrant communities. Promotoras are not
retired nurses or language translators.
A)
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B)
Which of the following activities best
21. exemplifies a community health nurse forging
a relationship?
Dealing with sensitive subjects
Introducing one's self as a community health
nurse
Listening to more than just what is said
Being aware of the long term commitment to
the client
B
Feedback:
In forging a relationship, CHNs begin with
creating a “perception of presence” by
identifying themselves as a public health
nurse and passing out their card with the
instruction to the client to call upon them
when needed. Acting as a resource involves
dealing with “sensitive subjects” and requires
“honesty, asking direct questions, and
ignoring rude behavior.” Detecting and asking
the next question “means listening to more
than what is said.” When a client is truly
heard and all information is on the table,
making an informed judgment is then
possible. Sense of time includes the
awareness of the long-term commitment of
the community health nurse to the client and
the belief that results can occur, despite the
lack of progress or even regression on the part
of some clients.
C)
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A)
B)
C)
After teaching a class on urban health to a
group of community health nursing, the
22. instructor determines that the teaching was
successful when the students describe it as
which of the following?
Providing care to those individuals who are
living in ghettos
Addressing the needs of immigrants living in
large cities
Considering effects of environment on the
After teaching a class on urban health to a
group of community health nursing, the
22. instructor determines that the teaching was
successful when the students describe it as
which of the following?
Providing care to those individuals who are
living in ghettos
Addressing the needs of immigrants living in
large cities
Considering effects of environment on the
health of large cities
Ensuring the appropriate planning of
attractive and equitable places
C
Feedback:
Urban health considers those characteristics
of the environment as they relate to the health
of the population living within large cities.
Individuals living in ghettos and immigrants
living in large cities are but two segments of
the urban population. Urban planning works
to improve the welfare of individuals and
communities by creating more healthful,
efficient, attractive, and equitable places.
A)
B)
C)
D)
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Ans:
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A)
B)
C)
A rural community health nurse is acting in
the role of a mentor. Which of the following
23.
activities would the nurse most likely be
doing?
Providing childbirth classes
Contacting a specialist for a client
Collecting immunization data for program
development
Orienting a new rural health nurse to the
community
D
Feedback:
In the role of a mentor, the rural community
health nurse would engage in guiding new
community health nurses, nursing students,
and other nurses new to the rural community.
Childbirth classes would be characteristic of
the educator role. Contacting a specialist for a
client reflects the nurse's role as a referral
agent. Collecting immunization data for
program development reflects the nurse's role
as a change agent/researcher.
Chapter 28 Public Settings
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A)
As a guest speaker for a group of community
health nurses who are considering corrections
nursing as a career, a corrections nurse
1. provides an overview of the history of
corrections nursing. Which of the following
would the nurse describe as the historic view
of corrections nursing?
Health care to inmates occurred primarily as
emergency treatment.
Inmates were viewed as not deserving care
paid by public dollars.
The emphasis was on corrections, not
punishment.
Prisons provided safe havens from
communicable diseases.
B
Feedback:
Although the correctional system of prisons
and jails has been around for a very long time,
it historically provided minimal, if any, health
care to inmates. Prison was a punishment, and
the inmates were viewed as not deserving of
care that was being paid for from public
dollars. Communicable diseases were and
continue to be a major health issue.
B)
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Ans:
A)
B)
C)
D)
Ans:
A nurse is considering a career in public
health nursing. The nurse determines the need
2.
to obtain which of the following for entrylevel practice?
Associate's degree in nursing
Bachelor's degree in nursing
Master's degree in nursing
Post-master's degree certification
B
Feedback:
The American Nurses Association
recommends that an entry-level PHN should
have a bachelor's degree in nursing. Some
states, such as California, require nurses to
take additional classes and obtain certification
beyond a bachelor's degree if the BSN
program does not offer specific content (e.g.,
child abuse, public health didactic and
Bachelor's degree in nursing
Master's degree in nursing
Post-master's degree certification
B
Feedback:
The American Nurses Association
recommends that an entry-level PHN should
have a bachelor's degree in nursing. Some
states, such as California, require nurses to
take additional classes and obtain certification
beyond a bachelor's degree if the BSN
program does not offer specific content (e.g.,
child abuse, public health didactic and
practicum). PHNs working with specific
populations, or in administration, should hold
a master's degree. A PHN with a master's
degree in community/public health nursing
may take a national certification examination
offered by the American Nurses Credentialing
Center.
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B)
C)
D)
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When describing the differences between
public health nursing and nursing in general,
3. which of the following would an instructor
include as characteristic of public health
nursing? Select all that apply.
Acute care services
Focus on the greater good
Seek out of clients in need
Community commitment
Health restoration
B, C, D
Feedback:
Public health nurses focus on the greater
good, seek out clients in need, and are
committed to the community. Public health
nursing is grounded in social justice and
focuses on health promotion and disease
prevention. Public health nursing does not
usually include acute care services or health
restoration.
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A)
B)
C)
D)
E)
Ans:
A)
B)
C)
D)
Which of the following activities best reflects
4. a public health nurse's role in the public
health function of assessment?
Prioritizing the issues of a community to
determine appropriate interventions
Evaluating for potential safety hazards in a
childcare center
Ensuring that children in a day care center are
properly immunized
Working with officials to develop a program
Which of the following activities best reflects
4. a public health nurse's role in the public
health function of assessment?
Prioritizing the issues of a community to
determine appropriate interventions
Evaluating for potential safety hazards in a
childcare center
Ensuring that children in a day care center are
properly immunized
Working with officials to develop a program
for solving a problem
A
Feedback:
The public health function of assessment is
reflected when a public health nurse identifies
the problems in a community and then
prioritizes which issue to address first by
deciding which issue impacts the most people
and what interventions will help the
population thrive. Evaluating for potential
safety hazards and ensuring proper
immunizations reflect the assurance function
of public health. Working with officials to
develop programs reflects the function of
policy development.
A)
B)
C)
D)
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C)
D)
Ans:
Which one of the following statements best
illustrates the similarities and differences
5.
between public health nursing and other types
of nursing?
The priorities are the same for both public
health nursing and other types of nursing.
In hospital nursing, nurses must address the
issues that come to them. Whereas in public
health nursing, it is necessary for the nurse to
actively seek out and identify potential
problems and situations.
Nurses whose main practice is in the hospital
are required to collaborate more effectively
than public health nurses.
Nurses who work in public health do not use
the nursing process as a foundation for their
work.
B
Feedback:
In hospital nursing, nurses must address the
issues that come to them. Whereas in public
health nursing, it is necessary for the nurse to
actively seek out and identify potential
problems and situations. The priorities vary
for both public health nursing and other types
of nursing and certainly within different
communities that a public health nurse
Nurses who work in public health do not use
the nursing process as a foundation for their
work.
B
Feedback:
In hospital nursing, nurses must address the
issues that come to them. Whereas in public
health nursing, it is necessary for the nurse to
actively seek out and identify potential
problems and situations. The priorities vary
for both public health nursing and other types
of nursing and certainly within different
communities that a public health nurse
practices. Nurses who work in public health
must collaborate as must nurses who work in
the hospital. However, the types of people and
agencies that a public health nurse must
collaborate with vary from the types of people
and agencies that a hospital nurse must
collaborate with. Nurses who work in public
health use the nursing process as a foundation
for their work, just as nurses who work in
hospitals do. In public health nursing, the
community is the client but the nursing
process may also be applied to individuals
and families.
D)
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B)
C)
D)
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After teaching a group of students about the
federal agencies involved in public health, the
instructor determines that the teaching was
6.
successful when the students identify which
agency as the main organization that is
involved in public health?
Environmental Protection Agency
Department of Homeland Security
Department of Agriculture
Department of Health and Human Services
D
Feedback:
The main organization involved with public
health is the Department of Health and
Human Services (DHHS). Other federal
agencies that also impact public health
include the Environmental Protection Agency
(EPA), the Department of Homeland Security,
the Department of Agriculture, the
Department of Education, and the Department
of Veterans Affairs.
A public health nurse is employed by the
7. Indian Health Services. This nurse is working
at which of the following levels?
Local
Community
State
Federal
D
Feedback:
The Indian Health Service is an agency
headed by the Department of Health and
Human Services, a federal agency. Thus the
nurse would be working at the federal level.
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A)
B)
C)
D)
Ans:
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B)
C)
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After teaching a group of students about
public health nursing and the U.S. Public
Health Service Commissioned Corps, the
8. instructor determines that the students need
additional instruction when they state which
of the following is necessary to qualify for a
position in the Corps?
Age over 45 years
Bachelor's degree in nursing
Valid nursing license
U.S. citizenship
A
Feedback:
To qualify as a nurse in the Commissioned
Corps, one must be a U.S. citizen, <44 years
old, able to pass a physical examination,
possess a bachelor's or higher degree from an
accredited nursing program, pass the National
Council Licensure Examination (NCLEX),
and hold a valid nursing license from one of
the 50 states, the District of Columbia, Puerto
Rico, Guam or the U.S. Virgin Islands.
A public health nurse working with several
communities to develop appropriate programs
9. for health surveillance. Which agency would
the nurse contact to obtain information on this
topic?
Centers for Disease Control and Prevention
National Institutes of Health
Agency for Health Care Research and Quality
Food and Drug Administration
A
Feedback:
The nurse would contact the Centers for
Disease Control and Prevention that is
responsible for health surveillance and the
prevention of disease and bioterrorism. The
National Institutes of Health provide medical
research. The Agency for Health Care
Research and Quality is responsible for
research on health care quality and
effectiveness. The Food and Drug
Administration works to ensure the safety of
food, medication, medical procedures, and
equipment.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A community health nurse is advocating for
the development of school-based health
10.
centers in the community high schools as a
means to accomplish which of the following?
Maintain the current absentee rate
Provide contraceptive services
Increase ready access to health care services
Promote increased use of emergency services
C
Feedback:
School-based health centers (SBHC) provide
ready access to health care for large numbers
of children and adolescents during school
hours, reducing absences from school due to
health care appointments. SBHCs provide a
variety of services in a user-friendly manner
at a convenient location. Many SBHCs do not
provide contraceptive services on the school
site due to school district policy or state law.
These centers also are a cost-effective way to
decrease visits to the emergency department.
Provide contraceptive services
Increase ready access to health care services
Promote increased use of emergency services
C
Feedback:
School-based health centers (SBHC) provide
ready access to health care for large numbers
of children and adolescents during school
hours, reducing absences from school due to
health care appointments. SBHCs provide a
variety of services in a user-friendly manner
at a convenient location. Many SBHCs do not
provide contraceptive services on the school
site due to school district policy or state law.
These centers also are a cost-effective way to
decrease visits to the emergency department.
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B)
C)
D)
Ans:
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Which one of the types of services that may
be available in a school-based health center
11.
may be controversial and not be supported by
all parents and community members?
On-site sexually transmitted infections testing
and treatment
On-site provision of contraceptives
Well-child care
Sick-child care
B
Feedback:
Many school-based health centers do not
provide contraceptive services on the school
site because of school district policy or state
law.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
During a class, an instructor reviews the
impact of the Supreme Court decision
regarding Estelle v. Gamble. The instructor
12.
determines that the students understand the
material when they identify which of the
following about this decision?
It created the need for cleaner, less crowded
facilities.
It led to major reforms including
establishment of inmates' rights.
It required the use of managed care
organizations for service.
It mandated care to be provided in a timely
fashion.
B
Feedback:
The Supreme Court ruled that not providing
medical services inflicted pain and denied
inmates of their Eighth Amendment rights.
B)
establishment of inmates' rights.
It required the use of managed care
organizations for service.
It mandated care to be provided in a timely
fashion.
B
Feedback:
The Supreme Court ruled that not providing
medical services inflicted pain and denied
inmates of their Eighth Amendment rights.
This decision led to major reforms in the
corrections health system. Medical providers
were hired and inmates' rights were
established. The decision did not address
facilities or use of managed care
organizations. Treatment in a timely fashion
was not part of this decision. However, later
lawsuits involve this issue.
C)
D)
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A)
B)
C)
D)
E)
Ans:
A)
B)
C)
D)
Ans:
Which of the following health conditions
13. would the corrections nurse expect to address
as most prevalent? Select all that apply.
Heart disease
Tuberculosis
Hepatitis C
Asthma
Substance abuse
B, C, E
Feedback:
Communicable diseases such as tuberculosis
and Hepatitis C are of great concern in the
correctional community. In addition, drug
abuse by inmates is very high. Heart disease
and asthma rates vary.
A school nurse functions to promote a healthy
school environment. Which of the following
14.
would be most appropriate for the nurse to
do?
Advocating for proper nutrition and exercise
to prevent and reduce the incidence of obesity
in school-age children
Providing care for children with asthma
Developing individualized health plans
Engaging in incidental teaching about
scoliosis
A
Feedback:
Promotion of healthful school living
emphasizes planning a daily schedule for
monitoring healthful classroom experiences,
extracurricular activities, school breakfasts
B)
C)
Providing care for children with asthma
Developing individualized health plans
Engaging in incidental teaching about
scoliosis
A
Feedback:
Promotion of healthful school living
emphasizes planning a daily schedule for
monitoring healthful classroom experiences,
extracurricular activities, school breakfasts
and lunches, emotional climate, discipline
programs, and teaching methods. It also
includes screening, observing, and assessing
to identify needs early and report illegal drug
use, suspected child abuse, and violations of
environmental health standards. Health
promotion involves the nurse in supporting
the physical, mental, and emotional health of
school personnel by being an accessible
resource to teachers and staff regarding their
own health and safety. Providing asthma care
and developing individualized health plans
are examples of providing health services.
Engaging in incidental teaching reflects the
function of health education.
D)
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B)
C)
D)
E)
F)
Ans:
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A school nurse who is not a nurse practitioner
works in an elementary school (K-4) with
15. 1,200 students. Which of the following would
the nurse engage in with this group? Select all
that apply.
Screening for scoliosis
Vision and hearing screening
Teaching basic health practices
Monitoring chronic illnesses
Ordering medications
Providing primary care
B, C, D
Feedback:
Vision and hearing screening, teaching basic
health practices, and monitoring chronic
illnesses are appropriate school nurse
activities for children in this age group.
Scoliosis screening would be more
appropriate for children in their early
adolescent growth spurt years, not at this age.
A school nurse would not order medications.
A school nurse practitioner would provide
primary care and if allowed by the state,
prescribe medications.
Monitoring chronic illnesses
Ordering medications
Providing primary care
B, C, D
Feedback:
Vision and hearing screening, teaching basic
health practices, and monitoring chronic
illnesses are appropriate school nurse
activities for children in this age group.
Scoliosis screening would be more
appropriate for children in their early
adolescent growth spurt years, not at this age.
A school nurse would not order medications.
A school nurse practitioner would provide
primary care and if allowed by the state,
prescribe medications.
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D)
E)
F)
Ans:
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A school nurse is describing the
responsibilities associated with this specialty
16. to a group of students. Which of the following
would the school nurse identify as a primary
responsibility?
Providing care to children with special health
needs
Preventing illness among the school
community
Performing health screenings
Assessing acute health problems
B
Feedback:
The primary responsibilities of the school
nurse are to prevent illness and to promote
and maintain the health of the school
community. The school nurse serves not only
individuals, families, and groups within the
context of school health but also the school as
an organization and its membership (students
and staff) as aggregates. Caring for children
with special health needs, performing health
screenings, and assessing acute health
problems are aspects associated with the
primary responsibilities of preventing illness
and promoting and maintaining the health of
the school community.
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D)
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A school nurse is reviewing the population of
school age children for chronic conditions.
17. Which of the following would the school
nurse expect to find most often? Select all that
apply
Rheumatoid arthritis
Asthma
Diabetes
HIV/AIDS
Tuberculosis
Seizures
B, C, F
Feedback:
The four chronic conditions most often seen
in school-age children are asthma, diabetes,
seizures, and severe food allergies.
Rheumatoid arthritis is not as common. HIV/
AIDS and tuberculosis are more commonly
seen in correctional settings.
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A)
B)
C)
D)
E)
F)
Ans:
D)
Ans:
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A)
B)
A school nurse is providing care to a group of
children with severe food allergies. Which of
18.
the following would be most important for the
nurse to include in the child's plan of care?
Ensuring that the child has ready available
access to EpiPen
Advising teachers to call the child's parents in
case of a reaction
Teaching other students how to administer the
EpiPen
Administering daily medication to control the
allergies
A
Feedback:
Severe food allergies can lead to anaphylactic
shock. School nurses coordinate and work
with students and their families, along with
school personnel to raise awareness and enlist
caution. They also work with families and
health care providers to ensure that
epinephrine via an autoinjector EpiPen is
available for the child in case of emergencies.
School nurses also work with teachers and
lunch room personnel to alert them of the
allergy, explain what can happen in a case of
anaphylaxis, and provide training on how to
use the EpiPen or other needed medication.
Calling the child's parents in case of a
C)
EpiPen
Administering daily medication to control the
allergies
A
Feedback:
Severe food allergies can lead to anaphylactic
shock. School nurses coordinate and work
with students and their families, along with
school personnel to raise awareness and enlist
caution. They also work with families and
health care providers to ensure that
epinephrine via an autoinjector EpiPen is
available for the child in case of emergencies.
School nurses also work with teachers and
lunch room personnel to alert them of the
allergy, explain what can happen in a case of
anaphylaxis, and provide training on how to
use the EpiPen or other needed medication.
Calling the child's parents in case of a
reaction would be important but prompt
treatment with epinephrine is the priority.
Responsible adults, not other children should
know how to administer the epinephrine.
Daily medication usually is not required for
children with food allergies, however,
avoidance of the allergen is.
D)
D)
Ans:
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B)
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Ans:
A corrections nurse is working to develop
programs for inmates and reviews the
19. demographics of this population to determine
potential issues. Which of the following
would the nurse expect to find?
Greater portion of inmates who are white
Increasing numbers of women in prisons
Equal distribution of socioeconomic
backgrounds
Incarceration primarily for commission of
minor crimes
B
Feedback:
Looking at the demographics of inmates,
there are many differences from the general
population. First, inmates have all committed
some type of crime, with nearly half (52%)
being violent crimes. National statistics
indicate a larger portion of Black (3,042 per
100,000) and Hispanic (1, 261 per 100,000)
male inmates than White male inmates (487
per 100,000). Although males are still the
majority population (88.6%), trends show an
increase in the number of women in state or
federal prisons. In addition, the inmate
population is drawn disproportionately from
lower socioeconomic backgrounds when
C)
backgrounds
Incarceration primarily for commission of
minor crimes
B
Feedback:
Looking at the demographics of inmates,
there are many differences from the general
population. First, inmates have all committed
some type of crime, with nearly half (52%)
being violent crimes. National statistics
indicate a larger portion of Black (3,042 per
100,000) and Hispanic (1, 261 per 100,000)
male inmates than White male inmates (487
per 100,000). Although males are still the
majority population (88.6%), trends show an
increase in the number of women in state or
federal prisons. In addition, the inmate
population is drawn disproportionately from
lower socioeconomic backgrounds when
compared with the general public.
D)
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A corrections nurse is proactively working
with the institution to develop programs for
the facility to address problems to address the
20.
trends for the future. Which type of program
would be most appropriate for the nurse to
recommend?
Treatment of typical disorders found in
younger inmates
Dealing with older, sicker, and longer periods
of incarceration for many inmates
Clinics to address acute disease conditions
Education for release after shorter
incarcerations
B
Feedback:
Typically, inmates are older, sicker, and
remain in prison longer than in previous
years. Therefore, the nurse would need to
develop programs to address older inmates
with more chronic illnesses and longer
incarcerations.
A)
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B)
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A)
B)
C)
D)
Ans:
A corrections nurse is visiting a local nursing
school to describe this career. Which of the
21.
following would the nurse include in the
discussion?
Lower salaries than other fields
Primarily assessment oriented
Extensive employee benefits
Low safety risk
C
A corrections nurse is visiting a local nursing
school to describe this career. Which of the
21.
following would the nurse include in the
discussion?
Lower salaries than other fields
Primarily assessment oriented
Extensive employee benefits
Low safety risk
C
Feedback:
Salaries depend upon the state, although they
tend to be higher salaries than in other nursing
fields. Moreover, corrections nurses usually
receive extensive employee benefits and
insurance packages as government
employees. Corrections nurses must have
good mental health and assessment skills.
They must be able to communicate well and
be strong nursing advocates and strong
advocates for their clients. They work in an
intense environment where their safety could
be threatened, and they must deal with clients
who may be noncompliant, combative, and
manipulative. Corrections nurses must also be
very flexible and knowledgeable about a
variety of nursing specialties.
C)
D)
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B)
C)
D)
Ans:
A school nurse is addressing the dental health
issues of the local community of school
22.
children. Which activity would be most
appropriate at the community level?
Educating parents about the importance of
oral health
Teaching children how to brush and floss
properly
Assisting with finding resources for those
without dental insurance
Advocating for the fluoridation of drinking
water
D
Feedback:
At a community level, school nurses can
educate the public about the benefits of dental
fluoride treatments. They can advocate for
fluoridation of drinking water, school-based
fluoride rinses or gels, and dental sealant
programs. At the classroom level, school
nurses can provide dental education and
provide toothbrushes, toothpaste, and floss to
ensure that students are able to practice good
dental hygiene habits. At an individual level,
school nurses can assist in finding resources
C)
without dental insurance
Advocating for the fluoridation of drinking
water
D
Feedback:
At a community level, school nurses can
educate the public about the benefits of dental
fluoride treatments. They can advocate for
fluoridation of drinking water, school-based
fluoride rinses or gels, and dental sealant
programs. At the classroom level, school
nurses can provide dental education and
provide toothbrushes, toothpaste, and floss to
ensure that students are able to practice good
dental hygiene habits. At an individual level,
school nurses can assist in finding resources
for those with no dental health insurance.
Finally, school nurses can successfully
educate parents regarding the importance of
oral and dental health.
D)
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Which of the following would the school
nurse who is dealing with a primarily
23.
adolescent school population focus on? Select
all that apply.
Substance abuse
Eating disorders
Suicide prevention
Sexual activity
Dental sealants
A, B, C, D
Feedback:
Many of the health issues that modern
adolescents face are a result of their own
choices and high-risk activity; for example,
sexual activity, substance abuse, injury, and
violence. Eating disorders are most prevalent
in adolescent females. Dental sealants are
more appropriate for elementary school
children.
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A)
B)
C)
D)
E)
Ans:
A)
B)
C)
Which one of the following statements about
the common roles and functions of public
24.
health nurses, school nurses, and corrections
nurses is most accurate?
Emphasis is placed on the treatment of
disease and disability.
Nurses in all of these areas serve the
population as client as opposed to individuals
as clients.
All of these specialty nursing fields are paid
very well because their setting is supported
24.
A)
B)
C)
D)
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B)
C)
D)
Ans:
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Chapter 29 Private Settings
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Ans:
the common roles and functions of public
health nurses, school nurses, and corrections
nurses is most accurate?
Emphasis is placed on the treatment of
disease and disability.
Nurses in all of these areas serve the
population as client as opposed to individuals
as clients.
All of these specialty nursing fields are paid
very well because their setting is supported
through public funds.
Public health nurses can influence the health
of vulnerable populations more than any of
the other specialties.
B
Feedback:
Nurses in all of these areas serve the
population as client as opposed to individuals
as clients. Emphasis is placed on prevention
of disease or disability. These community
nurses all work in settings that are supported
by public funds but the amount of pay varies.
All of these specialties of nursing can
influence the health of vulnerable
populations.
After reviewing the history of nurse-managed
health centers, the instructor determines that
1. the teaching was successful when the students
identify which of the following as the
beginnings of today's model?
1920s
1940s
1960s
1980s
C
Feedback:
Today's NMHCs trace their roots to changes
in national health care laws begun in the
mid-1960s. However, the nursing model of
holistic care focusing on vulnerable
populations and integrating primary care and
public health dates back to the 19th century.
When describing nurse-managed health
2. centers to a group of students, which of the
following would the instructor emphasize?
Use as a vital safety net health care provider
An alternative to primary care for insured
persons
Focus on the individual in the community
Affiliation with a local acute care facility
A
Feedback:
Nurse-managed health centers have emerged
as a vital safety net health provider in
America's health care delivery system. A
“safety-net provider” is defined as a provider
that by mandate or mission organizes and
delivers a significant level of health care and
other health-related services to the uninsured,
Medicaid recipients, and other vulnerable
populations. The distinctiveness of these
centers is the community orientation. The
centers can be a freestanding business or may
be affiliated with universities and other
service institutions.
A)
B)
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B)
C)
D)
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C)
D)
Ans:
After describing the various models for nursemanaged health centers, the instructor
determines that the student understand the
3.
information when they identify which
organization structure as being partnered
legally with a human services organization?
Academic nursing center
Freestanding center
Subsidiary center
Affiliated center
D
Feedback:
An affiliated center is one in which there is a
legal partnership with a health care or human
services organization. An academic nursing
center is located within a School of Nursing.
A freestanding center is an independent center
with its own governing board. A subsidiary
center is part of a larger health care system.
Which of the following statements about the
4. focus of nurse-managed health centers is most
accurate?
The focus is providing clinical experiences
for nursing students.
They are truly community oriented.
They all have the same practice models.
They only focus on health promotion and
wellness.
B
Feedback:
Nurse-managed health centers are truly
community oriented. They may provide
clinical experiences for nursing students but
this is not their focus. They vary in practice
models. They provide a range of services
from health promotion and wellness to
conventional primary care.
A)
B)
C)
D)
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B)
C)
D)
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Ans:
A nursing instructor is preparing a group of
students for a clinical rotation in a nurse5. managed health center. Which of the
following would the instructor include when
describing the students' role?
Clinical supervision
Passive participation
Use of tertiary-level activities
Implementation of best practices
D
Feedback:
Nurse-managed health centers implement
evidence-based practice via best practices or
the application of the best available evidence
to improve practice. Thus students also would
follow this approach. Students' roles are
similar to their staff mentors; faculty roles
would involve clinical supervision. Students
assigned to these centers are active
participants in the vital activities of the center.
Which of the following would be the most
6. likely source of funding for services provided
in a comprehensive primary care center?
Government grants
Medical insurance plans
Another nurse-managed care center
Private contracts
B
Feedback:
In the comprehensive primary care centers,
advanced practice nurses provide primary
care services. Such services are usually
reimbursable under Medicaid and managed
care medical insurance plans. In wellness
centers, public health nurses and other
interdisciplinary team members provide a
range of primary and secondary prevention
strategies. These services are usually not
reimbursed by insurance plans, but are often
covered by grants and contracts. Often one
nurse-managed care center partners with one
or more nurse-managed care centers or other
community based organizations to provide
strength to the proposal for funding.
C)
D)
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B)
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A)
B)
C)
D)
Ans:
Which of the following criteria must a nursemanaged health center meet to ensure
7.
designation as a Federally Qualified Health
Center?
Located in a densely populated area
For profit status
Consumers comprise the majority of the
board of directors.
Care provision to women and children
exclusively
C
Feedback:
In order to qualify, the centers must: be
located in a medically underserved area or
serve a medically underserved population;
have a nonprofit, tax exempt, or public status;
have a board of directors, a majority of whom
must be consumers of the center's health
services; provide culturally competent,
comprehensive primary care services to all
age groups; and offer a sliding scale fee and
provide services regardless of ability to pay.
C)
board of directors.
Care provision to women and children
exclusively
C
Feedback:
In order to qualify, the centers must: be
located in a medically underserved area or
serve a medically underserved population;
have a nonprofit, tax exempt, or public status;
have a board of directors, a majority of whom
must be consumers of the center's health
services; provide culturally competent,
comprehensive primary care services to all
age groups; and offer a sliding scale fee and
provide services regardless of ability to pay.
D)
Which of the following statements about
8. funding sources for nurse-managed health
clinics is most accurate?
All nurse-managed health clinics can be
reimbursed by Medicaid and managed care
medical insurance plans.
Grants can be used as a source of initial start
up funding and/or to support ongoing
activities.
It is common for nurse-managed health
clinics to receive funding from one primary
source.
Contracts are awarded based on competition
and are renewable when goals and objectives
are not met.
B
Feedback:
Grants can be used as a source of initial start
up funding and/or to support ongoing
activities. In comprehensive primary care
centers, advanced practice nurses provide
primary care services that are usually
reimbursable under Medicaid and managed
care medical insurance plans. Most nursing
centers operational and salary budgets entail a
combination of funding sources. Contracts are
usually noncompetitive and renewable when
goals and objectives are met.
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C)
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D)
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A)
B)
A)
B)
C)
D)
Ans:
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C)
D)
Ans:
After discussing nurse-managed care centers
with a group of community health nursing
students, the instructor determines that the
9.
teaching was effective when the students
identify which of the following as one of the
main challenges?
Ensuring adequate populations for services
Exerting a positive influence on community's
health
Continuing services after funding has stopped
Managing the multitude of services provided
C
Feedback:
Sustainability, or the ability to carry on
services and health promotion activities when
funding is no longer available, is one of the
main challenges of NMHCs. The populations
served are vast and not predicted to decrease
in light of the current status of health care.
Nurse-managed health centers have much to
offer toward resolving the national health care
crisis facing vulnerable populations who are
uninsured or underinsured and exerting a
positive influence on the community's health.
Management of the multiple services may be
challenging, but the sustainability of the
center is paramount.
Which party is usually required to describe
10. detailed plans for sustainability after the
award period ceases?
The client
The funder
The providing organization
The insurer
C
Feedback:
In the past, funders were often confronted
with the task to help organizations find and
secure other resources, or extend their own
financial support, to ensure the continuity of
services. More recently, both public and
private funders are stipulating that
organizations describe detailed plans for
sustainability after the award period ceases in
their application submitted for funding.
The funder
The providing organization
The insurer
C
Feedback:
In the past, funders were often confronted
with the task to help organizations find and
secure other resources, or extend their own
financial support, to ensure the continuity of
services. More recently, both public and
private funders are stipulating that
organizations describe detailed plans for
sustainability after the award period ceases in
their application submitted for funding.
11.
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A)
Which of the following statements about faith
community nursing is most accurate?
Nurses are uniquely able to focus on the
spiritual influences on health.
Faith community nursing is one of the newest
nursing specialties, and one of the oldest
means of health care delivery.
Faith community nursing is restricted to
Christian religious institutions in the United
States.
For hundreds of years, deaconesses, sisters,
and lay members of religious communities
have been engaged in health promotion.
B
Feedback:
Faith community nursing is one of the newest
nursing specialties, and one of the oldest
means of health care delivery. Nurses have
the unique ability to bridge the disciplines of
medicine and religion and assist the client in
understanding the physical and spiritual
influences on health. The parish nursing
movement soon spread outside of Christian
religious institutions and beyond the borders
of the United States to Canada, Australia, and
New Zealand. For hundreds of years,
deaconesses, sisters, and lay members of
religious communities have been involved in
ministering to the sick.
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B)
C)
D)
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D)
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A community health nursing instructor is
developing a class plan about faith
community nursing for a group of community
12.
health nursing students. Which of the
following would the instructor expect to
include?
One of the oldest nursing specialties
One of the newest means of health care
delivery
Diversity in activities and interventions
Differences from parish nursing
C
Feedback:
Activities and interventions used by faith
community nurses are as diverse as their faith
communities. Faith community nursing is one
of the newest nursing specialties and one of
the older means of health care delivery.
Nurses practicing in the faith community may
be referred to a faith community nurses
(FCN), parish nurses, health ministry nurses,
or congregational nurses depending upon
preference and the traditions of the faith
community.
A)
B)
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B)
C)
D)
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C)
D)
Ans:
Which of the following agencies was
13. instrumental in developing the first Scope and
Standards of Parish Nursing Practice?
International Parish Nurse Resource Center
Health Ministries Association
American Nurses Association
Parish Nurse Institute
B
Feedback:
The Health Ministries Association provides
additional resources and support for faith
community nursing practice and was
instrumental in developing the first Scope and
Standards of Parish Nursing Practice. The
International Parish Nurse Resource Center,
formed in the 1980s, has provided educational
programs and resources for nurses seeking to
practice as a parish nurse for over two
decades. The American Nurses Association in
conjunction with the Health Ministry
Association has developed the Scope and
Standards of Practice for this field of nursing.
The Parish Nurse Institute is an organization
Health Ministries Association
American Nurses Association
Parish Nurse Institute
B
Feedback:
The Health Ministries Association provides
additional resources and support for faith
community nursing practice and was
instrumental in developing the first Scope and
Standards of Parish Nursing Practice. The
International Parish Nurse Resource Center,
formed in the 1980s, has provided educational
programs and resources for nurses seeking to
practice as a parish nurse for over two
decades. The American Nurses Association in
conjunction with the Health Ministry
Association has developed the Scope and
Standards of Practice for this field of nursing.
The Parish Nurse Institute is an organization
dedicated to the education and support of
registered nurses who wish to practice nursing
as Parish Nurses or Faith Community Nurses.
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B)
C)
D)
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Faith community nurses engage in seven
diverse nursing roles. Which one of the roles
14.
is distinctly unique to faith community
nursing?
Advocate
Integrator of faith and health
Coordinator of volunteers
Developer of support groups
B
Feedback:
To achieve the goal of faith community
nursing, seven diverse nursing roles are
central to incorporate into practice: Health
educator, health counselor, advocate, referral
agent, developer of support groups,
coordinator of volunteers, and integrator of
faith and health. A distinctly unique role of
the FCN is as integrator of faith and health.
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B)
C)
D)
Ans:
A)
B)
C)
D)
E)
F)
Which of the following roles would be critical
to a faith community nurse to assume to
15.
achieve the goals of this practice? Select all
that apply.
Advocate
Health educator
Volunteer coordinator
Health counselor
Case manager
Direct care provider
Which of the following roles would be critical
to a faith community nurse to assume to
15.
achieve the goals of this practice? Select all
that apply.
Advocate
Health educator
Volunteer coordinator
Health counselor
Case manager
Direct care provider
A, B, C, D
Feedback:
The faith community nurse assumes seven
diverse nursing roles as essential for practice
including: health educator, health counselor,
advocate, referral agent, developer of support
groups, coordinator of volunteers, and
integrator of faith and health. Case manager
and direct care provider are not considered
roles of the faith community nurse.
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A)
B)
C)
D)
E)
F)
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A faith community health networks with a
local transportation service to provide service
16. to several clients in the community needing
rides to health care appointments. The nurse
is functioning in which of the following roles?
Developer of support groups
Referral agent
Advocate
Health counselor
B
Feedback:
The faith community health (FCN) nurse
functions as a referral agent through
networking with community agencies to assist
and guide the client through the health care
system and connect the client with needed
community resources. As a developer of
support groups, the faith community nurse
develops groups tailored to the faith
community needs such as coping with loss
and grief, cancer, caregiver stress, chronic
illness, single parenting, addiction recovery,
and more. The FCN may lead or facilitate the
support groups or may train others to fulfill
those positions. As an advocate, the FCN uses
knowledge of the health care system and
awareness of safe and effective care practices
to facilitate appropriate, timely intervention.
In the health counseling role, the nurse seeks
to understand the individual's perceptions,
fears, and barriers that prevent the person
from taking action.
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A)
B)
C)
D)
Ans:
Referral agent
Advocate
Health counselor
B
Feedback:
The faith community health (FCN) nurse
functions as a referral agent through
networking with community agencies to assist
and guide the client through the health care
system and connect the client with needed
community resources. As a developer of
support groups, the faith community nurse
develops groups tailored to the faith
community needs such as coping with loss
and grief, cancer, caregiver stress, chronic
illness, single parenting, addiction recovery,
and more. The FCN may lead or facilitate the
support groups or may train others to fulfill
those positions. As an advocate, the FCN uses
knowledge of the health care system and
awareness of safe and effective care practices
to facilitate appropriate, timely intervention.
In the health counseling role, the nurse seeks
to understand the individual's perceptions,
fears, and barriers that prevent the person
from taking action.
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B)
C)
D)
Ans:
Ans:
Place in order, the steps involved in creating a
faith community nursing position within a
faith community.
A) Seek support of the faith community
members and staff.
B) Seek formal approval from the
17. organization's governing body.
C) Assess the community the nurse plans to
serve and identify the health needs of the faith
community and the roles of the faith
community nurse that meet those needs.
D) Solicit input from the staff and spiritual
leaders of the faith community.
C, A, D, B
Feedback:
First the faith community nurse must assess
the community the nurse plans to serve and
identify the health needs of the faith
community and the roles of the faith
community nurse that meet those needs. Then
the faith community nurse must seek support
of the faith community members and staff.
Then the faith community nurse must solicit
input from the staff and spiritual leaders of
the faith community. Finally, the faith
community nurse must seek formal approval
from the organization's governing body.
community nurse that meet those needs.
D) Solicit input from the staff and spiritual
leaders of the faith community.
C, A, D, B
Feedback:
First the faith community nurse must assess
the community the nurse plans to serve and
identify the health needs of the faith
community and the roles of the faith
community nurse that meet those needs. Then
the faith community nurse must seek support
of the faith community members and staff.
Then the faith community nurse must solicit
input from the staff and spiritual leaders of
the faith community. Finally, the faith
community nurse must seek formal approval
from the organization's governing body.
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Which of the following are the main
18. categories of occupational health nursing
practice? Select all that apply.
Safety
Compliance
Health promotion
Care
B, C, D
Feedback:
Occupational health nursing practice can be
divided into three main categories:
compliance, care, and health promotion.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An occupational and environmental health
nurse recently treated approximately 20
employees for hand injuries. The employees
19. all work on the factory assembly line. The
nurse decides to implement a program for
primary prevention. Which of the following
activities would be appropriate?
Institute an orientation for employees about
the equipment
Conduct hearing screening tests of the
employees
Institute whirlpool treatments for injured
extremities
Ensure adherence to physical therapy regimen
for injured workers
A
Feedback:
Instituting an orientation program reflects
primary prevention, that is, preventing an
illness or injury from occurring. Conducting
hearing screening would reflect secondary
Institute whirlpool treatments for injured
extremities
Ensure adherence to physical therapy regimen
for injured workers
A
Feedback:
Instituting an orientation program reflects
primary prevention, that is, preventing an
illness or injury from occurring. Conducting
hearing screening would reflect secondary
level of prevention. Whirlpool treatments and
physical therapy would reflect tertiary level
activities.
C)
D)
When describing the major functions of an
occupational and environmental health nurse,
20.
which of the following would the nurse
identify as being the most time consuming?
Activities involving safety education
Care of injured employees
Programs for improved working conditions
Teaching activities for healthy nutrition
B
Feedback:
In addition to emergency care and nursing of
ill employees, the activities of many industrial
nurses involved safety education, hygiene,
nutrition, and improvement of working
conditions. Yet, a significantly high number of
industrial injuries and sick employees kept
many nurses too busy to do anything but care
for the ill.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
After teaching a group of community health
nursing students about the trends affecting
occupational and environmental health
21.
nursing, the instructor determines that more
teaching is needed when the students identify
which of the following as a trend?
Continued escalation of health care costs
Upturn in the global economy
Increase in worldwide competition
Increase in technologic hazards
B
Feedback:
Four critical issues affect the practice of
occupational and environmental health
nursing. First, the downturn in the global
economy, and in the economy of the United
States specifically, has skeletonized many
worksites, shut down companies, eliminated
night or evening shifts, or moved companies
Upturn in the global economy
Increase in worldwide competition
Increase in technologic hazards
B
Feedback:
Four critical issues affect the practice of
occupational and environmental health
nursing. First, the downturn in the global
economy, and in the economy of the United
States specifically, has skeletonized many
worksites, shut down companies, eliminated
night or evening shifts, or moved companies
to less expensive communities. Second,
increasing worldwide competition requires
businesses to remain competitive by reducing
or controlling operating costs at the lowest
level possible. Third, there has been an
increase in technologic hazards that require a
sophisticated approach as well as knowledge
of toxicology, epidemiology, ergonomics, and
public health principles. Fourth, health care
costs continue to escalate at faster rates than
most company profits do.
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B)
C)
D)
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Which activity would an occupational and
22. environmental health nurse expect to perform
in the future based on current trends?
Supervise care for emergency illnesses
Counsel employees about health risks
Perform periodic health assessments
Suggest cost-effective in-house health
services
D
Feedback:
Future occupational health nurse activities
will involve recommending more efficient
and cost-effective in-house health services.
Supervising care for emergency illnesses,
counseling employees about health risks, and
performing periodic health assessments are
current occupational and environmental
health nursing activities.
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A)
B)
C)
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A)
B)
C)
Which of the following would an
occupational and environmental health nurse
23.
need to keep in mind when selecting the field
of nursing?
The workplace is very similar to a health care
institution.
The nurse focuses on health not workforce
productivity.
Production or service is a primary goal.
Which of the following would an
occupational and environmental health nurse
23.
need to keep in mind when selecting the field
of nursing?
The workplace is very similar to a health care
institution.
The nurse focuses on health not workforce
productivity.
Production or service is a primary goal.
The nurse functions in a supervisory position.
C
Feedback:
Unlike hospitals or ambulatory care centers,
the workplace is a non-health care institution
in which production or service (not health
care) is the primary goal. The occupational
and environmental health nurse participates in
the organization's goals through activities that
contribute to the productivity of the
workforce. An occupational and
environmental health nurse in the
organization is in a staff position, taking on
the role of a consultant, educator, or role
model in the workplace, but has no
supervisory responsibilities or power to hire
or fire workers.
A)
B)
A)
B)
C)
D)
Ans:
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C)
D)
Ans:
A community health nursing student is
interviewing several occupational and
environmental health nurses about their
experiences. Each of the nurses works in a
24.
small organization and is the only nurse for
the company. Which of the following would
the student most likely note as being similar
among the nurses?
Use of critical thinking skills
Collegial relationships
Decrease in workload
Role certainty
A
Feedback:
The occupational and environmental health
nurse, especially in smaller organizations,
may be the only nurse in the company. As a
result, she or he has none of the on-site
consultation and direction that are needed for
comfortable, competent, and independent
decision making. Nurses who use critical
thinking skills to develop a framework for
independent problem-solving enhance their
efficiency. In addition, the nurse may feel
isolated because of being the only health
Collegial relationships
Decrease in workload
Role certainty
A
Feedback:
The occupational and environmental health
nurse, especially in smaller organizations,
may be the only nurse in the company. As a
result, she or he has none of the on-site
consultation and direction that are needed for
comfortable, competent, and independent
decision making. Nurses who use critical
thinking skills to develop a framework for
independent problem-solving enhance their
efficiency. In addition, the nurse may feel
isolated because of being the only health
professional. The corporate culture and
leadership may foster work overload, be
nonsupportive, and have limited career
opportunities for the nurse. The nurse may
experience role ambiguity due to a lack of
professional preparation or inadequate
orientation and continuing education.
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B)
C)
D)
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Which of the following about the educational
preparation for occupational and
25.
environmental health nursing is most
accurate?
Any licensed nurse can provide the services
necessary.
Because it is a specialty of nursing, a
Bachelor's degree in nursing is required.
Ideally, a nurse would be prepared for these
specialties at the graduate level.
This career option is restricted to advanced
practice nurses.
C
Feedback:
Ideally, a nurse would be prepared for these
specialties at the graduate level. It is a
minimum requirement that the nurse be
licensed but there is a special knowledge set
and skill set required for this position. A
Bachelor's degree in nursing is not required
for this job but would be a good start. This
career option is not restricted to advanced
practice nurses.
A)
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Which of the following are adverse working
26. conditions that may impact the health status
of nurses. Select all that apply.
Physical hazards
Radiation hazards
Biological hazards
Chemical hazards
Low pay
A, B, C, D
Feedback:
Nurses may be exposed to physical, radiation,
biological, and chemical hazards. Nursing is
not considered to be a low-paying job.
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B)
C)
D)
E)
Ans:
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After discussing the effects of shift work on
workers' health, the nurse educator knows that
27. the nursing students understand this concept
when the nursing students make which of the
following comments?
“It is beneficial for workers to have their
circadian rhythms disturbed.”
“Rotating shifts negatively impacts sleep and
rest cycles.”
“Shift work interferes with a person's social
life.”
“Insufficient sleep is associated with
respiratory problems and weight loss.”
B
Feedback:
Rotating shifts negatively impacts sleep and
rest cycles. It is not beneficial for workers to
have their circadian rhythms disturbed. Shift
work may interfere with a person's social life
but that is not a primary effect on health.
Insufficient sleep is associated with obesity
and diabetes.
A)
B)
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C)
A)
B)
C)
Which of the following statements about
28. nurse entrepreneurship in community/public
health practice is most accurate?
It allows for innovation in meeting needs of
the community.
Nurse entrepreneurs are most commonly
associated with institutions.
It is very easy for a nurse to become an
entrepreneur.
Which of the following statements about
28. nurse entrepreneurship in community/public
health practice is most accurate?
It allows for innovation in meeting needs of
the community.
Nurse entrepreneurs are most commonly
associated with institutions.
It is very easy for a nurse to become an
entrepreneur.
It is most likely to fail.
A
Feedback:
Nurse entrepreneurship allows for innovation
in meeting the needs of the community. Nurse
entrepreneurs are not most commonly
associated with institutions. It is very difficult
for a nurse to become an entrepreneur. There
may be failure in nurse entrepreneurship but
without the risk of failure, it is not possible to
advance.
A)
B)
C)
C)
D)
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Chapter 30 Home Health and Hospice Care
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D)
Ans:
The nurse educator knows that the nursing
student understands the contributions that
1. Lillian Wald made to home care when the
nursing student makes which one of the
following statements?
“Lillian Wald made the earliest known effort
to care for the sick poor at home.”
“Lillian Wald trained nurses so that wealthy
women would hire them as visiting nurses.”
“Lillian Wald began home visiting in New
York City and is famed for professionalizing
visiting nurses.”
“Lillian Wald approached congress with the
idea of Medicare Home Health Benefit.”
C
Feedback:
Lillian Wald began home visiting in New
York City and is famed for professionalizing
visiting nurses. It was the Ladies Benevolent
Society in Charleston, South Caroline who
made the earliest known efforts to care for the
sick at home. It was Florence Nightingale
who trained nurses so that wealthy women
would hire them as visiting nurses. Lillian
Wald did establish insurance coverage for
home care with the Metropolitan Life
Insurance Company but this was in the early
visiting nurses.”
“Lillian Wald approached congress with the
idea of Medicare Home Health Benefit.”
C
Feedback:
Lillian Wald began home visiting in New
York City and is famed for professionalizing
visiting nurses. It was the Ladies Benevolent
Society in Charleston, South Caroline who
made the earliest known efforts to care for the
sick at home. It was Florence Nightingale
who trained nurses so that wealthy women
would hire them as visiting nurses. Lillian
Wald did establish insurance coverage for
home care with the Metropolitan Life
Insurance Company but this was in the early
1900s and the Medicare Home Health Benefit
did not exist until 1965.
D)
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After reviewing the various events associated
with the history of home health care, the
students demonstrate understanding of the
2.
events when they state which of the following
as the most significant influence on the
growth of home care agencies?
Creation of the visiting nurse associations
Era of the Medicare Home Health Benefit
Enactment of the Balanced Budget Act
Discharge of nonacute clients
C
Feedback:
The number of Medicare-certified home care
agencies grew rapidly until enactment of the
Balanced Budget Act of 1997 that sought
explicitly to reduce federal payments for
home health care by changing the payment
from reimbursement for each visit to the
Medicare Prospective Payment System that
determined Medicare payment rates based on
client characteristics and need for services.
Visiting nurse associations, discharging of
nonacute clients, and the Era of the Medicare
Home Health Benefit had no effect on the
growth of agencies.
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A)
B)
C)
D)
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B)
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C)
Which one of the following statements best
3. describes the family caregiver burdens of
providing home care?
Family members are expected to contribute
financially to cover all of the costs of home
care.
Individuals recovering from severe illness or
living with debilitating chronic illness rely on
family members for unpaid assistance.
Informal caregivers assume a considerable
physical, psychological, and economic burden
in the care of their loved one at home.
Caregivers often describe themselves as
emotionally and physically drained.
D
Feedback:
The best description of family caregiver
burdens is that caregivers have other
responsibilities but that their caregiver tasks
compete for time, energy, and attention
leaving them emotionally and physically
drained. Informal caregivers assume a
considerable physical, psychological, and
economic burden in the care of their loved
one at home. Individuals recovering from
severe illness or living with debilitating
chronic illness rely on family members for
unpaid assistance. The other two statements
describe the burden in part but the best
description is where caregivers often describe
themselves as emotionally and physically
drained.
D)
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Ans:
A)
B)
C)
D)
Ans:
When evaluating a client's eligibility for
4. Medicare-reimbursed home care, which of the
following is crucial?
The client needs visits by a homemaker.
The client is homebound.
The client is a veteran.
The client is terminally ill.
B
Feedback:
Homebound status is a requirement and
means the person can only leave the home
with difficulty and only for medical
appointments or adult day care. Medicare
requires that the recipient of reimbursable
services need skilled services. The services of
The client is homebound.
The client is a veteran.
The client is terminally ill.
B
Feedback:
Homebound status is a requirement and
means the person can only leave the home
with difficulty and only for medical
appointments or adult day care. Medicare
requires that the recipient of reimbursable
services need skilled services. The services of
a homemaker are not considered a skilled
service and are not a requirement for
receiving services. There are no requirements
that the client be associated with the military,
either now or in the past. A client must be
considered terminally ill to receive hospice
services reimbursed by Medicare but not
home health care—the person would just
require skilled services.
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B)
C)
D)
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An instructor is describing the various types
of home health care agencies and uses the
5.
visiting nurse association as an example of
which of the following types?
Voluntary nonprofit
Hospital-based
For-profit proprietary
Noncertified
A
Feedback:
Visiting nurse associations are examples of
voluntary nonprofit agencies. Hospital-based
agencies are those involving a hospital
operating a separate department as a home
health agency. It may be nonprofit or generate
revenue for the hospital. For-profit
proprietary agencies can be governed by
individual owners, but many are part of large,
regional, or national chains that are
administered through corporate headquarters.
Many agencies providing services in the
home remain outside the federal Medicare
system that reimburses skilled nursing. These
noncertified agencies are usually private and
derive their funding from direct payment by
the client or from private insurers.
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A)
B)
C)
D)
Ans:
Assessment of a client in the home reveals
that his or her services will be paid by a
6.
government source. Which of the following
would be a possible source of payment?
Insurance company
Health maintenance organization
Medicare
Preferred provider organization
C
Feedback:
Government payers include Medicare,
Medicaid, the military health system
(TRICARE), and the Veterans Administration
system. Corporate payers include insurance
companies, health maintenance organizations
(HMOs), preferred provider organizations
(PPOs), and case-management programs.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
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A home health care nurse performs an initial
visit to a client and determines that the client
meets the criteria for services with Medicare
7.
reimbursement. The nurse understands that
this service will be reimbursed for which
period?
30 days
60 days
90 days
120 days
B
Feedback:
The Medicare prospective payment system
(PPS) pays an agency for a 60-day “episode
of care.” All services and many medical
supplies must be provided under the payment
amount adjusted to geographic location and
determined by the client's clinical and
functional status at the start of care, as well as
the projected need for services over the
anticipated 60-day period.
Quality measures are being determined for a
home health care agency. Which of the
8.
following would the agency want to achieve
higher percentage rates?
Hospital admissions
Urgent unplanned medical care
Deteriorating wound status
Decreased pain with movement
D
Feedback:
A home health care agency would want to
achieve higher percentages of the measure
involving decreased pain with movement. A
higher percentage indicates that the clients are
improving with care. The agency would want
to achieve decreased or lower percentages for
hospital admissions, urgent unplanned
medical care, and deteriorating wound status.
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A)
B)
C)
D)
Ans:
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A home health care nurse is working with
9. informal caregivers. Which of the following is
most important?
Include the client's spouse or significant other
in the plan
Visit frequently to manage and maintain
equipment
Focus on caretaker abilities, not their
limitations
Use nurse's intuition to determine what to
teach first
C
Feedback:
Keeping a positive attitude that is focused on
abilities, not limitations, of the caregivers is
most important. The home health care nurse
includes all family members and caregivers in
the plan, teaches family members and
caregivers how to manage and maintain
equipment, and chooses an area to teach first
that the client or caretaker is motivated to
learn.
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B)
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When providing home health care, which
10. individual is responsible for coordinating the
care?
Registered nurse
Social worker
Physician
Dietician
A
Feedback:
The registered nurse is considered the
coordinator of care. The social worker is
another clinical staff member but is not the
coordinator of care. The physician directs the
skilled care to clients by agreeing (signing the
nurse-generated paperwork) with the plan of
care established by the registered nurse who
coordinates the care. The dietician is another
clinical staff member but is not the
coordinator of care.
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A)
B)
C)
D)
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A)
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B)
C)
D)
Ans:
When visiting a client in the home for the first
11. time, which of the following is absolutely
critical to remember?
There may be dangers lurking around every
corner.
Clients are glad to have the nurse in their
home.
The nurse is a guest in the client's home.
The nurse knows what is best for the client.
C
Feedback:
Once the nurse arrives at the client's home,
there is the challenge of getting through the
closed door and making the connection. The
nurse must always remember that he or she is
a guest in the home. Although there may be
dangers, the nurse must focus on the client
while maintaining a watchful eye. Clients
may be apprehensive or suspicious about a
nurse coming to visit, wondering why or what
they did. Not all clients are welcoming. The
nurse needs to start where the client and
family are, not what the nurse thinks is best.
A home health care nurse reviews the most
common conditions managed at home. Which
12. of the following are the most common
conditions managed at home? Select all that
apply.
Chronic skin ulcer
COPD
Heart failure
Terminal cancer
Diabetes
A, C, E
Feedback:
The most common diagnoses managed at
home are diabetes, chronic skin ulcer,
essential hypertension, heart failure, and
osteoarthritis
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A)
B)
C)
D)
E)
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A)
B)
C)
D)
Ans:
When developing the plan of care for a client
receiving home health care services, which of
13.
the following would be the most important
goal?
Promotion of client independence
Complete resolution of the problem
Detecting family conflicts
Ensuring access to resources
A
Feedback:
The most important goal of home health care
is to promote independence and selfmanagement. Every effort is made to develop
the capacity for self-care so that the home
team can safely withdraw. Complete
resolution of the problem in many cases is
unrealistic. Detecting family conflicts and
ensuring access to resources are areas that the
nurse addresses and intervenes if necessary to
promote the ultimate goal of self-care.
When providing palliative care to a client
14. receiving hospice care, which of the following
would be important? Select all that apply.
Assume nothing about what is wrong
Use the most complex interventions first
Believe what the client is reporting
Be persistent in trying different strategies
Wait until the symptoms recur to relieve them
A, C, D
Feedback:
When providing palliative care, the nurse
should make no assumptions about what is
wrong; believe the client's report of
symptoms; anticipate the symptoms and
relieve them before they recur; choose the
least complex and most manageable
interventions that clients and families can
manage themselves at home; and never give
up, but persist in trying different palliative
strategies.
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B)
C)
D)
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A)
B)
C)
D)
E)
Ans:
The family of a hospice client is holding a
vigil at the client's bedside. During a visit, a
hospice nurse participates in this vigil and
15.
encourages each of the family members to say
their good-byes. The nurse is demonstrating
which of the following?
Palliative care
Guided letting go
Connecting
Responsive use of self
B
Feedback:
Guiding letting go is a truly unique nursing
practice that involves helping the client to let
go of former activities and hopes, including
life itself. This involves listening to intense
emotions and helping the person and family
find resolution. Sometimes it involves
participating in a vigil at the bedside of the
dying person and encouraging loved ones to
say their final words of farewell. Palliative
care involves the relief of suffering without
curing the underlying disease. Connecting
refers to the centrality of relationships in
providing hospice care as the nurse seeks to
understand the emotional and spiritual distress
common to the end of life. Responsive use of
Guided letting go
Connecting
Responsive use of self
B
Feedback:
Guiding letting go is a truly unique nursing
practice that involves helping the client to let
go of former activities and hopes, including
life itself. This involves listening to intense
emotions and helping the person and family
find resolution. Sometimes it involves
participating in a vigil at the bedside of the
dying person and encouraging loved ones to
say their final words of farewell. Palliative
care involves the relief of suffering without
curing the underlying disease. Connecting
refers to the centrality of relationships in
providing hospice care as the nurse seeks to
understand the emotional and spiritual distress
common to the end of life. Responsive use of
self is the process expert nurses use to
understand the lives of vulnerable clients in
the community resulting in stereotypes and
assumptions being overturned.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
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As part of a group exercise, students are to
compare and contrast home care and hospice
care. The instructor determines that the
16.
activity was successful when the students
identify which of the following as reflective
of home health care?
Emphasis on rehabilitation
Focus on health of the whole family
Expert use of opioids for suffering
Management of symptoms
A
Feedback:
Home health care emphasizes rehabilitation
and stabilization of the client whereas hospice
emphasizes the quality of life and comfort.
Focusing on the whole family, expert use of
opioids for suffering and management of
symptoms are features associated with
hospice care. In contrast, home health care
focuses on the health of the client; opioids are
used hesitantly to reduce suffering; and
symptom management may require
hospitalization if unmanageable.
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A)
B)
C)
D)
Ans:
A home health care nurse is assigned to visit a
client's home. The nurse identifies the area as
17. a problem neighborhood. Which of the
following would be most appropriate for the
nurse to do?
Perform the visit via telephone
Have another nurse buddy along
Reschedule the visit for another time
Leave the cell phone at home
B
Feedback:
If there is a question of safety, the nurse
should have another nurse accompany him or
her on the visit. It would be inappropriate to
perform the visit over the telephone. The
nurse needs to physically see the client to
perform the assessment. The agency typically
has policies about how soon after a referral
the client must be seen. So, rescheduling the
visit may not be an option. In addition,
rescheduling the visit does nothing to address
the safety issues. The nurse should carry his
or her cell phone but leave any valuables,
such as cash, wallet, or purse locked in the
care.
A)
B)
C)
D)
Ans:
A home health care nurse is invited as a guest
speaker to talk to a group of students about
challenges of working in the home. As part of
18. the discussion, the nurse describes medication
safety. Which of the following would the
nurse include as a measure to address this
issue?
Asking the client what he or she takes the
drug for
Throwing out any medications over 1 month
old
Reconciling drugs in the home with those on
the discharge sheet
Setting up medication boxes to organize the
medications
C
Feedback:
It is important for the home health care nurse
to reconcile the medications in the client's
home with those on the discharge sheet. If
B)
old
Reconciling drugs in the home with those on
the discharge sheet
Setting up medication boxes to organize the
medications
C
Feedback:
It is important for the home health care nurse
to reconcile the medications in the client's
home with those on the discharge sheet. If
there are any discrepancies, then the nurse
should contact the client's primary care
physician to clarify any differences and
confirm the orders. Asking the client what he
takes the drug for provides limited
information. The nurse needs to know if he or
she is taking it currently, and if so, the
frequency and dosage. Throwing out any
medications that are over 1 month old is
inappropriate. A medication may have been
ordered previously but was inadvertently
missed on the discharge sheet. The nurse must
always double check the order and with the
physician about any medication. Setting up
medication boxes are helpful to organize the
medications, but the nurse still needs to verify
that the client should be taking the
medication.
C)
D)
D)
Ans:
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C)
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B)
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Ans:
When describing the philosophy of hospice
19. care to a group of students, which of the
following would the instructor include?
The right to die and euthanasia
Working with people in their last year of life
Holistic and family-centered care to
terminally ill clients
Weaving hospice concepts around curative
treatment
C
Feedback:
The philosophy of hospice care includes
holistic and family-centered care to terminally
ill clients. Hospice care is delivered to
terminally ill people with the recognition that
death is a human experience. Euthanasia is
not part of the care. Hospice care can be
initiated after a physician has declared that a
person has 6 months or less to live. Hospice
care is initiated in the final phase of a person's
illness when he or she is not receiving
curative treatment.
C)
terminally ill clients
Weaving hospice concepts around curative
treatment
C
Feedback:
The philosophy of hospice care includes
holistic and family-centered care to terminally
ill clients. Hospice care is delivered to
terminally ill people with the recognition that
death is a human experience. Euthanasia is
not part of the care. Hospice care can be
initiated after a physician has declared that a
person has 6 months or less to live. Hospice
care is initiated in the final phase of a person's
illness when he or she is not receiving
curative treatment.
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
After teaching a group of students about
hospice and its view of end-of-life care,
20.
which statement by the students indicates a
need for additional teaching?
Care should attend to the body, mind, and
spirit.
Death is not considered a taboo topic.
Medical technology should be used widely.
Clients have a right to truthful discussion.
C
Feedback:
The hospice movement has emphasized four
major changes in end-of-life care: (1) care
should attend to body, mind, and spirit; (2)
death must not be a taboo topic; (3) medical
technology should be used with discretion;
and (4) clients have a right to truthful
discussion and involvement in treatment
decisions.
A client will receive hospice care under the
Medicare Hospice Benefit. The nurse
21.
understands that which of the following is
true?
The client denies terminal prognosis.
The client has a prognosis of at least 6 months
of life.
The client chooses life-extending care.
The hospice acts as clinical and financial case
manager.
D
Feedback:
The Medicare Hospice Benefit requires that a
client, who has a prognosis of 6 months or
less, must sign up for the comfort-focused
The client has a prognosis of at least 6 months
of life.
The client chooses life-extending care.
The hospice acts as clinical and financial case
manager.
D
Feedback:
The Medicare Hospice Benefit requires that a
client, who has a prognosis of 6 months or
less, must sign up for the comfort-focused
hospice benefit and waive the regular hospice
benefit. This mandates that the client
acknowledge a terminal prognosis and choose
comforting care instead of life-extending care.
When this choice is made, the hospice
coordinates care in all settings, functioning
both as clinical and financial case manager.
B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When describing the role of hospice nurses to
22. a group of students, a hospice nurse identifies
which of the following as most important?
Speaking the truth
Sustaining oneself
Encouraging choice
Strengthening the family
B
Feedback:
Although speaking the truth, encouraging
choice and strengthening the family are key
interventions of a hospice nurse, sustaining
oneself is the priority. Effective hospice
nurses understand that to care for others, they
must care for themselves because without a
healthy nurse, the client cannot thrive.
Which of the following Medicare definitions
prevent people who could benefit from home
care services from receiving those services,
23. even when it would be most cost effective for
the client to receive home care rather than
more expensive emergent and inpatient
interventions? Select all that apply.
Home-bound status
Medical necessity
Prospective payment
Skilled nursing
A, B, D
Feedback:
The entire model for service provision in the
home must change to a health care delivery
system that continuously serves those living
with disabling and terminal illness to
Home-bound status
Medical necessity
Prospective payment
Skilled nursing
A, B, D
Feedback:
The entire model for service provision in the
home must change to a health care delivery
system that continuously serves those living
with disabling and terminal illness to
maximize well-being at home, anticipate and
prevent crises, and minimize emergent and
inpatient interventions. The Medicare
definitions of homebound, medical necessity
and skilled nursing must become extinct.
Which one of the following Medicare policies
prevent people who could benefit from
hospice services from receiving those
24.
services, even when it would be most costeffective for the client to receive hospice
rather than inpatient interventions?
Controlled cost at the expense of assuring
quality of life and comfort
That a person must discontinue treatment in
order to receive hospice service.
Education and support for clients and family
caregivers
Refusing to pay for homemaking and personal
care that might keep a person at home as long
as possible
B
Feedback:
The Medicare requirement that patients
receiving hospice benefits must have
discontinued treatment in order to receive
hospice service. It is not appropriate for there
to be controlled cost at the expense of
assuring quality of life and comfort.
Education and support for clients and family
caregivers is important, and homemaking and
personal care might keep a person at home as
long as possible that would reflect a cost
savings in the long run.
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