Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 01: Health: A Community View
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes the primary reason that Americans are concerned about health care?
a. Politicians are discussing how to improve health care.
b. The media has provided mixed messages about the health care system.
c. Our national health care costs keep increasing.
d. The new health care system offers free services to Americans.
ANS: C
The primary reason for the focus on health care is the constantly increasing costs, which
cannot be sustained. The costs of caring for the sick accounted for the majority of escalating
health care dollars, which increased from 5.7% of the gross domestic product in 1965 to
17.8% in 2015. Politicians and the media both influence Americans’ perceptions about health
care; however, they are not the primary reason why Americans are concerned. The new health
care system will change the health care access and availability, but will not necessarily be
offering any free services to Americans.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse has begun to lobby with politicians for changes to the health care system. Why is this
involvement important?
a. Nurses, as central characters in several popular TV series, are currently very
visible in American media.
NURSIfor
M various units in our health care
NGmanaging
TB.COthe
b. Nurses are primarily responsible
system.
c. Nurses are the largest segment of health care providers.
d. Nurses are the only group that is employed both inside and outside of hospitals.
ANS: C
As the largest segment of health care providers, nurses are informed about the current health
care system and all the problems that result from people not seeking care until they are
desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually
believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to
our current health care delivery system, can also be instrumental in working politically to
create a health care delivery system that will meet health needs. While nurses are in several
current TV series and are employed both inside and outside of hospitals, physicians and other
health care providers are as well. Nurses are often managers, but managers often have other
backgrounds, such as business administration.
DIF: Cognitive Level: Understand (Comprehension)
3. What conclusion can be drawn from examining where nurses are employed?
a. There is a trend toward consolidation of health care into large central medical
centers.
b. There is an increased emphasis on community-based health care.
c. There is an obvious need to decrease health care costs by cutting positions.
d. Managed care organizations (MCOs) are employing nurses to improve customer
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
relations.
ANS: B
MCOs are employing nurses in many capacities. Although hospitals are closing and acute care
is increasingly found in central medical centers, the same trend may be seen in an increase in
neighborhood-based practice centers. While positions are cut in most industries, health care is
recognized as an area where growth in employment is expected. However, nurses are
increasingly employed in community settings as opposed to hospitals. This change reflects the
move toward community-based care rather than hospital-based tertiary care. To help decrease
the continued rise in health care costs, the increased emphasis is on disease prevention rather
than high-cost treatment.
DIF: Cognitive Level: Understand (Comprehension)
4. Which ethical belief would be most helpful in the current health care crisis?
a. Emphasis should be on individual and corporation freedom in the marketplace.
b. Emphasis should be on individual autonomy and freedom of choice.
c. Emphasis should be on social justice and collective responsibility.
d. Emphasis should be on the effectiveness of technology in resolving problems.
ANS: C
Public health recognizes the necessity of collective action in keeping the environment safe and
in egalitarian tradition and vision. An overinvestment in technology and seeking of cures
within the market justice system has stifled the evolution of a health system to protect and
preserve the health of the population. Although individual autonomy and freedom of choice
are important, so is the recognition of collective responsibility in ensuring social justice,
which entitles all people to basic necessities.
NURSINGTB.COM
DIF: Cognitive Level: Apply (Application)
5. What is the primary problem seen in Healthy People 2020’s emphasis on choosing healthy
lifestyle behaviors, such as daily exercise or healthy food choices?
a. Emphasis on other lifestyle choices, such as not smoking and minimal use of
alcohol or drugs, is also needed.
b. All of us must work together to make unhealthy behaviors socially unacceptable.
c. It costs more to make healthy choices, such as buying and eating fresh fruits and
vegetables as opposed to quick and cheap fast-food choices.
d. Public policy emphasizes personal responsibility but ignores social and
environmental changes needed for well-being.
ANS: D
Although all responses are accurate, the primary problem is the emphasis on personal choices
in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for
community responsibility and action that addresses environmental or cultural restraints to
health.
DIF: Cognitive Level: Apply (Application)
6. What responsibility does the American Nurses Association (ANA) Code of Ethics require of
the nurse beyond giving excellent care to patients?
a. Accept longer work schedules to ensure that professional care is always available
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
to clients.
b. Recognize the need for experienced nurses to mentor new graduates to help
increase and expand the number of professionals available.
c. Support health legislation to improve accessibility and cost of health care.
d. Volunteer to work overtime as needed to ensure maximum quality of care.
ANS: C
The ANA Code of Ethics promotes social reform by focusing on health policy and legislation
to positively affect accessibility, quality, and cost of health care. The code does not directly
address workplace issues, such as work schedules or need for overtime.
DIF: Cognitive Level: Analyze (Analysis)
7. What is the community health nursing definition of health?
a. Health is a person’s goal-directed purposeful process toward well-being or
wholeness.
b. Health is an individual’s physical, mental, and social well-being, not merely the
absence of disease or infirmity.
c. Health is the mutual adaptation between a person and his or her environment in
meeting daily existence.
d. Health is families and aggregates choosing actions to ensure safety and well-being.
ANS: D
The text stresses that health is not just the result of an individual’s choices, but choices and
actions of individuals, families, groups, and communities that lead to better health.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
8. How does community health nursing define community?
a. A group of persons living within specific geographic boundaries
b. A group of persons who share a common identity and environment
c. A group of persons who work together to meet common goals
d. A group of persons who resolve a community concern
ANS: B
Community health nurses work with both geopolitical groups (within specific geographic
boundaries) and phenomenological groups (who have a common identity based on culture,
history, or goals). A particular phenomenological group may or may not have been a planned
group—that is, a group that came together to resolve a recognized common problem or to
meet a common goal. However, of all the choices, a group of persons who share a common
identity (phenomenological group) and environment (which implies a specific geographic
setting) is the broadest and most complete definition.
DIF: Cognitive Level: Apply (Application)
9. Which variable has a major influence on a community’s health?
a. Behavior choices made by persons in the community
b. Number of health care providers and hospitals in the community
c. Quality of the public safety officers (police officers, firefighters, etc.)
d. The number and credentials of public health officials in the community
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Individual behavior choices are responsible for about 50% of health outcomes. Individual
choices are affected through interaction with other individuals, and their mutual social and
physical environments. The number of health care providers has not played a major role in the
health outcomes in the community in comparison to individual health behaviors. The quality
of public safety officers and number of public health officials have not been identified as
major contributors to the determinants of health.
DIF: Cognitive Level: Apply (Application)
10. What change could most effectively lead to a longer life span in Americans?
a. Parenting and sexual behavior classes in all public school systems
b. Legislation restricting alcohol and drug use
c. Notably reducing speed limits on all state and federal highways, and changing the
age limit for driving to 21 years of age
d. The belief that smoking is shameful and disgusting, as well as expensive,
becoming the social norm
ANS: D
Smoking is responsible for almost 20% of all deaths in the United States. Although smoking
is an individual’s choice, all people are affected by social norms. Parenting and sexual
behavior classes and legislative changes may influence health, but may not necessarily lead to
a longer lifespan. Community health nurses should recognize that health is influenced by a
web of factors, some that can be changed and some that cannot. Influencing social norms may
better promote change among Americans.
DIF: Cognitive Level: Apply (Application)
NUR
B.COinMthe United States today?
SI
NGT
11. What is the health issue causing
the
most
concern
a. Diabetes epidemic
b. Increase in cardiac disease
c. Increase in obesity
d. Rise in cancer rates
ANS: C
The widespread increase in incidence of overweight and obesity has led to calls for
population-based measures to address this issue. The overarching problem of obesity has led
to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there
should be in a decrease in the other health issues.
DIF: Cognitive Level: Understand (Comprehension)
12. What factors are most responsible for the increasing length of life of Americans over the past
100 years?
a. Better nutrition and family planning options
b. Education concerning the need to reduce salt and fat in the diet
c. Improved medical care, including exciting new technologies
d. More efficient cancer screenings and early intervention
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Average increased life span over the past 100 years can be largely attributed to higher
standards of living, better nutrition, a healthier environment, and having fewer children.
Public health efforts such as immunization and medical care have also contributed.
DIF: Cognitive Level: Understand (Comprehension)
13. Why would a public health nurse want to know about morbidity and mortality statistics on the
local, state, and national level?
a. To be able to share current trends in health problems with the community
b. To be able to observe the community’s statistics over time and compare the
community with other communities
c. To justify local budgets and the need for increased income from citizens
d. To publicize current health issues and suggest appropriate actions to citizens
ANS: B
Although being informed and being able to educate the public is always preferred and nurses
often do have to justify budgets, data are needed to compare the local community with itself
over time and with other communities so that problems may be recognized and action taken to
confront health issues. The first step is always to recognize problems as they develop.
DIF: Cognitive Level: Apply (Application)
14. How do public health efforts differ from medical efforts in improving the health of our
citizens?
a. Medical care providers autonomously choose appropriate interventions, whereas
public health care providers must engage in whatever actions legislation requires.
b. Medical care providers are self-employed or agency employed, whereas public
GTand
B.C
URSINby
OMthrough the government.
health care providers are N
employed
paid
c. Medical care providers focus only on individuals, whereas public health care
providers focus only on aggregates.
d. Medical care providers focus on disease diagnosis and management, whereas
public health care providers focus on health promotion and disease prevention.
ANS: D
Medical care providers are restricted by insurance and government regulations. Providers may
also be employed in government facilities, such as Veterans Administration facilities.
However, medical care providers primarily focus on diagnosis and treatment of disease,
whereas public health care providers try to promote health and prevent disease. Although
medical care providers primarily focus on individuals and public health care providers
primarily focus on aggregates, their practice is not limited to only individuals or only
aggregates.
DIF: Cognitive Level: Apply (Application)
15. Which primary prevention would the school nurse choose to address the school’s number of
unwed pregnancies?
a. Create a class on parenting for both the moms-to-be and the dads-to-be.
b. Convince the school board to allow sex education classes to include birth control
measures.
c. Employ the moms-to-be as 1-hour-a-day employees in the school daycare center
for children born to school students.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Establish a class where all the unwed moms-to-be can learn infant care.
ANS: B
Primary prevention relates to activities directed at preventing a problem before it occurs by
altering susceptibility or reducing exposure for susceptible individuals. Primary prevention
consists of two elements: general health promotion and specific protection. Health promotion
efforts enhance resiliency and protective factors and target essentially well populations.
Specific protection efforts reduce or eliminate risk factors. Although all choices would be
appropriate actions in a school, only education regarding sexuality and birth control would
help prevent future pregnancies.
DIF: Cognitive Level: Apply (Application)
16. What would be the proper term for the action of the school health nurse arranging for all the
students in the elementary school to receive H1N1 immunizations?
a. Health education
b. Secondary prevention
c. Specific protection
d. Tertiary prevention
ANS: C
Immunizations are a specific protection effort as part of primary prevention. Primary
prevention relates to activities directed at preventing a problem before it occurs by altering
susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of
two elements: general health promotion and specific protection. Health promotion efforts
enhance resiliency and protective factors and target essentially well populations. Specific
protection efforts reduce or eliminate risk factors. Secondary prevention refers to early
NURS
INGthe
detection and prompt intervention
during
period
TB.C
OMof early disease pathogenesis. Tertiary
prevention targets populations that have experienced disease or injury and focuses on
limitation of disability and rehabilitation. Health education would relate to educating the
students about the immunization not making the arrangements for the immunization to be
given.
DIF: Cognitive Level: Understand (Comprehension)
17. Which action would probably result in the largest change in health care outcomes for
Americans?
a. Establish large numbers of scholarships for education of nurses, physicians, and
other health care providers.
b. Fund a one-time extremely large stimulus to allow all health care providers and
agencies to create and integrate computer network systems for client health care
records.
c. Increase funding for hospitals and medical centers to expand their neighborhood
clinics.
d. Redirect a large portion of federal funding from acute care to health promotion
activities.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Of the choices given, health promotion activities would make the largest difference. Increased
expenditures on acute care will not notably change the health of the population, whereas
funding that addresses health promotion such as education and safe environments would
improve the health of the aggregate.
DIF: Cognitive Level: Apply (Application)
18. Which task will be most helpful in meeting the public health agency’s goals?
a. Complete staff evaluations in preparation for individual meetings to plan their
agency and individual goals for the next year.
b. Actively participate in community agencies’ collaborative action plan to meet the
community’s health goals for the year.
c. Meet with the college of nursing faculty to finalize student objectives and
schedules for the next semester.
d. Teach a free course in healthful living for community residents.
ANS: B
Although all tasks may be necessary and important, intra-agency cooperation to meet the
health goals of the community as a whole is more central to the agency’s mission than other
choices that meet the needs of individuals or groups rather than the community as a whole.
DIF: Cognitive Level: Analyze (Analysis)
19. A community health nurse is overwhelmed with all that needs to be done in one day. Which
task could most easily be postponed?
a. Reviewing the most recent hospital patient data collected by the local college of
nursing
NU
RSINnew
GTB.C
M
b. Deciding which of several
possible
clinicOoptions
would be most effective in
better meeting the needs of the local community
c. Evaluating the results of the most recent community-wide screening program
before planning for the next community health program
d. Giving testimony to the state legislature on a new health and safety bill
ANS: A
All of the tasks are related to assessing needs, implementing new care options, or evaluating
health outcomes measures in the community except reviewing hospital patient data. Hospital
patient data may be helpful but not directly related to the agency’s ability to promote primary
health and prevent disease.
DIF: Cognitive Level: Analyze (Analysis)
20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit
to make a home visit to a patient who had been discharged the previous day and to give
follow-up care (for overload pay). What kind of nursing would this nurse be doing?
a. Acute care hospital nursing
b. Community-based nursing
c. Community health nursing
d. Public health nursing
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere
in the community. Community-based nursing practice refers to “application of the nursing
process in caring for individuals, families and groups where they live, work or go to school or
as they move through the health care system” (McEwen and Pullis, 2009, p. 6).
Community-based nursing is setting specific, and the emphasis is on acute and chronic care
and includes such practice areas as home health nursing and nursing in outpatient or
ambulatory settings. As the nurse is not focusing on the health of the community but on an
individual, it is not community or public health nursing. It is not acute care hospital nursing
because the nurse is seeing the patient in his or her home.
DIF: Cognitive Level: Apply (Application)
21. Which task is most crucial for the community health nurse to do well?
a. Review the most recent morbidity and mortality data.
b. Create a new clinic to better meet local health needs.
c. Evaluate the results of the recent screening program.
d. Give testimony regarding proposed state health legislation.
ANS: D
Public health’s core functions are assurance, assessment, and policy development. Giving
testimony regarding legislation directly reflects policy development, which would have a
wider impact than the other options, which are more local and narrow in focus.
DIF: Cognitive Level: Analyze (Analysis)
22. A new public health nurse carefully assessed all the local mortality and morbidity data in
preparation for making appropriate planning suggestions at a meeting next week. What other
NURcan
SIfeel
NGprepared?
TB.COM
action is crucial before the nurse
a. Ask other nursing staff their perceptions of the community’s needs.
b. Assess the nurse’s own assets, strengths, and ability to contribute.
c. Meet members of the community to determine their culture and values.
d. Review discussions and decisions from previous meetings.
ANS: C
Community health nurses must work with the community. It is essential to assess an
aggregate’s needs and resources and identify its values. The best way to do this is by meeting
with the members of the community to determine their culture and values. Assessing one’s
own assets, asking other nursing staff, and reviewing previous discussions will not allow the
nurse to assess the needs of the community.
DIF: Cognitive Level: Apply (Application)
23. Why are high-risk and vulnerable subpopulations identified by public health nurses before
deciding on appropriate interventions?
a. It is easiest to make improvements among these groups.
b. Populations are not homogeneous, and resources are limited.
c. Such groups are most vocal about their needs and wants.
d. These groups are often recipients of special funding.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Populations are not all the same. The needs of subpopulations must be assessed. The high-risk
and vulnerable subpopulations must be identified early. Those individuals who do not receive
service early become very expensive high-cost users later.
DIF: Cognitive Level: Understand (Comprehension)
24. A nurse works hard to develop alliances among various community organizations toward
improving health in the community. What are actions such as this called?
a. Building coalitions
b. Collaboration
c. Communication
d. Community cooperation
ANS: A
By definition, the nurse’s actions are coalition building. Although collaboration has a very
similar meaning, Table 1.4 stresses that collaboration is focused more on enhancing the
capacity of an individual or a group. The nurse is establishing cooperative alliances, but not
yet working with them toward a goal.
DIF: Cognitive Level: Understand (Comprehension)
25. After completing a master’s degree, a nurse took a course in marketing. Should the agency
reimburse the nurse’s tuition costs?
a. No, courses taken for personal enjoyment are not eligible.
b. No, courses taken outside the professional’s responsibilities are not eligible.
c. Yes, the nurse is demonstrating professional commitment by continuing education.
d. Yes, the nurse could use such information in social marketing for the agency.
ANS: D
NURSINGTB.COM
Social marketing tools using marketing principles and technologies are designed to influence
the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information
would be extremely helpful for agency personnel in improving community health and lifestyle
choices.
DIF: Cognitive Level: Apply (Application)
26. Which factor is most responsible for differences in an individual’s health?
a. Culture of the majority of the community’s citizens
b. Individual’s education and income
c. Number of physicians and other health care providers in the community
d. Quality of the community health agency and hospital in the community
ANS: B
Factors that contribute to wide variations in health disparities are education, income, and
occupation. This is best addressed by looking at an individual’s education and income. The
culture, number of physicians, and quality of agencies in the community do not play as
important of a role in individual health.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
1. What are the leading health indicators found in Healthy People 2020? (Select all that apply.)
a. Financial issues
b. Health system issues
c. Individual behaviors
d. Issues related to legal and illegal immigration
e. Legislative issues
f. Physical and social environmental factors
ANS: B, C, F
Ten leading health indicators are identified in Healthy People 2020, including individual
behaviors, physical and social environmental factors, and health systems issues. Financial
issues, issues related to legal and illegal immigration, and legislative issues are not found in
Healthy People 2020.
DIF: Cognitive Level: Understand (Comprehension)
2. What historically have been public health nurses’ two most important priorities? (Select all
that apply.)
a. Establishing school nursing to improve care of children
b. Engaging in political activity to improve living conditions
c. Giving superb clinical bedside care in the home
d. Increasing funding to public health efforts
e. Teaching family members how to care for their family
f. Working with the community to confront health issues and poverty
ANS: B, F
NU
RSINnursing
GTB.C
M
Neither administering bedside
clinical
norOteaching
family members to deliver care in
the home has adequately addressed the true determinants of health and disease. The early
public health nurses resolved that collective political activity should focus on improving
social and environmental conditions such as poverty.
DIF: Cognitive Level: Understand (Comprehension)
3. Based on Healthy People 2010, what are the two primary goals of Healthy People 2020?
(Select all that apply.)
a. Eliminate health disparities.
b. Expand health promotion activities in every community.
c. Improve funding, including diverting funds from other priorities to health care.
d. Improve health outcomes measures to be more consistent with other developed
nations’ outcomes.
e. Increase quality and years of healthy life.
f. Reduce mortality and morbidity figures nationwide.
ANS: A, E
As published, the two goals are to increase quality and years of healthy life and eliminate
health disparities. Expanding health promotion activities in every community, improving
funding and improving health outcomes, and reducing mortality and morbidity are not the
primary goals of Healthy People 2020.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 02: Historical Factors: Community Health Nursing in Context
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes the time period when communities began to agree on collective action to
stay healthy?
a. When industrialization occurred
b. When large urban centers began to develop and the population expanded
c. When people gathered together to settle in villages
d. When people were nomads engaged in hunting and gathering
ANS: D
Primitive prehistorical societies had health practices to ensure their survival. Isolation and
fumigation were used for thousands of years. This time period is best described by when
people were nomads engaged in hunting and gathering. Industrialization, development of
large urban centers, and settlement into villages do not describe this time period.
DIF: Cognitive Level: Understand (Comprehension)
2. Which best describes the first measures used by large communities to ensure community
health?
a. Building safe sewage disposal systems
b. Healthy food choices and exercise
c. Praying to the gods for preservation
d. Use of medicine and other herbal remedies
ANS: A
NURSINGTB.COM
In classical times, large cities grew, and elaborate drainage systems were constructed. In
Leviticus, the Hebrews formulated the first hygiene code. This hygiene code protected water
and food by creating laws that governed personal and community hygiene, such as contagion,
disinfection, and sanitation. This is best described through the building of safe sewage
disposal systems. Healthy food choices and exercise, praying to the gods for preservation, and
the use of medicine and other herbal measures were not among the first measures used by
large communities to ensure health.
DIF: Cognitive Level: Understand (Comprehension)
3. A nurse has determined that there is always a consistent level of people in the population who
experience pneumonia. Which best describes the prevalence of this disease?
a. Prevalent
b. Endemic
c. Epidemic
d. Pandemic
ANS: B
By definition, when diseases are always present in a population they are called endemic.
Diseases which were occasionally present and often fairly widespread are called epidemic.
Pandemic is used to describe the existence of a disease in a large proportion of the population.
Prevalent means widespread, and would not be the best term to describe this disease.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
4. Which best describes an innovation introduced by the Romans?
a. Citizenship duties
b. Immunizations
c. Hospitals and nursing homes
d. Daily exercise
ANS: C
The Romans introduced many health innovations such as fresh water, public physicians,
hospitals, surgeries, infirmaries, and nursing homes. Unfortunately, these services were only
for the wealthy. Citizenship duties, immunizations, and daily exercise were not innovations
introduced by the Romans.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best describes a modern public health practice that was originally developed as a
means of self-protection from the Black Death (bubonic plague)?
a. Care in a hospital
b. Chemical intervention
c. Isolation and quarantine
d. Herbal remedies
ANS: C
Modern public health practices, such as isolation, disinfection, and ship quarantines, emerged
in response to the bubonic plague. Care in a hospital was originally developed by the Romans.
Chemical intervention and herbal
were notMused to self-protect from the Black
NURremedies
INGTB.C
S
O
Death.
DIF: Cognitive Level: Understand (Comprehension)
6. Which disease provided immunity to smallpox?
a. Cowpox
b. Measles
c. Mumps
d. Scarlet fever
ANS: A
Those that had an infection of cowpox were thereafter immune from smallpox, which was
endemic and killed about 10% of the population. Measles, mumps, and scarlet fever did not
provide immunity to smallpox.
DIF: Cognitive Level: Understand (Comprehension)
7. A scholar during the Sanitary Revolution created medical topographies. What was the
advantage of these surveys?
a. Citizens knew which wells were safe to use for drinking water.
b. People knew what housing areas to avoid.
c. Results demonstrated geographical factors related to regional disease.
d. The king could isolate areas of disease from safe areas.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: C
Survey methods were being used to study health problems. The medical topographies
illustrated geographical factors related to regional health and disease. They did not address the
safety of wells, housing areas, or the isolation of disease.
DIF: Cognitive Level: Understand (Comprehension)
8. How did Edwin Chadwick’s ideas help decrease disease in the nineteenth century?
a. The minimum wage was increased leading to improved quality of life.
b. Parish workhouses where poverty-level children labored for their room and board
were closed.
c. Social reform legislation resulted in changes such as sidewalks.
d. The new emphasis on individual responsibility encouraged people to act to protect
their own health.
ANS: C
Edwin Chadwick’s Report on the Sanitary Conditions of the Labouring Population of Great
Britain led to legislation for social reform, including child welfare, factory management, clean
water, sewers, fireplugs, and sidewalks. This report did not address increasing the minimum
wage, closing parish workhouses, or increasing individual responsibility.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best describes how John Snow was able to decrease deaths from cholera?
a. Removed a source of contaminated water
b. Created the world’s first antibiotic
c. Encouraged the new process of vaccination
NURShome
INGquarantine
d. Helped pass laws that required
TB.COM
ANS: A
John Snow demonstrated that cholera was transmissible through contaminated water. He
removed the pump handle from the contaminated water so an alternate source of water had to
be used. Alexander Fleming created the first antibiotic. Legislators were responsible for
encouraging the new process of vaccination and passing laws related to home quarantine.
DIF: Cognitive Level: Understand (Comprehension)
10. Which best describes the achievement that Lemuel Shattuck is well known for in the United
States?
a. Publishing the census of Boston, which demonstrated the effect of sanitary reforms
b. Demonstrating the usefulness of vital statistics by analyzing environmental data
c. Developing ideas about public health care reform, which were eventually adopted
d. Establishing a state board of health to deal with the problems he had noted
ANS: C
Lemuel Shattuck organized the American Statistical Society and issued a census, which
demonstrated high mortality rates. His report of the Massachusetts Sanitary Commission
recommended modern public health reforms. However, nothing was actually done about the
recommendations for almost two decades. Eventually, the merit of his ideas was recognized.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
11. Which nursing intervention would have most likely been used by Florence Nightingale when
treating wounded soldiers?
a. Establishing private visits with spouses
b. Improving food, clothing, and cleanliness
c. Administering intravenous medications
d. Completing a community assessment of the army hospital
ANS: B
Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens
and a laundry and provided food, clothing, dressings, and laboratory equipment. Her focus on
environmental improvements did not address private spousal visits, administration of IV
(intravenous) medications, or completion of a community assessment.
DIF: Cognitive Level: Understand (Comprehension)
12. Which best describes how Nightingale responded to challenges about her suggestions for
reform of health care?
a. She influenced male friends as political leaders to publicize her ideas.
b. She conveyed her statistical data in more detail and depth, and shared it with
political leaders.
c. She encouraged those who challenged her to come up with more acceptable
approaches to lowering the death rate.
d. She understood their concerns and tried to word her suggestions in a more
politically acceptable way.
ANS: B
Nightingale felt very strongly about the unnecessary loss of life and shared her findings
NUleaders
RSINchallenged
GTB.COher
M conclusions, she rewrote her report in
widely. When prominent male
more depth and redistributed it to members of Parliament and military leaders.
DIF: Cognitive Level: Understand (Comprehension)
13. When comparing a surgeon today with a surgeon of Nightingale’s time, which best describes
the primary difference in how they would operate on a patient?
a. Current physicians have better surgical equipment (tools).
b. Current physicians have nursing support staff in the operating room.
c. Current physicians would carefully scrub between cases.
d. Current physicians would prescribe antibiotics in the operating room.
ANS: C
Physicians in Nightingale’s time believed in spontaneous generation, which stated that disease
organisms grew from nothing, and were unaware of how diseases spread. Consequently, they
did not use sanitary operating procedures, including scrubbing between cases. The different
surgical equipment, nursing support, and use of antibiotics do not describe the primary
difference.
DIF: Cognitive Level: Apply (Application)
14. Which scientific belief or idea eventually changed medical practice and decreased morbidity
and mortality?
a. Bad fluids cause disease, which can be cured by their removal.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. Specific contagious organisms cause disease.
c. Spontaneous generation theory—disease grows naturally.
d. The miasmic theory—environmental conditions cause disease.
ANS: B
The emergence of the germ theory of disease focused diagnosis and treatment on the
individual organism and the individual disease. The theories related to bad fluids causing
disease, spontaneous generation, and miasmic theory were all proven to be incorrect.
DIF: Cognitive Level: Understand (Comprehension)
15. Why did local and state governments start to become more involved in controlling disease?
a. Hospitals were becoming overcrowded.
b. Businesses were unable to make a profit when employees were ill.
c. Physicians demanded government support in their individual efforts.
d. Citizens were becoming upset with local conditions.
ANS: D
Community outcry for social reform forced state and local governments to take notice of
deplorable conditions and take more responsibility for controlling the spread of bacteria and
other microorganisms. Hospital overcrowding, unprofitability of businesses, and physician
demand for government support did not influence the increased involvement of local and state
governments.
DIF: Cognitive Level: Understand (Comprehension)
16. Which intervention was the first step in controlling the incidence of tuberculosis (TB)?
a. Institutions were requiredNto R
report
INTB
GTcases.
B.COM
U
S
b. Federal funding was devoted to seeking TB causes and cures.
c. Physicians began surveillance of TB cases.
d. States built large public hospitals to treat patients with TB.
ANS: A
Physicians fought being required to maintain surveillance of TB and TB health education.
States had to build large state hospitals for treatment but that did not notably control the
incidence. The New York City Health Department required institutions to report cases of TB
in 1894 and required physicians to do the same by 1897.
DIF: Cognitive Level: Understand (Comprehension)
17. Which best describes the overall result of Abraham Flexner’s report?
a. All medical schools reorganized into the German model.
b. Citizens were encouraged to become more involved in medical education.
c. Folk healers again became more widely used than physicians.
d. Funding was withdrawn from weak medical schools.
ANS: D
Funding was withdrawn such that scientifically inadequate medical schools closed, not
reorganized into the German model. The Flexner report outlined shortcomings of weak
schools that were not built on the German model of a scientific base. Physicians now emerged
who had been taught the germ theory of disease. The report did not address citizen
involvement in medical education or the increased use of folk healers.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
18. Which group was primarily responsible for the establishment of the first school of public
health?
a. The American Medical Association
b. The Association of State Departments of Public Health
c. The federal government
d. The Rockefeller Foundation
ANS: D
Philanthropic foundations influenced many health care efforts. The Rockefeller Sanitary
Commission strived for the eradication of hookworm. This model of prevention was so
successful that the Rockefeller Foundation established the first school of public health in
1916.
DIF: Cognitive Level: Understand (Comprehension)
19. A family living in England in 1860 was part of the community where district nursing was
implemented. Who would most likely have seen this family?
a. A social worker and a nurse
b. A health teacher and a nurse
c. A nurse
d. A physician and a nurse
ANS: A
A nurse and a social worker were assigned to each district to meet the needs of their
communities in nursing, social
health
This plan was widely accepted and
NUwork,
RSIand
GT
B.Ceducation.
M
N
O
very successful.
DIF: Cognitive Level: Apply (Application)
20. Which intervention was most helpful in assisting people become educated on healthful living
in nineteenth-century England?
a. Brochures were distributed without charge in public places.
b. Health visitors joined nurses in providing care in the homes.
c. Nurses spent the majority of their time teaching families.
d. Schools set up health programs for neighborhood adults.
ANS: B
Health pamphlets alone had little effect, so health-visiting services enlisted home visitors to
distribute health information to the poor. Eventually, although Nightingale thought district
nurses should be the health teachers, district nurses provided care for the sick while the health
visitor provided health information in the home.
DIF: Cognitive Level: Understand (Comprehension)
21. Which best describes the district nursing service created in the United States by Lillian Wald
and Mary Brewster?
a. House on Henry Street
b. Visiting Nurses Association
c. New York City District Nursing Service
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Wald and Brewster Nursing Service
ANS: A
They established a district nursing service on the Lower East Side of New York City called
the House on Henry Street for all the unemployed and homeless immigrants who needed
health care. It later evolved into the Visiting Nurse Association of New York City and helped
establish public health nursing in the United States.
DIF: Cognitive Level: Understand (Comprehension)
22. Which statement best summarizes Wald and Brewster’s approach to home nursing?
a. “All services all the time”
b. “Helping people to help themselves”
c. “One person, one family, at a time”
d. “Your home or ours”
ANS: B
The nursing service adopted the philosophy of meeting health needs of aggregates including
social, economic, and environmental determinants of health. This aggregate approach
empowered people of the community. A later director summarized their role as “one of
helping people to help themselves.” Because they were empowering others, the other
statements do not fit this philosophy.
DIF: Cognitive Level: Understand (Comprehension)
23. Which did Lillian Wald help establish?
a. Child employment centers with shortened work days
b. Daycare centers for preschool-aged
NURSINchildren
GTB.COM
c. Nurseries for infants of working mothers
d. School health nursing for school-aged children
ANS: D
Wald convinced the New York City Health Commissioner to put a public health nurse into a
school. The experiment was so successful that schools adopted nursing on a widespread basis,
thereby creating the field of school health nursing. Child employment centers, daycare
centers, and nurseries for working mothers were not created by Wald.
DIF: Cognitive Level: Understand (Comprehension)
24. Which statement best summarizes the view of nurses as seen in novels over the past 100
years?
a. Nurses are and have always been seen as very strong intelligent women.
b. For the past 50 years, nurses were primarily viewed as promiscuous women.
c. Nurses are controlling, almost sadistic women who enjoy their power over
patients.
d. Nurses are obedient handmaidens to physicians, following whatever orders are
given.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In the early 1900s novels began to depict strong, independent, female nurses. This continued
until the 1960s and 1970s when they were presented very negatively as promiscuous “bed
hopping honeys.” Popular literature showed the most negative image of nurses, and classics
and children’s literature showed a more positive image.
DIF: Cognitive Level: Understand (Comprehension)
25. Which best describes the primary focus of health care efforts in the United States?
a. Acute illnesses and trauma
b. Chronic diseases
c. Diarrhea and starvation
d. Infectious diseases
ANS: B
Whereas diarrhea, starvation, and infectious diseases are major causes of death in developing
countries, in developed countries such as the United States, chronic diseases are the primary
cause of mortality.
DIF: Cognitive Level: Understand (Comprehension)
26. Which statement best describes why there is an increased need for advanced practice nurses in
primary care?
a. Clinics are being built in many middle-class neighborhoods.
b. Hospitals are increasing their number of beds.
c. More nurses are choosing to obtain master’s degrees.
d. Most physicians are specialists.
ANS: D
NURSINGTB.COM
In 2010, about two thirds of the active physicians in the United States were specialists.
Because so many physicians are specialists and there is increasing demand for primary care
providers, there are increased opportunities for advanced practice nurses in primary care.
Hospitals are decreasing the number of beds, not increasing them. The need does not relate to
clinics being built in middle-class neighborhoods or to nurses choosing to advance their
education.
DIF: Cognitive Level: Understand (Comprehension)
27. Which statement best explains the continued incidence of infectious disease in the United
States today?
a. Illness theory explains that there are many causes of illness resulting from
environmental conditions.
b. No single theory adequately explains why a particular person gets a particular
illness at a particular time.
c. The germ theory explains that a specific infection is caused solely by the invasion
of particular bacteria.
d. The theory of susceptibility states that an individual only gets ill when there is
extensive stress in his or her life.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Each theory explains some disease under some conditions, but no single theory accounts for
all disease. Infectious agents cause disease when a person is susceptible as a result of stress
and/or environmental conditions. The definition of germ theory is correct; however, this does
not best explain the continued incidence of infectious disease in the United States. Illness
theory is not a major theory that is used to discuss incidence of infectious disease.
DIF: Cognitive Level: Apply (Application)
28. Which best describes the primary concern both historically and today for many people when
they become ill?
a. Can they get an appointment to see their physician in a timely fashion?
b. Can they get admitted to their local hospital without delay?
c. How can they afford to take time off from work and lose pay to be ill?
d. Will the expenses be covered by their health insurance?
ANS: C
The greatest health concerns at the beginning of the twentieth century were lost wages
associated with sickness. This continues today as many employment positions do not have
sick leave; if employees are not at work, they do not get paid. All illnesses do not require a
visit to a physician or admission to a hospital. Historically, the public has not paid much
attention to health care charges as health care insurance from third party reimbursement has
been the payer for many health care services.
DIF: Cognitive Level: Analyze (Analysis)
29. Which statement best describes the increase in life expectancy among Americans during the
twentieth century?
Nby
B.C
a. Life expectancy increased
UR30
SIyears;
NGTthe
OM can be attributed to advances
majority
in medical technology.
b. Life expectancy increased by 30 years; the majority can be attributed to public
health efforts.
c. Life expectancy increased by 30 years; the majority can be attributed to improved
physician education.
d. Life expectancy increased by 30 years; the majority can be attributed to increased
access to care.
ANS: B
During the twentieth century, the health and life expectancy of persons living in the United
States improved dramatically. It is important for nurses to realize that of the 30 years of life
expectancy gained during the century, 25 years were attributable to public health efforts. The
advances in medical technology, improved physician education, and increased access to care
have not had the impact on increasing life expectancy that the public health efforts have had.
DIF: Cognitive Level: Understand (Comprehension)
30. Which is a major challenge for health care provider education today?
a. Ensuring that research findings related to families and groups are included in the
curriculum
b. Expanding the curriculum to allow additional experiences in community health
settings outside the hospital
c. Increasing course emphasis on environmental influences on health
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Refocusing the curriculum from care of the individual to needs of aggregates
ANS: D
There is an obvious need for a primary care curriculum that prepares students to meet the
needs of aggregates through population-based strategies that include understanding of
statistical data and epidemiology. Primary health care and health promotion rather than acute
care treatment would be emphasized. Such a curriculum would move the focus from the
individual to a broader population approach.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which tool(s) were used by Florence Nightingale to create change? (Select all that apply.)
a. Her incredible beauty and personality
b. Influence of all the nurses Nightingale trained
c. Political advocacy
d. Publication of treated soldiers’ death rate changed from 42% to 2%
e. Use of statistics to demonstrate the effectiveness of her interventions
f. Wealth of her family and relatives
ANS: C, D, E
Nightingale focused on the aggregate of British soldiers and used graphically depicted
statistics and other data to demonstrate effectiveness of her interventions, which allowed her
to become a political advocate on behalf of the soldiers. Nightingales’ beauty and personality,
influence among nurses, and wealth were not tools used to create change.
NUR(Comprehension)
SINGTB.COM
DIF: Cognitive Level: Understand
2. Which of Nightingale’s ideas were forgotten until recently? (Select all that apply.)
a. The need for education for women
b. The influence of environment on health
c. The importance of clinical practice for expertise to develop
d. The need to recognize gender role limitations
e. The problem-solving (nursing) process
f. The use of statistics and a sound research base
ANS: B, F
As the text remarks, it is interesting to note that the paradigm for nursing education and
practice did not incorporate her emphasis on statistics and a sound research base. It is also
curious why her writing on health’s social and environmental determinants was not consulted
until much later. Nightingale did not make issue with the need for education for women,
importance of developing expertise through clinical practice, gender roles, or the
problem-solving (nursing) process.
DIF: Cognitive Level: Apply (Application)
3. Which best describes why folk healers are used by many people? (Select all that apply.)
a. Folk healers are often effective.
b. Folk healers do not charge for their efforts.
c. Folk healers integrate religion and medicine.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Folk healers use media very effectively.
e. Folk healers may involve the whole family.
f. Many physicians recommend folk healers.
ANS: A, C, E
Folk healers offer repeated success, as many of their medicines are effective; their healing
practices are socially cohesive, often including family and neighbors; and folk healers often
integrate religion and morality with medicine. Folk healers usually have a charge for their
services. Folk healers may or may not be using media to promote their services. Most
physicians do not recommend folk healers.
DIF: Cognitive Level: Understand (Comprehension)
4. What current emphases are focusing attention on public health? (Select all that apply.)
a. Cost containment and managed care models
b. Focus on disease prevention and health promotion
c. Increased funding for care of chronic diseases
d. Liberal politicians encouraging public health as part of a national health reform
e. Movies showing national disasters and government lack of preparedness
f. Shortage of the H1N1 flu vaccine
ANS: A, B
With a current focus on cost containment and organization of health care services under
managed care, the emphasis is increasingly on the community and public health. The
community need for a focus on prevention, health promotion, and home care may become
more widespread with the changing patterns of reimbursement. Holistic care requires multiple
dimensions and must have more attention in the future. Unfortunately, funding has not
NURSIare
increased, politicians and legislation
focused
NGnot
TB.C
OMon public health, and there has not been
an emphasis on movies showing national disasters and lack of government preparedness.
DIF: Cognitive Level: Understand (Comprehension)
5. Which were the chief factors that led to the creation and growth of health insurance plans?
(Select all that apply.)
a. Hospitals banded together, and their leaders encouraged such plans.
b. Hospitals thought such a plan would allow them to expand further and faster.
c. It was an employer alternative to increasing employee pay compensation.
d. Nurses fought for the right of all citizens to purchase insurance as desired.
e. Physicians were concerned with nonpayment of their office fees.
f. Politicians encouraged this alternative to government-supported health care.
ANS: A, C
Physicians later sought insurance plans, but originally only hospitals created insurance plans
based on American Medical Association (AMA) leadership encouragement. During World
War II increasing salaries was not an option, so offering health insurance helped ensure
employee retention. Although government-supported health plans were suggested as early as
the 1930s, politicians were not seriously discussing government-supported care.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 03: Thinking Upstream: Nursing Theories and Population-Focused Nursing
Practice
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which statement best summarizes Lillian Wald’s achievements?
a. She suggested new nursing specialties.
b. She demonstrated how to improve health in communities.
c. She gave expert clinical nursing care to her clients.
d. She was appointed a national nursing leader.
ANS: B
Lillian Wald improved health in a community by using diplomacy and neighborhood power.
She was elected president of a national nursing organization and created new nursing
specialties such as school nursing. However, she is primarily known for her creation of Henry
Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably
improved health in many communities.
DIF: Cognitive Level: Understand (Comprehension)
2. Which statement best describes “thinking upstream”?
a. Modifying economic, political, and environmental factors
b. Preparing for nursing career long-term goals by planning now
c. Seeking causes of water and air pollution “upstream” from cities
d. Trying to understand how or why someone got ill
NURSINGTB.COM
ANS: A
Upstream thinking actions focus on modifying economic, political, and environmental factors
that are the precursors of poor health throughout the world.
DIF: Cognitive Level: Understand (Comprehension)
3. Which statement best describes a weakness of early nursing theories?
a. Many nurses did not know or understand the theoretical basis of nursing practice.
b. Most nursing theories focused on microscopic individual concerns.
c. The theories did not reflect the actual world of nursing practice.
d. The theories had global applicability to nursing practice.
ANS: B
Most nursing theories have an extremely narrow focus on individual nurse–patient care
situations. This microscopic focus ignores the broader global social macroscopic perspective.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes the primary purpose of nursing theory?
a. To improve nursing practice
b. To demonstrate that nursing is a profession
c. To organize nursing knowledge
d. To serve as a basis for ongoing nursing research
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A
Although nursing theory does serve as a basis for ongoing research, does help demonstrate
that nursing is a profession, and may help nurses organize their knowledge; its primary
purpose is to improve nursing practice.
DIF: Cognitive Level: Understand (Comprehension)
5. A client did not attend the clinic for required follow-up care after his extensive surgery. Using
the Health Belief Model, which would be the most appropriate conclusion for the nurse to
make?
a. The client is noncompliant.
b. The client is suffering from self-neglect.
c. The health care system is not meeting the client’s perceived needs.
d. The health care system is not accessible for the client.
e. The nurse has not motivated the client appropriately.
ANS: C
Although it is easy to blame the patient for being noncompliant or neglecting himself or
herself, or to blame the nurse for not “educating” the patient appropriately, it is equally
plausible that the health care system is not meeting the client’s perceived needs. Clients can
have many reasons for not keeping an appointment, such as family emergencies, lack of
funds, or lack of transportation. Sociocultural and ethnic barriers can also be factors. This is
part of the Health Belief Model where the premise is that the world of the perceiver
determines the action.
DIF: Cognitive Level: Apply (Application)
NURS
INGdifficult
6. Which assumption makes Orem’s
theory
TB.COtoMuse?
a. That nurses will always be caring for families and groups
b. That clients are able to control their environment
c. That clients recognize the need for nursing intervention
d. That teaching clients self-care is the primary goal of nursing practice
ANS: B
Orem’s theory emphasizes self-care not the need for nursing intervention. It assumes that the
client can control his or her environment, whereas most persons cannot control work, school,
or neighborhood environments. Orem’s theory is focused on individual self-care. The primary
focus of nursing practice is on self-care needs and activities.
DIF: Cognitive Level: Understand (Comprehension)
7. Which statement best describes the major assumption of the Health Belief Model (HBM)?
a. People will act if action is both easy and convenient.
b. People will act if exposed to fear messages stressing their vulnerability.
c. The major determinant of preventive health behavior is avoiding disease.
d. The major determinant of preventive behavior is providing proper health
education.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The HBM is based on the assumption that the primary reason people act is disease avoidance.
Such avoidance means they perceive themselves as susceptible to a serious disease, there is
some cue to action, and there are more benefits than barriers to acting.
DIF: Cognitive Level: Understand (Comprehension)
8. Which assumption of the Health Belief Model (HBM) is problematic?
a. People have both free will and access to health resources.
b. People listen to the advice given by health care professionals.
c. People are influenced by health messages given over media channels.
d. People make what they perceive as rational decisions in a given situation.
ANS: A
The HBM assumes that people have access to health resources, but such resources are not
always available to certain groups. Economic, political, and environmental constraints
interfere with free choice. The HBM may effectively promote behavior change by altering the
patient’s perspectives, but it does not acknowledge the health professional’s responsibility to
reduce health care barriers. The HBM places the burden of action exclusively on the client.
DIF: Cognitive Level: Understand (Comprehension)
9. A nurse is using Milio’s framework for prevention to improve the health of clients. Which
would the nurse most likely implement?
a. Create appropriate national health policies.
b. Develop health programs that make healthy choices the easiest choices.
c. Promote nationwide educational programs with information on making healthy
choices.
NURSIfor
d. Stress that clients are responsible
NGtheir
TB.C
OM
own
health.
ANS: A
The range of available choices is critical in shaping a society’s overall health status. Policy
decisions in governmental and private organizations shape these choices. Hence,
national-level policy making is the best way to impact the health of most Americans rather
than continue to concentrate on imparting information in an effort to change individual
behaviors. Milo challenged the notion that the main determinant for unhealthful behavior
choice is lack of knowledge.
DIF: Cognitive Level: Apply (Application)
10. A nurse is using Milio’s approach when caring for a client. Which advantage will the nurse
experience?
a. It will allow for care interventions outside the hospital system.
b. It will demonstrate the effectiveness of using a variety of community resources.
c. It will encourage the assessment of the personal and societal resources of the
client.
d. It facilitates open communication between the client and the nurse.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
As the model focuses on sociopolitical and environmental constraints to a client’s free choice,
it also encourages assessment of such constraints, as well as suggesting alternative avenues to
helping the patient obtain needed care. Milio encourages the practice of nursing from a broad
understanding of health and illness.
DIF: Cognitive Level: Apply (Application)
11. Which health-related variable is examined by the critical theoretical perspective?
a. Cultural beliefs
b. Effect of history and tradition
c. Ethnic and racial differences
d. Social inequalities
ANS: D
Critical theoretical perspective examines social inequalities within the broader political,
economic, and social systems of society that keep people from reaching their full potential.
Cultural beliefs, the effect of history and tradition, and ethnic and racial differences are not
examined by the critical theoretical perspective.
DIF: Cognitive Level: Understand (Comprehension)
12. A nurse is using the critical theoretical perspective in daily nursing practice. Which activity
would the nurse most likely complete?
a. Criticize health insurance programs as a barrier to health care.
b. Expose social values underlying the health care system.
c. Promote individual freedom and decision-making.
d. Exert control over the client’s environment.
ANS: B
NURSINGTB.COM
Improvements can only be made if societal and personal values are made explicit. Once these
values are recognized, they are more easily confronted. Change may be sought toward a more
just society. Society must change for health and medical care to improve. Inequities of health
care are connected to historically located social arrangements and cultural values of society.
DIF: Cognitive Level: Apply (Application)
13. A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the
community. Which strategy would the nurse most likely implement?
a. Address the root causes of health problems.
b. Choose one of the 28 focal areas for emphasis in funding and media attention.
c. Concentrate on the goals of improving the quality of life.
d. Continue funding expansion of the health care system.
e. Expand efforts to put all medical records on electronic media.
ANS: A
The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social,
economic, political, and value-laden processes of daily life that affect health (social
determinants of health). Based on Healthy People 2020, advances are needed in these areas in
order to improve health.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
14. Which is most closely associated with morbidity and mortality outcomes?
a. Number of physicians per capita
b. Insurance status
c. Crime rate
d. Personality traits
ANS: B
Tremendous disparities for access exist between insured and uninsured people in the United
States. Access to care is associated with economic, social, and political factors, and depending
on individual and population needs, it can be a primary determinant of health status and
survival. Structural variables such as race-ethnicity, educational status, gender, and income
are highly predictive of health status.
DIF: Cognitive Level: Understand (Comprehension)
15. A nurse has accepted a new position in a public health department. Which characteristic is
crucial to the nurse’s success?
a. Advanced educational preparation
b. Being knowledgeable about the community’s needs
c. Listening and showing respect
d. Caring and empathetic personality
ANS: C
Rather than nursing to the community, the nurse must work with the community to be
successful. Listening, being patient, providing accurate information, and respecting the
experiences of community members are essential for success.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
16. A nurse is using a macroscopic approach when providing care. Which would the nurse most
likely demonstrate?
a. Emphasizing behaviors that will help in healing
b. Examining the family’s responses to illness
c. Explaining how these actions will help in healing
d. Providing testimony to legislators concerning proposed legislation
ANS: D
All the choices focus on individual client care (microscopic) except for the nurse who is
politically involved as demonstrated by providing testimony relevant to proposed legislation
(macroscopic).
DIF: Cognitive Level: Apply (Application)
17. A nurse is using Milio’s framework to promote healthy eating choices among members of the
community. Which intervention would the nurse most likely implement?
a. Provide community education about healthy food choices.
b. Promote legislation to increase taxation on unhealthy food choices.
c. Lobby for health insurance providers to pay for participation in health promotion
programs.
d. Encourage community members to be responsible for making healthy choices.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
One of the propositions of Milio’s framework is that alteration in patterns of behavior
resulting from decision-making of a significant number of people in a population can result in
social change. Some behaviors, such as tobacco use, have become difficult to maintain in
many settings or situations in response to organizational and public policy mandates.
Increasing taxation on unhealthy food choices may make it more difficult for community
members to make these unhealthy choices.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. A nurse has a broad, aggregate focus when providing care to clients. Which best describes
how this approach will help improve client outcomes? (Select all that apply.)
a. Ensures that collaborative efforts of many professionals will be used
b. Confirms the individual’s responsibility for resolving the health problem
c. Empowers decision-making based on both individual and community goals, needs,
and priorities
d. Enables the nurse to ask for assistance from other community professionals
e. Encourages allocation of time for population-focused preventive efforts
f. Upholds professional nursing standards of care
ANS: C, E
Having a broader focus will help both nurse and patient make appropriate decisions.
Unfortunately, it cannot ensure that others will help. Ideally, it will help both parties recognize
that health problems are not just an individual’s responsibility but often a result of
environmental, sociopolitical, and economic factors as well. Encouraging the nurse to allocate
NURSpromotion
INGTB.C
time for population-focused health
efforts
OM will also help the nurse’s individual
clients over the long term.
DIF: Cognitive Level: Apply (Application)
2. A community health nurse is using the Health Belief Model (HBM) as a basis for providing
client care. Which best describes the problems associated with using the HBM? (Select all
that apply.)
a. It ignores the need to reduce health system barriers to action.
b. It is extremely difficult to change the client’s belief system.
c. It is the nurse’s responsibility to persuade clients to engage in the appropriate
behavior.
d. Clients do not have the knowledge to correctly analyze the seriousness of the
disease or their susceptibility to it.
e. Clients expect health professionals to take preventive actions for them.
f. The choice and the burden for acting are entirely with the client.
ANS: A, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
A major problem with this model is that the burden for taking action is totally with the client.
The model requires health professionals to assume responsibility for modifying the client’s
perceptions so they recognize the need to act. Although the line between persuading and
educating is a fine one, nurses are responsible for education. Persuasion may border on
coercion. Further, the model assumes that all responsibility is personal, ignoring barriers in
the health care system, which may make it difficult for an individual to take appropriate
action.
DIF: Cognitive Level: Apply (Application)
3. A nurse is using the critical theoretical perspective in practice. Which best describes how the
nurse would respond when a client suggests that the physician prescribe a widely advertised
medication for tension and anxiety? (Select all that apply.)
a. Can you tell me what is going on in your life right now?
b. Do you know anyone else who is suffering such tension and anxiety?
c. How does your family feel about you having so much tension and anxiety?
d. Would you consider using the generic equivalent of this medication?
e. What led you to believe this medication would be of help to you?
f. What have you tried in the past to relieve tension and anxiety?
ANS: A, F
The best answer is to ask what is going on in the client’s life at that moment because
situational stresses often occur to everyone. Next, asking what previously has been effective
in relieving the symptoms may suggest more appropriate actions than medication. Although
generics would be less expensive than brand-name medication, medication should not be the
first approach to resolving a symptom before even examining why the symptom is occurring.
N R I GTB.COM
S N
DIF: Cognitive Level: Analyze U
(Analysis)
4. According to the critical theoretical perspective, which should be held responsible for many of
the illnesses of Americans today? (Select all that apply.)
a. Advertisers who market sugar- and fat-saturated food products
b. Alcoholic beverage manufacturers, marketers, and sellers
c. Manufacturers of products that increase morbidity and mortality
d. Corporations who modify their emission rates
e. Restaurants that attempt to keep meal costs low
f. Tobacco manufacturers who sponsor sports events
ANS: A, B, C, F
McKinlay (1979) further delineated the activities of the “manufacturers of illness—those
individuals, interest groups, and organizations which, in addition to producing material goods
and services, also produce, as an inevitable byproduct, widespread morbidity and mortality”
(pp. 9, 10). The manufacturers of illness embed desired behaviors in the dominant cultural
norm and thus foster the habituation of high-risk behavior in the population. The
manufacturers of illness include everyday examples such as the tobacco industry, the alcohol
industry, and multiple corporations that produce environmental carcinogens. The existing U.S.
Health Care System, in a misguided attempt to help, devotes its efforts to changing the
products of the illness manufacturers and neglects the processes that create the products.
DIF: Cognitive Level: Analyze (Analysis)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 04: Health Promotion and Risk Reduction
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse reviewed information before meeting with the community residents who were
attending a program on healthful living. Which best describes the action by the nurse?
a. Disease prevention
b. Health promotion
c. Health improvement
d. Specific protection
ANS: B
Health promotion is any combination of health education and related support for health
behaviors. It is not specific protection or disease prevention because no specific disease is
being avoided. Although healthful living may indeed improve health, there is nothing to
suggest the attendees were not currently healthy.
DIF: Cognitive Level: Apply (Application)
2. A 50-year-old woman comes to the clinic for her first mammogram. Which best describes the
action of this client?
a. Disease prevention
b. Health improvement
c. Health protection
d. Primary health promotion
ANS: C
NURSINGTB.COM
Health protection is used to detect disease in its early state or maximize health within the
constraints of disease. Unfortunately, screening will not prevent disease. Screenings are a
secondary health promotion—not a primary health promotion.
DIF: Cognitive Level: Apply (Application)
3. Which is the best definition of health?
a. A goal and a resource for living
b. A lack of disease or illness
c. Complete state of well-being
d. Freedom from pain or discomfort
ANS: C
Health was originally defined as a lack of illness or disease. More recently, health has been
defined as a state of complete physical, mental, and social well-being. Today, health’s
definition is based on the realization that health allows one to realize aspirations, to satisfy
needs, and to change or cope with the environment. Health is a goal but also a resource for
living.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. A nurse was becoming frustrated. She had given her client extensive information on his health
problem, but the client continued to be noncompliant in making needed changes. Which
principle had the nurse forgotten?
a. A person may have a higher priority than improving his or her health.
b. Information, while necessary, will not motivate people to change.
c. People need repetition over time to be able to absorb information.
d. Physicians, not nurses, are perceived as experts in health.
ANS: B
Information alone is rarely enough to motivate a person to act. Information is necessary to
know what to do and how to do it before the person chooses to act, but other factors are
primarily responsible for motivating people to change their behavior. Although other priorities
may result in delay of change, the fact that the client has returned to the nurse demonstrates
interest in changing. Repetition may be helpful, but apparently the nurse has given
information on more than one occasion because she believes extensive information has been
given.
DIF: Cognitive Level: Apply (Application)
5. The nurse working with a client to change behavior to maximize health asked the client to
bring his family to the next visit. Which best describes why the nurse wants the family to
come with the client?
a. To analyze the family’s beliefs about health
b. To determine the family’s support of the client
c. To establish the family’s communication patterns
d. To evaluate the family’s approval of the proposed changes
ANS: D
NURSINGTB.COM
Under the Theory of Reasoned Action, it is assumed that all behavior is determined by
intentions, which are determined by attitude toward the behavior and the norms associated
with the behavior. That in turn is determined by whether or not important persons approve or
disapprove of the behavior. The family’s beliefs about health, support of the client, and
communication patterns are irrelevant if the family does not approve of the changes that have
been proposed.
DIF: Cognitive Level: Apply (Application)
6. A nurse is using the theory of reasoned action when working with a client to exercise on a
regular basis. Which would be the easiest way for the nurse to determine if the client will
engage in this activity?
a. The client’s intention to exercise regularly
b. The client’s perception of the threat of illness if he doesn’t exercise regularly
c. Society’s emphasis on the importance of regular exercise
d. The pros and cons of regular exercise
ANS: A
The theory of reasoned action attempts to predict a person’s intention to perform or not
perform a certain behavior based on the assumption that all behavior is determined by one’s
behavioral intention. The client’s perception of the threat of illness, the opinion of society, and
benefits of regular exercise are not major factors discussed using the theory of reasoned
action.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
7. A nurse is using the theory of planned behavior when working with a client to change her
behavior and improve her health. Which consideration should be made by the nurse?
a. If environmental limitations may prevent the person from acting
b. The availability of needed environmental supports for the client
c. The client’s belief about factors that may facilitate or impede the behavior
d. If the suggested behavior is actually the most effective approach
ANS: C
The theory of planned behavior stresses that perceived control is a major factor in whether or
not the client performs the behavior. Thus, the nurse needs to understand the client’s beliefs
about factors that may facilitate or impede the behaviors. Using this theory, the environment
is not considered as a major factor in client change, nor is the analysis as to if the behavior is
the most effective approach.
DIF: Cognitive Level: Apply (Application)
8. Some people believe that the air within their workplace makes them ill. Which premises
support this belief?
a. They consistently feel worse on workdays and weeks without holidays.
b. There has been media coverage of “sick buildings” where there is very little air
exchange with fresh air outside.
c. Research has demonstrated that some buildings emit poisonous vapors that make
anyone who works there ill.
d. When a small group of persons begins to believe something, the others in the
NURitSasIwell.
NGTB.COM
larger group begin to believe
ANS: A
As the question discusses risk, the textbook states that the risk factor must precede the
problem and that the problem would increase with exposure. Feeling ill only on workdays
would imply that some factor in the workplace is responsible. The media coverage, research
related to poisonous vapors, and “group think” responses do not address the fact that the
repeated exposure to the risk factor may be what is making them ill.
DIF: Cognitive Level: Apply (Application)
9. It is rumored that there is something in the workplace that is causing persons employed there
to feel ill. Which action would be most appropriate for the nurse to take?
a. Ask researchers to set up a study to confirm the health hazard in the environment.
b. Assess the risk, including identifying any toxic substance.
c. Confirm the extent to which the illness resulted from intergroup agreement on the
illness and cause.
d. Insist that the media not further spread stories of possible sick buildings until the
truth of the situation can be studied.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The media report news; they do not create it without any basis. Researchers are not asked to
confirm a preconceived conclusion but to seek what factors are active in a situation. “Group
think” is a well-known phenomenon, but one would have to ask what led the communication
leaders to believe originally that there was a hazard in the environment. Risk assessment in a
questionable situation begins with identifying a possible hazard and describing the risk.
DIF: Cognitive Level: Analyze (Analysis)
10. Which risk factors are least subject to modification?
a. Choice of lifestyle behaviors
b. Environmental exposure
c. Nutritional options
d. Recreational activities
ANS: B
An individual may choose to control lifestyle behaviors, nutrition choices, and recreational
options. An individual cannot alone control his or her neighborhood, employment setting, or
other environmental exposures.
DIF: Cognitive Level: Understand (Comprehension)
11. Which best describes why risk reduction is of such importance in the United States today?
a. Families suffer when family members die from avoidable causes.
b. Risk reduction activities will decrease insurance costs to individuals and their
employers.
c. The leading causes of death are all related to lifestyle choices.
d. Risk reduction can decrease the ongoing rise in national health care expenditures.
ANS: C
NURSINGTB.COM
Approximately 50% of annual U.S. deaths occur as a result of modifiable lifestyle factors. The
leading causes of death with the highest mortality are all related to lifestyle factors. A change
in these factors will also reduce health care expenditures and insurance costs for those persons
with insurance. However, unnecessary deaths are even more important.
DIF: Cognitive Level: Apply (Application)
12. Which is the cause of most preventable deaths in the United States?
a. Alcohol
b. Drug addictions
c. Sexually transmitted diseases
d. Tobacco
ANS: D
Smoking is the leading cause of preventable deaths, accounting for about one out of every five
deaths.
DIF: Cognitive Level: Understand (Comprehension)
13. A nurse is completing a health history with a client. Which question would be most important
to include?
a. How many alcoholic drinks do you have in a day?
b. How many sexual partners have you had in the past month?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. What nonprescription drugs do you take on a routine basis?
d. What kinds of tobacco do you use daily?
ANS: D
As smoking is the leading cause of preventable deaths, accounting for about one out of every
five deaths, it is crucial that tobacco use be queried in each health history. After asking about
tobacco use, the others should also be included in a health history.
DIF: Cognitive Level: Analyze (Analysis)
14. During a health history, the client looked confused and said, “But everybody drinks, like at
parties and such. How much drinking do you think is too much?” Which would be most
appropriate response by the nurse?
a. “Alcohol should be used only in moderation.”
b. “It’s okay as long as you don’t binge, and you eat food with your drinks.”
c. “Per day, no more than one drink for women and two drinks for men.”
d. “Total abstinence is the only healthy choice.”
ANS: C
Because most Americans drink alcohol, it is probably not effective to teach total abstinence.
Alcohol in moderation is not a specific answer to the client’s question. The Dietary Guidelines
for Americans suggest no more than one drink for women and two drinks for men per day,
which is a specific response to the client’s question.
DIF: Cognitive Level: Apply (Application)
15. Which best describes the reason why so many Americans are obese?
a. Culture requires eating atNcelebrations
holidays.
RSINGTand
B.C
U
OM
b. For many people, caloric intake is more than needed for their physical activity.
c. Physical education is no longer a required subject in most elementary and
secondary schools.
d. The expected portion size in restaurants has vastly increased over time.
ANS: B
Although many factors have led to obesity in American society—including cultural pressure,
increased portion sizes in restaurants (portion distortion), offers of more food at a reduced
price (“super-size”), and a perceived lack of time to cook nutritious inexpensive foods—the
primary cause remains the consumption of more calories than needed for physical activity.
With computers and television as recreational choices, Americans are as a group sedentary
rather than physically active.
DIF: Cognitive Level: Understand (Comprehension)
16. Based on statistics, which group is probably more physically active?
a. A group of adults living in the southern U.S. states
b. A group of elderly mall walkers
c. A group of high school graduates employed in blue collar occupations
d. A group of highly paid college graduates
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Research has shown that those with higher levels of education and higher income enjoy
physical activity more. Those of mature age, with less education, with less income, and/or
living in the southern U.S. states engage in far less activity.
DIF: Cognitive Level: Understand (Comprehension)
17. A young couple is searching for a home in a new neighborhood. Which neighborhood would
most likely promote a healthy lifestyle?
a. One near a large active military base
b. One with excellent health facilities nearby
c. One with high walkability
d. One with superb recreational facilities
ANS: C
One’s environment is a significant factor. Those living in neighborhoods with high
walkability engage in significantly more walking than those living in neighborhoods with low
walkability. Having health and recreational facilities in the neighborhood can assist with
health, but the family would need to be able to afford to purchase services at these businesses.
Having a large active military base nearby would not play a major role related to the healthy
lifestyle in the neighborhood.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which factors have a profound, if sometimes unrecognized, impact on one’s health? (Select
all that apply.)
NURSINGTB.COM
a. Adequate resources to allow
easy access to health services
b. Interpersonal relationships with family and friends
c. Local, state, and national policies
d. Number and quality of health care providers within transportation range
e. Physical neighborhood where one works and lives
f. Understanding the need for healthy lifestyle choices
ANS: A, B, C, E
Health is affected by biology. Behaviors, social environment, physical environment, policies,
and access to quality health care are all factors that affect health. The number and quality of
health care providers is not relevant if one does not have access to them because of lack of
insurance or financial resources. Understanding the need for healthy lifestyle choices is
important, but knowledge alone is not adequate to change behavior.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse is using Pender’s model to explain what influences individuals to pursue health
promotion activities. Which factors would be examined? (Select all that apply.)
a. A belief that one can change one’s behaviors
b. Environmental choices possible
c. Fear of negative consequences if action is not taken
d. The rewards one believes will result if action is taken
e. The threat of an early death if behavior is not changed
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
f.
What one’s family and peers believe should be done
ANS: A, B, D, F
Fear and threat are not aspects of Pender’s model. Although fear may cause an initial attempt
at change, fear is not a long-term motivator for ongoing action. Pender does include perceived
benefits, perceived self-efficacy, interpersonal influences, and available situational
(environmental) options as factors that motivate persons to engage in health actions.
DIF: Cognitive Level: Apply (Application)
3. A nurse is using the Health Belief Model to help a client improve lifestyle choices. Which
interventions would the nurse most likely implement? (Select all that apply.)
a. Conduct an ongoing public information campaign to motivate people to take
action.
b. Emphasize how important it is to change behavior immediately.
c. Examine the individual’s perceptions of his or her health in relation to current
lifestyle behavior choices.
d. Review how lifestyle changes can reduce risk and improve the client’s life.
e. Share statistics regarding the probability of health problems and their seriousness if
action is not taken.
f. Use communication channels to send reminders of action currently needed.
ANS: C, D, E, F
An effective way to evoke action begins with examining the individual’s perceptions of his or
her health and current lifestyle choices so education to change perceptions can occur. Sharing
information regarding the probability of illness or perceived susceptibility and using
communication channels to serve as cues to action may both be motivating. Similarly,
NURcan
reviewing how lifestyle changes
risk and
SIreduce
NGTB.C
OMimprove life may change the person’s
perception of the benefits of acting. Unfortunately, although people have to know what to do
and how to do it before they can take action, information alone will not motivate people to act.
Continued harassment, as in emphasizing how important it is for people to act, also is not
motivating.
DIF: Cognitive Level: Analyze (Analysis)
4. A nurse was becoming frustrated. It had been 2 weeks, and although the client had verbalized
that the best time of day to take a 15-minute walk was early in the morning, the client had not
begun to exercise. Which principles of the Transtheoretical Model had the nurse forgotten?
(Select all that apply.)
a. A decision to act always occurs before action begins.
b. Behavior change is difficult and takes time.
c. Continuing to stress to the client how important exercise is will help the client
decide to exercise.
d. Discussing with the client why he or she is not yet exercising may help the client
recognize his or her own resistance.
e. The nurse should offer some reward if the person exercises for at least a week.
f. Verbalizing compassion for how difficult it is to change is a crucial intervention.
ANS: A, B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The Transtheoretical Model is based on the assumption that behavior change takes place over
time, progressing through a sequence of stages. The fact that the person had stated the best
time to exercise demonstrates the client has moved through precontemplation and
contemplation and is preparing to act. The nurse is being rather optimistic in thinking change
will occur within 2 weeks. Although being compassionate is helpful, it is not a crucial step in
the beginning of the process. Personal resistance to change is probably obvious and does not
need further discussion as the patient has moved beyond the stage of analyzing pros and cons
to the change.
DIF: Cognitive Level: Apply (Application)
5. Which actions have been effective in reducing problems related to alcohol use? (Select all that
apply.)
a. Abstinence education programs in elementary schools
b. Enforcement of ban on sales of alcohol to minors
c. Increased taxes on alcoholic beverages
d. Media campaigns that show unpleasant behaviors such as vomiting after drinking
e. Stringent laws on accurate labeling of alcoholic content in beverages
f. Suggesting children be taught appropriate use of alcohol in the home
ANS: B, C
The prevalence of underage drinking declined significantly when states enacted the minimum
legal drinking age of 21 years. The states with more stringent drinking laws have a lower
prevalence of binge drinking. Enforcement of the legal drinking age, as well as enforcement
of bans on sales of alcohol to minors, helps prevent underage drinking, as have increased
excise taxes on alcoholic beverages.
N R I G B.C M
U (Comprehension)
S N T
O
DIF: Cognitive Level: Understand
6. A nurse asks a client how she has been sleeping. Which best describes the rationale behind
this question? (Select all that apply.)
a. Accidents and injury may occur with the sleep-deprived client at fault.
b. Interventions for sleep problems are primarily common sense.
c. Many adults report sleep problems or occasional lack of sleep.
d. Many important functions occur during sleep.
e. Nurses can determine whether the patient has a sleep disorder.
f. A sleep assessment is easy and inexpensive to complete.
ANS: C, D
Almost three-fourths of all adults report having a sleep problem at least once a week, yet sleep
is an essential component of chronic disease prevention and health promotion. Many
important functions occur while we sleep, such as release of hormones, memory
consolidation, and decrease in blood pressure.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 05: Epidemiology
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. An epidemiologist has written a summary of a food poisoning outbreak, including its cause
and ways to prevent it from occurring in the future. Which best describes what has been done?
a. Analytic epidemiology
b. Descriptive epidemiology
c. Prospective cohort study
d. Retrospective cross-sectional survey
ANS: B
There are two principal types of epidemiology: (1) analytic epidemiology and (2) descriptive
epidemiology. Descriptive epidemiology describes the amount and distribution of disease,
which may suggest possible causes. These causes can then be confirmed or corrected through
more advanced methods of research. Analytic epidemiology investigates the causes of disease
by determining why a disease rate is lower in one population group than another. A
prospective cohort study monitors a group of disease-free individuals to determine whether
and when disease occurs. Retrospective studies compare individuals with a particular
condition or disease and those who do not have the disease.
DIF: Cognitive Level: Apply (Application)
2. Two brothers played with their cousin. One brother later became quite ill, whereas the other
did not. Which provides the best explanation for this occurrence?
N RSINGTB.COM
a. Difference in length of timeUexposed
b. Difference in how actively the children played
c. Difference in genetic inheritance between the two brothers
d. Difference in lifestyle between the two brothers
ANS: C
Assuming the two brothers lived in the same household, the environment and the agent or
infectious organisms are the same. The only difference could be between the two brothers
themselves and their genetic inheritance.
DIF: Cognitive Level: Apply (Application)
3. In which circumstance would it be more helpful to use the wheel model of epidemiology than
the epidemiological triangle model?
a. When factors outside the triangle model are involved
b. When there are multiple causes for a chronic disease
c. When research has not yet determined the exact cause
d. When trying to explain the situation to a lay person
ANS: B
The epidemiological triangle model of agent-host-environment is very useful, especially with
single-cause infectious diseases. However, with the multiple factors involved in chronic
diseases, the wheel model is more useful in analyzing and identifying the multiple variables.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
4. Which best describes the importance of discovering all of the variables that may be involved
in creating a disease state in some persons?
a. People want an explanation of why they are ill.
b. Knowing causes helps obtain funds for research to try to create a cure.
c. Finding variables that are susceptible to prevention or early intervention is
important.
d. It is important to educate communities on how to avoid any risk factors.
ANS: C
Identifying risk factors is critical to creating or discovering specific prevention and
intervention approaches that reduce chronic disease morbidity and mortality. Because some
risk factors cannot be avoided, knowing other risk factors involved allows for more
possibilities of preventing the problem. These variables need to be identified first so that
health care providers are able to provide an explanation to persons as to why they are ill,
obtain funding for research for the problem, and educate the community about the avoidance
of the known risk factors.
DIF: Cognitive Level: Apply (Application)
5. Which best describes the advantage of the web of causation model in comparison with the
epidemiological triangle model?
a. The web of causation model is easier to understand and use.
b. The web of causation model is more widely known and publicized.
c. The web of causation model is more recent and current.
d. The web of causation model shows the relationships among variables.
ANS: D
NURSINGTB.COM
Although it is a more recently created model, the web of causation model is more useful
because it illustrates the complexity of relationships among causable variables. It is not easier
to understand and use as it has more variables than the three (agent, host, and environment) in
the epidemiological model.
DIF: Cognitive Level: Understand (Comprehension)
6. Which has been determined to be a major variable in transmission of sexually transmitted
infections?
a. The pathogenesis of the involved agents
b. The susceptibility of the host
c. The environment in which the hosts live
d. The amount of sex education provided in the schools
ANS: C
The researchers concluded that ecosocial or contextual conditions strongly enhance sexually
transmitted infection risk by increasing sexual risk behaviors and likelihood of exposure to
infection. Thus, the environment has been determined to be a more important variable in
sexually transmitted infections than the pathogenesis, susceptibility, and the amount of sex
education provided.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
7. A community health nurse determined exactly how many cases of a particular disease were
currently occurring in the community. Which action should the nurse take before determining
what interventions should be planned?
a. Analyze whether the disease was a priority to the nurse’s agency
b. Compare the current rate with the previous rate of disease
c. Determine what resources are available to intervene
d. Share the findings with the public health agency leadership
ANS: B
No conclusions can really be drawn from just knowing a number. Only by converting that
count to a rate and then comparing the rate with the previous rate, or with the rate in the
broader environment or a similar community nearby, can any conclusions be drawn as to
whether there is a problem or intervention needed. Once the rate has been calculated, the
nurse will be able to share the findings with leadership, determine the resources available to
intervene if necessary, and determine if the disease is a priority.
DIF: Cognitive Level: Apply (Application)
8. People were very concerned about another outbreak of swine flu. All care providers were
asked to report, without individual names, any new cases to the public health department for
tracking. Which would be most helpful for the local media to report to keep citizens
informed?
a. The ongoing incidence rate
b. The ongoing prevalence of the illness
c. How many were hospitalized
d. How many had died so far in local hospitals and care facilities
ANS: A
NURSINGTB.COM
As only new cases were being reported to the health department, the media could only report
the ongoing incidence rate, that is, the number of new cases reported each day. The prevalence
rate is the number of all cases of a specific disease or condition in a population at a given
point in time which would not assist in knowing the number of new cases. Those infected with
the flu may or may not be hospitalized or have died from the flu.
DIF: Cognitive Level: Apply (Application)
9. When trying to determine whether the swine flu outbreak was getting worse, which rate
should be carefully observed?
a. The crude death rate
b. The age-specific death rate
c. The swine flu incidence rate
d. The swine flu prevalence rate
ANS: C
The incidence rate of new cases would be most useful for detecting short-term acute disease
changes, because the swine flu duration is usually relatively short. The prevalence rate is the
number of all cases of a specific disease or condition in a population at a given point in time.
Crude death rates summarize the occurrence of mortality. An age-specific death rate
characterizes the death rates of a particular age group in the population.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
10. A newspaper published an article stating that the athletic banquet at the local high school had
approximately 1000 family members in attendance. Exactly 650 persons became ill within 24
hours, complaining of severe diarrhea, vomiting, and cramping. Which best describes the
attack rate?
a. 650 persons
b. 1000 persons
c. 650:1000
d. 6.5%
ANS: C
Rates are calculated by the number of people with the problem over the number exposed to
the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness.
Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect.
DIF: Cognitive Level: Apply (Application)
11. In a particular community, the rate of new cases of diabetes and the rate of new cases of flu
during the month of January were precisely the same. Which disease would have the higher
prevalence rate?
a. As an acute condition, flu would have the higher prevalence rate.
b. As a chronic condition, diabetes would have the higher prevalence rate.
c. Flu would have the higher prevalence rate because people can get flu several times
in one season.
d. Flu would have the higher prevalence rate because it is so contagious.
ANS: B
NURSINGTB.COM
Diabetes would have the higher prevalence rate because it is a long-term chronic condition
that typically does not decrease. Although flu might have a higher incidence rate of new cases,
because flu is typically of short duration, the prevalence rate would remain low. Flu is
contagious, which could increase the incidence rate but not the prevalence rate.
DIF: Cognitive Level: Apply (Application)
12. Which statement best describes why the incidence and prevalence of gonorrhea is unknown?
a. Gonorrhea is not a reportable condition.
b. Gonorrhea can vary in how long the infection remains in the body.
c. Gonorrhea can be cured with antibiotics, so people do not remain infected.
d. People are ashamed to admit they have gonorrhea.
ANS: A
Morbidity rates (incidence and prevalence rates) are not available for many conditions
because surveillance of many chronic diseases is not widely conducted. Furthermore,
morbidity rates may be subject to underreporting when they are available. In other words,
there is no responsibility to report cases of most diseases, including gonorrhea. Information is
only available related to conditions where care providers are required to report that specific
condition or where those affected die and mortality data are available.
DIF: Cognitive Level: Analyze (Analysis)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
13. Which group should be used to determine the community’s pregnancy rate?
a. All persons between 15 and 45 years old in the community
b. The total population of the community
c. The total population of women in the community
d. Women between 15 and 45 years old in the community
ANS: D
Although pregnancy is not specifically addressed, the text stresses that only those susceptible
to a particular condition should be considered in the denominator. In the case of pregnancy,
only women of childbearing age are susceptible.
DIF: Cognitive Level: Apply (Application)
14. Which research study would determine the attributable risk of a sedentary lifestyle in cardiac
disease?
a. Measuring all cases of cardiac problems in a specific community
b. Comparing the number of persons with cardiac disease among athletes with the
number among nonathletes in a community
c. Subtracting the rate of cardiac disease among athletes from the rate of cardiac
disease among nonathletes
d. Calculating the relative risk and then subtracting the attack rate to determine the
attributable risk
ANS: C
Attributable risk is determined by subtracting the rate of disease among nonexposed
individuals (such as athletes) from the rate of disease among those exposed (the individuals
with a sedentary lifestyle).
NURSINGTB.COM
DIF: Cognitive Level: Apply (Application)
15. A nurse conducted a study of two skin lotions: (1) an inexpensive one and (2) an expensive
one. The nurse found that there was a relative risk of 0.7 for skin sores using the inexpensive
one and a relative risk of 1.2 using the expensive one. Which skin lotion should the nurse use?
a. Impossible to tell from the data given
b. It made no difference which lotion was used
c. The expensive lotion
d. The inexpensive lotion
ANS: D
A risk factor of less than one means the factor is actually protective, so the inexpensive lotion
is helpful in preventing skin sores. A risk factor of more than one means the factor increases
risk, so using the expensive lotion increases the probability of getting a skin lesion.
DIF: Cognitive Level: Apply (Application)
16. Which best describes a model that demonstrates the progression of disease from
prepathogenesis through disease outcome?
a. Epidemiological model
b. Ecosocial model
c. Natural history model
d. Wheel model
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: C
The natural history of disease model explains disease from prepathogenesis through resolution
of the disease process. The epidemiological model involves the epidemiological triangle:
agent, host, and environment. The ecosocial model emphasizes the role of evolving
macro-level socioenvironmental factors to understand health and illness. The wheel model
subscribes to multiple-causation rather than single-causation disease theory, and is more
useful in analyzing complex chronic conditions and identifying factors that are amendable to
intervention.
DIF: Cognitive Level: Understand (Comprehension)
17. A student athlete receives a screening examination before being active in school sports.
Which level of prevention is being used?
a. Health prevention
b. Primary prevention
c. Secondary prevention
d. Tertiary prevention
ANS: C
Screening, because it may result in early diagnosis and treatment, is secondary prevention.
Primary prevention refers to interventions that occur before the disease develops. Tertiary
prevention focuses on limitation of disability and the rehabilitation of those with irreversible
disease. Health prevention is not considered to be a level of prevention.
DIF: Cognitive Level: Apply (Application)
18. For which would a screening test be most appropriate?
B.COMsociety punishes those known to
a. Disease A, which must beNcaught
URSIearly
NGTbecause
have the disease
b. Disease B, which can be controlled if caught early in the disease process
c. Disease C, which people need to know whether they have contracted, even though
there is no treatment for the disease
d. Disease D, because people may want to use that information in family planning
ANS: B
It is extremely useful to the individuals concerned and society if screening can lead to early
diagnosis and successful control of the disease process. There is no point in doing a screening
if there is no treatment or if there is a known risk of social stigma and discrimination if it
becomes known that the person has the disease. Discussion and disagreement continue as to
whether genetic information should be used in family planning.
DIF: Cognitive Level: Understand (Comprehension)
19. One hundred women received notification that their screening tests suggested that they might
have a serious health problem. Which action should the nurse take to ensure that they will
complete follow-up testing?
a. Compliment them on their willingness to be tested and suggest an immediate
appointment before they have too much time to think about the issue.
b. Imply that the test could be wrong; the testing materials may not be effective, but
the only way to be sure is to be tested further.
c. Point out that screening is only suggestive and that not all positive screenings
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
mean they actually have the health problem.
d. Reassurance is not therapeutic; reality must be faced. Emphasize the need for
immediate treatment.
ANS: C
Not all positive screening results are confirmed with further diagnostic testing. The positive
predictive value of a test (proportion of true positive results relative to all positive test results)
is usually known for any screening test. Although one could argue that the test could be
wrong, it is more therapeutic—because you want people to attend future screenings—to
emphasize that screening is only suggestive than to say the screening test is inaccurate.
DIF: Cognitive Level: Apply (Application)
20. Which would be the best method to increase the positive predictive value of a screening test?
a. Test a large population at once
b. Test a group at high risk for the health problem
c. Use a very sensitive screening test
d. Use a very specific screening test
ANS: B
The positive predictive value is affected by what proportion of the tested population has the
problem. To increase the positive predictive value, screen populations most at risk for the
problem. Testing a large population at once, using a very sensitive or very specific screening
test would not increase the positive predictive value of a screening test.
DIF: Cognitive Level: Understand (Comprehension)
21. Which is the most effective way
if Healthy
N Rto determine
I G B.C
M People 2020 is improving the health
U S N T
O
of Americans?
a. Availability of relatable data on total population’s health problems
b. Comprehensive and systematically collected surveillance data on the health status
of various population groups
c. Increased financing to allow ongoing collation of information
d. Willingness of individuals to share health information with the federal government
ANS: B
Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and
continuing data to characterize health problems and evaluate goal achievement. Surveillance
is crucial. Without surveillance data, there is no relatable data available. Increased financing
will not assist in determining if the health of Americans is improving. Although it is important
for individuals to be willing to share health information so that data collection can be
completed, individual health information alone will not be an effective determinant of the
health of Americans.
DIF: Cognitive Level: Understand (Comprehension)
22. A researcher is examining potential risk factors in comparison with disease at a specific time
through collecting data regarding current exercise, sleep patterns, and current health status
among 12-year-olds. Which research study would be most appropriate?
a. Cross-sectional study
b. Prospective study
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Retrospective study
d. True experiment
ANS: A
By definition, a cross-sectional study examines relationships between potential causal factors
and disease at a specific time. A prospective study monitors a group of disease-free
individuals to determine if and when disease occurs. A retrospective study compares
individuals with a particular condition or disease with those who do not have the disease. A
true experiment involves both an experimental group who receives an intervention and a
control group who does not receive an intervention.
DIF: Cognitive Level: Apply (Application)
23. A researcher, interested in the onset of early menses, compared the life experiences and
history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did
not, to determine what variables might be observed. Which would be the most appropriate
categorization of this study?
a. Cross-sectional study
b. Prospective study
c. Retrospective study
d. True experiment
ANS: C
When a study looks at individuals with a particular condition in comparison with those who
do not have the disease, based on their exposures to various life situations, it is a retrospective
study; that is, the study requires participants to look back at previous experiences. A
cross-sectional study examines relationships between potential causal factors and disease at a
INGTB.C
specific time. A prospective N
study
a group
URSmonitors
OMof disease-free individuals to determine if
and when disease occurs. A true experiment involves both an experimental group who
receives an intervention and a control group who does not receive an intervention.
DIF: Cognitive Level: Apply (Application)
24. One famous study followed a cohort of nurses over their lives, collecting data and health
histories as they aged. Which would be the most appropriate categorization of this study?
a. Cross-sectional study
b. Prospective study
c. Retrospective study
d. True experiment
ANS: B
Prospective studies monitor a group of individuals to determine if and when disease occurs. A
cross-sectional study examines relationships between potential causal factors and disease at a
specific time. A retrospective study compares individuals with a particular condition or
disease with those who do not have the disease. A true experiment involves both an
experimental group who receives an intervention and a control group who does not receive an
intervention.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
25. A researcher wanted to engage in the best possible research design to obtain reliable
information about the possible cause(s) of a disease. Which design would the researcher
choose?
a. Cross-sectional study
b. Descriptive study
c. Prospective study
d. Retrospective study
ANS: C
The most advantageous research design, because it obtains more reliable information and can
more easily establish a stronger temporal relationship between presumed causal factors and
their effects, is a longitudinal cohort prospective study. A cross-sectional study examines
relationships between potential causal factors and disease at a specific time. A descriptive
study focuses on the amount and distribution of health and health problems within a
population. A prospective study monitors a group of disease-free individuals to determine if
and when disease occurs. A retrospective study compares individuals with a particular
condition or disease with those who do not have the disease.
DIF: Cognitive Level: Apply (Application)
26. A researcher has limited time and funds. Which research design would be most appropriate?
a. Cohort study
b. Incidence study
c. Longitudinal study
d. Retrospective study
ANS: D
B.COare
M costly in terms of resources and staff
Because longitudinal, cohort,Nor
incidence
UR
SINGTstudies
and often lose subjects over time, a retrospective study may be used because it is faster and
less demanding of resources.
DIF: Cognitive Level: Apply (Application)
27. On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to
determine whether a new drug would notably lower the blood levels of cholesterol in
otherwise healthy persons. Which study would the researcher most likely use?
a. Cross-sectional study
b. Experimental study
c. Prospective study
d. Retrospective study
ANS: B
Experimental design is used to test treatment and prevention strategies. Subjects are randomly
assigned to the experimental group to obtain the new drug while the control group receives a
placebo or alternative. The changes in blood cholesterol level would then be measured. A
cross-sectional study examines relationships between potential causal factors and disease at a
specific time. A prospective study monitors a group of disease-free individuals to determine if
and when disease occurs. A retrospective study compares individuals with a particular
condition or disease with those who do not have the disease.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
28. A client has developed pellagra because of a lack of certain B vitamins. Which best describes
the classification of the nutritional deficiency?
a. Relative risk factor
b. Agent factor
c. Environment factor
d. Host factor
ANS: B
Nutritional deficiencies are included under agent factors. Although too much of an agent can
cause disease (such as obesity related to diabetes), so can too little of an agent. Relative risk
indicates the extent of excess risk incurred by exposure relative to nonexposure. Host factors
are intrinsic factors and describe one’s susceptibility or response influence to the exposure to
the agent, such as genetics, age, sex, ethnicity, and human behavior. Environment factors are
extrinsic factors and they influence the existence of the agent, exposure, or susceptibility to
the agent such as physical environment, biological environment, and socioeconomic
environment.
DIF: Cognitive Level: Apply (Application)
29. Which best describes the Tuskegee Syphilis Study?
a. It provided excellence in research design.
b. It used an extensive subject base leading to confirmed conclusions.
c. It developed information about the causes and treatment of syphilis.
d. It implemented unethical and racist treatment of uninformed subjects.
ANS: D
GTB.C
M resulting in incredible harm to the
As treatment was knowinglyN
withheld
manyO
years
URSINover
subjects and their families, public outrage over unethical, racist, and discriminatory behavior
of the researchers continues today.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. An epidemiologist is gathering data to determine which factors may lead to disease. Which
data will be gathered? (Select all that apply.)
a. Demographic characteristics
b. Disease characteristics
c. Geographic data
d. Health protection measures taken
e. Length of the disease process
f. When disease struck the area
ANS: A, C, F
The person-place-time model suggests epidemiologists examine demographic characteristics
of the community (person characteristics), geographic or environmental factors (place), and
common time factors (time—or when the disease struck). Disease characteristics, health
protection measures taken, and length of the disease process are not used when determining
which factors may lead to disease.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
2. Which information must be analyzed to derive an adequate explanation of disease? (Select all
that apply.)
a. Description of commonalities among those who became ill
b. Depiction of the possible pathogen
c. Explanation of the health care system in the community
d. Portrayal of the geographic area where people became ill
e. Review of the methods by which disease can be spread
f. Substances that are effective in sanitizing the area described
ANS: A, B, D
The epidemiological triangle includes the agent (pathogen), host (people who are susceptible
and become ill), and environment (the geographic area where people became ill). These three
areas allow for an explanation of disease. Explanation of the health care system in the
community, review of the methods by which disease can spread, and substances that are
effective in sanitizing are not part of examining the epidemiological triangle.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes the advantage of the ecosocial epidemiology model over both the web of
causation model and the epidemiological triangle model? (Select all that apply.)
a. It decreases the focus on the individual person.
b. It demonstrates the usefulness of molecular epidemiology in disease prevention.
c. It emphasizes the role of complex political and economic context.
d. It is more useful in public policy campaigns in explaining what people need to do
to protect themselves.
NURSonIN
GTB.C
M
e. It reflects the current emphasis
ecology
andOthe environment.
f. Its use suggests possible public policy interventions.
ANS: A, C, F
The ecosocial approach challenges both the individually focused risk factor approach and
molecular epidemiology (sequencing of genes to improve individual susceptibility), because it
emphasizes the role of macro-level socioenvironmental factors, especially complex political
and economic forces in health and illness. Molecular epidemiology, the use of public policy
campaigns, and the relationship between ecology and the environment are not advantages of
the use of the ecosocial approach.
DIF: Cognitive Level: Understand (Comprehension)
4. Which factors are necessary to assume there might be a cause-effect relationship between a
particular variable A and a specific illness? (Select all that apply.)
a. It is easy to understand how the variable A could lead to the illness.
b. Research studies consistently demonstrate a relationship between variable A and
the illness.
c. The illness is frequently seen without the presence of variable A.
d. The more of variable A present, the sicker the person becomes.
e. Variable A is always found after the person becomes ill.
f. Variable A is never found in the presence of other illnesses.
ANS: A, B, D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
There are six criteria for assuming possible causation including strength of the association,
dose-response relationship, temporally correct relationship, biological plausibility,
consistency among studies, and specificity. Only the “easy-to-understand,” consistent research
studies and the increased dose leading to increased illness are consistent with those six
criteria.
DIF: Cognitive Level: Understand (Comprehension)
5. A nurse wanted a screening test that was very sensitive in determining who might have a
particular illness. What might be a problem with using such a sensitive test? (Select all that
apply.)
a. Many persons have true negative test results.
b. Persons who test negative are able to celebrate their healthy state.
c. Persons who do not have the illness are told that they might, which leads to
anxiety, as well as time and cost of follow-up diagnostic tests.
d. Such a test may have lower specificity, so some persons with the disease are told
they are disease free and hence do not receive care.
e. There is no problem; it is best to use the most sensitive screening test available.
f. Persons who have the disease are notified and receive treatment.
ANS: C, D
The problem with very sensitive tests is that the test picks up almost all people with the
disease but also many others who do not have the disease. These “false positives” result in
persons needing follow-up diagnostic tests. Additional time, effort, and expense, as well as
worry, result until the negative test results are obtained. There is no problem with persons
receiving true negative test results and celebrating that knowledge or with persons having
their condition correctly diagnosed
N R and
I treated.
G B.C M
U S N T
O
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 06: Community Assessment
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes how care can be appropriately given in a community?
a. Provide individualized care to unique individuals as much as resources allow.
b. Consider the community itself as the “client.”
c. Administer care according to the priorities of the local health department.
d. Prioritize care for the sickest populations first.
ANS: B
As it is clearly impossible and impractical to give service to each person in a community, the
best approach considers the community itself to be the unit of service. The nurse partners with
community members to identify community problems and develop solutions to ultimately
improve the community’s health. The community health nurse does not administer care
according to the priorities of the health department or care for the sickest populations first.
DIF: Cognitive Level: Understand (Comprehension)
2. Which provides the most accurate way to explain community health nursing?
a. Being employed outside a medical center, such as in a physician’s office
b. Focusing care on the community as a whole
c. Providing care within the community, rather than a hospital or extended-care
facility
d. Working for a public health department
ANS: B
NURSINGTB.COM
Not only is community a context or place where a community health nurse gives care, but the
community as a whole is the focus of the nurse’s efforts. Being employed outside a medical
center, providing care within the community, and working for a public health department all
describe settings where a community health nurse may be employed, but do not demonstrate
the emphasis on providing population-focused care.
DIF: Cognitive Level: Understand (Comprehension)
3. Which activity would be most helpful to a person in whom a serious chronic illness has been
diagnosed?
a. Discuss it with a religious leader on a confidential, do-not-tell basis.
b. Join a support group of others with the same illness.
c. Share the diagnosis with coworkers and neighbors to gain sympathy and support.
d. Tell extended family because many diseases have a genetic component.
ANS: B
Although a person might choose to do any of these, the most helpful action over the long term
is to join a support group with persons having the same diagnosis for mutual learning, sharing
of resources, and support. Religious leaders could also be helpful, but many people do not
have a religious leader.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. Which is a major factor in determining which people or groups are most likely to be helpful to
a particular individual?
a. Anyone who has time to be available
b. Environmental proximity
c. Same employment responsibilities
d. Similar religious faith
ANS: B
Although it is certainly more common to have friends who are similar to ourselves in many
ways, those most likely to be called on and respond are those in close environmental
proximity. Proximity facilitates the recognition of commonality and the development of
cohesion among members.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best describes how people typically respond when asked of what community are they a
member?
a. Geographic community (neighborhood or city)
b. House of worship participants or members
c. Occupational or professional group
d. Those who are devoted to a particular craft or hobby
ANS: A
Although individuals might well respond in terms of any of the possible responses, the most
common response is in terms of geographic location of one’s home or place of residence.
Traditionally, a community is an entity delineated by geopolitical boundaries; this view best
exemplifies the dimension ofNlocation.
URSINGTB.COM
DIF: Cognitive Level: Understand (Comprehension)
6. Which best describes what community members receive from each other?
a. Safe environment to live and work
b. Entertainment and recreational opportunities
c. Socialization and role fulfillment
d. Useful services such as physicians and medical centers
ANS: C
A major feature of a community is the relationships that community members form with one
another. These functions provide socialization, role fulfillment, goal achievement, and
member support. Not all communities are safe environments, have medical centers, or offer
recreational opportunities.
DIF: Cognitive Level: Understand (Comprehension)
7. An individual lives in a healthy community. Which characteristic would this community most
likely display?
a. Ability to adapt and respond to changes
b. Lack of environmental pollution
c. Low unemployment rate
d. Ongoing growth in population
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A
The community’s ability to respond effectively to changing dynamics and meet the needs of
its members indicates productive functioning. A community may or may not be able to control
environmental pollution because the pollution is often from outside the community itself.
Similarly, employment, or lack thereof, may be due to factors outside the community’s
control. In many communities, growth is not expected; simply not losing more population is a
great achievement.
DIF: Cognitive Level: Apply (Application)
8. A nurse is helping a community develop its capacity to address future problems. Which
activity is the nurse most likely implementing?
a. Addressing problems in priority order
b. Promoting collaboration and team building
c. Developing community competence
d. Providing education about health issues
ANS: C
Although such activities are educational, collaborative, and ideally do address problems in
some order by priority, building a community’s capacity to address future problems is called
developing community competence.
DIF: Cognitive Level: Apply (Application)
9. Which best describes shoe leather epidemiology?
a. Implementing the wheel model of epidemiology
b. Engaging in extensive truth seeking like a detective in the community
c. Traveling throughout theN
community
absorb
an overall impression of it
URSINGtoTB.C
OM
d. Facilitating sharing of the community’s history by community leaders
ANS: C
Shoe leather epidemiology refers to establishing hypotheses about the community’s health,
strengths, and possible problems through the down-to-earth approach of traveling through the
area, and observing and interacting with community members. Implementing the wheel
model, engaging in truth seeking, and facilitating sharing of the community’s history do not
demonstrate the process of traveling through the community to absorb its overall impression.
DIF: Cognitive Level: Understand (Comprehension)
10. A community health nurse wants to obtain an overview of the community, but has limited
time and resources. Which method would the nurse most likely use to obtain this information?
a. Engage in a windshield survey
b. Establish a health department committee of community leaders willing to fill out
periodic surveys related to various health issues in the community
c. Live in the community for several years
d. Review public health department records from up to 5 years ago
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The easiest way to obtain an overview of the community is through a windshield survey by
driving or walking throughout the area and making organized observations. A group that is
willing to respond to surveys and review public health records and that lives in the community
would be very helpful but not easy or fast.
DIF: Cognitive Level: Apply (Application)
11. Which best describes how the U.S. Census Bureau surveys are helpful to a community health
nurse?
a. They provide the distribution of age, sex, race, and ethnicity in the community.
b. They document the mortality and morbidity of the community.
c. They ensure that all community residents are involved.
d. They temporarily give employment opportunities to residents.
ANS: A
Although they may offer temporary employment to some community residents and ideally all
residents are counted, the value of the Census Bureau data is in clarifying the distribution of
age, sex, race, and ethnicity of the community, which may also suggest health needs. The
Census Bureau does not collect data on mortality and morbidity.
DIF: Cognitive Level: Understand (Comprehension)
12. A public health nurse wanted statistics on the disability, illness, and other health-related
variables for the state. Which would be the best resource for the nurse to obtain the most
extensive data?
a. State health department records
b. State department of vital statistics
NURSIand
c. The Centers for Disease Control
NGPrevention
TB.COM
d. The National Center for Health Statistics
ANS: D
The National Center for Health Statistics compiles annual National Health Survey data. It also
publishes reports on prevalence of disability, illness, and other health-related variables. It
tracks trends by nation, state, and year. The state health department records, state department
of vital statistics, and Centers for Disease Control and Prevention will not provide all of the
data that the nurse is trying to find.
DIF: Cognitive Level: Apply (Application)
13. Which best describes when a community health nurse would try to collect data on a health
issue?
a. When available data exists
b. When data must be purchased from the agency that collects it
c. When there is no source of previously collected data
d. When the data previously collected is available to the public
ANS: C
Formal data collection does not exist for all health data. Therefore, many nurses must perform
additional data collection, compilation, and analysis. It is not necessary for the nurse to try to
collect data on a health issue if there is available existing data, the ability to purchase data,
and the nurse is able to use previously collected data that is available for public information.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
14. All of the needed objective data on a specific health problem are available for the community
health nurse. Which best describes why the nurse would also interview community residents
about the health problem?
a. To confirm the accuracy of the previously collected data
b. To emphasize to residents the importance of the health problem
c. To obtain the residents’ personal insights and beliefs about the problem
d. To update the previously collected data
ANS: C
The nurse must understand the community’s perspective on health status, the services used or
required, and their concerns. Official data do not capture this type of information. Data
collected directly from an aggregate may be more insightful and accurate.
DIF: Cognitive Level: Apply (Application)
15. A nurse begins to collect information about a particular health problem from community
residents. Which potential problem would most likely arise?
a. Residents might become suspicious about why the nurse needs this information.
b. Residents might believe the nurse is becoming intrusive in their personal lives.
c. Residents might wonder why they are being asked about the problem when
previous surveys may also have asked about the same problem.
d. Residents might begin to expect service to be given to address the problem.
ANS: D
Although the process of needs
indicate
NUassessment
RSINGTcan
B.C
M strengths and weaknesses, it can also
O
raise expectations for new services to address problems. It is also possible that this data
collection may cause residents to become suspicious and wonder why this data collection is
necessary. However, in most cases, this is not problematic. The problem will arise if residents
expect that services will be provided when they may not.
DIF: Cognitive Level: Apply (Application)
16. The nurse is interviewing community members as part of a community assessment. Which
group of people would the community health nurse most likely want to interview?
a. Bankers who could share economic data on the community
b. Long-time residents who were informal leaders in the community
c. Pastors and other religious leaders who share the faith of the community
d. Realtors who could share housing and living conditions in the community
ANS: B
The nurse needs to interview key informants in the community to gather data about the health
of the community. Although each group could share some information, the long-time informal
leaders would be most knowledgeable about the overall strengths and concerns of the
community.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
17. A nurse was debating about which approach to use to both obtain data about community needs
and encourage community participation in their resolution. Which approach would be most
effective in meeting both goals?
a. A community forum, open to all interested residents of the community
b. A community survey mailed to all residents
c. Establishing focus groups with selected participants
d. Conducting in-depth interviews with select community residents
ANS: C
All of the responses would be helpful in obtaining information about the community.
However, only focus groups promote group interaction and encourage further participation in
planning solutions to identified problems.
DIF: Cognitive Level: Apply (Application)
18. A community health nurse has completed a community assessment and is now writing a
community diagnosis for the problem. Which component of the diagnosis will be used to
summarize the assessment data of the problem?
a. Identification of the health risk
b. Evidence supporting the choice of priority
c. The aggregate that needs the intervention
d. The cause of the identified health problem
ANS: A
The identification of the health problem or risk represents a synthesis of all assessment data.
The evidence can suggest the magnitude of the problem. The aggregate states who will be the
beneficiary of the nurse’s action plan. The cause of the health problem directs the focus of the
NURSINGTB.COM
intervention.
DIF: Cognitive Level: Apply (Application)
19. A community health nurse is trying to determine the success of a planned intervention. Which
would the community health nurse most likely examine?
a. Changes in funding made available to the agency to continue their efforts
b. An increase or decrease in the number of persons asking for assistance
c. Current problem data to compare with original baseline data
d. Feedback from community residents
ANS: C
By comparing baseline data, the nurse can construct benchmarks to gauge the achievement of
program objectives. Such epidemiological data are also important for documentation of a
program’s long-term effectiveness. The planned intervention would most likely cause some
type of a change in funding, change in service use, and allow the residents to provide
feedback; however, these things would not provide the best information about success of the
program.
DIF: Cognitive Level: Apply (Application)
20. A community health nurse found a very small number of families in the community who were
desperately in need of basic preventive health services. Which ethical approach supports
expending agency resources on these few, but needy, families?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a. Beneficence suggests focusing on the most needy, so resources should be
expended on these families.
b. Deontological ethics suggest that the nurse must give priority to the intervention
that would have the broadest impact.
c. Utilitarianism (the most good for the largest number) would suggest continuing to
focus on broader community needs.
d. Virtue ethics would suggest focusing on these families to support the nurse’s own
character development.
ANS: A
Each response is an accurate portrayal of a branch of ethics. Beneficence and social justice
would give moral advantage to the most vulnerable. By caring for these families, the demands
of utilitarianism (the most good for the largest number) would also be met as caring for the
weakest supports the whole community.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which best describes the aspects central to the definition of community? (Select all that
apply.)
a. Geographic boundaries at a point in time
b. Whatever is most convenient for the nurse
c. Patterns of disease found
d. Persons who share common goals and interests
e. Persons who band together to address a shared problem
f. The name the people have
NU
RSIthemselves
given
NGTB.COM
ANS: A, E, F
The person-place-time model suggests epidemiologists examine demographic characteristics
of the community (person characteristics), geographic or environmental factors (place), and a
point in time (i.e., the present in comparison with the past and hope for future). Therefore,
using the model, any item related to geographic boundaries, persons with shared goals, or a
particular time would be correct.
DIF: Cognitive Level: Understand (Comprehension)
2. Which is a central function unique to community health nursing? (Select all that apply.)
a. Being willing to travel to give care in an appropriate setting
b. Collaborating and cooperating with other health care team members
c. Gathering appropriate comprehensive assessment data on the community
d. Incorporating epidemiological approaches throughout the nursing process
e. Keeping accurate and detailed medical records on care given
f. Being willing to contribute to health policy development
ANS: C, D, F
Although all nurses ideally arrange transportation to their employment site, keep accurate
records, and collaborate with health care team members, only community health nurses are
expected to engage in comprehensive community assessment, incorporate epidemiology, and
contribute to health policy development.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
3. Which are considered the most important determinants of a healthy community? (Select all
that apply.)
a. Child-friendly neighborhoods
b. Several different choices of houses of worship
c. Employment opportunities
d. Low crime rate
e. Safe food and water supplies
f. Varied housing choices
ANS: A, D
The public is more concerned with quality-of-life issues, with the most important
determinants of a healthy community being low crime rates and a child-friendly neighborhood
environment. Although employment opportunities are important, many are low-paying,
no-benefit service positions that are inadequate to support family life. Although the food may
be expensive, most cities have safe food and water supplies.
DIF: Cognitive Level: Understand (Comprehension)
4. Which from vital statistics records is useful to community health nurses? (Select all that
apply.)
a. Relatively early age of death may suggest a new pathogen in the community
b. Divorce rate, suggesting whether children will need additional services
c. Documentation of the mortality and morbidity of the local community
d. Indication of whether the total population is growing or declining
e. Records of occurrence of congenital malformations
NURSfamily
INGT
B.COM
f. Stability of marriages, making
structure
become obvious
ANS: C, D, E
Vital statistics record births, marriages, divorce, adoptions, and deaths in the community.
Useful information would include conditions of birth, such as congenital malformations from
the birth records. Death records suggest local mortality and morbidity trends. Overall growth
or decline in the community’s population can be seen.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 07: Community Health Planning, Implementation, and Evaluation
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes what Lillian Wald suggested in regards to providing care to individuals
and families?
a. Public health nurses should encourage clients to join the Henry Street settlement
for mutual growth and support among the families.
b. Public health nurses should focus on providing care in the client’s home.
c. Public health nurses should recognize the larger social and economic forces that
the family cannot control.
d. Public health nurses should try to understand that educating clients on how to stay
healthy is the nurse’s primary responsibility.
ANS: C
Wald emphasized that one could not understand an individual without understanding the
family, and the family is in the grip of larger social and economic forces that they cannot
control. It was not suggested by Wald that clients be encouraged to join the Henry Street
settlement, focus on providing care in the client’s home, or that it was the nurse’s
responsibility to keep clients healthy.
DIF: Cognitive Level: Understand (Comprehension)
2. Which best describes why it is important for the nurse to be knowledgeable about the
community when providing care to individuals?
NURclients,
SINGthey
TB.C
OMknow the community to find the
a. As nurses travel to meet with
must
client’s residence.
b. On the basis of information from community assessment, community health nurses
can be visible and vocal advocates for health care reform.
c. Community health nurses are expected to have information about the community
to share with individual clients.
d. Individuals and families are strongly influenced by the community and
environment around them.
ANS: D
The nurse must be particularly aware of how individuals and families are influenced by the
community and environment around them although it is indeed important to be an advocate
for health care reform and to have information regarding resources available for client
services in the process of giving care. It is assumed that community health nurses can read
maps—or use a global positioning system in their car—to find client addresses.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes how the Health Planning Model for care of aggregates differs from the
customary nursing process applied to the care of an individual?
a. The nurse must be aware of age, gender, race, ethnic group, religion, educational
background, occupation, and marital status of the aggregate.
b. The nurse must first decide on and define the aggregate to receive care.
c. The nurse must determine how best to ensure that each participant receives an
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
equal number of services.
d. The nurse must choose which health care need should have first priority.
ANS: B
The nurse decides which aggregate to focus on and then carefully defines that aggregate.
Whether caring for an individual, a family, or an aggregate, the nurse must know the
demographics of the client and choose which health need has first priority. In caring for
aggregates, each participant does not receive an equal number of services, but only those
services that each participant needs.
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse is using a systems framework when caring for individuals, families, and aggregates in
the community. Which best describes an aspect that would be more challenging when caring
for an aggregate as opposed to caring for an individual?
a. Ability to communicate clearly with the client
b. Analyzing power and decision-making within the system
c. Defining the system’s structure and functions
d. Recognizing the system’s goals
ANS: B
Although all aspects can be challenging, it is probably more challenging to recognize the
interacting aspects of a large aggregate system in its power distribution, consensus activities,
accommodation, and authority within the decision-making process.
DIF: Cognitive Level: Apply (Application)
5. A nurse is caring for an aggregate
client.
N R asIhisGor her
B.C
M Which task would the nurse complete
U S N T
O
first?
a. Determine the setting of the aggregate.
b. Gain access into the aggregate.
c. Identify the nurse’s own strengths and preferences.
d. Review the resources available to use in the community.
ANS: C
A nurse should also consider personal interests and strengths in selecting an aggregate for
intervention. For example, the nurse should consider whether he or she has an interest in
teaching health promotion and preventive health or in planning for organizational change,
whether his or her communication skills are better suited to large or small groups, and
whether he or she has a preference for working with the elderly or with children. Thoughtful
consideration of these and other variables will facilitate assessment and planning. After
self-reflection, the nurse will need to determine the setting of the aggregate, consider how to
gain access, and identify the community resources available.
DIF: Cognitive Level: Apply (Application)
6. A nurse decided that a high-risk aggregate most needed education about diabetes. Which
would be the best approach when teaching the group?
a. Involve participants in small group activities applying the information.
b. Organize the information into a visual presentation such as a PowerPoint
presentation.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Share the nurse’s expertise directly with the group at a meeting for that purpose.
d. Use handouts and pamphlets with pictures consistent with the local cultural groups
throughout.
ANS: A
Most persons do not enjoy lectures, so the nurse must initiate small group involvement and
participation. Those with less educational experience are more comfortable in informal
learning settings. Visual only presentations, such as power point presentations and handouts
are not the best approach to use with adult learners. Sharing of the nurse’s expertise is an
important part of the teaching process but will not be effective if the participants are not
actively involved in the learning process.
DIF: Cognitive Level: Apply (Application)
7. A community health nurse has determined that the number one priority is to help families in
which one member has diabetes. Which action would be most appropriate to maximize
services to persons with diabetes?
a. Ask friends with diabetes about what services they want improved.
b. Duplicate the diabetic organization’s services, because not all patients with
diabetes have yet received services.
c. Meet with the diabetic organization to see how the public health department can
augment what it is offering.
d. Submit a request for funding so that the public health department can also offer
services to patients with diabetes.
ANS: C
The nurse should augment existing resources or create a new service rather than duplicate
NUaggregate.
RSINGTItB.C
what is already available to the
is assumed
OM that if the nurse has concluded that
diabetic issues are the number one priority, there is no pressing need to ask specific questions
of friends with diabetes.
DIF: Cognitive Level: Apply (Application)
8. A nurse is determining the needs of a selected aggregate. Eight percent of the aggregate has
diabetes. Which best describes the action that should be taken next to determine if this should
be a priority?
a. Ask the American Diabetes Association if 8% is a worrisome rate.
b. Discuss the findings with the head of the public health department.
c. Review the literature to determine the national and state diabetic rate.
d. Determine what the aggregate’s diabetic rate has been in the past.
ANS: C
A rate by itself is meaningless unless compared with previous trends (although the instructor
or the head of the local public health department may or may not know that particular piece of
information) or with state or national norms. The easiest way to find those norms would be to
check the literature to determine the typical incidence in a similar environment or community.
The literature review could include research reports and statistics that will help determine
whether this finding represents a priority for this aggregate.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
9. A nurse has assessed an aggregate, determined the priority health needs, and decided on what
intervention to offer. Which will best determine if the intervention will be successful?
a. Accuracy of the nurse’s assessment
b. Careful planning and implementation of the intervention
c. Determination of the aggregate’s perspective of the need for the intervention
d. Selection of appropriate evaluation measures both in process and on completion
ANS: C
Interventions are seldom successful unless the aggregate has input into determination of need,
its priority, and appropriateness of the intervention.
DIF: Cognitive Level: Apply (Application)
10. Which action must a nurse take to be successful in addition to the typical assessment,
diagnosing, and planning directly related to the intervention project?
a. Advocate for community empowerment throughout the process.
b. Choose superb people to implement the plan.
c. Confirm administrative support throughout the project.
d. Continue to assess both barriers and resources throughout the project.
ANS: A
An essential component is to have a strong level of community involvement. The nurse is
responsible for advocating for client empowerment throughout the process. Attention to
community involvement and empowerment helps ensure that the outcomes reflect the
community’s needs and will be accepted.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
11. A nurse found that several professionals resented time spent interacting with and teaching
clients. Which describes the most likely underlying motivation for resisting client
involvement?
a. Believing that people could change their lives if they really wanted to do so.
b. Empowering others shifts power from the experts to the community.
c. It is more efficient to plan appropriate care without listening to client ideas.
d. Longtime experience with community members has led to disillusionment.
ANS: B
Successful programs rely on empowering citizens to make decisions about their care.
Empowering citizens causes power to shift from health providers to community members.
Many prefer to remain in positions of power rather than sharing. Client ideas must be included
in the planning process in order to get them involved. Empowerment will lead the clients to
change their lives.
DIF: Cognitive Level: Apply (Application)
12. A nurse assessed carefully and created a comprehensive intervention plan including primary,
secondary, and tertiary care for individuals and families. Which factor may the nurse have
overlooked?
a. Are other staff members interested in such a project?
b. Are there adequate resources for such a project?
c. Is there support from the administration for the project?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Does the nurse have adequate energy and time for such a project?
ANS: B
The nurse must validate the practicality of any planned intervention. This can best be
accomplished by examining if there are adequate resources for the project. Interest of other
staff members, support from administration, and the nurse’s time and energy should all be
considered, but are irrelevant if there are not enough resources to implement the project.
DIF: Cognitive Level: Apply (Application)
13. Which must be created before establishing the evaluation plan for a health project?
a. A clear set of both short-term and long-term goals
b. Decision as to who will collect the evaluation data
c. Observable and measurable objectives
d. Setting up a computer program to analyze the evaluation data
ANS: C
Goals are generally what is desired, while observable and measurable objectives are used to
determine whether or not the goal was achieved and whether the project was successful.
Deciding who will collect the data and analysis of the data are irrelevant if it has not been
clearly decided what will be measured through the creation of objectives.
DIF: Cognitive Level: Understand (Comprehension)
14. A nurse had all the details carefully arranged for a project: location, speaker, seating
arrangement, refreshments, handouts, visual aids, and students to distribute and collect
evaluation sheets. Which aspect of the project may be a problem?
a. The administrator’s greetings
time. M
NURwent
INover
GTB.C
S
O
b. The environment was so comfortable that no one listened to the presentation.
c. Something totally unexpected and unplanned for happened.
d. A student lost the evaluation sheets.
ANS: C
Although implementation should follow the plan, the nurse must also prepare for unexpected
problems. If the project fails, it is crucial to analyze what went wrong so it can be avoided in
the future. Planning for the unexpected and unplanned events is the best response as it
encompasses a variety of things that may go wrong. Any one or a combination of the other
answers may be an unplanned event.
DIF: Cognitive Level: Apply (Application)
15. A nurse starts to collect evaluative data for a major health project one month after it starts.
Which best describes the purpose of this data collection?
a. Filling out the forms helps the aggregate feel involved in the process.
b. Formative evaluation allows the nurse to make changes if needed.
c. Funding agencies require ongoing evaluations to continue contributing.
d. The nurse needed to know if the desired outcomes were being achieved.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Evaluation includes reflecting on each previous stage to determine strengths and weaknesses.
Process evaluation, also called formative evaluation, would allow one to change the project
while it is being implemented. By collecting data one month after the project starts, it will be
hard to determine if the desired outcomes are being met. Aggregate involvement is not
increased by filling out evaluation forms one month after project implementation. Collecting
data one month after project implementation is not typically completed to assure ongoing
funding.
DIF: Cognitive Level: Apply (Application)
16. Which best describes where the majority of time is spent by a community health nurse?
a. Caring for individuals
b. Caring for families
c. Caring for groups
d. Caring for aggregates
ANS: A
Although the focus of care is the aggregate, the community health nurse will find the majority
of time is spent caring for individuals.
DIF: Cognitive Level: Understand (Comprehension)
17. Which best describes the principal outcome of the Hill-Burton Act?
a. Increased number of hospital beds
b. Increased availability of high technology in health care
c. Reduced overall health care costs
d. Required certificates of need before expensive new construction is started
ANS: A
NURSINGTB.COM
The Hill-Burton Act was also called the Hospital Survey and Construction Act, which was to
address the need for better hospital access. Federal aid was given to states for construction of
hospitals. The Heart Disease, Cancer, and Stroke Amendments of 1965 increased the
availability of high technology in health care. The National Health Planning and Resources
Development Act attempted to reduce overall health care costs. State government developed
and implemented the requirement for hospitals to obtain approval for certain projects by
requiring a certificate of need.
DIF: Cognitive Level: Understand (Comprehension)
18. Which best describes the primary purpose of the Heart Disease, Cancer, and Stroke
Amendments of 1965?
a. To improve coordination and planning of health care
b. To increase the availability of high technology in health care
c. To reduce overall health care costs
d. To require certificates of need before expensive new construction or technologies
are created
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Its purpose was to make the latest technology for the diagnosis and treatment of heart disease,
cancer, stroke, and related diseases available to community health care providers through the
establishment of regional cooperative arrangements. The National Health Planning and
Resources Development Act attempted to reduce overall health care costs and to increase
acceptability, accessibility, continuity, and quality of health care services. State government
developed and implemented the requirement for hospitals to obtain approval for certain
projects by requiring a certificate of need.
DIF: Cognitive Level: Understand (Comprehension)
19. Which best describes a flaw of many of the health care bills passed during the last four
decades?
a. They avoided interfering with the current health care approach and did not
improve problems of access or duplication of efforts.
b. They encouraged each state to do what was best for its residents without
consideration of what was best for the nation as a whole.
c. They created new layers of bureaucracy in health care administration.
d. They did not include financing to pay for the suggested changes.
ANS: A
Although each bill attempted to meet some problem in health care planning and delivery, none
really improved quality, access, and cost issues. Current health care providers and institutions
heavily influenced outcomes.
DIF: Cognitive Level: Understand (Comprehension)
20. Which describes why the National Health Planning and Resources Development Act of 1974
NU
B.COM and acceptability, improve quality, and
SINGT
was unsuccessful in its efforts
toRincrease
accessibility
constrain rising costs?
a. A new president forced the legislation’s repeal.
b. No federal financing was included to implement the law.
c. The federal government made no effort to enforce the law.
d. The law did not affect the current health care delivery system.
ANS: D
The 1974 Act was unsuccessful because it grandfathered in the entire health care system. In
other words, nothing had to change.
DIF: Cognitive Level: Understand (Comprehension)
21. Which best describes the first efforts at improving community health?
a. Environmental planning of water and sewer systems
b. Mass community immunizations
c. Passing laws requiring quarantine of infected persons
d. Segregation of ships from harbors until the harbormaster checked the sailors
ANS: A
The first communitywide efforts toward improving health were environmental planning for
water and sewer systems. Mass community immunizations, laws regarding quarantine, and
segregation of ships were not among the first efforts to improve community health.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
22. Which is the most important component of the Planning Approach to Community Health
(PATCH) model?
a. Use of data to develop strategies
b. Community participation throughout the process
c. Intensive planning by all professionals involved
d. Selection of professional outcome measures
ANS: B
An essential element of the PATCH model is community participation. The idea is that health
promotion is a process that enables the population to have more control of its own health.
Selection of professional outcome measures and intensive planning by all professionals are
not a part of the PATCH model. Use of data to develop comprehensive health strategies is part
of the PATCH model, but is not the most important component.
DIF: Cognitive Level: Understand (Comprehension)
23. Which best describes the purpose of the Assessment Protocol for Excellence in Public Health
(APEX-PH)?
a. To improve the functioning of public agencies by peer evaluation
b. To provide intensive planning for all professionals involved in public health
c. An evaluation process involving both community and public organizations
d. A self-evaluation by all the groups involved in public health planning
ANS: C
The APEX-PH program is a true self-assessment and is intended to be more of a public
endeavor involving the community,
asNwell
as public
NURSI
GTB.C
OM organizations.
DIF: Cognitive Level: Understand (Comprehension)
24. Which is the most important phase of the Mobilizing for Action through Planning and
Partnership (MAPP) model?
a. Conduct assessments identifying strengths and current health status
b. Evaluate current local health care systems and forces for change
c. Guide the community toward long-range visioning
d. Mobilize the community to become involved
ANS: D
The MAPP model is a planning model that is based on first mobilizing the community;
guiding the community toward a shared vision for long-range planning; and, finally,
conducting assessments of community strengths, forces of change, health status, and the local
health system. Without completion of the first phase, the model is unable to be implemented.
DIF: Cognitive Level: Understand (Comprehension)
25. Which best describes why states will increasingly monitor and report on quality and cost of
health care?
a. Citizens are increasingly complaining of high medical costs in a depressed
economy.
b. Congress has been unsuccessful in reducing health care costs.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Taxation has decreased, resulting in fewer funds available for health care.
d. Hospitals and nursing homes are demanding increased funding.
ANS: B
When Congress rejected President Clinton’s plan for health care in 1994, the federal
government withdrew from active health planning. Most states have become very involved in
various aspects of health care planning as state funding from the federal government
decreased and state budgets are not increasing. States are forced to determine priorities for the
resources available. Even though citizens do complain about high medical costs, this is not the
reason why states are becoming more involved with health care reporting and monitoring.
Although hospitals and nursing homes may want increased funding, much of this control
comes from federal legislation, which is not impacted by the states. Taxation has not
decreased.
DIF: Cognitive Level: Understand (Comprehension)
26. Which approach has been suggested to improve the functioning of local and national health
planning?
a. Increase nursing involvement.
b. Invite citizen participation in health care provision.
c. Invite more health professionals to be involved in health planning.
d. Increase community involvement among hospitals.
ANS: A
The textbook suggests increased nursing involvement as one method of strengthening local
and national health planning. Nurses can assess aggregates, identify health needs, and perform
planning, intervention, and evaluation. Health would improve if nurses reemphasized the
NURinsights
B.C
larger aggregate and shared their
with
planning
SINGT
OM groups.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which best describes the provisions of the Affordable Care Act (ACA) of 2010? (Select all
that apply.)
a. It provided free health insurance to all U.S. citizens.
b. It required all U.S. citizens to be covered by health insurance.
c. It prohibited insurance companies from denying coverage because of pre-existing
medical conditions.
d. It gradually decreased the number of health insurance options available to
Americans.
e. It reduced expenses for families by capping out-of-pocket expenses.
f. It required all school-age children to have access to health care services.
ANS: B, C, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The Affordable Care Act (ACA) of 2010 required all U.S. citizens to have health insurance. It
put individuals, families, and small business owners in control of their health care. It reduced
premium costs for millions of working families and small businesses by providing hundreds
of billions of dollars in tax relief—the largest middle class tax cut for health care in history. It
also reduced what families had to pay for health care by capping out-of-pocket expenses and
requiring preventive care to be fully covered without any out-of-pocket expense. It prohibited
insurance companies from denying insurance coverage because of a person’s preexisting
medical condition. Free medical insurance, a decreased the number of health insurance
options available and a requirement that all school-age children had access to health care
services were not part of the Patient Protection and Affordable Care Act.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse would like to quickly and easily learn more about an aggregate. Which sources of
information would be best for the nurse to use to quickly and easily become informed about
an aggregate? (Select all that apply.)
a. Conduct a telephone survey of those aggregate members
b. Interview people who have previously been involved with the aggregate
c. Review any available records or previously gathered data
d. Send a mail survey to everyone in the surrounding geographic area
e. Try to find a few key informants and ask for their input
f. Use observation without anyone in the aggregate knowing he or she is being
observed
ANS: B, C, E
Unfortunately, telephone surveys would probably not be effective because many persons no
longer have landlines but relyNonRcellIphones.
ThereMwould be no easy way to obtain the
GTB.C
U
S
N
O be expensive and time consuming and
appropriate telephone numbers. A mail survey would
probably would receive few responses because participants would be asked to think, write,
and act to return the survey. Observing without letting persons know they are being observed
borders on unethical. However, interviewing persons previously involved and reviewing
previously gathered data would be possible.
DIF: Cognitive Level: Apply (Application)
3. Which would be the most appropriate indicator for determining the needs of an aggregate?
(Select all that apply.)
a. Demand for services as seen in the behaviors of the chosen aggregate members
b. Experts’ determination of what is needed in the situation
c. Nurse’s own expertise, skill, and preferences
d. Obvious health disparities between the advantaged and disadvantaged populations
e. Review of the literature to determine the typical needs of a typical community
f. Verbalized expression of need from the chosen aggregate
ANS: A, B, D, F
There are four types of needs to be assessed: (1) expressed need as seen in behavior; (2)
normative need or the need determined by expert health professionals; (3) perceived need
expressed by the aggregate including wants and preferences; and, finally, (4) relative need,
which is the gap showing health disparities between the advantaged and disadvantaged
populations. The nurse’s expertise and review of the literature are not the most appropriate
indicators for determining the needs of an aggregate.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse has completed a community health project. Which actions must be performed by the
nurse? (Select all that apply.)
a. Ask for media coverage of the project to maximize public relations.
b. Ensure that adequacy and appropriateness of the intervention are measured.
c. Be certain the efficiency and cost benefits are measured.
d. Collect statistics for careful analysis.
e. Communicate follow-up recommendations to the community.
f. Write a comprehensive report on the project to be distributed to anyone interested.
ANS: B, C, E
A summative evaluation includes measurement of adequacy, appropriateness, efficiency, and
cost-benefit measurements. The intervention will have limited impact unless follow-up
recommendations are communicated to the aggregate on completion of the project. Media
coverage may or may not be helpful, depending on the project and the intervention. Statistics
are useless unless carefully chosen to reflect measurement of objectives. Reports are often
shelved without being read, so only those immediately involved should have both input into
any report and a copy of the outcome findings.
DIF: Cognitive Level: Apply (Application)
5. Which important events related to health care occurred during the Reagan administration?
(Select all that apply.)
a. Increase in national health planning and coordination of efforts
b. Decrease in both federal control and federal funding
c. Increase in state funding N
URconcurrent
SINGTB.C
OMby local boards of health
with
control
d. Implementation of Medicare funding based on diagnosis-related groups
e. Suggestions to shift costs and reduce costs
f. Suggestions to mobilize the community to become involved
ANS: B, D, E
The Reagan administration encouraged competition. Emphasis was on cost shifting and cost
reduction with greater state power, less centralization, and less national control. The Omnibus
Budget Reconciliation Act of 1981 reduced federal funding, which also decreased federal
planning efforts. The federal government recommended eliminating planning agencies. Also
during this time was the implementation of basing payments to Medicare on diagnosis-related
groups. A reduction in federal funding caused cost shifting and cost reduction to be
emphasized.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 08: Community Health Education
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse has instructed a client several times what he needs to do to get better, but the client
has not followed these instructions. Which offers the best explanation for this behavior?
a. Barriers prevent action.
b. The client does not understand.
c. The client does not really care.
d. Barriers prevent desire to change.
ANS: A
Often the patient is blamed and labeled as being noncompliant. It is more helpful to wonder
what barriers interfered with the patient’s ability to engage in appropriate action. It is unlikely
that the client doesn’t understand or doesn’t care, rather the barriers are preventing action
from being taken. Barriers may prevent the change, but not necessarily the desire to change.
DIF: Cognitive Level: Apply (Application)
2. Which best describes one of the most fundamental nursing principles suggested by
Nightingale?
a. Be open to the patient’s preferences and priorities.
b. Engage in health teaching.
c. Keep the focus on individualized care for each person.
d. Meet physical needs, such as air, food, and water, first.
ANS: B
NURSINGTB.COM
Although Nightingale would probably agree with each of the listed suggestions, she
emphasized that health teaching is one of the most fundamental nursing principles.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes why health education in the community is more effective than health
education in a hospital or clinic?
a. Being in the patient’s home emphasizes the importance of the teaching.
b. It is easier to focus on the nurse’s words and demonstrations outside of health
settings.
c. The setting is familiar and comfortable to participants.
d. There are too many interruptions in hospitals and clinics.
ANS: C
There can be interruptions and distractions anywhere, including in a patient’s home. In the
community, the setting is familiar and comfortable.
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse is implementing a comprehensive and entertaining educational program. Which
action must the nurse complete first?
a. Be sure all the electronics (such as the computer showing the PowerPoint slides)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
are working.
b. Develop an open and trusting relationship with participants.
c. Distribute evaluation materials to participants.
d. Greet each participant and welcome him or her to the event.
ANS: B
At the core of health education is the development of trusting relationships based on nurturing
interactions; thus, this action must be completed before completing any other action.
DIF: Cognitive Level: Apply (Application)
5. Which best describes why community health education programs are important?
a. It provides a way to reinforce voluntary behavior changes.
b. Health education is an area that has desperately needed improvement.
c. Health education prevents the occurrence of disease.
d. It is the most cost-effective way of improving health.
ANS: A
Health education is designed to predispose, enable, and reinforce voluntary behavior
conducive to health. Health education is unable to prevent disease from occurring, and it is not
the most cost-effective way to improve health.
DIF: Cognitive Level: Understand (Comprehension)
6. Which is most likely to determine if a health education program will create change?
a. Amount of input and participation by learners
b. Funds available for obtaining educational resources
c. Participant attendance at N
the R
entire
INprogram
GTB.COM
U
S
d. Quality of the instructors involved in the program
ANS: A
The lasting effect of cognitive and behavioral changes is determined by learner participation.
Funding, attendance, and quality of instructors are not important if learners are not
encouraged to participate in the program.
DIF: Cognitive Level: Understand (Comprehension)
7. A nurse is selecting goals for an educational program. Which method should be used?
a. Ask the formal leadership of a community what the learning needs are.
b. Interview informal leaders about the learning needs of the community.
c. Use the expertise of professional nurses skilled at assessing needs.
d. The target audience must determine their needs and priorities.
ANS: D
Learners must be involved in determining their own health education needs and priorities.
Both the formal and informal leadership would have useful information to share, but the
crucial component is input from the target group.
DIF: Cognitive Level: Apply (Application)
8. A nurse is planning a health education program in the community. Which consideration must
be made by the nurse?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
The listed priorities of Healthy People 2020
The skills and abilities of the nurse educator
The sociopolitical cultural context of the community’s environment
What learning materials have already been created and are available for use
ANS: C
Community health education with the community as client is based on practical, useful, and
scientifically sound methods and widely accessible technology. An effective program relates
economic, political, and epidemiological factors to internal behavioral and communication
factors. Thus the program activities are viewed within a sociopolitical structure especially
within the local environmental settings.
DIF: Cognitive Level: Apply (Application)
9. Which is the best way to assess if learning has occurred?
a. There is an appreciation for the new knowledge and skills learned.
b. Participants passed an examination designed to measure learning.
c. Participants stayed attentive throughout the program.
d. There is a long-term change in knowledge and behavior.
ANS: D
By definition, learning is an enduring change involving modification of insights, behaviors,
perceptions, or motivations. An appreciation for the new knowledge, passing an examination,
and staying attentive does not address the entire scope of the learning process.
DIF: Cognitive Level: Understand (Comprehension)
10. Which led to the creation of the
Model
NUHealth
RSINBelief
GTB.C
M (HBM)?
O
a. Attempting to explain why individuals engage in health actions
b. Attempting to identify health behaviors of military spouses
c. Attempting to understand why people chose unhealthy and high-risk behaviors
d. Attempting to understand why people did not flock to free health care
ANS: D
The HBM was created to explain why people did or did not participate in health education
programs to prevent or detect disease, even when the programs were free. The HBM addresses
factors that provide health-enhancing behaviors. Pender’s Health Promotion Model (HPM)
aims to explain why individuals engage in health actions. HPM has been used in studies
identifying factors that enhance health-promoting behaviors of military spouses.
DIF: Cognitive Level: Understand (Comprehension)
11. Which needs to be considered when using the Health Belief Model (HBM)?
a. Prior behaviors
b. Perceived benefits
c. Health promoting behaviors
d. Personal benefits
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The HBM is a value expectancy theory that addresses factors that promote health-enhancing
behavior. The HBM considers perceived susceptibility, perceived severity, perceived benefits,
perceived barriers, and other sociopsychological and structural variables. Self-efficacy,
defined as the notion that an individual can act successfully on a given behavior to produce
the desired outcome, was later added to the HBM.
DIF: Cognitive Level: Understand (Comprehension)
12. Which factor is found in the Health Belief Model (HBM) but not in Pender’s Health
Promotion Model (HPM)?
a. Individual perception
b. Likelihood of action
c. Personal threat as motivator
d. Self-efficacy
ANS: C
Pender’s HPM is a competence or approach-oriented model and, unlike the HBM, does not
rely on personal threat as a motivating factor. Both attempt to explain behavior, based on
individual perceptions, and both include self-efficacy as a factor. (Although the HBM did not
originally include self-efficacy, it was added in the revised model.)
DIF: Cognitive Level: Understand (Comprehension)
13. Which best describes the primary purpose of both the Health Belief Model (HBM) and Health
Promotion Model (HPM) models?
a. To create an alternative to analyzing each individual person’s motivation
b. To find a more efficient way to explain behavior to other professionals
NURSIdoNor
GTdoB.C
M in health actions
c. To help explain why individuals
not O
engage
d. To assist professionals in knowing how to intervene in client decisions
ANS: C
The models are meant to provide an organizing framework to explain why individuals engage
in health actions. Therefore, they are also useful in assessing patients’ motivations and
explaining their behavior.
DIF: Cognitive Level: Understand (Comprehension)
14. Which method is most consistent with Freire’s approach to empowerment?
a. Encouraging active participation and dialogue in critical reflection
b. Recognizing that the best resources to create change are found in powerful leaders
c. Reminding learners of their responsibility for their own learning
d. Using the “banking” approach with nurses sharing their expertise with patients
ANS: A
Banking education where teachers give information, which learners then regurgitate at
examination time, is not useful. Problem-solving education with active participation and
ongoing dialogue encourages learners to be critical and reflective about health issues.
DIF: Cognitive Level: Understand (Comprehension)
15. A nurse is teaching diabetic self-care in a small group. Which is the first action the nurse
should take?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Assess group needs each day before beginning.
Create new and innovative teaching approaches for each session.
Implement the most effective teaching methods.
Listen carefully to understand participants’ issues.
ANS: D
Listening is the first phase and is essential to understanding the issues. Assessing group needs,
creating new teaching approaches, and implementing effective teaching methods can be
completed after listening to the issues of the participants.
DIF: Cognitive Level: Apply (Application)
16. A nurse who is providing education spends more time being quiet than giving information.
Which best explains this behavior?
a. The nurse had previously reviewed the day’s material.
b. The nurse is demonstrating respect for the participants.
c. The nurse is encouraging group discussion.
d. The nurse is listening to the group’s dialogue to identify problems.
ANS: D
The exchange of ideas and concerns creates a problem-posing dialogue and identifies root
problems or generative themes. The group members themselves create relevant action plans
that are congruent with their own reality. Therefore to be effective, the nurse must listen to
ensure that teaching reflects what the group wants to learn. Demonstrating respect,
encouraging group discussion, and being prepared are all important roles of the nurse, but the
reason why the nurse is quiet is to listen and understand the issues the group faces.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
17. Which best describes the goal of participatory action research?
a. Analytical epidemiological findings
b. Careful descriptive research studies
c. Experimental studies using both experimental and control groups
d. Social change resulting from stakeholders’ strategies
ANS: D
The goal of participatory action research is social change. The strategies reached collectively
by the involved stakeholders lead to changes within the group and the community.
Participatory action research does not produce analytical epidemiological findings, descriptive
research studies, or experimental studies.
DIF: Cognitive Level: Understand (Comprehension)
18. A nurse is asked, “Why are you so rarely in the department office?” Which would be the most
appropriate response?
a. “I have to be where the people are.”
b. “I prefer to write my reports in my car immediately after my intervention.”
c. “I thought I was paid to be in the community, not the office.”
d. “I try to avoid paperwork as much as possible.”
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
One of the underlying premises of community health is to “start where the people are.”
Therefore, the nurse must spend a great deal of time and effort in the community interacting
with community members and must be where the people are. Writing reports in the car,
avoiding paperwork, and simply stating one is being paid to be in the community do not
demonstrate the nurse’s connection to the community.
DIF: Cognitive Level: Apply (Application)
19. A very busy day is planned at a community health fair, and a nurse spends time greeting and
meeting each person who walks in. Which best describes the rationale for this action?
a. To distribute evaluation forms immediately so the participants can fill in the
appropriate answers after each interaction with a professional
b. To immediately establish a friendly relationship and a level of trust
c. To make sure everyone knew who was sponsoring this free event
d. To most efficiently send the person to the area consistent with his or her apparent
health need
ANS: B
The core of health education is the therapeutic and healing relationship between the nurse and
clients. Inclusion and trust must be established before creating change. The nurse enhances
inclusion by greeting clients on arrival in a warm fashion. Distribution of evaluation forms,
informing participants of program sponsorship, and sending clients to the appropriate area of
the health fair are not as important as the need for establishing a relationship.
DIF: Cognitive Level: Apply (Application)
20. A nurse is trying to improve on providing culturally effective care in the community. Which
NURto
B.C
SImeet
NGTthis
OM
behavior would be most effective
goal?
a. Being willing to change communication patterns to increase client comfort
b. Demonstrating expertise in recognizing physiological differences caused by
ethnicity
c. Exhibiting sensitivity to individual differences resulting from culture and
experiences
d. Expressing the importance of valuing diversity and differences
ANS: C
Unfortunately, voicing the need for valuing diversity is not always consistent with behavior. It
is often useful to change communication patterns to increase client comfort, although the
nurse must sometimes refuse to fulfill client demands. However, it is always crucial to exhibit
sensitivity to individual concerns, cultural background, or previous life experiences.
DIF: Cognitive Level: Apply (Application)
21. A nurse is using the Framework for Developing Health Communications to create a health
program in the community. Which is the first step the nurse would take?
a. Determine factors related to the health problems, such as low socioeconomic status
or educational level
b. Assess health resources available (e.g., money, staff, materials)
c. Establish goals and objectives that are prioritized and time specific
d. Target the program to meet the audience’s learning needs as they perceive them
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
Understanding the intended audience’s learning needs and targeting the program or message
to the audience is key to activating effective health education. After understanding the
audience’s needs, it will be important to determine the factors related to health problems,
assess health resources available, and establish goals and objectives.
DIF: Cognitive Level: Understand (Comprehension)
22. A nurse wants to make sure that the teaching materials and the communication channels being
planned for use during an educational program will be effective. Which action should the
nurse take?
a. Create materials based on the goals of the program, assuming a low literacy level
b. Determine the reading level of the audience and the materials to be distributed
c. Only use materials that have been professionally developed by a commercial group
d. Pretest the materials with members of the target group to obtain feedback
ANS: D
Pretest the materials to obtain feedback about the understandability and acceptability of the
materials with this particular audience. Learning in advance what works and what does not
saves time and effort later. The best way to determine literacy level and congruency of
available resources with the target group’s needs is by pretesting the materials.
DIF: Cognitive Level: Apply (Application)
23. Which best describes the operational definition of “health literacy” in the United States?
a. Being able to read and write at the fifth-grade level
b. Being able to accurately complete a health self-assessment questionnaire
NUR
c. Knowing how to access and
use
information
make health decisions
SI
NGTB.CtoOM
d. Knowing one’s right to obtain health care services
ANS: C
Literacy as a whole is typically defined as being able to read and write at the fifth-grade level.
Health literacy, however, is defined as being able to access, understand, and use information
to make health decisions. Only the latter type of literacy empowers clients to best act on their
own behalf.
DIF: Cognitive Level: Understand (Comprehension)
24. When handed the consent form to sign before treatment could be given, a client looked at the
nurse and said, “I’m sorry; I forgot my glasses today.” Which action should be taken by the
nurse?
a. Ask if the client can use a magnifying glass to better see the form
b. Suggest the client bring his glasses or someone else with him to assist with the
forms
c. Tell the patient why the form was necessary and point to where the patient should
sign
d. Wonder if the patient might have difficulty with reading and therefore summarize
the content of the form for the client
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The Institute of Medicine report related that millions of U.S. adults are unable to read and act
on health instructions and messages. Among the recommendations is a need for clear
communication with clients. Because the underlying issue may be reading, the other responses
are not appropriate suggestions for this nurse–client interaction.
DIF: Cognitive Level: Apply (Application)
25. A nurse is trying to determine a client’s reading level. Which action should be taken by the
nurse?
a. Ask the client how he or she would rate his or her ability to read.
b. Ask the client to assess his or her own health literacy and give examples.
c. Determine the number of years of formal education the client completed.
d. Use a literacy assessment tool, many of which are in the literature.
ANS: A
Any of the responses might be effective at assessing literacy, but the single question asking
how often help might be needed is the fastest and easiest. Nurses are limited in the time
available for assessment. One question is easier for a client than a complete assessment tool.
Asking about years of education can be dismaying to someone who did not complete many
years of formal schooling. Clients may not understand the question when asked to assess their
own health literacy.
DIF: Cognitive Level: Apply (Application)
26. During a health education program, a nurse continues to ask questions and encourages
attendees to contribute examples from their own lives relevant to the discussion. Which best
describes the rationale for the nurse’s action?
NUmore
RSImaterial
a. To avoid having to prepare
NGTB.C
OM to the topic
related
b. To let the participants feel appreciated and knowledgeable
c. To allow the participants to learn by doing through active participation
d. To apply Freire’s principles of learning
ANS: C
One of the key concepts of community organizing practice is the principle of participation,
which essentially means that active participation—or learning by doing—results in a greater
likelihood of change in behavior and attitude.
DIF: Cognitive Level: Apply (Application)
27. A nurse is helping clients to change their behavior. Which would be most effective?
a. Counseling through the Ask, Advise, Assess, Assist, and Arrange approach
b. Encouraging them to interact with others who also need to change their behavior
c. Showing them how the inappropriate behavior is hurting their friends and family
d. Using subtle rewards when small steps are taken toward the appropriate behavior
ANS: A
Ask, Advise, Assess, Assist, and Arrange is the five As approach to counseling as seen, for
example, in smoking cessation programs. The other responses are not as comprehensive as the
five A approach to counseling.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
MULTIPLE RESPONSE
1. Which best describes what Knowles says is especially typical of adult learners? (Select all
that apply.)
a. Barriers such as low self-esteem must be ignored when sharing information.
b. Learning is based on what knowledge will be needed in the future.
c. Learning draws on the learner’s previous life experiences.
d. They need to know why professionals think this knowledge is important.
e. Sharing experiences with others enriches and motivates learning.
f. They want information related to current developmental tasks.
ANS: C, E, F
Knowles suggests all learners want to know why they need to learn material. Material related
to previous life experiences, current developmental tasks, or dealing with current challenges is
useful and accepted by adult learners. Material chosen by professionals based on what might
happen in the future or that ignores barriers such as lack of resources or low self-esteem will
not be retained. Active participation through discussion with others helps involve and
motivate adult learners.
DIF: Cognitive Level: Understand (Comprehension)
2. Which can be found in both the Health Belief Model (HBM) and Pender’s Health Promotion
Model? (Select all that apply.)
a. Cues to action
b. Demographics
c. Perceived barriers
NURSINGTB.COM
d. Perceived benefits
e. Perceived severity
f. Perceived susceptibility
ANS: A, B, C, D
A review of the tables will show that only the HBM includes both perceived severity and
perceived susceptibility. All other factors are found in both models.
DIF: Cognitive Level: Understand (Comprehension)
3. Which variables are missing from both the Health Belief Model (HBM) and Health Promotion
Model (HPM)? (Select all that apply.)
a. Ignoring the impact of being socially and politically disenfranchised
b. Inaccessibility of health services
c. Nurse’s responsibility to give power and control to the individual and the
community
d. Omitting the influence of social, structural, and physical environmental factors
e. Reality of negative outcomes if appropriate behavioral changes are not made
f. Recognizing the influence of families on the individual’s decisions
ANS: A, B, D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The models are very useful in relation to changing individual behaviors, but they do not
address the complex relationships among social, structural, and physical factors in the
environment, such as lack of social support systems or inaccessible health services. Changes
are needed to improve care for socially and politically disenfranchised groups. Knowledge is
always within a social context and is always bound to power relationships. A nurse cannot
assign power and control to an individual. The individual must take on power, although
perhaps with the nurse’s guidance.
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse involved with a community group told peers that the group was learning networking,
negotiating, lobbying, and information seeking. Which provides the best explanation for why
the nurse is not working toward a noticeable improvement in health status for the group?
(Select all that apply.)
a. The nurse cannot improve the health of the group alone.
b. There are ways that these skills will be useful throughout the participants’ life
span.
c. The nurse is focused on teaching, not direct interventions.
d. There are no immediate solutions to the current health problems in most
communities.
e. The nurse is still trying to obtain free health care for the group participants.
f. There are not enough resources to change the health status of the group.
ANS: B, D
Nurses use empowerment strategies when helping people develop skills in problem solving,
critical thinking, networking, negotiating, lobbying, and information seeking to enhance
health. Because health problems
social
and political
NURhave
IN
GTB.C
M aspects, group members must
S
O
develop action strategies. Health problems are complex and do not usually have easy and
immediate solutions. The nurse is using these strategies to promote involvement by the
members of the community group to help change their health status in the future. These
strategies do not focus on teaching, rather on group empowerment. These strategies do not
suggest that the nurse is trying to obtain free health care for the group members or that there
are limited resources available to change the health status of the group.
DIF: Cognitive Level: Apply (Application)
5. A nurse is teaching a coworker about effective strategies to use when providing health
education. Which suggestions would most likely be included? (Select all that apply.)
a. Be encouraging and give positive feedback for helpful comments
b. Include details about each aspect of the information
c. Decide what the client needs to know
d. Review and summarize the key points at periodic intervals
e. Incorporate demonstrations, illustrations, and real-life examples
f. Use medical terminology so clients can look up more information later
ANS: A, D, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The nurse must determine what the client wants to know, not what the nurse believes the
client needs to know. The nurse should not go into excess detail but focus on a few concepts
or key points, that is, stick with the essentials; use clear and concise language while avoiding
technical terms; encourage participants by use of questions related to their life experiences;
use demonstrations and real-life examples to illustrate major points and summarize the key
points to help the audience retain the material.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 09: Case Management
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A health care provider has charged more than what is allowed by a third-party payer. Which
would most likely be the result?
a. Provider may be removed from the list of providers for the third-party payer.
b. The third-party payer will reexamine the payment for that procedure.
c. Provider would get the typical payment instead of what was charged to the
third-party payer.
d. The third-party payer would be forced to increase its typical payment for that
procedure.
ANS: C
Client service use reflects a greater emphasis on health care costs. Third-party payers evaluate
the appropriate use and costs of health care resources. Therefore, at least on the first occasion,
the most probable result would be that the provider gets the listed payment, not what the
provider charged.
DIF: Cognitive Level: Apply (Application)
2. A nurse is explaining case management to a client. Which statement would be the most
appropriate for the nurse to make?
a. “We assess, plan, facilitate, and advocate to save money as much as possible.”
b. “We coordinate your care so you obtain needed services without incurring undue
NURSINGTB.COM
costs.”
c. “We seek the lowest cost provider to give you what care is necessary.”
d. “We collaborate with you to coordinate your care for the best outcome.”
ANS: D
There is no single definition of case management. But it is a collaborative process to meet an
individual’s health needs through communication and available resources to promote quality
cost-effective outcomes. The response “with you” shows a collaborative approach to
coordinating care for the best outcome.
DIF: Cognitive Level: Apply (Application)
3. A hospital is going to start a care management program. Which group of clients would most
likely be selected to first receive such services?
a. Clients who represent the most common diagnosis group to be admitted
b. Clients who request such services from their local hospital
c. Clients with chronic illnesses
d. Clients with the least education
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The overall goal of care management is to improve the coordination of services provided to
clients who are enrolled in a care management program. Examples of groups of people who
may be served by care management services include the elderly, children from low-income
families who receive Medicaid services, and groups of people with chronic illnesses. The
other groups do not represent groups who are typically enrolled in a care management
program.
DIF: Cognitive Level: Apply (Application)
4. Who first created the idea of a continuum of care, which later evolved into the term “case
management”?
a. Florence Nightingale, when she engaged in activities such as writing letters for the
wounded.
b. Lillian Wald, who created health education programs for the whole community.
c. Social workers, who function as discharge planners, use the term.
d. Those who coordinated services for discharged psychiatric patients after World
War II (WWII) used the term.
ANS: D
The concept of continuum of care originated after WWII to describe the long-term services
required for discharged psychiatric patients. The term “case management” first appeared in
social welfare literature during the early 1970s. Nightingale, Wald, and social workers were
not involved in the creation of the idea of the continuum of care.
DIF: Cognitive Level: Remember (Knowledge)
5. Which best describes the aftermath of the deinstitutionalization of mentally ill patients into the
NURSINGTB.COM
community during the 1970s?
a. Community health centers were created and gave care to such clients.
b. Families were eager to accept their family members back home.
c. Many mentally ill clients without social skills ended up in nursing homes.
d. Without follow-up care, many clients were readmitted to care.
ANS: D
Several problems resulted from deinstitutionalization of mentally ill patients, because there
was no follow-up or monitoring. Many were readmitted to state hospitals. Many ended up
homeless or in prison facilities, not in nursing homes or with their family members at home.
Community health centers were created to provide care to these patients, but the
deinstitutionalized were unable to meet their basic needs and receive proper follow-up and
health care monitoring. Thus, they were readmitted to care.
DIF: Cognitive Level: Understand (Comprehension)
6. Which elderly persons are often the targets of case management?
a. Those who are homebound and have multiple complex problems
b. Those who live alone without close relatives
c. Those who show clear evidence of mental and physical decline
d. Those with chronic long-term health problems needing pharmaceutical
intervention
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Many older people have special, population-specific health care needs. Case management
services frequently target the elderly population, specifically homebound individuals or those
with complex problems. However, not all older persons require a case manager. The other
elderly groups are not the primary target of case management services.
DIF: Cognitive Level: Understand (Comprehension)
7. Which best describes the purpose of case management from the client’s perspective?
a. To help clients navigate a complex, fragmented, confusing health care system to
obtain appropriate care
b. To help clients recognize that health care resources are limited and must be used
wisely
c. To help clients understand their varied health problems and the best approach to
maintain their health
d. To help clients obtain whatever care they need or desire
ANS: A
Client-centered case management assists the patient through a fragmented and often confusing
health care delivery system and to achieve specific client-centered goals. Systems-centered
processes recognize that health care resources are finite. Helping clients understand their
health problems is a responsibility of health education, not case management.
DIF: Cognitive Level: Understand (Comprehension)
8. Which best describes a key strategy that is used as part of care management?
a. Align necessary services with the need of the population
b. Implement services as soon as possible
NURappropriate
c. Request front line staff make
SINGTB.C
OM
referrals
d. Utilize assigned case managers to complete this process
ANS: A
The purpose of care management is to reduce health risks and cost of care for a defined
population. AHRQ highlights three key strategies to enhance care management for target
populations: (1) Identify population(s) with modifiable risks; (2) Align CM services to the
needs of the population(s); and (3) Identify, prepare, and integrate appropriate personnel to
deliver the needed services.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best describes why utilization review departments are becoming case management
units?
a. Funding is available for case management responsibilities.
b. Monitoring service use alone does not improve patient outcomes.
c. It facilitates using nurse experts for case management.
d. It promotes the current trend of naming “utilization review” units “case
management.”
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Case management programs evolved from utilization review departments when those
departments demonstrated that monitoring service use alone is insufficient for managing
patient populations with diverse resource needs. There is not readily available funding for
case management responsibilities. Case management involves more than utilization review, so
there is a changing role of the nurse associated with the change of the name of the department.
Using nurse experts for case management is beneficial, but it is not the reason why these
departments transitioned.
DIF: Cognitive Level: Understand (Comprehension)
10. Which best describes why health care institutions are unhappy beyond the fact that they are
not receiving the previous high reimbursement for procedures from Medicaid or Medicare?
a. Because clients are well informed and know they do not really have to pay their
hospital bills
b. Because insurance companies and other third-party payers copy Medicaid’s
approach to holding down costs
c. Because it is harder to continue giving charity care when less reimbursement is
received from the federal government
d. Because recent legislation has required that all reimbursement be based on quality
performance measures
ANS: B
Although publication of quality measures is occurring, this is gradually being implemented.
The Centers for Medicare and Medicaid (CMS) have established value-based purchasing
programs for hospitals. The programs link Medicare payments to quality performance,
utilization of evidence-based practices, costs of care, and patient experience scores. However,
whatever the federal government
downMcosts is usually quickly copied by
NURdoes
INtoGhold
B.C
S
T
O
insurance and other third-party payers.
DIF: Cognitive Level: Understand (Comprehension)
11. Which best describes why nurses are increasingly becoming case managers when social
workers have historically been so successful in the role?
a. Because of the need for ongoing patient assessment.
b. Because of a shortage of licensed social workers.
c. Nurses seek such roles as being easier than direct clinical care.
d. Social workers expect higher salaries than nurses in the same role.
ANS: A
Traditionally, case managers were social workers. Client health care needs became more
complex, the need for ongoing patient assessment has emerged, and available resources have
become more numerous and diverse. Therefore, nurses have become case managers. There is
not a shortage of licensed social workers to fill these roles or a salary issue with social
workers being in these roles. These roles are different than direct clinical care but may not be
considered to be an easier role for the nurse.
DIF: Cognitive Level: Understand (Comprehension)
12. A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role.
Which will be most difficult for the nurse new to this role?
a. Having the ability to be a leader and work autonomously
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. Obtaining knowledge of community resources
c. Gaining knowledge of reimbursement structures and financial strategies
d. Getting practice at evaluating patient outcomes
ANS: C
Skills to ensure success in the role of case manager include sound knowledge of
reimbursement structures, knowledge of available resources within the community, ability to
evaluate patient outcomes, and an understanding of financial strategies. Such a nurse would
have to be flexible, be creative, communicate well, and be able to work autonomously.
Although the text does not discuss this, the typical baccalaureate program does not include
courses in reimbursement and financial implications of clinical decisions.
DIF: Cognitive Level: Apply (Application)
13. Which has the largest influence on the case manager’s role?
a. Criteria of the program for accepting clients
b. Location of the program
c. Population served by the program
d. The specific program that employs the case manager
ANS: D
The individual case manger’s role will vary depending on the specific program’s services. The
criteria of program acceptance, location, and population served by the program will not have
as large an influence on the case manager’s role as do the specific services of the program.
DIF: Cognitive Level: Understand (Comprehension)
14. A client has been referred to N
a case
Which action would the nurse most
R management
I G B.Cprogram.
M
U S N T
O
likely take first?
a. Admit the client for services.
b. Determine the appropriateness for inclusion in the program.
c. Contact the physician to determine if services are necessary.
d. Contact the most appropriate community agencies for additional assistance.
ANS: B
All clients referred for case management must undergo screening to determine their
appropriateness for inclusion in the program. Thus, this is the action the nurse must take first.
Not all referred clients need the services of a nurse case manager. Often, a nurse can arrange
community services or instruct the client and family in the most appropriate follow-up based
on client need and program design.
DIF: Cognitive Level: Apply (Application)
15. The case manager gave the client a list of eight possible sources for the equipment needed for
care after discharge. Which best describes why the nurse did not just tell the client the best
source for the equipment?
a. The client has a right to select providers of needed resources.
b. The nurse did not know which source was the best resource.
c. The client must make a decision independently.
d. The nurse did not care which source is chosen.
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Ethical issues for case managers include the client’s right to select providers of resources. As
a practical matter, nurses usually offer several choices, so there is no suggestion of
misconduct in pushing a particular provider.
DIF: Cognitive Level: Apply (Application)
16. A recently licensed registered nurse has been working as a case manager for the past 12
months and would like to become certified. Which organization should the nurse pursue
certification through?
a. Commission for Case Manager Certification
b. American Nurses Credentialing Center (ANCC)
c. American Nurses’ Association (ANA)
d. Centers for Medicare and Medicaid (CMS)
ANS: A
The only organization that offers a certification that this nurse is qualified to obtain is the
Commission for Case Manager Certification. The CCM practice requirement is 12 months
experience supervised by a CCM, 24 months as full-time case manager, or 12 months as a
supervisor of individuals who provide case management. The ANCC certification requires
that the nurse has practiced the equivalent of 2 years full-time as a registered nurse. The ANA
and CMS do not offer certification for case managers.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which best describes the goals
management
regardless of setting? (Select all
N ofRnursing
I G case
B.C
M
U S N T
O
that apply.)
a. Ensure that all clients have a case manager
b. Contain costs and control use of services
c. Decrease duplication and fragmentation
d. Enhance client’s quality of life
e. Focus on avoiding hospitalization or institutionalization
f. Maintain routine communication channels
ANS: B, C, D
Case management programs aim to provide a service delivery approach to ensure the
following: cost-effective care, alternatives to institutionalization, access to care, coordinated
services, and patient's improved functional capacity (Lyon, 1993). Not all clients need case
managers if they have adequate financial resources and can navigate the health care system.
Although hospitalization can often be avoided, in acute cases hospitalization would be the
most appropriate use of resources.
DIF: Cognitive Level: Understand (Comprehension)
2. Which clients may be eligible for hospital-based, disease-specific case management support?
(Select all that apply.)
a. Those who have high-cost conditions
b. Those with physicians who request such intervention for their patients
c. Those who may be maintained in a stable condition in their home environment
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Those who have access to private insurance plans
e. Those who have requested such services
f. Those whose hospital has a collaborative agreement with a home health nursing
agency
ANS: A, C
Case management services are often provided for individuals who are identified as having
medical conditions that are high-cost or high-volume acute and chronic illnesses such as
congestive heart failure. The goal is to keep these clients as healthy as possible and stable in
their home environment. Doing so will decrease the frequency and length of hospital stays and
therefore decrease health care costs.
DIF: Cognitive Level: Understand (Comprehension)
3. Which are considered part of the six components of case management? (Select all that apply.)
a. Assessment of client needs
b. Development of care plans
c. Giving direct client care as needed
d. Monitoring and evaluating care that is provided
e. Obtaining needed resources and funding for the client
f. Submitting appropriate forms to involved agencies for the client
ANS: A, B, D
There is a consensus in the literature that there are six components to case management: client
identification and engagement, assessment, care plan development, implementation and
coordination of plan of care, monitoring and evaluation, and closure of professional services.
The focus of each of these functions varies depending on the case management model.
NURSINresources
GTB.Cand
Providing direct client care, obtaining
OMfunding, and submitting appropriate
forms are not part of the core components of case management.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes how a case manager identifies people who would benefit from case
management services? (Select all that apply.)
a. Evidence-based criteria
b. Families who express doubt that the patient is receiving adequate care
c. Patient having setbacks from treatment
d. Referrals from health care providers or agencies
e. Risk identification from data management
f. Use of health risk screening tools
ANS: A, D, E, F
A variety of tools are used to identify people who would benefit from case management
services. These include health risk screening tools, evidence-based criteria, risk stratification
through data management, and referrals from hospitals and health care providers.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 10: Policy, Politics, Legislation, and Community Health Nursing
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which nurse fought to have American nursing controlled by nurses rather than physicians?
a. Clara Barton
b. Florence Nightingale
c. Lavinia Dock
d. Lillian Wald
ANS: C
Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to
control the nursing profession. Florence Nightingale was the first nurse to exert political
pressure on a government. Clara Barton was responsible for organizing relief efforts during
the U.S. Civil War. Lillian Wald was the driving force behind the federal government’s
development of the Children’s Bureau in 1912.
DIF: Cognitive Level: Remember (Knowledge)
2. Which nurse used political expertise to influence the federal government to develop a
Children’s Bureau?
a. Clara Barton
b. Florence Nightingale
c. Lavinia Dock
d. Lillian Wald
ANS: D
NURSINGTB.COM
Lillian Wald recognized the connection between social conditions and health. She was a
driving force behind the federal government’s development of the Children’s Bureau in 1912.
Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to
control the nursing profession. Florence Nightingale was the first nurse to exert political
pressure on a government. Clara Barton was responsible for organizing relief efforts during
the U.S. Civil War.
DIF: Cognitive Level: Remember (Knowledge)
3. Which best describes the most important factor in legislation?
a. The amount of financing and lobbying behind each choice
b. The beliefs, attitudes, and values of the policy
c. The preferences of the majority of American voters
d. The president’s ongoing encouragement for one particular choice
ANS: B
Public policy encompasses the choices made regarding goals, priorities, and how resources
are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the
policy. The influence of the president, preferences of Americans, and amount of financing
related to the legislation are not as important as the beliefs, attitudes, and values of the policy.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. Which is accomplished through the use of public policy?
a. Solutions to problems of public concern are developed.
b. A rational, logical problem-solving decision-making process is implemented.
c. Public safety nets for vulnerable populations are created.
d. Economic and business management principles are applied.
ANS: A
The field of public policy involves the study of specific policy problems and governmental
responses to them. Political scientists involved in the study of public policy attempt to devise
solutions for problems of public concern. The use of public policy may not involve the
implementation of a logical problem-solving, decision-making process. Public policy
addresses more than safety nets for vulnerable populations. Additional principles besides
economics and business management are applied through the use of public policy.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best describes why it is so difficult to change the paradigm of health care from disease
orientation to promoting health orientation?
a. The belief exists that those without insurance could obtain insurance if they
worked hard enough.
b. People find it difficult to agree on what the ideal paradigm should be.
c. People realize the media have exaggerated the problems that result from lack of
insurance.
d. Serious reallocation of resources would have to occur.
ANS: D
NU
RSINGTa B.C
A shift in the paradigm would
necessitate
substantial
OM reallocation of resources because the
vast majority of health spending is currently directed to medical care and biomedical research
and reflects a viewpoint of health care as a commodity. The allocation of resources has the
most influence on creating a paradigm shift. Individual opinions and the use of media do not
play as great of role as where resources are spent.
DIF: Cognitive Level: Understand (Comprehension)
6. Which best describes how the government controls conditions that individuals cannot?
a. Appeals to the common sense and good nature of the citizens
b. Establishes social mores that enable groups to control individuals’ behaviors
c. Passes and enforces law
d. Uses fear reinforced by police power
ANS: C
Government regulates conditions that individuals cannot control and provides individual
protection through a population-wide focus. These tasks are accomplished through passage
and enforcement of laws. These laws control individuals’ behaviors, which may lead to the
establishment of social mores and common sense related to the laws that have been
established.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
7. Which statement best describes why the federal government is unable to do whatever
politicians currently in power want?
a. The citizens would rise up in rebellion if actions were outrageous.
b. The lack of funds to implement actions is seen as unreasonable by a majority of
voters.
c. Only the actions authorized by the Constitution are legitimate.
d. The states would rebel and withdraw from the union.
ANS: C
The federal government is a government of limited powers, which means that, for a federal
action to be legitimate, it must be authorized. Only those actions that are within the scope of
the Constitution, the supreme law of the land, are authorized. Power of the states and citizens
is limited under the overall umbrella of the federal government. Funding is also controlled
through the powers of the federal government.
DIF: Cognitive Level: Understand (Comprehension)
8. Which is the basis for any American citizen to feel comfortable expressing an opinion on a
political issue?
a. Amendments to the Constitution
b. Articles of the Constitution of the United States
c. Declaration of Independence
d. Gettysburg Address
ANS: A
Amendments to the Constitution, later known as the Bill of Rights, were added after the
original Articles of the Constitution were ratified. These amendments protect individuals’
NURSIof
rights and freedoms. The Declaration
NGIndependence
TB.COM announced the freedom of America
from the British Empire. The Gettysburg Address was a speech given by President Abraham
Lincoln following the Civil War.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best describes who has the authority to act in every area except those specifically
mentioned in the Constitution?
a. Any individual citizen
b. Federal government
c. Local government
d. State government
ANS: D
Any powers not delegated to the federal government are reserved for the states. Thus,
individual citizens, the federal government, and local governments are excluded.
DIF: Cognitive Level: Understand (Comprehension)
10. Which best describes how the local government is provided authority?
a. Through the ability to tax local residents to meet local needs
b. Through the people themselves who band together to create the community
c. Power delegated from the federal level to the local level
d. Power delegated from the states
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
States may delegate powers to the local government. Which powers they delegate vary widely
from state to state. The federal government does not directly delegate power to the local level,
and this occurs through state government. Taxation and creation of a community do not
provide the local government with authority.
DIF: Cognitive Level: Understand (Comprehension)
11. Which statement best describes how policies in the private sector are different from policies in
the public sector?
a. Private sector policies are slow, deliberate, and reactive to events.
b. Private sector policies are determined by the opinions and feelings of those
employed in that sector.
c. Private sector policies are based on economics and market trends.
d. Private sector policies are based on rational decision-making.
ANS: C
Private policy is largely influenced by theories of economics and business management,
including consumerism and market trends. Such policies can react quickly and are often
proactive. In comparison, public policies are slow and reactive, and economics is just one of
many factors involved. Public policies are determined by voting shifts, electoral realignment,
and term limits.
DIF: Cognitive Level: Understand (Comprehension)
12. The president was sent a bill that he did not really like, but he would have been unpopular if
he vetoed it, so he did nothing. Which best describes what will happen to the bill?
NURSINGTB.COM
a. The bill is dead.
b. The bill returns to both houses to see if enough votes can be obtained to pass the
bill even without the president signing the bill.
c. The bill becomes law.
d. The bill sits there until the president signs it or vetoes it.
ANS: C
A bill that has been passed by the legislature goes to the president. The president may sign it,
so it becomes law; however, if he neither signs nor vetoes it, the bill becomes law by default.
DIF: Cognitive Level: Apply (Application)
13. The forces for the proposed bill are roughly as persuasive, powerful, and well financed as the
forces against the proposed bill. Which describes the most likely outcome?
a. The bill will be debated through a public hearing.
b. The bill will fail.
c. The bill will pass.
d. The bill will remain in the legislature until one side or the other has a majority of
votes.
ANS: B
It is far easier to defeat a bill than get one passed; therefore, the opposition always has the
advantage.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
14. Which statement best describes what happened to the hospitals built or expanded by
Hill-Burton Act funds?
a. Many such hospitals have consolidated or closed.
b. Not needing to expand, hospitals have used the funds to upgrade their facilities.
c. They have continued to use such funds to expand.
d. When funding ceased, so did hospital expansion.
ANS: A
The Hill-Burton Act authorized federal assistance in construction of hospitals, making
hospitals more accessible. However, with the high cost of health care and the decreasing
lengths of stay and increasing use of primary care, many hospitals are closing. Because
hospitals have closed, they are not further expanding or upgrading facilities.
DIF: Cognitive Level: Understand (Comprehension)
15. An individual has been terminated from his job and has lost his health insurance. Which
federal law allows him to continue his insurance benefits for a specified period of time?
a. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
b. Family Support Act of 1988
c. Health Maintenance Organization Act of 1973 (HMO)
d. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
ANS: D
An important requirement of COBRA focuses on the problem of the loss of insurance when a
person loses his or her job. With the growing number of unemployed, COBRA is even more
important. Employers who terminate an employee must continue benefits for the employee
NUperiod
RSIN
and dependents for a specified
ofGtime
if the
TB.C
OMemployee had health benefits before the
termination. HIPPA offers protections for patient privacy and confidentiality. The Family
Support Act expanded coverage for poor women and children and required states to extend
Medicaid coverage for 12 months to families who have increased earnings but are no longer
receiving cash assistance. The HMO Act provides grants for HMO development.
DIF: Cognitive Level: Apply (Application)
16. Which statement best describes an effect of the Welfare Reform Act of 1996?
a. Individuals who were required to obtain employment lost their health coverage.
b. Many were happy to be off the government dole and self-supporting.
c. Persons sought and obtained employment that often included insurance benefits.
d. The food stamp program decreased in size.
ANS: A
The law decreased the number of people on welfare and forced many individuals to take
low-paying jobs, many of which did not offer health insurance. Many individuals, particularly
women and children, subsequently lost Medicaid coverage.
DIF: Cognitive Level: Understand (Comprehension)
17. Which best describes the history of the State Child Health Improvement Act (SCHIP) of
1997?
a. The law included goals and programs but no funding to achieve them.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. The law received extensive support by both Republicans and Democrats.
c. The law was extended, not renewed by the Bush administration, and then renewed
by the Obama administration.
d. The law was passed by the majority of states but not by the federal government.
ANS: C
The law was extended several times, and then it was not renewed by the Bush administration.
The program was renewed again by the Obama administration in the Children’s Health
Insurance Reauthorization Act of 2009.
DIF: Cognitive Level: Understand (Comprehension)
18. Which best describes what happened after the Medicare Modernization Act of 2003 was
enacted?
a. Additional restrictions in coverage were imposed.
b. Experimental treatments were approved for reimbursement.
c. Reimbursement procedures became more efficient.
d. A prescription drug benefit was added.
ANS: D
The Medicare Modernization Act of 2003 provides seniors and people living with disabilities
some prescription drug benefit coverage, as well as more choices and better benefits. The act
did not impose additional restrictions to coverage, approve experimental treatments, or
provide efficiency with reimbursement procedures.
DIF: Cognitive Level: Understand (Comprehension)
19. A nurse is employed by the state
health
department.
Which activity would she most
N Rpublic
I G
B.C
M
U S N T
O
likely complete?
a. Set up a flu shot clinic at a neighborhood church.
b. Lobby for health care reform to cover more preventive services.
c. Monitor the incidence of influenza in the state.
d. Serve as a volunteer for a state legislator’s campaign.
ANS: C
One of the state health care functions is assessment of health needs based on statewide data
collection. This could be done by monitoring the incidence of influenza in the state. Setting up
a flu shot clinic would most likely be done at the local level, while lobbying for health care
reform would most likely be done at the federal level. Serving as a volunteer for a campaign
may be something a nurse would do, but would not be specifically related to employment by
the state public health department.
DIF: Cognitive Level: Apply (Application)
20. It has been proposed that a new, better approach to health care be tested with a small group to
evaluate its effectiveness. Which best describes why this cannot be done?
a. Any employment in the project would be only temporary, so it would be difficult
to find professionals to staff the program.
b. It is challenging to find appropriate sites located in the target area from which to
offer the pilot project service.
c. No one wants to accept free services if they include being a guinea pig in a
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
research project.
d. Offering a service establishes a precedent and a sense of entitlement, so it is
difficult to discontinue the program.
ANS: D
Once a direct health care service is offered, it is difficult to discontinue it. Existing programs
create tradition by establishing vested interest and a sense of entitlement.
DIF: Cognitive Level: Apply (Application)
21. Which best describes the most crucial step in policy formation?
a. Convincing both political parties and independents to support the proposed policy
b. Defining the issue and placing it on the agenda for possible action
c. Determining who has vested interest in what aspects of the policy
d. Trying to simplify the proposed legislation so the public will support it
ANS: B
How an issue is defined determines what the possible approaches to resolution might be. With
all the demands on legislators’ time, it is difficult for an issue to be seen as important enough
to have action taken. Defining the issue as crucially important and worthy of a place on the
agenda for possible action is the most critical step.
DIF: Cognitive Level: Understand (Comprehension)
22. A nurse suggests to the students that they attend the local district nurses’ association meeting,
where the nurse is an officer. Which provides the best rationale for this action?
a. Meeting outside the clinical area allows for more effective informal learning based
on discussion and interaction.
NURSINGTB.COM
b. Role models are typically the major influence on nurses choosing to become
politically active.
c. Students are often given extra credit from their instructor for such community
involvement.
d. Such groups want students to attend their meetings to encourage them to join and
to accept a committee responsibility.
ANS: B
Professional groups do not usually accept students into membership (especially since many
students may want a different specialty practice). Nurses most often identify positive role
models as the major influence that assisted them to become politically active. Therefore,
mentorship at the student level up to the expert level is important. Providing extra credit
should not be the motivator for students to learn from these role models. The learning that
occurs is a formal learning process related to learning more about political advocacy and
something that is difficult to demonstrate in a classroom environment.
DIF: Cognitive Level: Apply (Application)
23. Which statement best describes why nurses are not more effective in creating political
change?
a. Nurses are not listened to by politicians.
b. Nurses are not perceived as leaders in the health care field.
c. Nurses do not act or do not agree on what changes are needed.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Nurses do not know how to negotiate, communicate, and collaborate to create
change.
ANS: C
Nurses know how to communicate, collaborate, negotiate, and serve as leaders who can make
themselves heard. However, the various nursing subgroups do not agree on public policies.
DIF: Cognitive Level: Understand (Comprehension)
24. The local nursing association and the local medical association disagreed vehemently on
advanced practice nursing reimbursement. Which best describes why the two groups agreed to
join a coalition to send representatives to testify on a particular bill?
a. Although there was disagreement, both groups agreed to behave politely and
professionally.
b. Both associations had formed a coalition to collaborate on a bill that would benefit
patients.
c. Because the legislators had asked both groups to appear, the groups did not have a
choice.
d. The two groups were sharing costs and expenses, but their testimony would give
opposing viewpoints.
ANS: B
When two or more groups join to maximize resources, increasing their influence and
improving their chances of success in achieving a common goal, it is a coalition. Professional
groups often form coalitions to advance their shared interests.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
25. A nurse is employed by the state nursing association to serve as a lobbyist. Which would be
the most crucial task to achieve?
a. Be seen as a reliable and credible source of accurate information
b. Convince colleagues in nursing to join their local nursing organization and write to
encourage legislators to vote according to nurses’ goals
c. Offer to make large donations to the legislator who can forward nursing’s agenda
d. Visit every single legislator so the nurse is recognized in this role
ANS: A
An individual who establishes a reputation as a reliable and accurate resource as a lobbyist has
substantial influence. Certainly, it is also useful to convince colleagues to join nursing
organizations and write legislators or contribute to campaigns of legislators supportive of
nursing goals. Legislators rely on lobbyists to educate them on issues. The official must trust
the lobbyists to give accurate (though predictably biased) information, which is timely and up
to date.
DIF: Cognitive Level: Apply (Application)
26. A nurse represents the state professional association. Which action would the nurse complete
in relation to legislation?
a. Be prepared to contribute to campaigns of legislators who vote consistently with
nursing goals
b. Be prepared to confront verbally those on the opposite side of legislative issues
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Be prepared to provide testimony and comment on relevant issues
d. Be prepared to visit schools of nursing to present about the current legislative
issues
ANS: C
Although a nurse might do any of the above, the most effective is to provide testimony and
comment on issues of importance to nursing. Contributing is dependent on the financial
resources of the nurse. Legislators often appreciate volunteer hours spent on campaign tasks
as much as sums of money. Giving presentations to schools may be useful, but it may be
assumed that most nursing faculty can discuss legislative health issues. Verbal confrontations
are not always useful.
DIF: Cognitive Level: Apply (Application)
27. A nurse is unable to be actively involved in attending meetings at the state level. Which action
would be most useful for the nurse?
a. Asking students to remain informed regarding proposed legislation
b. Communicating, with rationales, her stand on proposed legislation to legislators
c. Remaining uninvolved so incorrect information is not inadvertently given
d. Writing letters to the local newspaper asking nurses to become involved
ANS: B
Grassroots cooperation can influence decisions. A high number of communications from
individual constituents via email, telephone, or postal mail have great influence.
DIF: Cognitive Level: Apply (Application)
28. A nurse states that he or she N
doesRnotIwant
become
G toB.C
M involved in politics because of family,
U S N T
O
school, work, and other commitments. Which would be the best reply to this statement?
a. “Good for you. We should all stay out of such dirty game playing!”
b. “I am sorry to hear that but I do understand.”
c. “It doesn’t matter; politics have nothing to do with nursing practice.”
d. “It won’t take much time to join ANA and pay dues so their lobbyist can represent
you.”
ANS: D
Some of the nursing organizations have full-time lobbyists who work in Congress, including
the American Nurses Association (ANA). These lobbyists help represent the interests of
nurses and society. Politics play a major role in nursing practice and nurses should be
encouraged to participate in organizations, even if it is through paying dues, so that their voice
can be represented.
DIF: Cognitive Level: Apply (Application)
29. Which statement best describes why nurses should contribute whenever possible to their state
nursing association political action committee (PAC)?
a. As PACs are a reality of political life, nursing needs to be heard.
b. Contributing money may result in a future political appointment.
c. Only money really has any influence on legislative votes.
d. PACs are being used to increase nursing salaries and working conditions.
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Because PACs are a reality of political life, nurses need to recognize their power and support
those that are committed to electing candidates sympathetic to health care issues. The
contribution of money will support the current nursing practice initiatives which will change
as nursing practice changes. These contributions will most likely not have any relationship to
a future political appointment. Legislative votes are influenced by a variety of factors and are
not limited only to money.
DIF: Cognitive Level: Understand (Comprehension)
30. Which best describes one of the strategic plan priorities for the Center of Disease Control’s
(CDC) Strategic Framework?
a. Eliminate waste of health care resources
b. Eliminate health disparities
c. Improve health care access
d. Improve health security at home
ANS: D
The three strategic plan priorities for the Center of Disease Control Strategic Framework are:
improve health security at home and around the world; better prevent the leading causes of
illness, injury, disability, and death; and strengthen public health and health care
collaboration. Improvement of health care access, elimination of wasting health care
resources, and eliminating health care disparities are not part of the strategic plan for the
CDC.
DIF: Cognitive Level: Understand (Comprehension)
31. A nurse would like to influence an internal private health policy. Which action should the
NURSINGTB.COM
nurse take?
a. Build or join a private entrepreneurial practice to provide lower cost services to
underserved groups
b. Participate in public discussions regarding quality and managed care
c. Support nursing research done that demonstrates positive clinical and economic
outcomes
d. Write managed care organizations to request that nurses receive reimbursement for
health services to clients
ANS: C
Internal nursing action is from within the agency, such as holding an important management
position. Nurses can support and use nursing research that demonstrates positive clinical and
economic outcomes. Such action also serves to validate the importance of nursing within the
health system. External strategies can include participation in discussions regarding aspects of
care or seeking employment in entrepreneurial practices.
DIF: Cognitive Level: Apply (Application)
32. What was the poverty guideline for a family of four in mainland United States in 2013?
a. Below $24,600
b. Below $16,240
c. Below $37,140
d. Below $41,320
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A
A four-person household must make less than $24,600 to be considered under the poverty
guideline according to the U.S. Department of Health and Human Services.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which best describes the purposes of professional societies such as the American Nurses
Association (ANA)? (Select all that apply.)
a. Providing control and oversight of the occupation
b. Creating licensing laws to control entry into the profession
c. Determining appropriate requirements for education into the profession
d. Establishing standards for practice
e. Protecting the interests of the practitioners
f. Safeguarding the public trust
ANS: A, D, E, F
Professional societies seek to further a particular profession, the interests of persons engaged
in that profession, and the public interest. Their roles are to maintain control and oversight of
the occupation—such as by writing standards for practice—as well as safeguarding the public
trust. Licensure and educational standards are responsibilities of individual states.
DIF: Cognitive Level: Understand (Comprehension)
2. Which is one legally required to obey? (Select all that apply.)
a. Directions to a destination
provided
by aB.C
policeM
officer
NU
RSING
T
O
b. Court decisions related to legislative
law
c. Delegation of responsibility for a task by a physician
d. Executive decisions, such as your employer requirements
e. Laws passed by your state or the federal government
f. Rules and regulations from agencies, such as the state board of nursing
ANS: B, E, F
Laws that all must obey include legislative law, regulatory agency rules and regulations, and
judiciary rulings regarding the law. Although physicians may delegate a task, a physician
cannot delegate responsibility.
DIF: Cognitive Level: Understand (Comprehension)
3. Which current issues are leading the World Health Organization (WHO) to reconsider its
initial definition of health? (Select all that apply.)
a. Environmental issues such as industrial toxins or carcinogenic commercial
products
b. Global, not local, problems such as spread of antibiotic-resistant bacteria
c. Need to move from containment and treatment to social intervention
d. Pressure from industrialized nations to emphasize chronic diseases rather than
infectious diseases
e. Realization that government actions influence the basic human right of health
f. Worldwide pandemics such as human immunodeficiency virus (HIV) and swine
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
flu, which require a different approach
ANS: A, B, C, E, F
WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination
and industrial toxins, and the exploration of carcinogenic commercial products (such as
tobacco). Globally, WHO is trying to eliminate antibiotic-resistant bacteria and the HIV
pandemic. HIV has changed the paradigm from traditional containment and treatment to a
more comprehensive approach of social intervention. There is a realization that health is a
basic human right and health problems are linked to government action and affect human
rights. The WHO is not emphasizing the chronic diseases faced by industrialized nations.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes the new national health goals as seen in Healthy People 2020? (Select
all that apply.)
a. Achieve a plan for universal basic health care for citizens
b. Create social and physical environments that promote good health
c. Eliminate health disparities
d. Eliminate preventable disease, disability, injury, and premature death
e. Achieve health equity
f. Promote healthy behaviors at every stage of life
ANS: B, D, F
Building on previous iterations, the updated 2020 version has four “over-arching goals” for
2020: (1) attain high quality, longer lives free of preventable disease, disability, injury, and
premature death; (2) achieve health equity, eliminate disparities, and improve the health of all
age groups; (3) create social and physical environments that promote good health for all; and
NURdevelopment,
(4) promote quality of life, health
SINGTB.Cand
OMhealth behaviors across all life stages.
Achieving a plan for universal basic health care for citizens, eliminating health care
disparities, and achieving health equity are not seen as national health goals in Healthy People
2020.
DIF: Cognitive Level: Understand (Comprehension)
5. Which statements best describe a notable change of the Omnibus Budget Reconciliation Act?
(Select all that apply.)
a. Legislated a funding increase for RN staffing
b. Changed from process evaluation to outcome evaluation when evaluating care
c. Established guidelines for the use of restraints
d. Created health maintenance organizations nationwide
e. Added prescription drug benefits for Medicaid recipients
f. Required all states to review certificates of need before agencies could expand
ANS: B, C, E
The Budget Reconciliation Act influenced funding and set up guidelines and regulations about
several issues including a move from process to outcome evaluation, use of restraints, and
prescription drugs for Medicaid recipients. The Health Maintenance Organization Act of 1973
established health maintenance organizations. The National Health Planning and Resources
Act of 1974 required health care facilities to obtain prior approval from the state for expansion
in the form of a certificate of need. The Nurse Training Act in 1964 provided funds for
nursing school construction and loans and scholarships for full-time study.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
6. Which were among the outcomes of the 1979 report Healthy People: The Surgeon General’s
Report on Health Promotion and Disease Prevention? (Select all that apply.)
a. A national committee was established to have hearings and study the problem
further.
b. Increased funds were allocated for health planning and health care.
c. Many of the recommendations were adopted on the federal level.
d. The Health Objectives Planning Act of 1990 was passed.
e. The federal government began to identify and monitor national health care goals.
f. The president addressed the American people about the need for health care
reform.
ANS: D, E
The federal government began to take a direct approach in identifying and monitoring national
health care goals after the Surgeon General’s report. The Healthy Objectives Planning Act of
1990 was passed. Healthy People 2000, Healthy People 2010, and Healthy People 2020 are
continuing the efforts. The establishment of a national committee, increased funding for
health planning and health care, adoption of recommendations at the federal level, and the
need for health care reform were not outcomes of the 1979 report.
DIF: Cognitive Level: Understand (Comprehension)
7. Which critical issues in health care were addressed by The Health Insurance Portability and
Accountability Act (HIPAA) of 1996? (Select all that apply.)
a. Portability of insurance coverage
NURSfor
INthose
GTB.C
M their jobs
b. COBRA, maintaining coverage
whoOlose
c. Insurance companies having a total monopoly in a certain geographic area
d. Insurance companies setting limits on coverage of longer than 12 months
e. Insurance companies charging seriously ill persons more than healthy persons
f. Insurance companies paying the same for mental health coverage as for physical
illnesses
ANS: A, D
The HIPAA of 1996 addressed insurance issues. Critical were the portability of coverage and
preexisting conditions. Insurers cannot set limits on coverage longer than 12 months. COBRA
was established through the Consolidated Omnibus Budget Reconciliation Act of 1985. The
McCarren-Ferguson Act of 1945 gave states the exclusive right to regulate health insurance
plans. The Mental Health Parity and Addictions Equity Act of 2008 mandated that insurance
companies must provide the same coverage for mental health as for physical illness. Health
Care Reform legislation prevents insurance companies from charging seriously ill persons
more than healthy persons.
DIF: Cognitive Level: Understand (Comprehension)
8. Which actions represent a shift in philosophy at the Centers for Disease Control and
Prevention (CDC)? (Select all that apply.)
a. Collecting and analyzing health data
b. Improving health security around the world
c. Allocating resources to treat specific diseases
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Strengthening public health
e. Creating transaction-based relationships
f. Preventing the leading causes of injury and illness
ANS: B, D, F
The CDC’s resources are used to leverage influence on the larger health system. This is done
by improving health security around the world, strengthening public health, and preventing
the leading causes of injury and illness. This is not demonstrated by collecting and analyzing
data which would not impact the larger health system, allocating resources to treat specific
diseases as this would have a narrow focus or creating transaction-based relationships.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 11: The Health Care System
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes the principal factor behind ongoing legislation on the federal level
related to health care?
a. Change is needed to reflect differences in health needs today.
b. Efforts must be put in place to control constantly increasing costs.
c. There is a need to focus on the population as a whole.
d. Technological breakthroughs should be expanded.
ANS: B
With the rapid growth of technology and increased demands on the private and public health
care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost
containment have become critical driving forces as health care delivery system changes are
made; however, cost-effectiveness often conflicts with the provision of quality care.
DIF: Cognitive Level: Understand (Comprehension)
2. Which best describes the most common organization for receiving personal health care in the
United States today?
a. A group of physicians all in a particular specialty group who share an office
b. Community health center that includes educational and social services
c. Fee for service by a physician in practice by himself or herself
d. Managed care organization with capitated payments to providers, both
NURSINGTB.COM
professionals and organizations
ANS: D
Managed care has become a dominant paradigm in health care. This model has replaced fee
for service by a physician in independent practice or physicians in a group practice, and care
in a community health center.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes how voluntary health agencies fit into the overall health care system?
a. They fill in the gaps between services offered by private and public health systems.
b. They primarily serve as sources of financial aid for the underserved.
c. They supplement the effort of the public health care system.
d. They support research, education, and services for particular groups of patients.
ANS: D
Voluntary health agencies are committed to specific diseases, organ or body structures, health
and welfare of special groups, or particular phases of health. Philanthropic groups support
research and programs. These organizations provide major sources of help in preventing
disease, promoting health, treating illness, consumer education, and advocacy and research.
Unfortunately, there continue to be overlaps among private, voluntary, and public agencies,
but without voluntary agencies, fewer services would be available.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. Which level of government primarily establishes regulations and provides funding for health
care?
a. Federal government
b. Local health departments
c. Regional health districts
d. State health departments
ANS: A
The federal government has been assuming a larger role in the protection of the population
through regulation and funding. Local health departments establish local health codes, fund
public hospitals, and provide services to populations at risk who often lack health insurance.
State health departments are highly dependent on the federal level of resources and guidance.
Regional health districts are not used as a level of government in the United States.
DIF: Cognitive Level: Remember (Knowledge)
5. Which federal agency is responsible for administering most of the federal health-related
activities?
a. Centers for Disease Control and Prevention (CDC)
b. Department of Health and Human Services (HHS)
c. Health Resources and Services Administration (HRSA)
d. National Institutes of Health (NIH)
ANS: B
Most health-related activities at the federal level are implemented and administered by the
HHS. The responsibility of the CDC is to keep the public safe and healthy. The responsibility
NURS
of the HRSA is to improve access
toIhealth
care services
NGTB.C
OM for vulnerable groups in the
population. The main responsibility of the NIH is biomedical and health-related research.
DIF: Cognitive Level: Remember (Knowledge)
6. Which federal agency is responsible for the Women, Infants, and Children (WIC) program,
food stamps, and school-based nutrition programs?
a. Aid to Dependent Children Department
b. Department of Agriculture
c. Department of Education
d. Department of Health and Human Services
ANS: B
The Department of Agriculture administers the inspection of meat and milk and provides
funds for the WIC program (supplemental nutrition), the food stamp program, and the
school-based nutrition program. The Aid to Dependent Children is a program, not a
department, that provided financial assistance to families with limited financial resources. The
Department of Education administers and coordinates resources related to education. The
Department of Health and Human Services is responsible for protecting the health of all
Americans.
DIF: Cognitive Level: Remember (Knowledge)
7. Which best describes the approach to health care used by states?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Federal funding encourages experimentation in creating new programs.
Insurance regulations concerning reimbursement cross state lines.
Information about successful programs is known to legislators.
States frequently develop new programs as federal funds become available to pay
for them.
ANS: D
Many state and local government programs were developed on the basis of availability of
federal funds. Funds are accompanied by regulations, which apply to all recipients. These
have served to standardize health policy. Federal funding is limited, thus there is limited
opportunity for experimentation. Legislators must be involved in ongoing education in order
to keep up to date on what is happening with programs that have been implemented. Insurance
regulations are monitored by individual states, so reimbursement concerns are unable to cross
state lines.
DIF: Cognitive Level: Understand (Comprehension)
8. Which has led to the more recent focus on cooperation between the state and the federal level
in relation to public health?
a. The emphasis of Healthy People 2020
b. The ongoing continued restriction of financial resources
c. The new presidential administration’s goals
d. The threat of bioterrorism
ANS: D
Cooperation between the state and federal levels has been brought to the forefront with efforts
to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition,
RSfederal
INGTlevel
B.Cfor
the state is highly dependent N
onUthe
OMresources and guidance. The
administrative goals of the president, emphasis of Healthy People 2020, and restriction of
available financial resources have not been the main factor that has led to an increase in
cooperation related to public health.
DIF: Cognitive Level: Understand (Comprehension)
9. Which health care provider organization is seeing an increase in the demand for their
services?
a. Physician practice
b. Hospice service
c. Hospitals
d. Long-term care facilities
ANS: D
Hospital stays have shortened and patients who are admitted are more acutely ill and require
more intensive care. Consequently, decreased hospital stays result in more home care
admissions and more discharges to long-term care facilities for short-term recovery and
rehabilitation. Hospice services and physician practices have not been as impacted as greatly
by this shift in where care is provided.
DIF: Cognitive Level: Understand (Comprehension)
10. Which advanced nurse does not have advanced education in a clinical specialty?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Clinical nurse leader
Clinical nurse specialist
Nurse midwife
Nurse practitioner
ANS: A
All the nurses have advanced education in some aspect of clinical care, such as obstetrics or
primary care. However, the clinical nurse leader is a manager of care at some point of care
and does not have a clinical specialty.
DIF: Cognitive Level: Understand (Comprehension)
11. Which best describes the effect of President Clinton’s Advisory Commission on Consumer
Protection and Quality in the Health Care Industry report (1999)?
a. Created improvement in both physician and nurse educational programs
b. Demonstrated the incredible influence on health care made by the insurance
industry
c. Increased national interest in improving health care and seeking reform
d. Stimulated the Institute of Medicine to explore quality in more depth
ANS: D
The report had a major impact in that it stimulated a series of more in-depth explorations of
the health care delivery system, which resulted in a series of reports developed by the Institute
of Medicine called the Quality Chasm Series. These reports then caused several other
movements within the health care system.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
12. Which best describes one of the current goals for the HHS?
a. Mandate minimum nurse to patient staffing ratios
b. Decrease medical malpractice claims
c. Monitor for health care fraud and abuse
d. Advance scientific knowledge and innovation
ANS: D
The HHS goals for 2015–2018 are: strengthen health care; advance scientific knowledge and
innovation; advance health, safety, and well-being of the American people; and ensure the
efficiency, transparency, accountability, and effectiveness of HHS programs. The goals do not
address nurse–patient staffing ratios, medical malpractice, or monitoring for fraud and abuse.
DIF: Cognitive Level: Remember (Knowledge)
13. Who primarily provides care for military personnel, their families, and veterans, as well as
Native Americans?
a. Federal government
b. Local health departments
c. Regional health districts
d. State health departments
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The federal government is responsible for the health care of specified populations including
military personnel, their families, and veterans. The federal government also is responsible for
health care for Native Americans. Local health departments and state health departments are
not the primary provider of care for these populations. Regional health districts are not used to
provide care for these populations.
DIF: Cognitive Level: Remember (Knowledge)
14. Which accurately describes the impact that the ACA had on expanding Medicaid?
a. There was no impact as Medicaid is funded by state governments.
b. Each state determined if they would accept the federal expansion of Medicaid.
c. Program enrollment decreased as less money was invested in Medicaid.
d. The cases of fraud and abuse within the Medicaid system rose.
ANS: B
One of the major provisions of the ACA resulting in large numbers of Americans receiving
health care coverage was through the expansion of Medicaid; however, each state was allowed
to determine whether they would accept this expansion. Ultimately, 31 states and the District
of Columbia elected to extend Medicaid coverage through the ACA and 19 chose not to.
DIF: Cognitive Level: Understand (Comprehension)
15. Which statement best describes the significance of the Health Plan Effectiveness Data and
Information Set (HEDIS)?
a. Data are publicized so consumers can make informed decisions about where to go
for care.
b. Data are used to measure performance in the accreditation of managed care
organizations (MCOs). NURSINGTB.COM
c. Obvious improvement in the provision of health care has resulted from requiring
health care providers to collect and analyze such data.
d. Physicians and other health care providers can publicize the data to market their
services to new clients.
ANS: B
The National Committee for Quality Assurance accredits MCOs and uses HEDIS to measure
performance and consumer satisfaction. Some outcome data are available to informed
consumers on the Web, but the data are not widely available. To date, these efforts have not
been successful to ensure quality care. Errors continue to be high and patients continue to be
dissatisfied.
DIF: Cognitive Level: Understand (Comprehension)
16. Which statement about the Agency for Healthcare Research and Quality (AHRQ) is accurate?
a. The AHRQ provides funding for medical and nursing research studies.
b. The AHRQ implements strategies to eliminate health disparities across the
country.
c. The AHRQ works to improve the safety of the health care system by publishing
clinical guidelines.
d. The AHRQ is a division of the Institute of Medicine.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The Agency for Healthcare Research and Quality (AHRQ) is the main federal organization
that works to improve the safety and quality of the health care system. This was largely
through funding research to make care safer and to improve quality by publishing materials to
educate health care systems and professionals to put research into practice and through
generation of measures and data to be used by providers and policymakers (AHRQ, 2017).
AHRQ support efforts for clinicians and providers includes clinical guidelines and
recommendations. AHRQ publishes research and reports specifically related to health care
disparities, quality, and evidence-based practice but does not implement strategies.
DIF: Cognitive Level: Understand (Comprehension)
17. Which report states that nurses should practice to the full extent of their education and
training?
a. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
b. Keeping Patients Safe: Transforming the Work Environment
c. Priority Areas for National Action
d. The Future of Nursing
ANS: D
The Future of Nursing report contains four key messages. One of the key messages is that
nurses should practice to the full extent of their education and training. Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care addresses potential causes of
disparities in health care. Keeping Patients Safe: Transforming the Work Environment
addresses critical quality and safety issues with a particular focus on nursing care and nurses,
and examines these issues from the perspective of the work environment. Priority Areas for
National Action identified 19 priority areas that should be addressed to improve quality.
N R I G B.COM
U (Knowledge)
S N T
DIF: Cognitive Level: Remember
18. Which best describes a health disparity that exists in the United States?
a. Caucasians have higher rates of mortality than minority groups.
b. Caucasians have increased access to see specialist physicians.
c. Minority groups have increased access to government insurance options.
d. Minority groups have a higher prevalence of chronic conditions than Caucasians.
ANS: D
Health disparities refer to observable or quantifiable differences in the presence of disease,
health outcomes, or access to health care among different groups or populations. In the United
States, health disparities have long been recognized as particularly problematic among ethnic
minorities, including blacks, Native Americans, and Hispanics. Research indicates that often
these groups have a higher prevalence of chronic conditions and higher rates of mortality and
poorer health outcomes when compared with the white population.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which functions are responsibilities of the states? (Select all that apply.)
a. Delegating power to localities and holding them accountable for results
b. Creating managed health organizations to decrease state health care costs
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c.
d.
e.
f.
Establishing and managing local health departments
Licensure of professional health care providers
Overseeing all insurance programs
Providing access to necessary health services
ANS: A, D, E, F
State governments focus particularly on financing and delivery of services and oversight of
insurance. The state is responsible for addressing the mission of public health—assessment,
policy development, and assurance—throughout the state. Tasks include assessment of health
needs based on statewide data collection; establishment of statewide health objectives; and
delegating power to localities as appropriate and holding them accountable. States license
health professionals as part of the statewide effort to develop and maintain essential
personnel. Creating managed health organizations and establishing and managing local health
departments are not a main responsibility of the state.
DIF: Cognitive Level: Understand (Comprehension)
2. Which activities would be a responsibility of local health departments? (Select all that apply.)
a. Ensuring quality of nursing education programs
b. Determining the safety of residents’ wells
c. Establishing requirements for professionals to maintain their licensure
d. Providing free health screenings
e. Providing health education programs on proper nutrition
f. Inspecting restaurants
ANS: B, D, E, F
Local health departments are responsible for the health needs of their constituents.
NURSsurveillance
INGTB.Cand
Community health services include
OMimmunizations, as well as health
education programs. Environmental health services on the local level include inspection of
food-processing plants and restaurants and control of waste, air, noise, and water pollution.
Local health departments protect the environment through such activities as inspecting wells
and public swimming pools. Ensuring quality of nursing education programs and continuing
competence of health professions are both state functions.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes how complementary and alternative therapies differ from traditional
health care? (Select all that apply.)
a. Alternative therapies have been documented as ineffective.
b. Complementary medicine is expanding because of paid media coverage.
c. Nurses rarely are involved in complementary or alternative therapies.
d. Providers vary in training and licensure.
e. Reimbursement is often unavailable.
f. Alternative therapies lack any research related to their effectiveness.
ANS: D, E
Alternative or complementary therapies are expanding because of consumer demand although
reimbursement for these services is lagging. The National Center for Complementary and
Alternative Medicine is currently researching their effects on health and disease. Training and
licensure requirements vary widely. Many nurses have incorporated alternative therapies into
their practice and seek more continuing education on such care.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
4. Which would be offered as part of the community health services of a local health
department? (Select all that apply.)
a. Immunization programs
b. Food inspection programs
c. Health promotion education
d. School-based clinics
e. Maternal-child programs
f. Community-based mental health programs
ANS: A, C, E
The local health department is responsible for monitoring the health status and meeting the
health needs of their constituents. This includes identifying unmet needs and taking actions to
meet these needs. Most services to groups and individuals are provided at the local level.
These services fall into the following four major categories: Community health services
include control of communicable disease such as surveillance and immunizations,
maternal-child health programs, nutrition services, and education; environmental health
services include food hygiene such as inspection of food-producing and food-processing
plants and restaurants; protection from hazardous substances; control of waste, air, noise, and
water pollution; and occupational health; personal health services provide care to individuals
and families in clinics, schools, and correctional institutions; mental health services are
provided through community-based mental health care.
DIF: Cognitive Level: Understand (Comprehension)
GTB.Cbill
URSinIaNpatients’
OMof rights? gave? (Select all that apply.)
5. Which would most likely be N
found
a. A statement about guaranteeing confidentiality
b. A statement about how to create a living will
c. A statement about who has access to the client’s medical information
d. A statement about completing the patient satisfaction survey
e. A statement about who will be the payer of the services provided
f. A statement about patient autonomy when making decisions
ANS: A, C, F
Health care facilities often have a “patients’ bill of rights.” Typically, a patients’ bill of rights
is a list of guarantees or promises for those receiving care at that facility or by providers.
Generally included are guarantees of confidentiality, promises of access to information, fair
treatment, informed consent, and autonomy over decisions, among other rights. Other
patients’ rights issues that are vitally important that continue to be discussed and debated are
information disclosure, physician and provider choice, direct access to specialists,
reimbursement for emergency care, and reimbursement denial.
DIF: Cognitive Level: Understand (Comprehension)
6. Which describes why a health care agency would want to achieve accreditation? (Select all
that apply.)
a. Accreditation assesses the quality of services and care of the organization.
b. Accreditation requires achievement of certain minimum standards.
c. Accreditation instills public confidence in the health care agency.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Accreditation is necessary in order to be reimbursed for services provided.
e. Accreditation provides a means for an organization to get outcomes data.
f. Accreditation assists with having the best technology at the agency.
ANS: A, B, C
Accreditation is one means to assess the quality of services and care of the organization.
Specific minimum standards must be met by an organization to obtain accreditation. Indeed,
accreditation serves the purpose of instilling public confidence in a program, institution, or
organization (IOM, 2016). Accrediting organizations require outcomes data, which they use to
assess overall performance, but these data are collected by the agency, not the accrediting
organization.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 12: Economics of Health Care
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which is the best definition of economics?
a. Assets that can be traded for different assets
b. Income and outgo of monies
c. Science of allocation of resources
d. Study of goods, services, talents, and transportation
ANS: C
Economics represents the science of allocation of resources. Resources are goods or services.
The other definitions do not fully describe economics.
DIF: Cognitive Level: Understand (Comprehension)
2. A client living in the 1920s received health care services. Which would have been the most
likely form of payment?
a. Patients paid out of their pockets for whatever care the provider charged.
b. Public health employees gave care to those who needed it.
c. There was little health care to be had, regardless of a person’s wealth.
d. Workers who belonged to a union had their bills paid by insurance.
ANS: A
Until the 1930s, the predominant method of health care financing was self-payment. Health
RSservices
INGTB.C
M
care providers charged a fee N
forUthe
they O
rendered,
and the patient paid the
out-of-pocket expense. The assumption was that those who could pay would pay and those
who could not pay should receive care and pay what they could. Insurance companies did not
exist in the 1920s.
DIF: Cognitive Level: Apply (Application)
3. Which statement best describes what happened to health care providers during the Great
Depression?
a. The amount of charity care greatly increased.
b. Both hospitals and physicians went bankrupt.
c. Government funding was legislated to assist those in need.
d. Public health greatly expanded to care for those in need.
ANS: B
With 25% of the population out of work, the number of patients capable of paying their
medical bills was reduced. Because public financing was limited, hospitals, physicians, and
other providers went bankrupt. Because hospitals and physicians were going bankrupt, there
was no way to increase charity care or services for those in need.
DIF: Cognitive Level: Remember (Knowledge)
4. Why did employers decide to offer health insurance as an employee benefit?
a. Hospitals and physicians quit offering charity care to those who could not pay.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. Society was focused on not having to pay for doctor visits and other needed health
benefits.
c. Teachers were role models for unions to demand insurance as a benefit.
d. To obtain and retain the limited number of persons available to work when
government rules prohibited raising wages, insurance was offered.
ANS: D
The idea of paying a small fee for guaranteed health care to have sickness cured was very
popular. Health care providers liked knowing they would receive payment for their services.
During World War II, faced with a limited workforce and governmental restrictions on wages,
employers began to see health insurance as a means of supplying workers’ benefits without
granting a wage increase. Teachers were not demanding insurance as a benefit. Hospitals and
physicians continued to provide charity care as they were able. Society understood that they
needed to pay for health services; however, businesses realized that providing insurance was a
way to keep their needed workforce.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best describes a flaw of indemnity plans?
a. Blue Cross and Blue Shield had a great idea, but they went bankrupt.
b. Cost sharing was expected of Blue Cross and Blue Shield enrollees.
c. Enrollees could not choose their provider or manage their own care.
d. Plans lacked any incentives to contain costs.
ANS: D
Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee
enjoyed free choice of provider and services. They preserve the enrollee’s right of choice and
NUorRS
IN
GThealth
B.COcare.
M These plans became very costly
allow the person to manage his
her
own
because there were no incentives for cost containment. Today, cost-sharing efforts (e.g.,
copayments, deductibles) help contain costs. Blue Cross and Blue Shield continue to be a
provider of health insurance.
DIF: Cognitive Level: Understand (Comprehension)
6. Which best describes the first government step in trying to stop constantly rising costs?
a. Insurance companies were told to cease adding new members to their plan.
b. Payment reimbursement was based on diagnosis and client characteristics rather
than on treatment given.
c. Physicians were limited to a maximum amount that would be paid for any
particular service.
d. Reimbursement was based on prospective payment, that is, in advance of
admittance for care.
ANS: B
The first efforts to control costs were made by the federal government when Medicare
hospital reimbursement was based on a prospective payment system. Payment would be based
on a classification system that identified costs according to diagnosis and client
characteristics. Restricting insurance companies to add new members to their plan was not
part of the first steps to try to stop constantly rising costs.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
7. Which statement best describes the message that public health leaders are trying to emphasize
to the public?
a. Assume responsibility for your own health by choosing healthy behaviors
b. Have a primary physician and get yearly checkups
c. Obtain immunizations and screenings when they are offered
d. Support legislative efforts to improve our medical care system
ANS: A
Although there are many public health messages in the media, from quitting smoking to
getting a checkup, the primary message currently being emphasized by public health, as well
as all the media coverage of the constantly increasing cost for health care, is for each person to
take responsibility for his or her own health through choosing healthy lifestyle behaviors.
Supporting legislative efforts is not as important as the need for individuals to take
responsibility for their own health.
DIF: Cognitive Level: Understand (Comprehension)
8. Which action would be the least expensive approach to treating chronic diseases?
a. Choose healthy lifestyle behaviors to retain health
b. Continue media campaigns encouraging early detection and treatment
c. Encourage patients to seek care at a local neighborhood health clinic
d. Suggest self-therapies that have been demonstrated to be effective
ANS: A
The five leading causes of death and illness can be positively affected by changes in lifestyle.
Healthy lifestyles can modify or even prevent most chronic illnesses. Seeking care at a
NURSINmedia
GTB.C
neighborhood health clinic, producing
campaigns,
OM and engaging in self-therapies are all
more expensive approaches to treating chronic diseases than choosing healthy lifestyle
behaviors.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best describes how having health insurance has affected lifestyle behaviors?
a. Health promotion disease prevention programs are attended because they are
reimbursable.
b. Health education is widespread because insurance companies promote such
education.
c. Medications and medical treatment are relied on for cure.
d. Screening is widespread because of insurance sponsorship.
ANS: C
Funding for behavioral changes is limited, inadequate, or unavailable. Weight loss programs
or smoking cessation programs are not reimbursable treatment regimens although more
expensive pharmaceutical interventions are reimbursable. Therefore, it is financially wise not
to worry until illness strikes because illness care is reimbursable, whereas preventive health
care is not.
DIF: Cognitive Level: Understand (Comprehension)
10. Which best describes why so many Americans continue to engage in unhealthy behaviors?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Americans are not knowledgeable on how to change their behavior.
Americans believe that most illnesses can be cured with insurance footing the bill.
Health is not a concern to most Americans.
Most Americans do not know which behaviors are unhealthy.
ANS: B
Society sees insurance as an economic shield protecting against all disease and illness. The
belief in cure rather than prevention, combined with this financial safety net, encourages
society to become a passive participant in health care. The pervasive societal thought is “I
don’t have to worry; I have insurance.” Americans are aware of which behaviors are
unhealthy, have knowledge on how to change their behavior, and are concerned about health,
but insurance has allowed them to take a passive approach to health.
DIF: Cognitive Level: Understand (Comprehension)
11. Which conclusion can be drawn from reviewing how health care costs are spread over a
person’s lifetime?
a. Health care expenditures increase with age.
b. Premature newborns incur more costs than other children from birth through
adulthood.
c. The majority of cost is incurred during middle age when chronic diseases strike.
d. Persons aged 85 years and above spend the most money on health care.
ANS: A
Health care expenditures increase with age, dramatically so at older ages.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
12. Which was a major change after Medicare began a prescription drug benefit?
a. Number of prescriptions ordered by physicians decreased
b. Medications increased without affecting patient care outcomes
c. U.S. expenditures on drugs approached the same level as that of other
industrialized nations
d. Use of drugs and their cost immediately increased
ANS: D
As with other health care services, once a funding source has been established, usage and
costs increase. Thus, the number of prescriptions ordered increased. For 2016, the U.S.
expenditure for pharmaceuticals was about 10% of health care expenditures, and these
expenditures continue to rise.
DIF: Cognitive Level: Understand (Comprehension)
13. Which best describes a current trend related to health care services?
a. Nonprofit organizations are assuming responsibilities for service from for-profit
organizations.
b. Health care organizations are offering services low in cost and higher in
reimbursement.
c. Ways to minimize reimbursement using current procedural terminology (CPT)
codes have been created.
d. Postponing computerized medical record programs increases profitability.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: B
There is a national shift from nonprofit health care to for-profit health care as large for-profit
organizations take over smaller community organizations. Because emphasis is on profit,
mechanisms of achieving higher reimbursement have been developed. Coding of the patient’s
illness from the CPT codes determines reimbursement. Use of computerized medical record
programs almost ensures that service can be reimbursed at the highest rate possible. This has
changed health care practices to the use of services that are low in cost and higher in
reimbursement. High-cost services are limited or not offered.
DIF: Cognitive Level: Understand (Comprehension)
14. Which action would help decrease the total health care costs in the United States?
a. Consolidate major health care facilities while expanding neighborhood primary
care clinics
b. Continue the move to computer-based medical records and other efficiencies in
informatics
c. Decrease current fraud and abuse
d. Streamline and make more consistent all documents needed for third-party
reimbursement
ANS: C
The billions of dollars spent on health care and struggles for control between providers,
consumers, and health care organizations have increased the risk of fraud and abuse. The
Federal Bureau of Investigation (FBI) estimates that health care fraud costs the U.S. tens of
billions of dollars annually. Thus, decreasing the fraud and abuse in the system would have
the largest impact over any of the other proposed actions.
NUR(Comprehension)
SINGTB.COM
DIF: Cognitive Level: Understand
15. Which statement best describes a major event that occurred in the 1960s that affected health
care?
a. The amount of charity care by health care providers greatly increased.
b. Hospitals began to voluntarily pay taxes to the communities where they were
located.
c. Legislation greatly expanded funds available to train physicians, nurses, and other
health care providers.
d. The Social Security Act was amended to create Medicare and Medicaid legislation.
ANS: D
The popularity and benefits of employer-provided insurance plans were recognized, as was
the reality that some segments of society were being neglected. The 1960s, with a pervasive
thrust for social justice, presented the opportunity to move toward universal health care
coverage. Titles XVIII and XIX of the Social Security Act created Medicare and Medicaid,
respectively. There was no increase in funding for training of health care providers, voluntary
payment of taxes by hospitals, and an increase in the amount of charity care provided in the
1960s.
DIF: Cognitive Level: Understand (Comprehension)
16. Which best describes how the federal government determines which projects are awarded
special funding for health care?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Those that are consistent with societal priorities, such as Healthy People 2020
Those that are supported by legislators
Those that are written by health care organizations that have special needs
Those that are consistent with the state’s long-term health goals
ANS: A
Allocation of federal resources is based on societal priorities, such as Healthy People 2020.
Legislative priority, priority within health care organizations, and priority within individual
states are not as important for federal funding as the societal priorities outlined in Healthy
People 2020.
DIF: Cognitive Level: Understand (Comprehension)
17. Which best describes what happens when a health care organization receives federal funding
for a special health care need?
a. Other groups see the project and write grants wanting similar projects in their
geographic area.
b. Participants continue to demand the services, so local funding has to be readjusted
to continue the care.
c. Research is done to demonstrate whether or not the intervention was successful
and should be replicated.
d. When funds cease, so does the health care; therefore, continuity is lacking.
ANS: D
When the funding is no longer provided, the programs cease, which results in lack of
continuity of care. Research may be done related to the program, other programs may be
developed because of the current program that is being implemented, and participants may
NURSIHowever,
encourage local funding to continue.
the
most likely outcome is that the program
NGTB.C
OM
will end when the funding ends, so there is no continuity in the services that are provided.
DIF: Cognitive Level: Understand (Comprehension)
18. Which best describes the health care services that are provided by philanthropic groups?
a. Direct care to patients with problems related to the group’s primary interest area
b. Legislative lobbying for increased funding for their special interests
c. Informational and research activities
d. Special services such as housing, transportation, or appearance aids
ANS: C
Philanthropic funding, whose services are typically research or disease oriented, pays a
limited amount of health care. Services are limited to the specific disease or population of
interest. Informational and research activities constitute the majority of services provided
although some give direct care or meet ancillary needs such as housing, transportation, or
wigs. Legislative lobbying and special services are not the primary health care services
provided by philanthropic groups.
DIF: Cognitive Level: Understand (Comprehension)
19. Which best describes what was done by large industrial giants to stop the constant increase in
their costs for health insurance for their employees?
a. Assembled their own health care programs
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. Established health promotion programs that employees were required to attend
c. Signed only certain providers to give care at a reduced rate in exchange for so
many new patients
d. Suggested that employees seek only the most necessary services
ANS: A
Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care
programs. They built hospitals, hired physicians, and provided health care services to their
employees. In an effort to market this concept, the phrase health maintenance organization
was created. These organizations were designed to provide comprehensive care to employees.
As these large health care programs were established, enrollees had limited freedom of choice.
Preventive care was covered and encouraged, but care was somewhat restricted, and care
providers were encouraged to reduce costs by providing only the most necessary services.
DIF: Cognitive Level: Understand (Comprehension)
20. Which best describes what physicians did to compete with new competition from health
maintenance organizations (HMOs)?
a. Accepted employment directly under the insurance company
b. Organized preferred provider organizations (PPOs) to negotiate with insurance
companies
c. Created private practices with colleagues within hospital medical complexes
d. Decided to strike and refused to work in the new HMOs
ANS: B
In an effort to compete with HMOs, physicians and hospitals organized the independent
practice model, which provided services to enrollees of one insurance company. This model
M
evolved into the PPO, whichN
offered
at aO
reduced
rate in exchange for a guaranteed
URSIservices
NGTB.C
increase in consumers. Physicians did not become directly employed by insurance companies,
set up private practices with colleagues, or decide to strike in order to compete with the
HMOs.
DIF: Cognitive Level: Understand (Comprehension)
21. Which best describes how the government was successful at containing costs?
a. The original legislation for Medicare and Medicaid had built-in cost controls.
b. Certificate-of-need requirements restricted provider overtreatment.
c. Utilization review determined appropriateness of care.
d. Prospective payments were based on diagnosis-related groups (DRGs).
e. Peer standard review organizations were effective watchdogs.
ANS: D
Prospective payment based on DRGs proved to be effective. The cost reduction that resulted
gave rise to the managed care revolution as providers searched for the most cost-effective
mechanism of care provision. Various efforts from, for example, certificate-of-need, peer
review, and utilization review were not effective.
DIF: Cognitive Level: Understand (Comprehension)
22. Which best describes how hospitals initially coped when Medicare reimbursement became
based on diagnosis-related groups (DRGs)?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Charged more for patients whose care was paid by insurance
Decreased nursing staff to cut labor costs
Lobbied politicians to increase Medicare reimbursement to reflect actual costs
Refused to accept Medicare patients
ANS: A
Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because
private insurance reimbursements were cost based, hospitals included the loss in their total
costs; therefore private insurance paid for covering care to both their enrollees and Medicare
patients. The implementation of DRGs did not cause hospitals to decrease nursing staff, lobby
politicians to increase Medicare reimbursement, or refuse to accept Medicare patients.
DIF: Cognitive Level: Understand (Comprehension)
23. Which statement best summarizes all of the changes resulting from attempts to control costs?
a. Conflict between providers, patients, employer, and insurance plans raged.
b. Costs were controlled, at least temporarily.
c. Demand for health care drastically dropped.
d. Most employers discontinued their insurance plans for employees.
ANS: A
All these changes resulted in conflicts among providers, patients, employers, and the
insurance plans, particularly when services deemed necessary by the consumer and provider
were denied insurance coverage. Everyone blamed everyone else. This did not allow for costs
to be controlled, impact the demand for health care, or cause employers to discontinue their
insurance plans for employees.
DIF: Cognitive Level: Understand
NUR(Comprehension)
SINGTB.COM
24. Which best describes how providers can legally improve their profit under the current
reimbursement process?
a. Accept more patients and work more hours so former high income is retained
b. Order the cheapest generic medications and treatments possible
c. Convince patients that they do not want expensive treatments
d. Practice conservatively to earn an incentive payment
ANS: D
As a reward for conservative medical practices, health care providers may receive a specified
amount of money or a percentage of the agreed reimbursement if services are delivered below
the limit set by the third-party payer. Thus, it is the responsibility of the provider to use this
conservative practice. Patient care should not be compromised as providers practice
conservatively.
DIF: Cognitive Level: Understand (Comprehension)
25. Which best describes why large employers would decide to self-insure?
a. To claim to offer more benefits to employees
b. To have more control over health care providers
c. To be more effective at keeping employees happy
d. To reduce administrative costs charged by insurance companies
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Some organizations have decided to self-insure their employees. This reduces the
administrative cost of insurance. Self-insurance does not claim to offer more benefits to
employees, allow for more control over health care providers, or do a better job at keeping
employees happy.
DIF: Cognitive Level: Understand (Comprehension)
26. When was the idea of national health care insurance first debated in the United States?
a. Clinton’s 1992 presidential campaign as he attempted to achieve such a plan
b. During President Johnson’s administration when Medicare and Medicaid were
instituted in the 1960s
c. President Franklin Roosevelt’s attempt to include health insurance in Social
Security legislation in the 1930s
d. President Theodore Roosevelt advocated such national medical coverage in 1916
ANS: D
European countries began a social model of health insurance in the early 1900s. President
Theodore Roosevelt advocated a similar plan for the United States in 1916. The other attempts
mentioned came after Theodore Roosevelt’s initial attempt in 1916.
DIF: Cognitive Level: Remember (Knowledge)
27. Which statement best describes why nurses should be knowledgeable about health care
funding?
a. To be able to be an effective employee for insurance companies
b. To be knowledgeable when media asks for opinions on some new legislation
c. To better serve as patient advocates in policy making for funding that provides
NURSI
NGTB.COM
appropriate care for the greatest
good
d. To know how to write nursing notes that reflect higher reimbursement possibilities
ANS: C
Increasing knowledge of health care funding and policy making will empower nurses to
advocate for the type of funding that provides appropriate care to obtain the greatest good.
Nurses need to use their political power. Nurses must advocate for health promotion disease
prevention funding. Although these skills are helpful when working for insurance companies,
talking to the media, and writing nurses notes, the primary reason why nurses need this
knowledge is to engage in the role as a patient advocate.
DIF: Cognitive Level: Understand (Comprehension)
28. Which best describes a carve-out service?
a. A particular service that is offered only by a designated provider or group.
b. A particular procedure that receives limited reimbursement.
c. A particular treatment is not allowed within a particular diagnosis.
d. A particular prescription drug that is only available to those with certain
conditions.
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Carve-out services might be designated for those who need the services the least. A carve-out
service (e.g., mental health care) is provided within a standard benefit package but delivered
exclusively by a designated provider or group. The other definitions do not correctly describe
a carve-out service.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which statements best describe what was unfortunate about the original private health
insurance plans that were developed? (Select all that apply.)
a. Because providers were paid for any service they gave, it was economically
advantageous for them to give as much care as possible.
b. Health care costs increased very rapidly.
c. Health education and health promotion interventions were not included in the idea
of health insurance.
d. It was immediately seen how much profit could be made by owning or managing
an insurance company.
e. Patients wanted any and all care that might help, regardless of how expensive it
was.
f. There was no limit on what care could be sought and given.
ANS: A, B, C, E, F
The majority of the population was protected. The emphasis was placed on illness care,
because providers received a fee only when a service was rendered, and all costs were
reimbursed. Insulated from having to pay for health care, consumers demanded complex and
NURSThese
INGT
B.COMwere a major force rapidly increasing
technologically advanced services.
demands
health care costs because people with insurance felt entitled to care, and, after all, there was a
guaranteed payer. Medical orientation was on curing at any cost. The profits of owning or
managing an insurance company were not immediately seen.
DIF: Cognitive Level: Understand (Comprehension)
2. Which best describes the effects of Medicare and Medicaid? (Select all that apply.)
a. All persons who were temporarily disabled now receive free care.
b. A previously unseen rise in demand for services occurred.
c. Many persons previously without access now receive health care.
d. Medicare reimbursement rates became the standard for all insurance carriers.
e. Indemnity insurance plans were offered.
f. Public health education was now financed.
ANS: B, C, D, E
The enactment of Medicare and Medicaid created an unprecedented demand for services, and
many persons without access to health care were now able to receive care using an indemnity
insurance plan. Medicare reimbursement rates generally became the standard for all insurance
carriers. These plans did not provide services for the temporarily disabled or change financing
for public health education.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
3. Which best describes what insurance companies did to decrease their constantly increasing
costs? (Select all that apply.)
a. Did not cover any illnesses that were diagnosed before the person (or his or her
employer) purchased insurance
b. Limited coverage to only certain services, eliminating any that were experimental,
nontraditional, or too costly
c. Reimbursed only the care that was requested by the patient’s primary physician
d. Limited providing insurance to companies who hired mainly young, healthy
persons
e. Required preapproval before expensive services were used
f. Ceased coverage on any person who used an exorbitant number of services,
whenever possible
ANS: A, B, C, E, F
Insurance companies attempted to reduce unnecessary use by limiting coverage for certain
services and people. Restrictions such as the establishment of a gatekeeper that required
preauthorization, limited coverage for preexisting illnesses, and exclusion of participants
whose use was deemed exorbitant were instituted. Such restrictions increased resentment and
resistance and were not very successful.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes the strengths of the American health care system? (Select all that apply.)
a. Offering the availability and use of technological advances in equipment and
b.
c.
d.
e.
f.
procedures
Having the ability to overcome concerns regarding access and rationing
Providing the highest quality
among
any M
industrialized nation
NURofSlife
ING
B.C
T
O
Having the lowest maternal and infant mortality rate among industrialized nations
Leading the world in laboratory and clinical research
Creating the best patient care outcomes
ANS: A, E
The United States leads the world in laboratory and clinical research. The United States also
exceeds other industrialized countries in the availability and use of technological advances.
We do not rank near the top in length of life or patient care outcomes although we spend far
more on health care than other industrialized nations. We are just beginning to confront the
issues of access and rationing.
DIF: Cognitive Level: Understand (Comprehension)
5. Who may receive benefits under Medicare? (Select all that apply.)
a. Federal employees
b. Persons aged 55 to 65 years who have bought into the system
c. Persons with end-stage renal disease
d. Those over 65 years of age, if eligible for Social Security benefits
e. Those who are dependents of elderly grandparents, usually because their parents
f.
are in prison as a result of drug abuse
Those with permanent disabilities
ANS: C, D, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Medicare pays specified health care services for all people 65 years of age and older who are
eligible to receive Social Security benefits. People with permanent disabilities and those with
end-stage renal disease are also covered.
DIF: Cognitive Level: Understand (Comprehension)
6. Which best describes how eligibility for Medicaid services is determined? (Select all that
apply.)
a. Anyone over age 65 years who is eligible for Social Security benefits may apply
for Medicaid.
b. Baseline eligibility is established by the federal government, but states may be
more lenient.
c. Children in low-income families may be eligible for free care.
d. Eligibility depends on family size and total family income.
e. Federal government establishes eligibility and gives funds to the states in
reimbursement for this care.
f. State government establishes guidelines for whether to participate and who will be
covered.
ANS: B, C, D
Medicaid provides universal health care coverage for the indigent and children. Eligibility is
dependent on the size and income of the family. The federal government sets baseline
eligibility requirements. State governments who wish to provide care to more citizens can
lower the eligibility requirements. The federal government mandates covered services, but
state governments may provide more services.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
7. Which statements best describe an unfortunate consequence of using diagnosis-related groups
(DRGs) to determine reimbursement? (Select all that apply.)
a. Insurance companies had to greatly increase their funding from employers.
b. The incentive was to undertreat and underuse health resources.
c. Health care providers had to accept losses for each patient treated.
d. Health care providers learned to cheat the system.
e. Health care providers refused to accept more patients whose reimbursement was
based on DRGs.
f. High quality of care was no longer assured.
ANS: B, F
Because costs were contained by both the federal programs and insurance companies, the
providers had a strong incentive to undertreat and underuse health resources. The public
feared that the quality of care being provided was less to keep costs as low as possible.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 13: Cultural Diversity and Community Health Nursing
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which statement best describes how the population of the United States is changing?
a. Growth will occur because of a decrease in the death rate.
b. Growth will occur because of ongoing immigration.
c. Growth will occur because of an increase in the birth rate.
d. Growth will occur because of lengthening of the normal life span.
ANS: B
The number of immigrants and refugees in the United States is projected to continue to
increase. The United States has grown largely through immigration. The growth will not occur
because of changes in death rate, birth rate, or life span.
DIF: Cognitive Level: Understand (Comprehension)
2. Which statement best defines Leininger’s term “culture universal”?
a. The preference to be cared for by someone from their own cultural group for
maximum ease and comfort
b. The commonalities of values, norms, and life patterns that are held in all cultures
c. The particular values, beliefs, and patterning of behavior that is universal within a
particular culture
d. The health care roles, norms, and behaviors that are involved when illness or injury
occurs
ANS: B
NURSINGTB.COM
Culture universal is used by Leininger to refer to the commonalities of values, norms of
behavior, and life patterns that are similarly held among cultures about human behavior and
lifestyles and form the basis for formulating theories for developing cross-cultural laws of
human behavior.
DIF: Cognitive Level: Understand (Comprehension)
3. A patient had wrapped a tummy band around her newborn’s abdomen. What should the nurse
say to the new mother?
a. “Can you explain to me the purpose of wrapping a band around the baby’s
tummy?”
b. “In the hospital, we prefer to expose the umbilical cord to air so it’s easier to put
medication on it as it dries up.”
c. “Let me put some medication on the baby’s cord, and then I’ll put the tummy band
back.”
d. “Please remove that band; it is not helpful as the umbilical cord needs to be kept
clean and dry.”
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Unless a particular action is harmful, the nurse should engage in culture care preservation and
maintenance. Before acting, it is helpful to know why the mother is engaging in this behavior.
If the mother responds, “I’m not sure; it’s just always been done,” the nurse can educate the
mother on how to care for the cord. If the mother appears to believe the tummy band is very
important, the nurse can cooperate with the behavior because tummy bands will not hurt the
baby.
DIF: Cognitive Level: Apply (Application)
4. A baby was dehydrated because of diarrhea. The mother explained that she had finally gone to
a folk healer who told her to give the baby herbal tea, which did seem to be helping a bit, but
the baby still seemed ill. Which statement would be the most appropriate reply by the nurse?
a. “Folk healers cannot cure such problems; let me give you appropriate fluids for
your baby.”
b. “Let’s go back to feeding the baby formula, and see how the baby does.”
c. “You continue to give the baby herbal tea, but let’s put some sugar and salt in the
tea.”
d. “Your healer is correct; fluids are crucial for your baby. Let me give you some
special fluids for you to give the baby.”
ANS: D
Rejecting the folk healer’s advice may cause the mother not to trust Western medicine. If
possible, the nurse should build on what the mother is doing. It is usually helpful to include
any behaviors that may be helpful or neutral in effect. In this case, the mother is encouraging
fluid, which is crucial, and tea is boiled, so the water is clearly safe. Just adding salt and sugar
is risky because of the need for careful measurement. Nothing in the example suggests the
nurse recognizes what kind of
teaRis I
being
It M
is easier to give the mother fluids with the
NU
GTgiven.
B.CO
S
N
appropriate electrolytes while supporting at least some aspect of the healer’s advice. It must
be remembered that most indigenous healing practices are innocuous.
DIF: Cognitive Level: Apply (Application)
5. A nurse carefully explained that the medication had to be taken three times a day, with each
meal. The patient came to the clinic with symptoms of medication overdose. How should the
nurse respond?
a. “Can you explain what you believe happened to make you so ill now?”
b. “Can you tell me when in the day you and your family eat?”
c. “Please review with me when I taught you to take your medication.”
d. “Why did you take more medication than we suggested?”
ANS: B
It is not helpful to confront the patient or accuse someone of noncompliance. A review of the
prescription may have been helpful, but because the patient had an overdose, one might
assume the medication is being taken more than three times a day. The nurse has engaged in
cultural imposition—that is, assuming the patient’s beliefs, values, and patterns of behavior
are identical to hers. Not everyone eats exactly three times a day. The family may eat more or
less than three times a day.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
6. A woman who spoke English was an immigrant from the Middle East, attending the clinic for
the first time with two female friends. When a male nurse attempted to get a health history,
the woman refused to respond to his questions. Which action should be taken by the nurse?
a. Ask a female nurse to talk with the client
b. Ensure that the client has privacy, with the two female friends waiting outside
before trying again
c. Explain that the woman cannot see a physician until the nurse obtains a health
history and does an initial examination
d. Stress that the clinic is free and she does not have to pay extra to see both the nurse
and the physician
ANS: A
He should ask a female nurse to talk with the client. Many culture groups have strong norms
regarding appropriate gender behavior. Norms are the rules by which human behavior is
governed and result from the cultural values held by the group. All societies have rules or
norms that specify appropriate and inappropriate behavior. Individuals are rewarded or
punished as they conform to, or deviate from, the established norms. Thus, this woman is
likely to not deviate from these cultural norms and should be given the opportunity to speak
with a female nurse. The other responses do not address the cultural needs regarding gender
that this client needs to have addressed.
DIF: Cognitive Level: Apply (Application)
7. A nurse was explaining a problem to the client so the client could make an informed decision
about alternative treatment approaches. The client responded, “The doctor will choose the best
treatment. Do whatever the doctor says.” Which action should be taken next by the nurse?
a. Ask if the client would like to discuss the choices with her family
NURSINGTB.COM
b. Explain that the client has to
decide, and wait for the client’s decision
c. Explain that physicians cannot decide; perhaps the client could just flip a coin?
d. Nothing; simply accept that some fatalistic-oriented clients literally do not know
how to choose
e. Suggest that the client discuss the situation with her ancestors and wait for
guidance
ANS: D
One of the three ways people are oriented is destiny, in which people must endure and accept
whatever comes in a fatalistic, inevitable manner, as destiny cannot be changed. The other
responses do not address the perspective of destiny that has been indicated by the client in the
initial response.
DIF: Cognitive Level: Apply (Application)
8. The nurse made a follow-up appointment for a client at the clinic, but the client did not come.
Two days later the client presented at the clinic explaining that a temporary job had come up
and he could not come back until he had finished and been paid for that job. Which action
should be taken by the nurse next?
a. Explain that patients are seen by appointment only, and set up another appointment
for the client
b. Reinforce the need to plan ahead before arranging another appointment
c. Stress that health is the number one priority, and try to fit the client in sometime
the same day
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Understand that some clients are present oriented, and fit the client in so care can
be given
ANS: D
Although health care systems are set up according to the expectation that clients can plan for
the future, some clients focus on the present with little attention to the future. For the patient
to receive care, the nurse should try to fit him in that day. Setting up an appointment would
possibly be useless because the client may not attend the future appointment either.
Poverty-stricken persons would be wise to accept employment when it becomes available.
DIF: Cognitive Level: Apply (Application)
9. When a nurse visited a client’s home, it was apparent that the client had not begun to
implement the needed exercise program. Rather, the client had been doing drawings about his
illness experience. Which action would be most appropriate for the nurse to take next?
a. Express admiration for his artistic ability, and do not schedule future visits because
the patient is noncompliant
b. Point out the negative consequences that will ensue if the client does not begin
exercising
c. Review with the client why exercise is so crucial to his recovery
d. Suggest drawing might be more forceful after exercising
ANS: D
The dominant cultural value is action oriented, so the client would be expected to have begun
to exercise. Dominant cultural values include an emphasis on productivity and being busy.
However, some persons are not action oriented but being oriented, with a focus on expression
of impulses and desires.
NURSINGTB.COM
DIF: Cognitive Level: Apply (Application)
10. A nurse reviewed the treatment the surgeon recommended for a woman’s breast lump. When
the nurse asked the woman if she could be admitted to the hospital for immediate surgery, the
husband thanked the nurse for her time and said they would get back in touch after they speak
with other family members. Which action would be most appropriate for the nurse to take?
a. Ask if there was some reason the woman could not be immediately admitted for
treatment
b. Explain to the woman why postponing the surgery was dangerous
c. Point out it that it’s the woman’s decision, and stress that she should go to the
hospital immediately
d. Recognize that the husband and other family members may need to have input into
this decision
ANS: D
We typically focus on the individual as the central figure in decisions about the self. However,
in other cultures female clients may seek assistance from other members of the family and
allow male relatives to make decisions about important health-related matters. The husband
has indicated by his response that collateral relationships are valued, thus decisions about the
client may be interrelated with the influence of illness on the entire family or group. The other
responses do not address the value of collateral relationships that the nurse must recognize
and address.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
11. When one woman asked her friend to stay while a painful procedure was done, it was
explained that only one immediate family member could be in the room. The woman asked
the nurse, “How do you define family?” Which would be the best response by the nurse?
a. “A person’s husband, wife, or children”
b. “Anyone related to you by law or by blood ties”
c. “Someone who lives with you and has ties of commitment”
d. “Whoever you tell us is your family”
ANS: D
Families are changing from the norm of husband, wife, and children to single parents,
blended, extended, committed, or cohabitation with domestic partners. Consequently, rather
than debate the definition of family, it is more practical and comprehensive to ask the client
whom he or she considers to be family.
DIF: Cognitive Level: Apply (Application)
12. In a client’s culture it is exceedingly rude to ask any questions about income or wealth. Which
action should be taken by the nurse to draw conclusions about the client’s socioeconomic
status (SES)?
a. Ask about the client’s education or employment position
b. Ask his or her religious leader to share such information with the nurse
c. Let the financial office deal with the problem
d. Refer the issue to the social worker who has better sources of information
ANS: A
SES may be determined by examining
occupation,
and educational level. If that is not
NURSINincome,
GTB.C
OM
possible, age, gender, possessions, location of residence, religion, and race may also be
considered.
DIF: Cognitive Level: Apply (Application)
13. A nurse was responsible for setting up a health fair with free pizza being served during lunch.
The nurse observed a few people who did not eat but just talked quietly during lunch. Which
action should be taken by the nurse?
a. Assume it was a religious fast day, and not worry about it
b. Discuss with the supervisor what are traditional foods in that neighborhood
c. Offer to let those who did not eat take the leftover pizza home for a meal later in
the day
d. Talk to the group, and ask what foods might have been more acceptable
ANS: D
Many ethnic groups prefer certain foods as part of their cultural identity. The nurse should
take this opportunity to learn foods preferred by the community. It cannot be assumed a
supervisor would know preferred foods of the community. Making assumptions about the
community or offering the leftovers to those who did not eat would not be culturally sensitive
approaches for the nurse to take with this population.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
14. A nurse tried to set up a clinic appointment for a Muslim patient on Friday of the following
week, but the patient insisted the appointment be made earlier in the week. Which best
explains the patient’s behavior?
a. The patient’s time orientation places a high value on the present: the sooner the
appointment, the better.
b. The patient’s “being” activity orientation requires spontaneity, including the need
to choose his own schedule.
c. A Muslim’s holy day is from sunset Thursday to sunset Friday.
d. The patient, a male, does not like being told what to do by the nurse, a female.
ANS: C
The nurse should know the days of religious worship. Protestants usually worship on
Sundays; Muslims’ day of worship is from sunset Thursday to sunset on Friday; and Jews and
Seventh-Day Adventists’ holy day is from sunset on Friday to sunset on Saturday. The other
responses do not recognize that the patient may have obligatory Friday prayer with his
congregation.
DIF: Cognitive Level: Apply (Application)
15. Before interviewing an Hispanic family, what is the most important action for the nurse to
take?
a. Compliment each member on some visible asset
b. Establish rapport, and gain trust and confidence
c. Greet them in Spanish even if badly spoken and accented
d. Recognize the male as the authority figure in the family
ANS: B
NUclient
RSIN
GTB.C
M to establish rapport and gain trust
Regardless of the culture of the
family,
it isOcrucial
and confidence before attempting to gather data. First impressions are important and the nurse
should ensure a mutually respectful relationship is created. Thus, starting by providing
compliments, greeting them with poor Spanish, or assuming that the male is the authority in
the family may all lead to an unacceptable first impression of the nurse to the family.
DIF: Cognitive Level: Apply (Application)
16. A woman stood very close to the nurse and asked a question about her husband’s condition.
The nurse took a step back and shared the requested information. No other questions were
asked. Was this a successful interaction?
a. No, because the nurse should not answer any questions about a client, even if the
wife is the one asking
b. No, because the woman and the nurse had different perceptions of personal space
c. Obviously yes, because the woman sought information, received it, and had no
further questions
d. Yes, because the nurse was knowledgeable and able to respond appropriately
ANS: B
Sense of spatial distance is significant because culturally appropriate distance zones vary
widely. Many cultures stand closer for important conversations, whereas the nurse stepped
back because being so close made the nurse uncomfortable.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
17. A nurse felt very good about an Asian man who had responded positively to the instructions
given to him. Later, the nurse heard him tell his wife that there was no way he could
implement the suggestions. Which best describes the problem that the client is experiencing?
a. Polite response may not equal agreement.
b. Men do not take instruction from women.
c. His culture may value harmonious relationships over expressing disagreement.
d. The nurse told him what to do but did not ask if he could do it.
ANS: C
Asian clients may provide the nurse with the answers they think the nurse wants to hear. This
behavior is consistent with their cultural value for harmonious relationships with others. The
other responses do not recognize this cultural variation among this population that the nurse
should recognize.
DIF: Cognitive Level: Apply (Application)
18. A nurse became frustrated because after each interview question there was a long pause before
the client responded. Which action should be taken by the nurse?
a. Accept the hesitation before receiving an answer
b. Ask the client what silence after a question means
c. Copy the client’s behavior; insert a pause before asking the next question
d. Recognize that the client was distracted, and reschedule the home visit
ANS: B
Wide cultural variation exists when interpreting silence. Some individuals find silence
uncomfortable, whereas others use silence to show understanding and respect. Because the
NUshould
RSIN
nurse is uncomfortable, action
beGtaken.
TB.CThe
OMonly way to know the meaning of the
silence is to ask.
DIF: Cognitive Level: Apply (Application)
19. A client, accompanied by her son, spoke only Spanish while the nurse did not. Which action
should be taken by the nurse to best meet the client’s need?
a. Ask the woman if it’s OK if the son translates for her
b. Call until she finds a Spanish interpreter employed by the agency
c. Let the son translate because he’s obviously informed about the problem
d. Use gestures and pantomime to make oneself clear
ANS: B
Asking the son would violate confidentiality, and gender issues may also arise. The only safe
approach is to obtain a Spanish interpreter who is knowledgeable about medical terminology
and procedures, as well as comfortable with cultural beliefs and health practices. It is
important to have an interpreter rather than trying to make gestures and pantomime so that the
communication between the nurse and client is clear and accurate.
DIF: Cognitive Level: Apply (Application)
20. At a military base, a family from Qatar, a Muslim Arabic country, came in to the prenatal
clinic because the wife believed she was pregnant. Which provider would be the most
appropriate choice for this client?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
A male obstetrician, expert in high-risk pregnancies
The female nurse midwife
The male obstetrician with a female nurse always in the room with the wife
Whichever provider was on duty until the pregnancy was confirmed
ANS: B
During pregnancy, many female clients will prefer female health care providers and may
refuse to be examined by a man. People from Arab Muslim countries feel even more strongly
about males touching a female.
DIF: Cognitive Level: Apply (Application)
21. A woman comes to the clinic, and the nurse believes that she is speaking French. She seems to
understand English. A provider will need to complete a physical examination to confirm the
health problem. Which action should be taken by the nurse?
a. Ask the client if she prefers a male or female provider
b. Ask a female provider to assume care
c. Ask the physician provider to see her immediately
d. Ask the secretary in the office who speaks French to assist in collecting a health
history from the client
ANS: A
When in doubt, the best way is to ask the client about culturally relevant aspects of
male–female relationships. This should be done at the beginning of the interaction before an
opportunity arises to violate culturally based practices. It is not appropriate to ask other staff
members to serve as interpreters during nurse–client interactions.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
22. After being given negative news about a health problem, the client, with tears running down
her face, asks, “Why did this happen to me?” Which is the most appropriate response by the
nurse?
a. “Could someone have cursed you?”
b. “Do you feel your life is out of balance?”
c. “God has a plan for each of us even if we do not understand it.”
d. “Why do you think it might have happened?”
ANS: D
Each response represents a particular belief about illness, but without knowing the patient’s
perspective, the wrong one could easily be chosen. It is difficult to be comforting without
knowing the client’s beliefs about the causation of illness. The best way to discover this is to
query the patient.
DIF: Cognitive Level: Apply (Application)
23. A nurse made a home visit for prenatal care and teaching for an Asian woman. The nurse
noted the woman was having a hot lunch of spicy foods the nurse did not recognize. When the
nurse suggested a cold drink with her meal, the woman looked horrified and distrusting.
Which best describes what has happened in this situation?
a. The interference with eating seemed incredibly intrusive and inappropriate.
b. The nurse was giving advice when advice had not been sought.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. The patient thought the nurse was offering an alcoholic beverage.
d. The yin and yang theory requires only hot food be eaten when female yin energy is
dominant, such as during pregnancy.
ANS: D
Many Asians ascribe to the yin-yang theory in which health is believed to exist when all
aspects of the person are in perfect balance. Yin energy is female and cold, and dominates
during pregnancy. To maintain balance and promote the health of the baby, she must eat yang
foods, which are hot.
DIF: Cognitive Level: Apply (Application)
24. Crying, a clinic patient explained that she knew she had this breast lump because she had
spread nasty gossip about her neighbor. Which action by the nurse would likely be the most
successful?
a. Explain the causes of a breast lump and the usual treatments
b. Refer the woman for an immediate biopsy to determine the status of the lump
c. Suggest that she has to repent and as much as possible undo her sin, but also make
an appointment for a biopsy
d. Suggest that she has to repent, apologize to her neighbor, and pray for forgiveness
ANS: C
The woman has expressed a magicoreligious perspective on illness. Because evil has caused
her illness, she must undo the evil. However, the nurse, as a practitioner of the biomedical
perspective, must also arrange for a biopsy as soon as possible so treatment can be begin.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
25. A nurse is called by a friend who complains of symptoms of a cold. Which response would be
the most appropriate by the nurse?
a. Ask the friend what she usually does for a cold and suggest that be done
b. Tell her to go to the urgent care center for assistance
c. Suggest that she make an appointment to see her health care provider
d. Point out to her that nurses are unable to treat patients
ANS: A
Seventy percent to 90% of all illness episodes are treated first, or exclusively, through
self-care, often with significant success. Symptoms of a cold do not seem to require drastic
action such as going to the urgent care center or seeing a health care provider. Engaging in
traditional healing interventions, learned in the family, will be comforting and probably will
help.
DIF: Cognitive Level: Apply (Application)
26. A nurse was assigned to create and implement a community education program with the goal
of preventing diabetes among the Hispanic population. As the nurse did not speak Spanish and
was just beginning to be comfortable with the neighborhood Hispanic culture, which would be
the best approach for the nurse to take?
a. Be sure to use appropriate images in the handouts.
b. Copy literature and procedures found successful in other Hispanic communities.
c. Tell the supervisor the nurse is not competent for this task.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Try to find Hispanic volunteers who may be able to do the actual teaching.
ANS: D
By using volunteers, the program can disseminate culturally appropriate information in a
culturally appropriate way. The success of educational efforts is often determined by the
credibility of the source and the sensitivity of the speaker in communicating information in a
culturally appropriate manner.
DIF: Cognitive Level: Apply (Application)
27. Which helps to balance the fact that poverty is typically a major factor in certain groups
having poorer health?
a. A strong community health center in the neighborhood
b. Intact families where fathers are married to children’s mothers
c. Strong family and community support for healthy behaviors
d. The large number of programs available to be of assistance in fighting poverty
ANS: C
Latino children who live in poverty enjoy relatively good health compared with children in
other low socioeconomic groups. It is believed that strong family-community support fosters
optimum family health behaviors. Many of these behaviors are integrated into the culture as
part of the family identity, traditions, and history. Without strong family and community
support having other resources in the community is insignificant. Strong support structures
can exist in communities where fathers are not married to children’s mothers.
DIF: Cognitive Level: Understand (Comprehension)
28. Which action was taken by the
N federal
R I government
G B.C Mto help improve health disparities among
U S N T
O
minorities?
a. Created scholarships and traineeships only for minority applicants
b. Created the National Center on Minority Health and Health Disparities
c. Established grants that funded only minority health projects
d. Legislated funds to create new colleges for preparing health professionals in
minority neighborhoods
ANS: B
The National Center on Minority Health and Health Disparities was developed in 2000 and
redesignated in 2010 as the National Institute on Minority Health & Health Disparities to
assist in the investigation of factors affecting minority health. Its mission is to promote
minority health and to ultimately eliminate health disparities. The federal government did not
create scholarships and traineeships specifically for minority applicants, establish grants for
minority health projects, or legislate funds to create new colleges to address the improvement
in health disparities.
DIF: Cognitive Level: Understand (Comprehension)
29. A nurse is caring for a client from a different culture. Which action would be the most helpful
for the nurse to take?
a. Ask to have a nurse from that culture assigned to the patient even if the nurse must
be obtained from a different clinical area
b. Be aware of cultural similarities and differences between the nurse and the client
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Explain that the patient must follow the rules of the hospital while a patient
d. Verbalize the nurse’s own discomfort, and ask for assistance with surmounting the
cultural differences
ANS: B
Recognizing both similarities and differences is being culturally aware. Although it would be
helpful to have a nurse from the same culture give care, that is often not feasible. A nurse
from another area cannot be expected to be clinically expert, to say nothing of the legal
problems of having a nurse from a different agency give care. Asking the patient for help
makes the problem belong to the patient, but it is the nurse’s problem. Asking the patient to
comply with the hospital regulations is being culturally insensitive.
DIF: Cognitive Level: Apply (Application)
30. An unidentified patient was injured in a hit-and-run accident and was conscious. When asked
how he felt, the patient looked very confused and responded in a language the nurse did not
recognize. Which action should the nurse take next?
a. Look closely at the person, try to determine the patient’s ethnic background, and
then seek someone fluent in his language
b. Report the language barrier to administration, and let them handle the problem
c. Tell the unit supervisor so various translators can be brought to the floor until the
language is recognized and communication can be established
d. Use gestures and pantomime until the nurse is able to determine what language the
patient is speaking
ANS: D
The nurse can report the problem and request a translator, but in the meantime the nurse
should pantomime words andNsimple
while
verbalizing them until communication can
URSIactions
NGTB.C
OM
be established using a translator from his culture. Just looking at a patient will not allow you
to assume his or her ethnic background.
DIF: Cognitive Level: Apply (Application)
31. The clinic was seeing a great number of Hmong immigrants from the mountainous regions of
the Far East. If the nurse could not obtain a translator, which would be the next best action?
a. Require each patient to bring a family member fluent in English
b. Start teaching Hmong patients English on each clinic visit
c. Suggest Hmong patients might be more comfortable seeking care elsewhere
d. Try to make flash cards with common phrases used during clinic visits
ANS: D
If a translator is not available, the nurse can try many approaches such as pantomime, but it
would also be helpful to have common phrases used with many patients on flash cards so
basic information can be obtained. Other Hmong patients or family members should not be
used as interpreters. It is unrealistic to teach English to patients at clinic visits. This population
needs care, so suggesting that they receive care elsewhere is not a therapeutic response by the
nurse.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
1. Which best describes the challenges when providing care to someone from a minority group?
(Select all that apply.)
a. Communication, both words and gestures, may be unfamiliar.
b. Few members of the minority group are nurses themselves.
c. Immigrants will soon adapt to the mainstream culture, but in the meantime many
are clinging to “the old ways.”
d. So few patients are minority group members that it is difficult to remember how
they prefer to receive care.
e. The nurse may have to confront personal values and beliefs.
ANS: A, B, E
Nurses must understand how patients define health and illness, how their cultural group cures
and cares for members, and how the nurse’s personal cultural background influences the way
in which care is delivered. The context and process of helping people involves at least two
people who often have different cultural orientations and lifestyles. Very few nurses are
members of a minority group. Although immigrants may adopt some of the ideas of the
mainstream culture, many will continue to use traditional practices and the nurse must be
aware and respect these cultural beliefs. Many minority group members represent the patient
population who receives care, so nurses must be aware and respect these cultural beliefs.
DIF: Cognitive Level: Understand (Comprehension)
2. Which are the most important factors in reducing disparities in health outcomes between
different cultural groups? (Select all that apply.)
a. A strong family structure
b. Access to a health care provider
N R I G B.COM
c. Access to transportation U S N T
d. Health care insurance
e. Having ongoing employment
f. Owning one’s own home
ANS: B, D
Disparities in health care can be reduced or even eliminated when adults have health care
insurance and a medical home defined as a setting that provides patients with timely,
well-organized care and enhanced access to providers. According to the Commonwealth Fund
(2007), when adults have insurance and a medical home, “their access to needed care, receipt
of routine preventive screenings, and management of chronic conditions improve
substantially.” Thus, having a strong family structure, access to transportation, ongoing
employment, and owning one’s own home are not nearly as important as having health
insurance and a medical home.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 14: Environmental Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which statement best describes the relationship between the environment and health?
a. Because of the large number of variables involved, the relationship between
environment and health cannot be researched.
b. Because the environment has such long-term effects on health, research findings
are not yet available.
c. Research shows that a healthy environment has limited impact on one’s health.
d. Research shows that a healthy environment increases quality of life and years of
healthy living.
ANS: D
A healthy environment increases quality of life and years of healthy living. Accumulated
evidence shows that the environmental changes of the past few decades have profoundly
influenced the status of public health. Globally, environmental factors contribute to nearly
25% of all deaths and increase disease burden (World Health Organization, 2016). The safety,
beauty, and life-sustaining capacity of the physical environment are unquestionably of global
consequence.
DIF: Cognitive Level: Understand (Comprehension)
2. When using an environmental perspective, which would be the most important question for a
nurse to ask when assessing potential health problems?
Nhave
RSbeen
INGfeeling?”
TB.COM
a. “Can you tell me how you U
b. “Can you tell me what you do at work?”
c. “What brings you here today?”
d. “What problems have you been having?”
ANS: B
Because 25% of worldwide preventable illnesses are caused by poor environmental quality,
nurses need to ask critical questions about their clients’ work and home environments to help
discern the contributions of specific hazards to their health. This can be accomplished by an
environmental health history. The other responses do not address a question that would be
addressed during an environmental health history.
DIF: Cognitive Level: Understand (Comprehension)
3. How does critical theory differ from other nursing theories such as the Health Belief Model or
Orem’s self-care deficit theory?
a. Critical theory can be used by professionals other than nurses.
b. Critical theory focuses on oppression and facilitates group action.
c. Critical theory is not directly related to health promotion.
d. Critical theory confronts changing an individual’s beliefs.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Critical theory is an approach that raises questions about oppressive situations, involves
community members in the definition and solution of problems, and facilitates group
interventions. The other two theories focus more on individual beliefs and choice of action.
DIF: Cognitive Level: Understand (Comprehension)
4. Which statement best describes why environmental health is more challenging than other
variables related to an individual’s health?
a. Environmental health affects susceptible individuals more than groups.
b. Environmental health demands that individuals be willing to change their beliefs.
c. Environmental health is dependent on social neighborhoods, as well as geography.
d. Environmental health requires social, economic, and political changes to improve.
ANS: D
Intervening to improve environmental conditions requires basic social, economic, and
political changes. Aggregates must work together to create such change. The other responses
do not address the multiple dimensions that must be impacted in order to impact change
within environmental health.
DIF: Cognitive Level: Understand (Comprehension)
5. Which nursing action would be the most helpful to the community’s long-term health?
a. Careful assessment, diagnosis, planning, and giving care to individual patients and
their families
b. Dialogue with community members concerning what health issues are of
importance in that community
c. Focusing on family health through school-based neighborhood clinics
NURSpolitical
INGTchange
B.COM
d. Helping the community create
through organization, use of media,
legislative lobbying, and mass demonstrations
ANS: D
The ultimate goal is liberating people from health-damaging environmental conditions by
using collective actions. Mechanisms have included strategic organization, litigation, public
hearing testimony, letter-writing campaigns, legislative lobbying, and mass demonstrations.
Helping the community create political change through organization, use of media, legislative
lobbying, and mass demonstrations shows how collective action can be applied. The other
interventions do not demonstrate the use of collective action.
DIF: Cognitive Level: Understand (Comprehension)
6. Which best explains why it is difficult to get others interested in environmental health?
a. Environmental problems just are not interesting or dramatic.
b. It’s difficult to get media interested.
c. People respond more to an acute crisis than chronic environmental problems.
d. People respond more to an individual asking for help than a community asking for
help.
ANS: C
People respond to acute crises with dramatic media coverage (such as hurricanes or
earthquakes), but ongoing consistent pressure is needed to ensure day-to-day environmental
integrity. Chronic environmental problems are rarely addressed effectively.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
7. What would be an appropriate term for intoxicated drivers, secondhand smoke, urban
crowding, noise, and mechanization?
a. Risks of living style
b. Risks in the built environment
c. Personal health risks
d. Modern day health risks
ANS: B
The built environment is the connection between people, communities, and their surrounding
environments that affect health habits and behaviors, interpersonal relationships, cultural
values, and customs. Most people live within areas that require almost daily contact with
potential health risks and threats, such as intoxicated or impaired drivers, secondhand smoke,
urban crowding, noise exposure, unabated traffic, and the stress of increased mechanization.
DIF: Cognitive Level: Understand (Comprehension)
8. What is meant by discriminatory land use?
a. Backlash against companies that do not protect the environment
b. Daily insults to people who live in a particular community
c. Locating industrial hazards in low-income communities
d. Political recognition that companies support a safe environment
ANS: C
Discriminatory land use ensures that many impoverished and marginalized groups, especially
people of color, live in close N
proximity
RSINtoGTindustrial
B.COMcontamination. Members of these
U
communities are at risk for illness and injury. The other responses do not correctly define
discriminatory land use.
DIF: Cognitive Level: Understand (Comprehension)
9. It has been learned that a particular industry has vastly polluted the surrounding
neighborhood. Which action would most likely be taken by those living in the neighborhood?
a. Band together to shut the industry down
b. Nothing, because of family ties and cost of relocation
c. Immediately move to a different neighborhood
d. Seek legal reimbursement for the hazard exposure
ANS: B
Residents may be unwilling to disrupt family ties and cultural roots to start over elsewhere, or
they may be unable to afford to move. Residents are revictimized by the difficulty in
obtaining compensation. Attempting to shut the industry down, seeking reimbursement for the
hazard exposure, and immediately moving to a different neighborhood are all costly
interventions and in most cases cannot be easily accomplished by most residents.
DIF: Cognitive Level: Apply (Application)
10. Which statement supports why it is believed that the risks of various employment positions
are inaccurate?
a. Companies refuse to share employee injury information.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. Because factories reimburse employees directly, the injury is not reported.
c. Individuals assume it is a personal problem, not an employment issue.
d. Most employment positions do not have known risks.
ANS: C
Statistics do not reflect unreported health problems. Collective problems related to
employment or occupation are often perceived as individualized injuries, and no one
“connects the dots.” Companies are willing to share employee injury information and
recognize the risks of employment, but the information may be inaccurate because of the
perception of individualized injuries.
DIF: Cognitive Level: Understand (Comprehension)
11. Why are health care providers concerned over such social issues as mass transit, clean power,
and the farming industry?
a. Because air pollutants are contributors to asthma and other health problems.
b. Clean power would reduce the pollution that results from burning of high-sulfur
coal.
c. Manure runoff from industrial farming is polluting water and killing fish
throughout the United States.
d. Mass transit would remove the problem of so many Americans being killed or
injured by drunken or impaired drivers.
ANS: A
All three (mass transit, clean power, and industry) emit air pollutants, which result in smog,
the most common outdoor air pollutant in the United States. Atmospheric pollutants cause or
contribute to asthma, allergic reactions, bronchitis, lung cancer, chronic respiratory disease,
NURSand
INplants.
GTB.C
and death. They also harm animals
The
most inclusive answer refers to air
OM
pollutants, although certainly, the others are true in society today.
DIF: Cognitive Level: Understand (Comprehension)
12. Which statement best describes what has happened to air quality since the United States
outlawed the use of chlorofluorocarbons, halons, and carbon tetrachloride?
a. Air quality immediately improved.
b. Air quality is slowly improving.
c. Little change occurred because these chemicals remain in the atmosphere.
d. Nothing has happened because other countries worldwide continue to extensively
use these products.
ANS: C
These chemicals, which were in widespread use, remain in the atmosphere. Thus, air quality
has not improved. This is a global concern and is being addressed worldwide by the World
Health Organization.
DIF: Cognitive Level: Understand (Comprehension)
13. Which is the leading cause of lung cancer among nonsmokers?
a. Secondhand smoke
b. Living near a nuclear power plant
c. Exposure to pesticides
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Radon gas
ANS: D
Radon exposure is the leading cause of lung cancer among nonsmokers in the United States. It
is estimated that radon causes an estimated 21,000 lung cancer deaths every year.
DIF: Cognitive Level: Understand (Comprehension)
14. Which best describes a food desert?
a. The inability to store foods at an acceptable temperature
b. The inability to have healthy foods at home
c. A neighborhood with little to no access to healthy foods
d. A neighborhood that has experienced a recent food-borne illness
ANS: C
A food desert is a neighborhood with little or no access to healthy foods. There are significant
disparities in access to healthy and fresh food supplies, with poor minority families being
more likely to live in a food desert. The other responses are not the correct definition of a food
desert.
DIF: Cognitive Level: Understand (Comprehension)
15. Which issue exists from communities using solid waste landfills to dispose of trash from
private residences?
a. Landfills are too wasteful, as solid waste can be burned to produce energy.
b. Methane gas may move through the soil to cause fire or explosions nearby.
c. There is an ongoing need to purchase more land as landfills eventually fill up.
d. People do not use landfills
garbage
N but
R dump
I Gtheir
B.C
M anywhere they will not be seen.
U S N T
O
ANS: B
Solid waste landfills accumulate methane gas, a byproduct of decomposing organic wastes.
Without proper venting, this volatile gas can move through soil and cause fires and explosions
in nearby areas. Waste incineration is not the best solution because it causes particulate air
pollution. Illegal dumping of garbage and purchasing additional land for more landfills are
concerns related to the disposal of trash from private residents, but methane gas explosions is
of primary concern.
DIF: Cognitive Level: Understand (Comprehension)
16. Which is a direct result of global warming?
a. Decreased prevalence of infectious diseases
b. Increased water pollution from soil erosion
c. Decreased protection from the ozone layer
d. Increased number of parasites and insects
ANS: D
Global warming is the gradual increase in the average temperature of Earth’s near-surface air
and oceans since the mid-twentieth century and its projected continuation (Easterling, 2011).
Rising global temperatures may enhance the quantity and distribution of parasites, insects, and
other disease vectors, potentially increasing the prevalence of a variety of infectious diseases.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
17. Which conclusion can be drawn concerning efforts to decrease environmental pollution?
a. The Environmental Protection Agency (EPA) sets priorities for environmental
problems and funds action.
b. Federal policies have been weakened, and enforcement lacks funding.
c. Federal recycling mandates have decreased waste products.
d. Legislation is increasingly being passed to force companies to lower toxic waste
emissions.
ANS: B
Legislation in the 1970s was aimed toward a comprehensive national environmental policy.
The momentum slowed in the 1980s, with policies being reversed and regulation losing its
funding. This trend has continued. The EPA sets rules but lacks resources to accomplish the
goals. There are no federal mandates for recycling, but local communities have made great
strides in this area.
DIF: Cognitive Level: Understand (Comprehension)
18. In a community presentation about asthma, a nurse explained the causes of asthma in children,
how to observe for “triggers” that lead to an attack, and how to use an inhaler. Which
statement best identifies what was omitted from this presentation?
a. The nurse did not ask the attendees to disclose if any of them smoke around
children.
b. The nurse did not address actions that should be taken to improve air quality and
only focused on the treatment of asthma.
c. The nurse did not address the need to avoid exposure to others who may have a
communicable disease.
NURgenetic
SINGcomponents
TB.COM related to asthma in families.
d. The nurse did not review the
ANS: B
By placing responsibility for the cause and cure of health problems exclusively on the
individuals, the belief is reinforced that all individuals are free to control their lives. Such a
perspective absolves society, government, industry, and business from accountability.
Research suggests that changing individual behaviors does not lead to significant reductions
in overall morbidity and morality in the absence of basic social, economic, and political
changes. Thus, the nurse must include information in the presentation that addresses the need
to improve air quality.
DIF: Cognitive Level: Apply (Application)
19. The local stream was full of trash. The Boy Scouts had a cleanup day so they could again
canoe on the stream. Which action should be taken by nurses in the local community?
a. Hold a dialogue with community members about the problem and its effects
b. Fight for stronger “do not trash” laws and harsher penalties
c. Lecture community organizations about the value of safe water for recreation
d. Put all personal trash in appropriate trash receptacles
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
An important nursing goal is to help people learn from their own experiences and analyze the
world with an intention to change it. It is essential that those affected participate in the process
of identifying and working to solve environmental problems. The nurse’s role is to ask critical
questions and help groups reflect on the environmental realities of their lives. The only way
for the nurse to promote this involvement is through a dialogue with the community members.
DIF: Cognitive Level: Apply (Application)
20. Which action should be taken by a small community group who hopes to accomplish goals
against a large powerful corporation?
a. Appeal to the chief executive officer’s conscience
b. Ask the corporation’s employees to encourage change
c. Begin legal action to force the corporation to change
d. Form coalitions with other groups that have similar goals
ANS: D
Brainstorm about all possible groups that might have a stake in the outcome of the issue.
Nurses can help make connections with larger, more powerful organizations.
DIF: Cognitive Level: Apply (Application)
21. How does participatory action research differ from other research methods?
a. Participatory action research does not use a control group.
b. Participatory action research does not require randomization.
c. Participatory action research is not based on a predetermined hypothesis.
d. Participatory action research poses solutions to the problem.
ANS: D
NURSINGTB.COM
Participatory action research calls for nurses, community members, and other resource people
to work together in identifying health problems, designing the studies, collecting and
analyzing the data, disseminating the results, and posing solutions to the problems. The
research process (use of control groups, randomization, and using a predetermined hypothesis)
is part of participatory action research.
DIF: Cognitive Level: Understand (Comprehension)
22. Which strategy should a nurse use to remember what should be included in a health history?
a. Always use a preprinted form
b. Depend on education to learn this
c. Depend on experience to know what to ask
d. Memorize the I PREPARE mnemonic
e. Memorize the I HEALTH mnemonic
ANS: D
The I PREPARE environmental exposure history mnemonic is a quick reference for primary
care providers.
I—Investigate potential exposures
P—Present work
R—Residence
E—Environmental concerns
P—Past work
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
A—Activities
R—Referrals and resources
E—Educate
This tool will help the nurse remember what to ask to determine environmental factors
relevant to health.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which describe a problem with the U.S. water quality today? (Select all that apply.)
a. Companies demand high reimbursement when asked to stop dumping heavy
b.
c.
d.
e.
f.
metals into local water sources.
Many aquifers are contaminated with pesticides and fertilizers.
More than 45 million Americans drink untreated water.
Sediment from construction, agriculture, and deforestation is often present.
Underground water, if contaminated, cannot be cleansed.
Water-related diseases (cholera, typhoid, dysentery) frequently occur.
ANS: B, C, D, E
More than 45 million Americans obtain water from private wells, which have no treatment or
monitoring guidelines. Water quality problems include dosing reservoirs with chemicals to
reduce algae, contaminating aquifers with pesticides and fertilizers, and leaching lead from
water pipes. Underground water cannot be cleansed. Companies demand high reimbursement
when asked to stop dumping heavy metals into local water sources and the frequent
occurrence of water-related diseases (cholera, typhoid, dysentery) are not current problems
with the water quality in the N
United
States.
URSI
NGTB.COM
DIF: Cognitive Level: Understand (Comprehension)
2. Which have been identified as part of the core environmental health competencies? (Select all
that apply.)
a. Assurance
b. Assessment
c. Policy development
d. Management
e. Advocacy
f. Communication
ANS: B, D, F
The National Center for Environmental Health, the Centers for Disease Control and
Prevention, and the American Public Health Association have established three core
competencies for Environmental Health professionals: (1) assessment, (2) management, and
(3) communication. Assurance, policy development, and advocacy are not part of the core
environmental health competencies.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 15: Health in the Global Community
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes why a nurse working in a U.S. urban area should be knowledgeable
about infectious diseases common to areas of Africa?
a. Nurses have an ethical commitment to care for others throughout the world.
b. Every infectious disease is just one airplane ride away.
c. Infection could occur if a nurse goes out in public.
d. Nurses meet people who may originally have been born elsewhere.
ANS: B
Infectious diseases do not recognize or respect country borders. With rapid international
travel, an infected person could easily be in any country in a very short period of time.
Problems throughout the globe can threaten human life. Although nurses have an ethical
commitment to provide care, infections can occur anywhere, and nurses may care for
populations who were originally born outside of the United States, the primary need for the
nurse to have this knowledge exists because infectious diseases can spread throughout the
world in a very short period of time because of the ease of travel in the world.
DIF: Cognitive Level: Understand (Comprehension)
2. Which is one of the biggest threats faced by developing countries that are trying to grow
economically and make a better life for their citizens?
a. Lack of education and knowledge
NURSINGTB.COM
b. Political unrest
c. Environmental hazards
d. Large population
ANS: D
Large populations create pressure. In developing countries, famine, trade problems, and war
may occur. Malnutrition, disease, or death may result. The poor suffer excess mortality and
morbidity. Quality of life is less. Overcrowding leads to pollution, stress, disease, and
violence. Each of these challenges represents a major barrier to economic growth. Thus, the
large population can cause there to be problems with lack of education, political unrest, and
environmental hazards.
DIF: Cognitive Level: Understand (Comprehension)
3. Which group makes up about 25% of the world’s population?
a. Children
b. Elderly
c. Teenaged adolescents
d. Caucasians
ANS: A
According to the World Health Organization, in 2013, 26.1% of the world population
consisted of children and 8.3% of the population were over age 65. The percentage of
teenaged adolescents and Caucasians is not reported in the text.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Remember (Knowledge)
4. Which has been a common result in countries with a severe HIV/AIDS epidemic?
a. Life expectancy dropped to 35 to 40 years but is slowly increasing.
b. Free clinics have begun distributing condoms to stop the spread.
c. International aid has begun to lower the infection rates.
d. Missionaries are establishing orphanages within their churches.
ANS: A
In countries severely affected by the HIV/AIDS epidemic, life expectancy dropped to 35 to 40
years. However, life expectancy has significantly improved over the last decade. International
aid, orphanages, and condom distribution may be present in these countries; however, the
main problem was decreased because of this epidemic.
DIF: Cognitive Level: Understand (Comprehension)
5. A public health nurse is partnering with a local community agency to create a media campaign
focusing on prevention of teenage pregnancy. Which is a key component of the Integrated
Model of Sustainability and Innovation that should be implemented?
a. Respect for the population of interest
b. One source of reliable funding
c. Administrative decision-making
d. Effective communication
ANS: D
An emphasis of the integration of research/discovery, teaching/learning, and
practice/service/engagement N
withRnurse-led
innovation
INGTB.C
M led to the development of the
U
S
O
Integrated Model of Sustainability and Innovation (IMSI). The key components of the IMSI
include effective communication, collaboration, community partnership, and a mosaic of
support or a diverse portfolio of funding sources to promote long-term sustainability of local
to global community-based projects. Conversely, unsustainable projects lack clear
communication, mutual respect, and a lack of community and administrative partnership and
are often dependent on only one or two sources of support.
DIF: Cognitive Level: Apply (Application)
6. Most of a country’s citizens have died from malnutrition or as the result of violence. Which
conclusion can be drawn?
a. Their country has a problem with an adequate water supply for agriculture.
b. They live in a country where weather interferes with food crops.
c. They live in a developed country involved in a war.
d. They live in a developing country.
ANS: D
Infectious disease and malnutrition are the primary causes of mortality in developing
countries. Cardiovascular disease, cancer, respiratory disease, stroke, violence, and traumatic
injury are the primary causes of mortality in a developed country. The problem of
malnutrition is broader than examining the environment associated with growing the country’s
food supply.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
7. Which statement best defines epidemiological transition?
a. A change from morbidity caused by a particular infectious disease to a different
infectious disease
b. A change from mainly infectious diseases to chronic diseases
c. A change in infectious diseases caused by a difference in agent, host, or
environment
d. A change in life spans of various age groups in a specific country
ANS: B
Many developed countries experienced an epidemiological transition from having an
infectious disease profile to having a chronic disease profile and are now plagued by chronic
diseases. Once plagued with high rates of infectious disease, developed countries significantly
reduce high mortality rates from these diseases through improved sanitation, nutrition, and
immunization and improved health care. Most developed countries have a more stable
economy and a wide range of industrial and technological development. These countries
experience an epidemiological transition. The other statements do not define epidemiological
transition.
DIF: Cognitive Level: Understand (Comprehension)
8. Which action to reduce tobacco-related deaths and diseases is supported by the World Health
Organization (WHO)?
a. Raise taxes on tobacco
b. Limit tobacco production
c. Prohibit the sale of tobacco
NURSINGTB.COM
d. Encourage tobacco exports
ANS: A
In 2003, the first global public health treaty was adopted at the World Framework Convention
on Tobacco Control. The treaty was designed to reduce tobacco-related deaths and diseases
around the world. In 2008, the WHO introduced MPower, which stands for Monitor tobacco
use and prevention policies; Protect people from tobacco use; Offer help to quit tobacco use;
Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and
sponsorship; and Raise taxes on tobacco
DIF: Cognitive Level: Understand (Comprehension)
9. Which strategy should be used to lower the risk of malaria among the world’s population?
a. Distribute insecticide-treated nets and antimalarial medications
b. Educate people to keep their windows closed at night
c. Spray neighborhoods with insecticides to kill any mosquitoes present
d. Spread DDT on bodies of water to prevent larva growth
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Effective low-cost strategies are available for malaria’s prevention, treatment, and control,
including insecticide-treated nets and new-generation medications. It would be very
dangerous to spray neighborhoods with insecticides, which also contaminate food. DDT has
been banned in the United States for many years because of its long-term harmful effects on
the environment, including food animals. Keeping the windows closed at night is not going to
prevent the threat that occurs during other times of the day.
DIF: Cognitive Level: Understand (Comprehension)
10. Which statement best describes what tobacco companies have done to counter their losses
resulting from U.S. efforts to decrease smoking tobacco?
a. Begun advertising in more subtle ways such as sponsoring sports programs or
building and naming large sport arenas
b. Bought off more restrictions on tobacco through the tobacco settlement funds,
which gave a large amount of money to each state
c. Increased international exports and targeted children
d. Rapidly decreased their tobacco components and focused on other products
ANS: C
Tobacco control and secondhand smoke policies have been implemented at various political
levels in the United States and abroad. To continue their profits, the tobacco industry has
targeted youth and dramatically increased international exports. The tobacco industry has not
begun to focus on other products, changed to more subtle advertising, or bought off more
restrictions on tobacco as ways to counter their losses.
DIF: Cognitive Level: Understand (Comprehension)
URDeclaration
SINGTB.C
OM
11. Which assumption underlies N
the
of Alma-Ata?
a. Communities should be encouraged to cooperate with national health goals.
b. Gross inequalities and disparities will always exist.
c. Health is a fundamental human right.
d. Public health agencies are responsible to plan and take action to improve health.
ANS: C
The concept of primary health care stresses health as a fundamental human right for
individuals, families, and communities; the unacceptability of the gross inequalities and
disparities in health status; the importance of community involvement; and the active role of
all sectors.
DIF: Cognitive Level: Understand (Comprehension)
12. Which best describes how the United Nations (UN) is able to implement its decisions?
a. Asking for funding from all member nations to obtain appropriate resources
b. Through five permanent members of its security council
c. Sending military units to developing countries
d. Using its moral authority and world opinion
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Regardless of size, wealth, or political system, all member nations have an equal vote in the
decision-making process. UN decisions seek to reflect world opinion and the moral authority
of the community of its 193 nations. The UN does not ask for funding from all member
nations, as some of the nations do not have additional funds to provide to the UN. The
security council is unable to implement decisions without support from all of the member
nations. It is not feasible for the UN to send military units to developing countries to
implement their decisions.
DIF: Cognitive Level: Understand (Comprehension)
13. Which nongovernment organization (NGO) is active in improving health on a global scale?
a. Carter Center
b. Centers for Disease Control and Prevention (CDC)
c. Pan American Health Organization
d. UNICEF
ANS: A
Collaborating with the United Nations are NGOs such as the Carter Center. The CDC is a
governmental agency. The Pan American Health Organization is an international public health
agency. UNICEF is an international agency.
DIF: Cognitive Level: Remember (Knowledge)
14. Which nongovernmental group has been expending millions of dollars to reduce the impact of
infectious diseases with profound effect on prevention and treatment for HIV/AIDS,
tuberculosis (TB), and malaria?
a. Carter Center
NURSINGTB.COM
b. Bill & Melinda Gates Foundation
c. Families for Freedom Foundation
d. Bradley Foundation
ANS: B
The Bill & Melinda Gates Foundation has local, national, and global objectives. Globally, the
foundation focuses on reducing hunger and poverty, and improving health. Within Africa, the
foundation has had a profound effect on improving access to antiretroviral medications and
prevention and treatment for HIV, TB, and malaria. The objectives of the Carter Center are to
prevent and resolve conflicts, to enhance freedom and democracy, and improve health. The
Families for Freedom Foundation provides education and support to families who are affected
by deportation. The Bradley Foundation supports public policy organizations and conservative
causes.
DIF: Cognitive Level: Remember (Knowledge)
15. Which statement best describes how the Centers for Disease Control and Prevention (CDC)
differs from its many peer agencies?
a. It focuses primarily on prevention.
b. It is a uniquely American approach to problem resolution.
c. It responds to health emergencies.
d. It uses years of experience as the basis for its actions.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The CDC applies research and findings to improve people’s daily lives and responds to health
emergencies—something that distinguishes the CDC from many of its peer agencies. Other
peer agencies of the CDC also are involved in focusing on primary prevention, using an
American approach to problem resolution, and using years of experience as the basis for
action.
DIF: Cognitive Level: Understand (Comprehension)
16. Which aspect of a developed country would be most worthwhile to be copied by a developing
country?
a. Education of health care professions
b. Health care reform policies to improve health care delivery
c. Advanced technology with its miracle interventions and cures
d. Our approach to rationing health care
ANS: B
Although transferring specialized medical technologies from developed to developing
countries may not always be appropriate, developing countries are currently learning from
health care reform policies and the technological revolution in developed countries. The
health care reform policies will improve health care delivery and be more helpful than
changing the education of health care professionals. There is not a rationing approach to
health care services in the United States that could be used by other countries.
DIF: Cognitive Level: Understand (Comprehension)
17. Which aspect of health care could be learned by a developing country from a developed
country?
NURSI
M
a. Acceptance of illness or disease
TB.CO
asNaGlearning
experience
b. Effective ways to treat chronic disease
c. Use of healthy behaviors to prevent illness
d. Delivery of primary health care
ANS: D
Likewise, developed countries have much to learn about low-technology initiatives such as
oral rehydration therapy for the treatment of diarrhea and the delivery of primary health care
as defined by the World Health Organization. The other behaviors such as acceptance of
disease, effective ways of treating chronic disease, and use of healthy behaviors to prevent
illness would most likely be passed on from developed countries to developing countries.
DIF: Cognitive Level: Understand (Comprehension)
18. What was the importance of the Lalonde Report, which proposed the “health field concept” in
1974?
a. It first called attention to the growing problem of air pollution.
b. It first emphasized the importance of basic hand washing.
c. It first emphasized influence of lifestyle and environment.
d. It was the first report that suggested a link between smoking and lung cancer.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
This report emphasized lifestyle and environment as determinants of health outside the
traditional medical sphere. It became the basis for rethinking new paradigms for health care
delivery. The report signaled the early beginnings of a health care paradigm shift from the
traditional medical model to a more holistic system-environment perspective. The report did
not call attention to the problem of air pollution, emphasize the importance of basic hand
washing, or suggest a link between smoking and lung cancer.
DIF: Cognitive Level: Understand (Comprehension)
19. In what way is the U.S. approach to primary health care inconsistent with the World Health
Organization (WHO) approach?
a. Our primary health care system does not provide universal coverage to all citizens.
b. Most U.S. citizens can afford health care through employer insurance plans.
c. Tertiary care is preferred over primary care.
d. U.S. hospitals make maximum use of the newest and best technology.
ANS: A
As a market-based society, the United States does not focus on primary health care and does
not provide coverage to all U.S. citizens. Few managed care models propose universal access
or the comprehensive primary health care that WHO, U.S. President Barack Obama, and the
late Senator Edward Kennedy advocate.
DIF: Cognitive Level: Understand (Comprehension)
20. Which would be the best example of service learning?
a. Student nurses collecting gloves and coats to distribute to the homeless
b. Student nurses distributing food on plates at a “feed the hungry” site
RSINGassistants
M minimum wage on the weekends
c. Student nurses employedNasUnursing
TB.COfor
d. Student nurses volunteering at the free clinic doing health assessments
ANS: D
Service learning is a teaching and learning strategy that integrates meaningful community
service with instruction and reflection to enrich the learning experience, teach civic
responsibility, and strengthen communities. Volunteering at a free clinic to perform health
assessments is the best example of how this definition can be applied. Collecting gloves and
coats and distributing food, while allowing the student to volunteer, does not allow the student
to apply materials learned in the classroom. Student employment cannot be considered
volunteering of services to the community.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. What have been the foci of international nursing research? (Select all that apply.)
a. Development of home care or transition from hospital to home
b. Diverse clinical conditions and experiences
c. Educational exchange programs for students and faculty
d. How to integrate technology into developing country health care systems
e. How to use a career in nursing to change the cultural expectations of gender roles
f. The importance of sharing resources with poverty stricken countries
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A, B, C
Since 1990, international nursing research has focused predominantly on the following areas:
student and faculty educational exchange programs, diverse clinical conditions and
experiences, the international development of home care or transition from hospital to home,
and maternal-child health. International nursing research has not focused on integrating
technology into the health care systems of developing countries, using a career in nursing to
change cultural expectations of gender roles, or the importance of sharing resources.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 16: Child and Adolescent Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which group of children is at the highest risk to have poor health?
a. African American children living in a suburb
b. Asian children living in an outer urban area
c. Hispanic children living in the inner city
d. White children living in a rural area
ANS: C
Significant disparities persist in health status of white children versus children of color.
However, children living in suburban areas and most outer urban areas experience superior
access to health services compared with children living in rural areas and inner cities,
especially if they are poor.
DIF: Cognitive Level: Understand (Comprehension)
2. What proportion of U.S. citizens are children?
a. 12%
b. 16%
c. 20%
d. 24%
ANS: D
NURU.S.
GTB.C
In 2015, there were 73.7 million
children
under
SIN
OMthe age of 18 years. Children represent
about 24% of the country’s population, down from a peak of 36% at the end of the
mid-1960’s baby boom.
DIF: Cognitive Level: Remember (Knowledge)
3. Which action should be taken by a typical community preparing for the expected demographic
changes in the United States?
a. Build more elementary schools
b. Build more high schools
c. Build more colleges
d. Build more adult condominiums
ANS: D
The number of children will increase, but the proportion of children as compared with adults
has been decreasing since the mid-1960s. Consequently, more housing for adults is needed.
DIF: Cognitive Level: Apply (Application)
4. If most students have no intention of ever leaving their local community, which language
should be chosen as the required foreign language in high school?
a. French, as it is a very romantic language
b. German, because many of the students’ names are German
c. Latin, as it is the basis for many other languages
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Spanish, to improve employment opportunities
ANS: D
By 2050, Hispanic children as a percentage of the population are expected to grow to 32%, up
from 25% in 2015. The percentage of children who are Hispanic has increased faster than that
of any other racial or ethnic group. More immigrants speak Spanish, and care providers need
to give culturally appropriate care. Speaking Spanish would be helpful. Because of these
reasons, it would be most appropriate for Spanish to be selected as the required foreign
language. Speaking French, German, or Latin would not be as practical as being able to speak
Spanish.
DIF: Cognitive Level: Apply (Application)
5. Which best describes why infant mortality rate is used as an international comparison of a
country’s health status?
a. Every country, regardless of other priorities, focuses on care of infants and their
mothers.
b. It is easy to obtain and compare such data.
c. It reflects medical care quality and access and public health practice.
d. The World Health Organization requires these data be reported to them each year.
ANS: C
It is an important marker because it is related to several factors, including maternal health,
medical care quality and access, socioeconomic conditions, and public health practices. Infant
mortality reflects the health and welfare of an entire community and is used as a broad
indicator of health care and health status.
DIF: Cognitive Level: Understand
NUR(Comprehension)
SINGTB.COM
6. Which statement best describes how the United States compares with other countries on infant
mortality rate?
a. Best of all the industrialized nations
b. About in the middle of the industrialized nations
c. Near the bottom of the industrialized nations
d. Gradually improving among the industrialized nations
ANS: C
The United States ranks a dismal 27th in infant mortality behind most other industrialized
nations, including Japan, Sweden, Spain, Hong Kong, Italy, France, and Canada. Fifty years
ago, the United States ranked 12th. The gap in infant mortality between the United States and
other nations has occurred in spite of the United States' comparatively high per capita
spending on health care and technological advancements.
DIF: Cognitive Level: Understand (Comprehension)
7. A school nurse at a high school suggests that all students have an educational unit on newborn
care in their required health class. Which provides the best rationale for this suggestion?
a. Because all adults should be knowledgeable in basic child care
b. Because the first year of life is the most hazardous until old age
c. To help convince students not to engage in sexual intercourse
d. To demonstrate the incredible responsibilities in parenthood
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: B
The first year of life is the most hazardous until the age of 65 years. Many parents, often out
of ignorance, do intentional acts that were not meant to injure or kill the child. Many new
parents feel unprepared to care for a newborn and lack knowledge of normal growth and
development. Newborn education would not help convince adolescents not to engage in
sexual intercourse. Although this education may show the responsibilities associated with
parenthood and is important for all adults to have, the purpose of the education is to prevent
injuries and accidents among the infant population.
DIF: Cognitive Level: Apply (Application)
8. Which indicator would be most informative in assessing the health of a newborn?
a. Apgar score at birth
b. Birth weight and length of gestation
c. Mother’s education and income from employment
d. When the mother began prenatal care at her local clinic
ANS: B
Birth weight and length of gestation are the most important predictors of infant health.
Although maternal education, income, and lack of prenatal factors are factors associated with
preterm birth and low birth weight, at the time of birth it is most important to assess the
weight of the infant and length of gestation. Using the Apgar score at birth is not as
informative of a tool for assessing newborn health as the birth weight and length of gestation.
DIF: Cognitive Level: Understand (Comprehension)
9. A woman vows to quit smoking and drinking immediately upon the surprising news that she
is 2 months pregnant. WhichNconcern
the nurse
URSIwould
NGTB.C
OM have for this woman?
a. Those with whom she shares living quarters might smoke or drink.
b. Fetal damage may already have occurred.
c. Peers may encourage her to resume old habits, and peer pressure is very strong.
d. She won’t be able to keep her vow.
ANS: B
The fetus can suffer damage very early in pregnancy, even before a woman knows she is
pregnant.
DIF: Cognitive Level: Apply (Application)
10. A nurse is caring for a woman, who has just found out she is pregnant. The woman begins
crying and says, “But I’m not trying to get pregnant!” Should this response by the woman be
concerning to the nurse?
a. No, because women may not consciously be aware of an unconscious desire to be
a mother
b. No, because about half of all pregnancies in the United States are unintended
c. No, because she admitted having unprotected sexual intercourse
d. Yes, because pregnancy can usually be avoided by appropriate precautions
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
This response should not surprise the nurse because approximately half of pregnancies in the
United States are unintended. Thus, it is important that women have good preconception
health throughout their reproductive years to help ensure optimal fetal health and development
should pregnancy occur.
DIF: Cognitive Level: Apply (Application)
11. A woman confides in the nurse that she and her husband want to become parents as soon as
possible. Which statement would be the best reply from the nurse?
a. “Ask some young parents if you can babysit for a while to get in practice.”
b. “Can you afford to become parents with all the items a baby will need?”
c. “Consider whether you are really ready to become parents.”
d. “Start living as healthy a lifestyle as possible right now.”
ANS: D
Adopting a healthy lifestyle and obtaining regular medical care before becoming pregnant can
help to ensure a healthy pregnancy. Questioning the woman’s statement would not be a
therapeutic response from the nurse, rather the nurse should reply by providing support and
education for the woman.
DIF: Cognitive Level: Apply (Application)
12. A mother is assessing the safety of toy that her toddler received as a birthday gift. Which
source would provide the mother with the most accurate information?
a. Ask the toddler’s daycare provider for her opinion.
b. Call the department store where the toy was purchased.
c. Explore the toy manufacturer’s website.
NURSafety
d. Search the Consumer Product
SINGCommission
TB.COM website.
ANS: D
The Child Safety Protection Act of 1994 requires manufacturers, importers, distributors, and
retailers to report choking incidents involving such products to the Consumer Product Safety
Commission. The U.S. Consumer Product Safety Commission provides information about toy
recalls.
DIF: Cognitive Level: Apply (Application)
13. A mother was very proud that she had cut back smoking from two packs a day, which she had
smoked for years, to only half a pack a day. Which would be the most appropriate response by
the nurse?
a. “I wish all smoking moms could see your example!”
b. “I’m so proud of you. You’re down to only 25% of what you used to smoke!”
c. “That must have been difficult, but you’re probably still getting nicotine, so it’s
important you quit entirely.”
d. “Your baby will really appreciate your efforts at quitting, especially if you do not
resume after the baby is born.”
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Quitting is best. Merely reducing cigarette use during pregnancy may not be enough to benefit
the fetus because women who cut back tend to inhale more deeply or take more puffs to get an
equivalent amount of nicotine. The nurse’s response must be supportive and recognize the
mother’s efforts but also continue to encourage total quitting.
DIF: Cognitive Level: Apply (Application)
14. Which is consistent with the American Academy of Pediatrics (AAP) recommendations for
breast-feeding?
a. A mother combines breast-feeding with the introduction of complementary foods
until the infant is 1 year old
b. A mother supplements breast-feeding with formula when then infant is 4 months
old
c. A mother stops breast-feeding her infant after introducing solid foods
d. A mother asks her employer to allow her to bring her infant to work so that she
may breast-feed
ANS: A
The AAP recommends exclusive breast-feeding for about the first six months of a baby’s life,
followed by breast-feeding in combination with the introduction of complementary foods until
at least 12 months of age, and continuation of breast-feeding for as long as mutually desired
by mother and baby.
DIF: Cognitive Level: Understand (Comprehension)
15. A mother was concerned about her child dying of some childhood disease, because that is
how some of her siblings died before her family came to the United States. Which would be
NU
SInurse?
NGTB.COM
the most appropriate response
byRthe
a. “You should see your doctor immediately if you ever think your child is ill.”
b. “Your child has been immunized, so the biggest danger is from accidents.”
c. “You have made sure your child has all the right immunizations so you can quit
worrying.”
d. “You’re right to be concerned, since susceptibility runs in families.”
ANS: B
Childhood is generally a healthy time of life. The incidence of childhood disease has
decreased because the majority of children receive a full complement of immunizations during
infancy and toddlerhood. The leading threat to children’s health is accidental injury and
exposure to environmental toxins, abuse, and violence.
DIF: Cognitive Level: Apply (Application)
16. A young mother was very proud because she had been taking her 9-month-old with her to
various garage sales where she had purchased a lot of toys for very little money. Which would
be the most appropriate response by the nurse?
a. “Be sure there are no small pieces as young children can easily choke.”
b. “Fantastic. Saving money on toys will allow you to buy more fresh fruits and
vegetables.”
c. “Toddlers love new toys; they will help with cognitive development.”
d. “You are doing an excellent job of giving your child lots of stimulation with new
playthings.”
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A
Infants and young children are at great risk for accidental injuries. The leading cause of injury
death for children under the age of 1 year is accidental suffocation caused by choking or
strangulation. Thus, it is important for the nurse to talk with the young mother about the
dangers of toys with small pieces. Safety of the infant should be the primary concern of the
nurse in this situation. Saving money on toys will not necessarily allow the young mother to
be able to purchase more fruits and vegetables. The infant is nine-months old and would not
be considered a toddler yet. It is not apparent in this situation if the toys are age appropriate
for the infant or would provide the appropriate amount of stimulation for a child at this
developmental level.
DIF: Cognitive Level: Apply (Application)
17. A mother explained that she had just dropped her 3-year-old off at her own mother’s so she
could come in for the required examination for her new job. She excitedly shared her hopes
that she would be able to afford a used car rather than having to ride a bus all the time. Which
would be the most appropriate response by the nurse?
a. “I’m sure the exam won’t show any problems. I’m so excited for you.”
b. “Don’t forget to buy a child’s seat when you get your car.”
c. “How do you think your child will adapt to you being at work all day?”
d. “It’s fantastic that you have a new job in this rough economy. Will your mother be
able to continue to babysit?”
ANS: B
Motor vehicle injuries are the leading cause of death for children from age 5 to 14 years in the
United States. Many injuries occur because adults fail to secure children in car seats in the
INolder
GTB.C
back seat of the vehicle or toN
insist
children
URSthat
OM buckle up. The most important step that
a parent can take to ensure a child’s safety in a motor vehicle is to correctly secure him or her
into a car seat, or seat belt when the child is older, for each ride. Safety of the toddler should
be the primary concern for the nurse in this situation. The nurse should focus on the safety of
the child in the response. Telling the mother that the exam will not show any problems
provides false reassurance to the mother, as problems may be detected. Asking if the woman’s
mother will continue to babysit or how the child will adapt to the mother being at work are not
relevant as this is a required examination for her new job.
DIF: Cognitive Level: Apply (Application)
18. A school nurse is developing a health education program for third grade students about how to
play safely. Which provides the best rationale for this nursing action?
a. The kids were playing chicken in front of the school buses each day.
b. The students are at the age when they begin to engage in risky behaviors.
c. Toys can have unexpected hazards from lead paint to small swallowable parts.
d. Without proper head protection, many sports can lead to traumatic brain injury.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Head injury from cycling and other wheeled sports, such as skateboarding, is a leading cause
of child death and disability. Without proper head protection, a fall from as little as two feet
can cause traumatic brain injury. The use of helmets and proper protective equipment can
substantially reduce the risk of injuries. Adolescents are the population who begin to engage
in risky behaviors. As third graders, these children are not typically at risk for swallowing
small parts from toys. Although the education may provide information about why it is not
safe to play chicken in front of the school buses, this is a behavior that should be stopped by
the rules and regulations that are in place at the school.
DIF: Cognitive Level: Apply (Application)
19. A school nurse is trying to decrease the effects of an incredible health crisis attacking school
children. Which action would be most appropriate for the nurse to take?
a. Arrange for booster shots to maximize immunization protection against childhood
infectious diseases
b. Arrange for swine flu and regular flu shots each year
c. Establish recreational programs that encourage physical exercise each day
d. For those whose parents give permission, teach adolescents about the need for
abstinence or “safe sex”
ANS: C
Childhood obesity has become a health crisis in the United States. Obesity has more than
doubled in children and tripled in adolescents over the past 30 years. An estimated one third
of children are overweight or obese. Children who are overweight are more likely to develop
cardiovascular disease, diabetes, bone and joint disease, sleep apnea, and face social
discrimination which can lead to poor self-esteem and depression. Nurses can design and
implement nutrition, healthy N
eating,
policies and standards in schools
RSIand
Gphysical
B.COactivities
M
U
N
T
in order to address this health crisis. Immunizing against infectious diseases and the flu and
teaching about the need for abstinence or “safe sex” does not address the obesity, which has
become a health crisis throughout the United States.
DIF: Cognitive Level: Apply (Application)
20. Which statement best explains why parents and nurses are often concerned about adolescents?
a. Adolescents engage in sexual acts without using protection.
b. Adolescents engage in very high-risk behaviors.
c. Adolescents love driving but are not as skilled as they believe.
d. Adolescents often experiment with alcohol or drugs.
ANS: B
In their struggle to gain independence and with their sense of immortality, many adolescents
engage in risk-taking behaviors, including alcohol and drug abuse, early and unprotected
sexual activity, unsafe driving, and participation in delinquent and violent activities that
threaten their health. To say adolescents engage in very high-risk behaviors is the inclusive
answer, because all other responses name only one problem.
DIF: Cognitive Level: Understand (Comprehension)
21. When the school health nurse suggested the school health clinic include sexual counseling and
free condoms if requested, an angry woman yelled, “Why do I care if some girls have no
morals and sleep around?” Which would be the most appropriate response by the nurse?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a. “Because taxpayers spend billions each year for teenage moms and their babies.”
b. “Because your son may have to pay child support to that girl for the next 18
years!”
c. “I understand your point of view, but since some parents don’t teach their children
morals, the school has to help.”
d. “We all should care for our neighbors and our neighbors’ children.”
ANS: A
Preventing pregnancy among teenagers can reduce the dropout rate, welfare dependency, low
birth weight, and infant mortality. According to an analysis by the National Campaign to
Prevent Teen Pregnancy, the estimated national cost of teen childbearing in the United States
cost taxpayers (federal, state, and local) is at least $9.4 billion per year.
DIF: Cognitive Level: Apply (Application)
22. A school nurse has identified that there has been an increase in sexually transmitted infections
(STIs) among the adolescents attending the school. Which intervention should be completed
by the nurse?
a. Arrange for the health department to come to the school to give information and
treatment on a confidential basis
b. Encourage the athletic coaches to distribute condoms in such a way that a boy can
obtain them in private
c. Have English teachers assign stories about the problems that result from adolescent
pregnancy
d. Have the bus drivers put a comic book about sexuality, STIs, and preventive
measures on each seat
ANS: A
NURSINGTB.COM
Barriers to health care such as lack of transportation, concerns about confidentiality, and lack
of access to preventive health services contribute to a high prevalence of STIs among teens.
Having a free clinic in the school removes some of the barriers.
DIF: Cognitive Level: Apply (Application)
23. Which individual is most likely to be the victim of violent crime?
a. A 10-year-old white female
b. A 15-year-old black female
c. A 15-year-old black male
d. A 10-year-old white male
ANS: C
Black males are the racial group most likely to be victimized. Violence is more likely to occur
with an adolescent than a child.
DIF: Cognitive Level: Understand (Comprehension)
24. Which factor is the single largest threat to child health?
a. Child abuse
b. Obesity
c. Poor nutrition
d. Poverty
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
Poverty is the greatest threat to child health. Children in poverty have less access to nutritious
food, shelter, and health care. They are often deprived of advantages such as good schools and
may live in substandard housing, have stressful home lives, live surrounded by drugs and
crime, and lack positive and nurturing adult role models.
DIF: Cognitive Level: Understand (Comprehension)
25. A school nurse is trying to determine health trends when making plans for health
programming in the school for the upcoming school year. Which would be the most
appropriate action for the nurse to take?
a. Conduct a survey in the community
b. Do an online search of groups that might collect and analyze such data
c. Examine records in the school health office to determine trends
d. Interview local health officials regarding problems beginning to occur
ANS: B
The federal, state, and local governments and many national organizations collect and analyze
data to track the well-being of children and adolescents. For example, the U.S. Department of
Health and Human Services (USDHHS) generates a yearly report, Child Health USA, on child
population characteristics, health status, and health care utilization. Such data are readily
accessible online. A number of key indicators are tracked on a regular basis by the federal
statistical system so that trends are revealed. State and local data also are used to track the
well-being of children. The most efficient use of the nurse’s time would be to use data that
already exists rather than trying to create new data. This could be done by performing an
online search for existing data. Once the existing data is collected, the nurse may then need to
look specifically at the data at the school or create new data to examine new or existing
NURSINGTB.COM
problems.
DIF: Cognitive Level: Understand (Comprehension)
26. A mother was debating whether or not to take her son to the clinic. His temperature was
104F and rising so she gave him acetaminophen (Tylenol). Which will most likely be the
deciding factor in the mother’s decision?
a. Whether or not the child is crying
b. Whether or not the fever goes down after the Tylenol
c. Whether or not the child seems to be getting better
d. Whether or not the child is covered under insurance
ANS: D
The ability to pay for health care greatly influences whether a parent takes a child to see a
health care provider. Having health insurance would be the most important deciding factor in
this situation, more important than if the child is crying, if the fever goes down, or if the child
seems to be getting better.
DIF: Cognitive Level: Apply (Application)
27. Which would be a source of care if families are employed at a salary above the poverty line,
but at too low of an income for health insurance?
a. Local health department clinics that provide care on a sliding scale
b. Health care providers who donate time and pharmaceutical samples to free clinics
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. School health clinics
d. The state Children’s Health Insurance Program (CHIP)
ANS: D
Although families may be able to get some assistance from any of the listed resources, the
CHIP is a publicly subsidized health insurance program for children. It was specifically
created for children whose family income is above Medicaid limits but whose families do not
receive health insurance through the parents’ employment (i.e., the working poor).
DIF: Cognitive Level: Understand (Comprehension)
28. When considering the benefits for the recipients, which is more beneficial: Medicaid or
private insurance?
a. Private insurance, because it is accepted by all providers, whereas Medicaid is not
b. Private insurance, because it gives its beneficiaries more benefits than Medicaid
gives
c. Medicaid, because it includes early and periodic screening, diagnosis, and
treatment services
d. Medicaid, because it is available for all children
ANS: C
Through the Early Periodic Screening, Diagnosis, and Treatment program, a child covered by
Medicaid can receive a range of health and health-related services beginning in infancy. The
program is designed to ensure availability and accessibility of health care resources and to
help Medicaid recipients and their parents effectively use these resources. The program’s
services far exceed those usually covered by private insurance. Private insurance may not be
accepted by all providers, as many insurance plans may limit the providers that can be seen
NUMedicaid
RSINGisTnot
B.C
under a certain insurance plan.
available
OM for all children, only those from
low-income families.
DIF: Cognitive Level: Understand (Comprehension)
29. A man, who looked about 45 years old, gave a cashier at a grocery store the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers for some
of the food he had just selected. Which conclusion can be drawn from this scenario?
a. He had a teenage daughter who was pregnant or with a young child.
b. He met the requirement for Aid to Dependent Families.
c. He really knew how to beat the welfare system.
d. He was handicapped, although his handicap was not immediately apparent.
ANS: A
WIC provides federal grants to states for the purpose of serving nutritionally at-risk,
low-income pregnant and postpartum women and their children up to five years of age. WIC
programs provide highly nutritious foods, nutrition education and counseling, and screening
and referral to needed services. To be eligible, women and children must meet income
guidelines established by each state, and a health professional must determine they are at
“nutritional risk.” Women and children who participate in Medicaid, the Food Stamp
program, or the Temporary Assistance for Needy Families program are automatically income
eligible for WIC. This man would not be eligible for WIC assistance himself because this
program is for women and children.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
30. Using a public health perspective, which has responsibility for a child’s health?
a. The child’s family
b. The businesses in the community
c. The entire community
d. The school system
ANS: C
Child health is affected by many factors; therefore, the responsibility for improving children’s
health rests with the entire community. This responsibility begins with parents and includes
health care professionals, community groups, businesses, and the public sector. When a child
gets older, he or she can be responsible for practicing healthy behaviors and obtaining proper
health care.
DIF: Cognitive Level: Understand (Comprehension)
31. Which best explains why an employer would care about the health needs of local children?
a. The children are the employer’s future workforce.
b. The employer needs positive media coverage and no scandals.
c. The community will provide greater support to employers that have family-based
policies.
d. Staying home to take care of sick children will impact the productivity of the
workplace.
ANS: A
Business and industry have an enormous stake in the health of the nation’s children. A strong,
productive workforce is ensured
the health,
NURonly
SIwhen
NGTB.C
OM social, and educational needs of the
next generation of workers are met. Furthermore, health risks cost employers in lost
productivity and increased health care costs. Avoiding scandal and negative media coverage
would not be a reason why employers would care about the health needs of the local children.
The community does not provide greater support to businesses that have family-based
policies. Although, businesses want to keep their employees at work instead of at home taking
care of ill children, businesses are concerned with more than just the children of their
employees. All children in the local community are a concern for employers as these are the
future workforce.
DIF: Cognitive Level: Understand (Comprehension)
32. How do the policies on children’s health in the United States differ from the policies on
children’s health in other industrialized nations?
a. Most industrialized nations, including the United States, have similar policies.
b. U.S. policies are more market based and less social justice based.
c. U.S. policies are voluntary, whereas in most countries they are required by law.
d. Although industrialized nations have policies on children’s health, the United
States does not.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In the United States, the government’s role in promoting or ensuring children’s health is more
limited than in many other countries. Other countries often have defined policies on children’s
health; the United States does not. Not only do such policies indicate that children are a
priority of the citizenry, but they also help shape the operation of programs and their funding.
DIF: Cognitive Level: Understand (Comprehension)
33. Which best describes the screening tests that are completed on all newborns in the United
States?
a. It varies from state to state, somewhere between 0 and 25 tests.
b. It varies from state to state, but all states have a common 26 conditions that are
tested.
c. Federal legislation mandates 29 tests.
d. The number varies greatly by state and by hospital policy.
ANS: A
Every infant born in the United States is screened shortly after birth for a number of genetic
disorders. Newborn screening is state-based so the number of conditions that babies are
screened for varies from state to state. All U.S. states and territories currently test for 26
health conditions including phenylketonuria, galactosemia, congenital hypothyroidism, and
sickle cell disease.
DIF: Cognitive Level: Understand (Comprehension)
34. According to the U.S. Department of Commerce, which rule must be followed by makers of
toy guns?
a. Darts from toy guns must be made of materials that will not penetrate skin.
INGofTlead
B.CorOlead-based
M
b. Toy guns cannot contain N
URS
parts
made
paint.
c. Reflective paint must be used on toy guns.
d. Toy guns must be distinguishable from real guns.
ANS: D
The U.S. Department of Commerce requires toy guns to be distinguished from real guns. In
many cases, the toy industry has established voluntary safety standards to minimize risk of
injury. There is not specific legislation from the U.S. Department of Commerce that outlines
the materials that must be used in darts of toy guns or banning the use of reflective or
lead-based paint or lead products.
DIF: Cognitive Level: Understand (Comprehension)
35. A nurse is trying to determine who would be the most appropriate person to make a health
care decision for an adolescent, the adolescent or the parent. Which consideration will the
nurse need to make?
a. The need for cultural competence
b. The need for access to care
c. The need for client autonomy
d. The need for client privacy and confidentiality
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
This situation addressed the need for client autonomy. When considering client autonomy, the
nurse must consider the following questions. In the specific case, who should make health
care decisions for a young client, especially when opposing opinions arise? The client? The
parents or guardian? The nurse or other health care professional? At what age does a child
become mature enough to participate in such decision-making? What laws does any given
state have that affect adolescent client autonomy? What should the community health nurse do
if he or she believes the client’s or parent’s decisions are not in the best interest of the client?
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Because of county need, a school nurse was transferred from a new suburban school to a large
inner-city school in an older low-income neighborhood. Which changes in role should be
anticipated by the nurse? (Select all that apply.)
a. An increased absentee rate because of infectious diseases
b. Cooperating with the school meal program to be sure fruits and vegetables and
other healthy choices are included
c. Regularly checking each child for visible signs of child abuse
d. Emphasizing to parents that their child cannot attend school until immunizations
are done
e. Need for lead poisoning screening and education
f. Screening for head lice several times a year
ANS: B, E
Because cheap food is often high in portion size and sugar and fat, school may be the only
place where children have theNopportunity
eat fruits,
URSINGTtoB.C
OM vegetables, and protein choices. Thus,
it will be important to make sure these choices are included in the school lunch program.
Because old neighborhoods often have lead pipes and old lead paint, lead screening is crucial
in older neighborhoods, particularly low-income neighborhoods where parents have fewer
resources and are often in aged housing. Stereotypes such as “only poor people get head lice”
abound. Head lice do not respect socioeconomic class, so such screening might be done in any
school. Similarly, child abuse occurs among families of all social economic classes. Free
immunizations are available, so this is probably not as big a problem as stereotypes about the
poor might suggest. Indeed it is usually in wealthier neighborhoods that parents are concerned
about mercury poisoning and try to avoid having their children immunized. There is unlikely
an increased absentee rate because of infectious disease, as these are not seen at an increased
incidence in suburban versus urban neighborhoods.
DIF: Cognitive Level: Apply (Application)
2. A school nurse brought a young boy back into a private office and asked him to remove his
shirt. Fresh welts across his back were seen. Which would most likely cause the nurse to be
concerned about the parents? (Select all that apply.)
a. The child had a tendency to act out frequently and really did “ask for it.”
b. The parents did not like their own child and had trouble hiding that fact.
c. The parents were dealing with a lot of stress and lacked support.
d. The parents were themselves abused as children.
e. The parents may be substance abusers.
f. The parents probably did not have health insurance for the boy.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: C, D, E
Most often, the perpetrators of maltreatment are parents and victims themselves from a cycle
of abuse. The two dominant characteristics of abusive parents include a history of substance
abuse and abuse from their own parents. They may be stressed by poverty, illness, or
disability, and they may lack social support systems or coping skills. In cases of abuse, it is
unlikely that the child “asked for it.” Because of a possible past history of abuse or substance
abuse, parents may be more likely to abuse their own children; it would not be because they
do not like their own child. Not having health insurance for the boy would not play a role in
whether he was being abused.
DIF: Cognitive Level: Apply (Application)
3. A nurse is developing a community education program about how to prevent sudden infant
death syndrome (SIDS). Which information would be included in the presentation? (Select all
that apply.)
a. Always place a baby on his or her back to sleep.
b. Use a semifirm sleep surface.
c. Allow the baby to sleep in a position that provides the most comfort.
d. Allow the baby to sleep with a favorite toy or blanket.
e. Do not let the baby get too hot during sleep.
f. Avoid exposing the baby to cigarette or cigar smoke.
ANS: A, E, F
Some of the recommendations to reduce the risk of SIDS include: always place a baby on his
or her back to sleep, for naps and at night; use a firm sleep surface, covered by a fitted sheet;
the baby should not sleep in an adult bed, on a couch, or on a chair alone or with anyone else;
NURbedding
B.C
keep soft objects, toys, and loose
of the
SINGTout
OMbaby’s sleep area; do not smoke during
pregnancy, and do not smoke or allow smoking around the baby; and do not let the baby get
too hot during sleep.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 17: Women’s Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which event caused attention that has resulted in the current emphasis on women’s health?
a. Hillary Clinton’s comments during the presidential race
b. Political correctness, including addressing the rights of women
c. New research studies that are focusing on women
d. Women’s movement from the 1970s
ANS: D
Beginning in the 1970s, the women’s movement called for the reform of systems affecting
women’s health. The current emphasis began before the presidential races that involved
Hillary Clinton. The women’s movement has caused there to be new research studies that
focus on women. Additionally, political correctness addressing the rights of women has
occurred because of the women’s movement.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse has recently learned of the death of a 22-year-old female friend. Which would be the
most likely cause of death?
a. Complications of childbirth
b. Accident or unintentional injury
c. Cancer
d. Cardiovascular disease
ANS: B
NURSINGTB.COM
In the adolescent to early adulthood years, the leading cause of death for women is
unintentional injuries (i.e., motor vehicle accidents, drug overdose). Complications of
childbirth, cancer, and cardiovascular disease are not among the most likely causes of death of
a 22-year-old female.
DIF: Cognitive Level: Apply (Application)
3. Which is the most common cause of death among women after age 75?
a. Accidents and unintentional injuries
b. Cancer
c. Cardiovascular disease (CVD)
d. Diabetes and its complications
ANS: C
About one in four Americans has one or more forms of CVD. One in ten women under age 60
years has some form of CVD; the ratio increases to one in three after age 65 years. CVD
continues to be the number one overall killer of women. Accidents and unintentional injuries
are the leading cause of death in the adolescent and early adulthood years for women. Cancer
is the number one cause among women age 35 to 74. Diabetes and its complications are
considered to be the fifth leading cause of death among women age 55 to 74, and the sixth
leading cause of death among women age 75 to 84.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Remember (Knowledge)
4. Which provides the best explanation for the importance of the “Go Red” and “The Heart
Truth” campaigns?
a. Because heart disease is so prevalent, we all need to know the usual symptoms so
we may seek help quickly.
b. Few people are aware of how to prevent chronic diseases such as cancer.
c. We need to increase awareness of the genetic component in chronic disease.
d. Women have different symptoms and require different treatment than men.
ANS: D
After the age of 65 years, women are twice as likely to die because of heart disease as men. In
part this phenomenon is because the subtle or absence of symptoms of coronary artery
disease. Women are still more likely to die from a first myocardial infarction. In 2002, the
American Heart Association launched the “Go Red” campaign for women and “The Heart
Truth” program for health care providers. Both programs are designed to educate about the
unique features of women and heart disease. These campaigns address heart disease and do
not include information about other chronic diseases such as cancer. Heart disease is caused
by both lifestyle choices and genetic factors, thus education needs to be provided related to
both of these aspects.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best explains why cancer rates increase as people get older?
a. Better prevention programs are available for cardiac disease, so cardiac disease
rates are decreasing, making cancer rates increase.
b. It is harder to screen for cancer than for other fatal diseases, so the rates are
NURSINtoGdetect
TB.C
OM
increasing because of the inability
the
cancer at an early stage.
c. Poor lifestyle choices, environmental exposures, and increased life expectancy
have all caused cancer rates to increase.
d. Other causes of death are decreasing, so it appears that cancer rates are increasing.
ANS: C
Cancer rates appear to be increasing for a number of reasons, including lifestyle choices
(smoking, diet, sun exposure); increasing exposure to environmental carcinogens; and age.
There has not been a significant decrease of cardiac disease or other causes of death.
Screening programs exist to detect cancers early and more cancers are detected at earlier
stages.
DIF: Cognitive Level: Understand (Comprehension)
6. “I want to get pregnant as soon as possible now that I’m married,” a 43-year-old female says
to the nurse. Which would be the most appropriate response by the nurse?
a. “Having a child will certainly cement your new marriage and give it a focus.”
b. “It’s understandable that your ‘biological clock is ticking’ and time is running
out.”
c. “You’re right, once you hit menopause you won’t be able to have a child.”
d. “We will help you, but you need to know that there are more risks for you at your
age.”
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
An additional risk factor, regardless of race, is advancing age. Women aged 40 years and
older have over three times the risk of dying of a pregnancy-related cause as women aged 30
to 39 years. Intrinsic maternal factors, such as increasing frequency of hypertension and a
greater likelihood of uterine hemorrhage, help explain this increase in the mortality rate. The
other responses are not therapeutic responses by the nurse. It is important for the nurse to
educate the woman that there can be more risks associated with becoming pregnant after age
40.
DIF: Cognitive Level: Apply (Application)
7. Which is the leading cause of death for women in their first trimester?
a. Anesthesia
b. Ectopic pregnancy
c. Hemorrhage
d. Pulmonary embolism
ANS: B
According to the Centers for Disease Control and Prevention, ectopic pregnancy is the leading
cause of maternal death in the first trimester. Historically, the leading cause of maternal death
had been pulmonary embolism, followed by pregnancy-induced hypertension, ectopic
pregnancy, hemorrhage, stroke, and anesthesia.
DIF: Cognitive Level: Remember (Knowledge)
8. Which best explains why many elderly women do not prepare meals or do housework?
a. Chronic diseases, especially arthritis and rheumatism, hinder their ability.
b. Living in a nursing home does not require them to do so.
c. They do not want to; theirNhusbands
URSINGcan
TB.C
shareOinMthe work.
d. With Social Security, they can afford to pay someone else to do these tasks.
ANS: A
Women are more likely than men to be disabled from chronic conditions. Arthritis and
rheumatism, hypertension, and impairment of the back or spine decrease women’s activity
level. Women are likely to have difficulty performing activities such as walking, bathing or
showering, preparing meals, and doing housework. The majority of elderly do not live in
nursing homes but are able to remain in their own homes. It is unlikely that they are not
willing to do any work or want to pay someone else to complete these tasks.
DIF: Cognitive Level: Understand (Comprehension)
9. A nurse has just been told by a friend that her physician has recommended a hysterectomy for
fibroids in her womb. Which would be the most appropriate response by the nurse?
a. “Hysterectomies are the most common surgical procedure done on women; you’ll
be fine.”
b. “Tell your doctor to remove your ovaries as well so you will never have to worry
about ovarian cancer.”
c. “There are other alternatives. Why don’t you seek a second opinion just to be sure
a hysterectomy is best for you?”
d. “Uterine fibroids are very common so don’t feel badly; you’ve already had your
children, so there’s no reason to keep your uterus.”
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: C
Hysterectomy is the second most frequently performed major surgical procedure among
women of reproductive age, after C-section. The most common reason for hysterectomy is
uterine fibroids. Optional procedures are becoming available to women. Myomectomy, or
removing only the tumors with repair of the uterus, uterine artery ablation, and the use of a
gonadotropin-releasing hormone to shrink the tumors can decrease the need for hysterectomy,
but women may not know about these alternatives. Community health nurses function as
advocates for women and can provide health education programs related to alternatives to
hysterectomy, indications for hysterectomy, and oophorectomy, and information regarding the
type of surgical approach and the purpose of a second opinion. Second opinions and higher
levels of education tend to decrease the rate of hysterectomies. Thus, it is important that the
nurse first encourage the friend to seek a second opinion rather than encouraging the
procedure or ovary removal.
DIF: Cognitive Level: Apply (Application)
10. A nurse is called by her pregnant sister, who tells her how she is going to request that her
physician deliver her baby via C-section so that the baby will be healthier. Which would be
the most appropriate response by the nurse?
a. ”There is not evidence to support that your baby will be healthier if it is born via
C-section.”
b. “That’s a great idea, now I will be able to plan when I will be able to visit you in
the hospital.”
c. “There are many benefits to both you and your baby by having a C-section. I am
glad you are making that request.”
d. “I think you should wait until you are in labor to make this request.”
ANS: A
NURSINGTB.COM
Birth by cesarean section (C-section) is the most prevalent surgical procedure experienced by
women in the United States and accounts for 32% of births. Several factors contribute to the
high rates of C-section, including physician fear of malpractice suits, routine use of early
induction of labor, and epidural anesthesia. The technology of fetal monitoring has been
shown to increase the C-section rate without improving neonatal outcomes.
The other responses do not consider the importance of education needed for the client in this
situation and that outcomes have not improved through the use of C-sections.
DIF: Cognitive Level: Apply (Application)
11. Which outcomes for the infant and mother have occurred because of fetal monitoring?
a. Improved outcomes for both infant and mother
b. No difference for the infant but improved outcomes for the mother
c. No difference for the mother but improved outcomes for the infant
d. No difference in outcomes for the infant but increased risk for the mother
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The technology of fetal monitoring has been shown to increase the C-section rate without
improving neonatal outcomes. C-sections are risky for the mother as they involve the risks of
any major surgery such as hemorrhage, infection, damage to adjacent structures, as well as
risks associated with anesthesia. Long-term sequelae for women include pelvic pain, along
with formation of adhesions and placental abnormalities that lead to complications in
subsequent pregnancies. Improved outcomes both for the mother and infant have not been
demonstrated.
DIF: Cognitive Level: Understand (Comprehension)
12. Which statement best explains the difference in suicide rate according to gender?
a. Men are less likely to attempt suicide and less likely to be successful.
b. Men are more likely to attempt suicide but less likely to be successful.
c. Women are more likely to attempt suicide but less likely to be successful.
d. Women are less likely to attempt suicide but more likely to be successful.
ANS: C
Women are more likely to attempt suicide but less likely to be successful. On the other hand,
men are less likely to attempt suicide, but are more likely to be successful.
DIF: Cognitive Level: Understand (Comprehension)
13. Which group of persons is most likely to be able to access health care?
a. Adults who work for small businesses
b. Unemployed women
c. Older women on fixed incomes
d. Young adults, aged 16 to 24 years
ANS: A
NURSINGTB.COM
Through the implementation of the ACA, young adults (i.e., those between ages 16 and 24
years) can now obtain coverage or stay on their parent’s insurance until the age of 26.
Previously, this aggregate made up approximately 50% of individuals without health
insurance. Women who choose not to enroll in the ACA are not likely to seek health care until
they or a family member is in acute distress. Older women on ?9?xed incomes may have
dif?9?culty meeting copayments required by Medicare and paying for prescription
medications.
DIF: Cognitive Level: Understand (Comprehension)
14. A woman with two young children is debating if she should try to work using child care or
stay at home and care for her children. Based on the current trends, which decision is she most
likely to make?
a. Enter the work force
b. Invite a relative to live with them to care for the children
c. Negotiate with her husband so he stays home with the children
d. Stay home with the children
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Sixty-four percent of women with young children (younger than 6 years) work outside the
home. Thus, it is most likely the woman will enter the workforce based on current trends. A
working woman is less likely to have a spouse or partner to help with the home and children.
Even when a spouse or partner is present, the burdens of housework and child care usually fall
more heavily on women, regardless of ethnicity.
DIF: Cognitive Level: Apply (Application)
15. Which group has the highest poverty rate in the United States?
a. Married couples with several children
b. Single female heads of household
c. Single male heads of household
d. Two adults cohabitating when one is unemployed
ANS: B
Women heads of households and their children are the poorest aggregate in the United States.
This phenomenon is labeled “the feminization of poverty.” In 2014, the poverty rate for single
female heads of household was 38.9% compared to 8.2% for men. Thus, married and
cohabitating adults are not the group that has the highest poverty rate in the United States.
DIF: Cognitive Level: Understand (Comprehension)
16. Which best explains how marriage customs have remained unchanged over the last couple
decades?
a. Lesbian and homosexual adults are adopting children.
b. Women are usually responsible for the children following a divorce.
c. Single adults are adopting children.
NUspinsterhood.
RSINGTB.COM
d. Women are trying to avoid
e. Women seek to marry at a young age.
ANS: B
Today, as in the past, when a relationship ends in divorce or separation, more women than
men have the responsibility of providing for themselves and their children. Differences today
include that many women are delaying marriage and many are not marrying. Single-parent
adoptions are legal; single women, including lesbians, are becoming adoptive parents.
DIF: Cognitive Level: Understand (Comprehension)
17. Which best explains why some community health nurses find nursing models inappropriate
for use in their clinical practice?
a. Models are almost always based on meeting the needs of individuals, not groups.
b. Models are too theoretical and not realistic.
c. Models, developed for the middle class, do not fit low-income families.
d. Models taught in nursing school are not remembered by nurses in practice.
ANS: C
Because many models were developed for the middle class, they may not be useful to
community health nurses working with low-income families.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
18. A middle-aged woman was obese and being treated for hypertension; and her blood tests
showed elevated triglycerides and low high-density lipoprotein (HDL). Besides
recommending physical activity, which nutritional guidance should be provided by the nurse?
a. Buy a good diet book, and follow its advice.
b. Eat fish and seafood such as salmon, halibut, tuna, and scallops at least three times
a week.
c. Use olive oil when you cook, especially if you are frying food.
d. You have to lose weight, so stop all desserts and eat nothing but salads for 2
weeks.
ANS: B
Metabolic syndrome is a group of risk factors that have been linked to an increased risk of
cardiovascular events. These factors include abdominal obesity (waist circumference greater
than 35 inches in women), dyslipidemia (elevated triglycerides and low HDL), insulin
resistance, and elevated blood pressure. The underlying etiology of metabolic syndrome is
related to the combination of inactivity, obesity, and genetics. Nutritional advice should focus
on weight loss, use of olive oil (but do not fry foods), and eating fish and seafood such as
salmon, halibut, tuna, and scallops at least three times a week to increase omega-3 intake.
DIF: Cognitive Level: Apply (Application)
19. A community health nurse suggested that a group of nursing students perform a diabetic
screening at a location where groups of people meet. Which site would be best for the
screening?
a. The senior citizens center, which always welcomes students back
b. The shopping mall where many young adults go to save money
c. The YWCA/YMCA down the street
NURSINGTB.COM
d. The Weight Losers group meeting
at the church
ANS: D
Adults who are obese and meeting at a group such as “Weight Losers” probably have not
previously been screened for diabetes. If the senior citizen center always welcomes students
back, they have clearly had screenings there before. Hence, even though older adults are at
risk, it would be better to choose a different group. Young adults and those working out at a
YMCA are not particularly at high risk.
DIF: Cognitive Level: Apply (Application)
20. Which is the leading cause of disability in the United States?
a. Arthritis
b. Car accident
c. Falls
d. Heart disease
ANS: A
Arthritis is the leading cause of disability in the United States. Car accidents, falls, and heart
disease are not among the leading causes of disability in the United States.
DIF: Cognitive Level: Remember (Knowledge)
21. Which is the most serious complication of women having osteoporosis?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Hip fracture
Need to avoid sunlight
Need to decrease weight-bearing physical activity
Stooped posture
ANS: A
The most serious complication of osteoporosis is hip fracture. Approximately 24% of people
with hip fractures die of complications within a year.
DIF: Cognitive Level: Remember (Knowledge)
22. A female client has recently been diagnosed with osteoporosis. Which would the nurse
anticipate as the most likely treatment prescribed by the health care provider?
a. Instructions to begin weight-bearing exercise at least three times a week
b. Instructions to increase the amount of calcium and Vitamin D in her diet
c. A prescription for hormone replacement therapy
d. A prescription for oral bisphosphonates
ANS: D
Guidelines issued by the National Osteoporosis Foundation recommend bone mineral density
tests for selected postmenopausal women and the use of oral bisphosphonates as the
?9?rst-line pharmacological treatment. In light of the results of the Women’s Health Initiative
Study showing that nonestrogen therapies fail or cause intolerable side effects, hormone
replacement therapy is currently considered second-line therapy for the disease. Prevention is
especially important early in life. Prevention involves an awareness of dietary practices such
as maintaining a correct balance of calcium, vitamin D, and protein throughout life, in
addition to regular weight-bearing, muscle-strengthening, and aerobic exercise.
NURSINGTB.COM
DIF: Cognitive Level: Apply (Application)
23. Which best explains why lung cancer kills more women than breast cancer?
a. Early detection and cure of breast cancer has lowered the death rate.
b. Pap smears lead to early detection and often the cure of uterine cancers, hence
avoiding breast metastasis.
c. There is no accepted treatment for lung cancer.
d. Women have begun smoking.
ANS: D
Lung cancer is responsible for more deaths yearly in U.S. women than breast, ovarian, and
uterine cancers combined. The increase in the incidence of lung cancer in women is due
primarily to an increase in their tobacco use. Eighty-five percent to 90% of all clients in whom
lung cancer develops have a history of cigarette smoking. The incidence of breast cancer
continues to increase and is the most common cancer among women, but it is not responsible
for as many deaths as lung cancer. Pap smears are used as a screening tool for early detection
of cervical cancer. There is accepted medical treatment for lung cancer, and it is similar for
both men and women with the disease.
DIF: Cognitive Level: Understand (Comprehension)
24. In a college health course, the question arose as to when a woman needs to see her health care
provider for a Pap smear. Which would be the most appropriate response by the nurse?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
“After you reach age 21.”
“Before having sexual intercourse, when you go to obtain your birth control.”
“If your periods change at all, go to see your health care provider.”
“If you have a vaginal discharge that’s unusual, go right in for a Pap smear.”
ANS: A
Current guidelines recommend cervical cancer screening to begin at 21 years of age. So it will
be important for the woman to have a Pap smear after beginning to have intercourse, or by the
age of 21. It is not necessary to obtain a Pap smear before having sexual intercourse. A Pap
smear may not be necessary for a change in periods or unusual vaginal discharge; these may
be signs of other problems that will not be diagnosed through a Pap smear.
DIF: Cognitive Level: Apply (Application)
25. A nurse is on the treadmill exercising, when the woman next to her says, “You’re a nurse.
Explain to me how the scale says I’ve lost weight, but my waist and tummy just keep getting
larger.” Which would be the most appropriate response by the nurse?
a. “I’m concerned. You need to see your health care provider to follow up on this.”
b. “Muscle weighs more than fat so you’re creating muscle while losing fat, but it
takes a while for the body to redistribute the weight.”
c. “Tell me what you’ve been eating in the last week or so.”
d. “You’re running so you’re strengthening your legs and thighs, but to lose around
your tummy, you have to exercise your abdominal muscles.”
ANS: A
The most common sign of ovarian cancer is abdominal enlargement. A woman may complain
that her skirts and slacks are getting tighter in the waist. Because ovarian cancer is a silent
NUthan
RSI
cancer that causes more deaths
any
pelvic
NGother
TB.C
OMmalignancy, the woman needs to see her
health care provider immediately for transvaginal ultrasonography, MRI, or computed
tomography scan along with a blood test (CA-125). Thus, it is important to refer the woman to
a health care provider and not try to minimize or rationalize the symptoms that she has
reported.
DIF: Cognitive Level: Apply (Application)
26. A parent at a school says to the school nurse, “I can’t keep that plate thing straight. What is
the bottom line about nutritious eating today?” Which is the most appropriate response by the
nurse?
a. “Avoid processed foods, and eat fresh fruits and vegetables.”
b. “Eat lots of protein, fruits, and vegetables, and don’t worry about the other rules.”
c. “Let me get you a copy of the Department of Agriculture plate that you can keep
on your refrigerator for easy reference.”
d. “Balance your plate with half of a plate of fruits and vegetables, and a quarter of a
plate of both proteins and grains.”
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The “My Plate” approach encourages persons to be mindful of the foods they eat in terms of
both portion size and proportion to other foods. One-half of the plate should consist of fruits
and vegetables, one-quarter each for meats/proteins and grains, preferably whole grains.
Recommendations also include decreased sodium and sugary foods. Thus, there are additional
considerations to keep in mind in addition to avoiding processed foods and eating fresh fruits
and vegetables. Giving the parent a copy of the plate does not help educate the parent about
the “My Plate” approach.
DIF: Cognitive Level: Apply (Application)
27. Which is the greatest single cause of absenteeism from school and work among young
women?
a. A child’s illness
b. Dysmenorrhea
c. Mental health disorders
d. Upper respiratory tract infection
ANS: B
Dysmenorrhea is the greatest single cause of absenteeism from school and work among young
women and causes the loss of approximately 140 million working hours annually; therefore
the economic influence of this condition is significant. A child’s illness, mental health
disorders, and upper respiratory tract infections do not cause as many days of absenteeism as
dysmenorrhea.
DIF: Cognitive Level: Remember (Knowledge)
28. Which is the most common sexually transmitted disease (STD)?
NURSINGTB.COM
a. Chlamydia
b. Gonorrhea
c. HIV
d. Syphilis
ANS: A
In 2016, the Centers for Disease Control and Prevention reported that the most common STD
was Chlamydia trachomatis infection, followed by gonorrhea. The spread of HIV and syphilis
are also of concern, but these rates are not as high as they are for chlamydia and gonorrhea.
DIF: Cognitive Level: Remember (Knowledge)
29. “I don’t want to listen to another lecture on safe sex. Just give me my antibiotic and let me
leave,” said a client. Which would be the best response by the nurse?
a. “As you wish. But can you tell me why you still engage in unprotected sex?”
b. “Gonorrhea is becoming resistant to antibiotics. It’s becoming difficult to treat
you, and permanent damage to your body is occurring.”
c. “Our policy requires that we review how to protect yourself even if you have heard
the information before.”
d. “These recurrent infections are damaging you inside; please consider using
condoms.”
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Gonorrhea is becoming resistant to all our current drugs. The Centers for Disease Control and
Prevention has had to change its treatment guidelines. Also, persons with gonorrhea often
have other sexually transmitted diseases (STDs) as well. This person has heard the lectures on
safe sex and is not changing personal behavior. Upholding policy or appealing to the person’s
better emotions is probably ineffective. Many people have become complacent about STDs.
The nurse is obligated to warn the patient that the infections are becoming resistant to
pharmaceutical treatment.
DIF: Cognitive Level: Apply (Application)
30. Which is the most likely reason for adult women to be injured?
a. Automobile accidents
b. Intimate partner violence
c. Falling
d. Stranger violence (theft, rape)
ANS: B
Intimate partnerviolence is the single largest cause of injury to women between the ages of 15
and 44 years in the United States—more than muggings, car accidents, and rapes combined.
DIF: Cognitive Level: Remember (Knowledge)
31. A woman was in the emergency department with a bruised and broken leg. She explained that
she had accidentally opened the car door on a trip and the door had blown back on her leg.
Her husband was very attentive, constantly asking the nurse to make his wife more
comfortable. Which actions should be taken by the nurse?
a. Ask the husband to step out of the room while you get a urine specimen, and, after
B.C
URSIyou
NGT
OMdeliberately hurt by someone?”
he leaves, ask the woman,N“Have
ever
been
b. Call x-ray immediately, and prepare for the leg to have a cast applied.
c. Put ice bags on the area until the leg can be repaired.
d. Try to get an additional pain medication order from the physician.
ANS: A
Abuse of women is often explained as accidental injury. Approximately 6% of visits made by
women to emergency departments are for injuries that result from physical battering by their
husbands, former husbands, boyfriends, or lovers. It is important for the nurse to understand
the state laws related to reporting known or suspected intimate partner violence. The AMA
and ANA advocate that all women should be assessed for intimate partner violence. Questions
should be posed privately, in nonjudgmental specific terms (i.e., “Do you feel safe?” “Have
you ever been hit, punched, slapped, or kicked?”) with follow-up questions if the woman
responds “yes.” In this situation, with a questionable explanation for the injury and an overly
attentive husband, it would be important to complete this assessment. This invention would be
more important than calling for x-ray, applying ice, or administering additional pain
medication.
DIF: Cognitive Level: Apply (Application)
32. Which best explains how the Public Health Service (PHS) Act, Title X, has been helpful to
families?
a. It provides funds for family planning, including contraception.
b. It created a child care subsidy to help adults obtain and retain employment.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. It provides housing for low-income families.
d. It prevents utility companies from shutting off service and allows for bills to be
subsidized.
ANS: A
Title X of the PHS Act is the Family Planning Public Service Act, which helped 5 million
women obtain family planning services in 2008. Since 1970, federally subsidized family
planning funds have been available to clinics and health departments throughout the country.
These facilities provide not only access to contraception but also routine preventive health
services, education, and counseling. The program is an important part of the public effort to
prevent low birth weight through addressing the relationship between lack of family planning
and those at greatest risk for low-birth-weight infants (women who are adolescents, single,
and/or low income). This program does not provide subsidies for child care or utility
payments or housing for low-income families.
DIF: Cognitive Level: Understand (Comprehension)
33. Which best explains how the Civil Rights Act amendments have been helpful to adult women
who are employed?
a. If both a man and a woman apply for a position, preference must be given to the
woman.
b. Everyone has permission to apply for any employment position regardless of
gender.
c. Employers are prohibited from paying different salaries to men and to women for
the same position responsibilities.
d. Discrimination against pregnant women or conditions involving childbirth or
pregnancy is prohibited. N R I G B.C M
U S N T
O
ANS: D
There is no affirmative action for gender, and pay scales remain different for men and women.
Anyone has always been able to apply for any position; the issue is whether or not you would
be chosen. The Civil Rights Act was amended to prohibit discrimination against pregnant
women or conditions involving childbirth or pregnancy. This landmark legislation makes it
unlawful for employers to refuse to hire, employ, or promote a woman because she is
pregnant. In addition, employee benefit plans that continue health insurance, income
maintenance during disability or illness, or any other income support program for disabled
workers must include disabilities resulting from pregnancy, childbirth, and other related
conditions. If employers allow disabled employees to assume lighter or medically restricted
assignments, the same considerations must extend to pregnant women.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. Which best explains why a community health nurse would choose to emphasize women’s
health? (Select all that apply.)
a. Different nurses prefer different specialties.
b. It is currently politically correct to verbalize support for female issues.
c. Many women’s groups are lobbying for more programs.
d. Many factors resulting in illness and death in women are preventable.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
e. Knowledge deficits prevent women from assuming responsibility for their own
f.
health.
Women face barriers in accessing health care.
ANS: D, E, F
Many factors that lead to death and illness among women are preventable or avoidable.
Knowledge deficits related to health promotion and disease prevention activities prevent
women of all educational and socioeconomic levels from assuming responsibility for their
own health and well-being. A significant number of women and their families face
tremendous barriers in gaining access to health care. Although different nurses select different
specialties, this does not explain why a nurse would choose women’s health. Because women
face tremendous barriers in addressing female issues, it is important that nurses provide
political support for these issues because of their professional commitment, not because it is
the politically correct action to take.
DIF: Cognitive Level: Understand (Comprehension)
2. Which are factors that have led to the decrease in mortality of some cancers? (Select all that
apply.)
a. An increase in mortality rate among other cancers
b. Early detection through emphasis on routine screening
c. Fewer sexual partners with emphasis on monogamy
d. An increased awareness of influence of lifestyle choices
e. Legislation such as the Clean Air Act
f. A decrease in tobacco use and smoking among women
ANS: B, D, F
NU
RSINchanges
GTB.Cand
The good news is that healthy
lifestyle
OMearly detection and intervention have
contributed to the decrease in mortality rates from some cancers. For example, the death rate
for colorectal cancer has been decreasing for the past 15 years because of early detection and
treatment (American Cancer Society, 2014). Lung cancer deaths are beginning to show a
slight decline that parallels a decreased incidence of smoking by women over the age of 18
years. Certain health choices may reduce an individual’s risk of cancer. Women could reduce
their risk for cancer by never smoking or by quitting if they already use tobacco products.
Eating a nutritious, plant-focused, high-fiber diet, along with adopting a physically active
lifestyle and maintaining a healthy body weight protect against both heart disease and many
cancers.
DIF: Cognitive Level: Understand (Comprehension)
3. Which describe health hazards to which nurses in hospitals are exposed? (Select all that
apply.)
a. Anesthetic gases
b. Dust
c. Heat and chemicals
d. Heavy lifting
e. Infectious diseases
f. Solvents and acids
ANS: A, D, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Hospital and other health care workers are exposed to infectious diseases, heavy lifting,
radiation, skin disorders, and anesthetic gases. Dust may be a health hazard for those
employed in textile and apparel. Launderers and dry cleaners may be exposed to heat and
chemicals as a health hazard. Solvents and acids may be a health hazard for those employed in
electronics.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 18: Men’s Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A male client reports that he is unable to change his health behaviors and adopt a healthier
lifestyle. Which is the most likely reason for his difficulty?
a. Lack of financial resources
b. Lack of transportation
c. Lack of programs
d. Lack of motivation
ANS: D
Two nurse researchers (Dallas & Neville, 2012) conducted a study to describe the health
education and health screening practices of older men living in an area of New Zealand and
the perceived barriers and benefits of healthy lifestyle choices. Of those men who did report
barriers, the most common reason was lack of motivation (12%), followed by lack of
knowledge related to availability of programs and screenings (8%). Reported external barriers
included: lack of programs, associated costs, and transportation challenges.
DIF: Cognitive Level: Apply (Application)
2. Which gender perceives and reports having better health?
a. Females
b. Males
c. No difference between genders in perceived health status
NURstrongly
SINGTbyB.C
OM more than gender
d. Perceived health status varies
individuals
ANS: B
Despite the differences in mortality rates, men tend to perceive themselves to be in better
health than women. In the National Health Interview Survey, which asked people to rate their
health status, men were more likely to rate their health as excellent or very good as opposed to
fair or poor.
DIF: Cognitive Level: Remember (Knowledge)
3. Which gender has higher morbidity rates with a higher prevalence of chronic diseases that
cause disability and limitation of activities?
a. Females
b. Males
c. No difference between genders in chronic health problems
d. Prevalence of chronic diseases varies strongly by individuals more than gender
ANS: A
A chronic condition is a condition that persists for at least 3 months or belongs to a group of
conditions classified as chronic regardless of time of onset. In general, women have higher
morbidity rates than men. Women are more likely than men to have a higher prevalence of
chronic diseases that cause disability and limitation of activities but do not lead to death.
DIF: Cognitive Level: Remember (Knowledge)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. Which statement best explains why men are sicker on hospital admission than women?
a. Men do not have access to care.
b. Men do not seek treatment until they are very ill.
c. Men have chronic conditions more than women.
d. Men have more acute illnesses than women.
ANS: B
Males continue to delay medical treatment, resulting in men being sicker when they do seek
health care. Because they are sicker, they require more intensive medical care. The main
reason that they are sicker does not relate to the increased or decreased incidence of acute or
chronic illness or lack of access to care, the delayed time in seeking treatment is what results
in them being sicker at the time of hospital admission.
DIF: Cognitive Level: Understand (Comprehension)
5. Which statement is correct?
a. Males are more likely to have colorectal testing than females.
b. Males are more likely to receive dental care than females.
c. Males are more likely to have routine physicals than females.
d. Males are more likely to be eligible for primary care services than females.
ANS: D
Men do not engage in these health protective behaviors at the same frequency as females
(Brown and Bond, 2008). Most men do not have routine checkups. National health surveys
indicate that women overall are more likely than men to have visits to various health care
providers (NCHS, 2016). Men are twice as likely to report no usual source of care although
eligibility for primary care inNmales
exceeds
that for
URSI
NGTB.C
OMfemales (Lynch, 2008). Men tend to have
fewer dental health care visits (64.1) versus women (68.9) (NCHS, 2016). Additionally, men
have lower rates of use of colorectal testing and procedures (men, 56.7, women, 58.9) (NCHS,
2011, p. 303).
DIF: Cognitive Level: Understand (Comprehension)
6. Which is a biological explanation for gender differences in health status?
a. Influence of hormones
b. Different treatment by parents
c. Random differences in genetic inheritance
d. Social expectations of appropriate gender behavior
ANS: A
Random differences are random and do not have a systematic effect. Although parents do
indeed treat male and female babies differently, that is an environmental effect, not a
biological one. Similarly, social expectations are a sociological explanation, not a biological
one. Several biological factors influence sex differences in mortality and morbidity rates,
including genetics, effects of sex hormones, and physiological differences. Biological
advantages for females may also exist later in life because estrogen protects against heart
disease. Some evidence supports the hypothesis that men’s higher testosterone levels
contribute to men’s lower high-density lipoprotein levels.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
7. Which is most effective in helping males choose healthier lifestyle behaviors?
a. Educational programs that include both threat and reward
b. Involvement in team sports at school or at work
c. Physician prescription for a specific behavior change
d. Support from a female family member concerned about the man’s well-being
ANS: D
Cheatham reported that several studies showed males to be more likely to change health
behaviors when these changes were suggested and supported by female family members
whom they believed were concerned about the well-being of the man. Thus, female support is
more important than educational programming, being part of a team, or a physician
prescription.
DIF: Cognitive Level: Understand (Comprehension)
8. Based on theory, which is men most likely to do when they become ill?
a. Ask their female partner what action might be helpful
b. Ignore symptoms or refuse to see them as symptoms of illness and act tough
c. See their physician as soon as possible
d. Talk to other men about what would be the best action
ANS: B
Boys are socialized to ignore symptoms and “toughen up.” Men may be aware of being ill, but
they make a conscious decision not to seek health care to avoid being labeled as “sick.”
Brown and Bond suggest that men lack somatic awareness and are less likely to interpret
symptoms as indicators of illness. Because of this ignorance and lack of recognition that a
NURStoIask
problem exists, they are not likely
NGothers
TB.Cwhat
OM action to take or to see a physician for
the problem.
DIF: Cognitive Level: Understand (Comprehension)
9. Why do some researchers believe data regarding health behaviors may be inaccurate in
relation to men?
a. Men are not socialized to tell the truth when interviewed.
b. Men do not know when they are ill.
c. Most of the data are collected about and from women.
d. Most of the data are collected by women.
ANS: C
Males are less likely than females to participate in the data collection process. Women are
often solicited in health surveys to report the health behavior of men. As proxies, they have a
tendency to underreport behavior. Men may not want to participate and will make light of
health problems. Males may conceal or suppress pain in an effort to appear strong. Men
believe that they are telling the truth, as they may be less willing to talk, may not recall health
problems, and may lack a health vocabulary. There is nothing to suggest that the data are
collected by women and that this causes a problem with inaccuracies.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
10. Which action would improve a man’s probability of obtaining health screenings and
health-promoting education?
a. Being active in organized sports
b. Joining the military
c. Seeking an andrology specialist physician
d. Working for an employer that requires employees to have an annual physical
examination
ANS: B
The medical specialty of andrology is considered too narrow. Many private insurance
companies will reimburse for illness but not preventive care, such as education or health
promotion activities. Men are socialized to view health as a resource that enables the body to
work. Therefore good health practices and preventive care are sometimes available in large
industries or organized sports (sports medicine). The most complete care is currently offered
by the military.
DIF: Cognitive Level: Understand (Comprehension)
11. Which single action has been most influential in changing men’s health behaviors?
a. Establishing well-man clinics during evening hours
b. Legislative action
c. Peer-reviewed journals such as the American Journal of Men’s Health
d. Running men’s health ads during sports events
e. The male consumer movement: seen in The National Organization for Changing
Men
ANS: B
NURthe
Health behaviors associated with
change
SIgreatest
NGTB.C
OM in a positive direction have been those
influenced by legislative action (e.g., seat belt use, use of smoke detectors, and drunk driving
laws). Well clinics, peer-reviewed journals, and the male consumer movement have not had as
much influence on men’s health behavior as legislative action.
DIF: Cognitive Level: Remember (Knowledge)
12. A man has been off work because of a recent illness. Which would be the most useful action
for the employer to take to support this man?
a. Encourage the man to return to work as soon as possible, possibly at something
less physically demanding
b. Reassure the man that he may have as much time off as he needs
c. Share the man’s need with other employees so that they may donate unused or
unneeded sick time to him
d. Suggest that other male employees visit the man at his home to help keep his
spirits up and demonstrate he is not forgotten
ANS: A
Time away from work because of occupational injuries should be kept to a minimum. Males
should be encouraged to return to work in an altered capacity rather than remaining away
from work until the injury is completely healed. Employment keeps the man active during the
day and also gives opportunity for socialization. Because the man should be encouraged to
return to work, it would not be appropriate to request additional sick time from other
employees or suggest that other employees visit him at home.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
13. Which question would be a good opening to address health concerns with a male client?
a. “How do you know when you are ill?”
b. “What sort of health problems or illnesses do you have?”
c. “What are your usual physical activities?”
d. “What would your wife say about your health?”
ANS: C
The text suggests to ask a man about how he spends his leisure time, what he is doing to take
care of himself, and what his usual physical activities are. Thus, asking about his physical
activities would be the most appropriate question. Asking how he knows when he is ill, the
sorts of illnesses he experiences, or what his wife says about his health would not be a good
opening to the conversation.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which advantages do women have in relation to health screenings? (Select all that apply.)
a. As the weaker sex, women are expected to be ill and see physicians more often.
b. Employers often require health screening of their employees.
c. Health care departments focus on maternal and child health.
d. Women enjoy socialization during visits to health care providers.
e. Women have more health screenings because of the need for birth control or
f.
physician visits related toNchildbearing.
R INGTB.COM
Women have more leisure U
timeSand
can more easily see their health care providers.
ANS: C, E
Maternal and child health is a major focus of many health departments, and there is not a
medical or nursing specialty within a health department that routinely exists to specifically
address men’s health. Routine reproductive health screening has been expanded to include
some general screening, such as testing blood pressure and urine and blood for chronic
problems. Men do not have routine reproductive health checkups that include screening,
which would detect other health problems at an early stage. Women see physicians more often
because of the need for physicians related to childbearing, not because they enjoy the
socialization with health care providers or have more time to complete these visits. Employers
may require health screening of their employees, both male and female. Women enjoy
socialization during visits to health care providers.
DIF: Cognitive Level: Remember (Knowledge)
2. Which strategies would be most helpful to implement with adolescent males at a high school?
(Select all that apply.)
a. A short required course on how to be a good parent
b. Assistance in learning how to control emotions and behaviors
c. Classes in male physiology, self-screenings, and influence of nutrition and exercise
d. Encouragement to be involved in organized team sports involving both genders
e. Recognition of reality factors such as the need to be employed after school hours
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
f.
Interpersonal communication with a male school nurse
ANS: A, C, F
Some suggestions that may improve male health are information about how their bodies
function, what is normal, what is abnormal, what action to take, and the contributions of
proper nutrition and exercise; self-care instruction, including testicular and genital
self-examination; help with fathering; and recognition that feelings of confusion and
uncertainty in a time of rapid social change are normal and that they may mark the onset of
healthy adaptation to change. Male nurses can be extremely effective in such an endeavor.
Providing assistance in learning how to control emotions and behaviors, encouraging the
involvement in organized team sports, and the recognition of reality factors would not be the
most important strategies to implement with adolescent males?
DIF: Cognitive Level: Understand (Comprehension)
3. Which strategies would most likely increase attendance at a clinic aiming to improve men’s
health in the community? (Select all that apply.)
a. Employing male nurses
b. Having male-friendly space for socialization
c. Having evening and weekend hours
d. Having male-accepted nibbles and drinks (pretzels and light beer)
e. Including lectures on male health each evening
f. Providing male-accepted and respected activities such as poker
ANS: A, B, C, F
Data demonstrated that usage of male clinics was highest with informal evening clinics
directed by male nurses. Based on the social rather than medical model, Australian clinics
NURmales
B.COM them with accepted and respected
promote well-being among older
byTproviding
SING
activities, as well as providing a male-friendly space for socialization. The room in which
staff members see men has decor geared toward men. The data did not demonstrate that
having male-accepted nibbles and drinks or including lectures on male health each evening
were effective in increasing attendance at the clinic.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 19: Senior Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which is the most useful way to discuss aging?
a. By divisions—young-old, middle-old, old-old, and elite-old
b. Chronological age
c. Functional age
d. Number of chronic comorbidities
ANS: C
Functional age refers to functioning and the ability to perform activities of daily living, such
as bathing and grooming, and instrumental activities of daily living, such as cooking and
shopping. This definition of aging is a better measure of age than chronological age. After all,
most older adults are more concerned with their functional ability than their chronological
age. Assisting older adults to remain independent and functional is a major focus of nursing
care.
DIF: Cognitive Level: Remember (Knowledge)
2. Which is an example of a nonstochastic theory of aging?
a. Cross-link theory
b. Error theory
c. Free radical theory
d. Immunologic theory
N R I G B.COM
e. Somatic mutation theory U S N T
f. Wear and tear theory
ANS: D
All the theories except one are stochastic theories, that is, theories that are based on the
assumption that events occur randomly and accumulate over time, which results in aging. The
only nonstochastic theory, which views aging as predetermined, is the immunologic theory.
DIF: Cognitive Level: Remember (Knowledge)
3. A woman said, “I’ve never been retired before. I didn’t plan it but it’s OK. I’m still doing
what I used to do otherwise; I go to church, make quilts for charity, and babysit my grandkids.
Do you think I should be trying to find another job for a few years?” Which would be the
most appropriate response by the nurse?
a. “For lots of people, retirement, even if unplanned, is much like life has always
been.”
b. “It’s okay to slow down at your age; why look for problems?”
c. “You really need to get out of your house more and be more active, even if you
don’t get paid at the position.”
d. “Without a job, you really don’t have an identity. Have you been to the
unemployment office?”
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The continuity theory of aging suggests that a person continues through life in a similar
fashion as in previous years. Because the woman stated she is doing what she has previously
done, and has not suggested any particular problems other than concern that what she is doing
is acceptable behavior, she should be supported. The statement that best supports her decision
states that retirement life is much like life has always been. The other statements do not
support her current satisfaction with her activities in her life.
DIF: Cognitive Level: Apply (Application)
4. A man stated, “I used to work out at the exercise room at work, but now that I’m retired I sit
and watch TV. My wife keeps nagging me to do something. What do you think I should be
doing at my age?” Which would be the most appropriate response by the nurse?
a. “I think you should try to please your wife. What is it she wants you to do?”
b. “It’s okay to slow down at your age; why look for problems?”
c. “You should try to exercise just as you did before. Is there a YMCA or club
nearby?”
d. “You’ve worked all your life; you have a right to rest now.”
ANS: C
The activity theory posits that activity is necessary to maintain life satisfaction. Physical
activity is beneficial for the health of people of all ages, including older adults. Therefore,
because the man has previously been physically active, he should continue to be physically
active to maintain satisfaction with his life.
DIF: Cognitive Level: Apply (Application)
5. In the supermarket checkout, a young woman complained to her friend, “Old people think we
NUtoRbeSI
TB.Chome.
OM Seems like a waste of money.” Which
taxpayers should pay for them
inNaGnursing
would be the most appropriate response by the nurse?
a. “Did you know more than 90% of all the elderly live in their own homes while
fewer than 5% live in care facilities?”
b. “Those old people built our society; we owe it to them to support them now.”
c. “Would it be better to put each person to sleep when they reach a certain age such
as 80 years?”
d. “You know, you’ll get old someday too. Won’t you want someone to take care of
you when you can’t anymore?”
ANS: A
In 2013, 93% of the Medicare population aged 65 years and older resided in traditional
community settings. Three percent resided in community housing with at least one service
available, and approximately 4% resided in long-term-care facilities. The other responses do
not support a therapeutic response by the nurse in this situation.
DIF: Cognitive Level: Apply (Application)
6. Which group would most need adult daycare services?
a. Caregivers who work all day
b. Elderly who are bored staying home alone
c. Elderly in whom Alzheimer’s has been diagnosed
d. Older men who want an opportunity to meet older women
e. Older women who want to engage in arts and crafts activities
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A
Adult daycare provides a safe and supportive environment during the day for adults who
cannot or choose not to stay alone. This service is often needed by caregivers who work
during regular hours or need respite.
DIF: Cognitive Level: Understand (Comprehension)
7. Which accounts for the largest source of per capita family income?
a. Employment income
b. Pensions
c. Savings
d. Social Security
ANS: D
In 2014, the median household income of older adults was $36,895. Aggregate income for the
population aged 65 years and over came largely from four sources: Social Security, earnings,
pensions, and asset income. Social Security accounted for 49% of per capita family income.
Among older Americans in the lowest fifth of the income distribution, Social Security
accounted for 67% and earnings accounted for 13% of per capita family income, and public
assistance accounted for 8%. For those in the highest fifth of the income distribution, Social
Security accounted for 18% of per capita family income, pension income accounted for 26%,
and earnings accounted for 40%.
DIF: Cognitive Level: Remember (Knowledge)
8. “I don’t understand,” a woman said. “I know I’m eligible for Medicare part A and it’s free.
Part B isn’t free. When will INever
INit?”
GTWhich
B.COwould
M be the most appropriate response by
URSuse
the nurse?
a. “Part A is only for hospital bills. Most care is given on an outpatient basis. Part B
pays a large portion of those costs.”
b. “Part A is a benefit because you paid into Social Security for more than 10 years.
In comparison, part B is optional if you want that additional insurance.”
c. “Part B is easy to pay for; they take the cost out of your Social Security check each
month.”
d. “Researchers have found that people don’t waste health care resources if they have
to pay a bit for them.”
ANS: A
All the responses are true, although the woman may not care about research findings. Further,
she may well prefer the money from her Social Security benefit to be paid to her rather than
go for additional insurance. However, the reason the woman needs to know why she should
pay for part B is that so much care today is given on an outpatient basis, including diagnostic
procedures, physicals, speech and occupational therapy, ambulances, durable medical
equipment, and some home health care services.
DIF: Cognitive Level: Apply (Application)
9. Which best describes why grandparents would be the primary caregivers for their
grandchildren?
a. Because they fell in love with the newborn and wanted that small person to be a
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
part of their lives
b. Because the parents were drug abusers or in the prison system
c. Raising a grandchild is easier because grandparents have already been experienced
parents
d. Raising a child gives purpose to life for the grandparents
ANS: B
Many older adults are faced with raising their grandchildren, often without the presence of the
grandchildren’s parents. Reasons include neglect related to parental substance abuse,
abandonment, emotional and physical abuse, parental death, mental and physical illness,
incarceration, teen pregnancy, and grandparents’ assisting adult children who work or attend
school.
DIF: Cognitive Level: Understand (Comprehension)
10. “My health problems are too much to handle,” said an elderly woman at her annual clinical
checkup. “What’s most important for me to do?” Which would be the most appropriate
response by the nurse?
a. “Focus on eating properly and staying active.”
b. “Get the shingles immunization along with your flu shot this year.”
c. “Keep active mentally—do you do crossword puzzles or Sudoku puzzles?”
d. “Stay involved with others. Do you ever go to the senior citizens center?”
ANS: A
Health care professionals must inform and educate elders about the benefits of health care
screenings and examinations, physical activity and fitness, and good nutrition. As the woman
was already getting an annual checkup, the nurse should stress nutrition and exercise.
NURSINGTB.COM
DIF: Cognitive Level: Apply (Application)
11. A nurse needed to do a quick assessment of a client’s lifestyle behaviors to counsel
appropriately. Which strategy would be the easiest way to determine the elderly woman’s
nutritional status?
a. Ask the woman to keep a food diary for 2 weeks and bring it to the clinic
b. Have the clinic dietitian interview the woman about her eating habits
c. Quiz the woman verbally as to her usual meals during the day
d. Use the DETERMINE mnemonic
ANS: D
All the responses are good approaches. However, the nurse should take a broad view of what
assets or barriers are involved in relation to nutrition. A nutrition checklist, described by the
mnemonic DETERMINE, reviews warning signs and risk factors of poor nutritional health.
(See Table 19.2 in the textbook for more information.)
DIF: Cognitive Level: Apply (Application)
12. A nurse is making the first home visit to a recently discharged elderly client. Which should
the nurse most likely expect to find?
a. A client who is unhappy with the disorganization of the house
b. A client who will expect the nurse to do everything now that the nurse is at his or
her house
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. A client who may have hearing or vision problems or both
d. A client who is upset with being discharged while still so ill and having to take on
problems at home
ANS: C
Sensory disabilities increase with age and may seriously affect an older person’s quality of
life and ability to carry out routine daily activities. The NHI Survey found that 7.3 million
noninstitutionalized American adults 65 years and older reported significant vision loss. One
in three adults 65 to 74 years of age and nearly half of adults 75 years old or older have
difficulty hearing. Thus, the nurse should be anticipating the needs of the client rather than
being concerned about the potential factors that the client may be upset about.
DIF: Cognitive Level: Apply (Application)
13. Which is the most common reason for visual impairment in older adults?
a. Cataracts
b. Glaucoma
c. Macular degeneration
d. Presbyopia
ANS: A
Among older adults, the three most common pathological eye conditions are cataracts,
macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most
reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally
clear lens of the eye. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with
near vision, generally occurs in the 40s.
DIF: Cognitive Level: Remember
NUR(Knowledge)
SINGTB.COM
14. A nurse completed the health assessment but needed to use the elderly woman’s bathroom.
The nurse noticed perineal pads under the sink. Which question would the nurse most likely
ask the woman?
a. “Can you tell me why you need to have perineal pads?”
b. “Do you know how to do Kegel exercises to help control your urine?”
c. “Does another woman live with you or visit often?”
d. “Why do you have perineal pads? Are you bleeding down there?”
ANS: B
Because the woman did not mention incontinence, it may be assumed to be very
embarrassing. Therefore, the nurse should matter-of-factly address urine control problems by
suggesting a self-help intervention of Kegel exercises. It may be assumed that the nurse,
having completed a health assessment, would know about bleeding, as well as frequent
visitors or family nearby.
DIF: Cognitive Level: Apply (Application)
15. An ambulance medic reported a client was on the way with a traumatic brain injury (TBI).
Which symptom would the nurse expect this client to display?
a. Blurred vision and a headache
b. Hypotension and tachycardia
c. Irregular heart rate
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Fecal incontinence
ANS: A
TBI symptoms may be mild, moderate, or severe. Symptoms of mild TBI include headache,
confusion, light-headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad
taste in the mouth, fatigue or lethargy, and a change in sleep patterns or thinking. Moderate or
severe TBI may demonstrate the same symptoms as mild TBI plus a headache that gets worse
or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to
awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or
numbness in the extremities, loss of coordination, and increased confusion, restlessness, or
agitation. The other symptoms are not indicative of TBI.
DIF: Cognitive Level: Apply (Application)
16. A nurse overheard an adult woman, shaking her head in exasperation as she said, “Dad,
you’re being unreasonable. It’s not safe!” Which is the most likely reason for this argument?
a. The dad wants to keep driving.
b. The dad wants to keep cooking his own meals.
c. The dad wants to keep taking care of himself each day without assistance.
d. The dad wants to marry some young woman who may just want his money.
ANS: A
One of the quality-of-life factors that is important to seniors is the ability to drive. Many older
adults depend on driving in order to maintain independence and personal mobility.
Age-related declines in vision, hearing, and other abilities as well as certain medical
conditions and medications can affect driving skills. Thus, safety is a concern for any elderly
driver. This safety concern outweighs the other concerns of cooking one’s own meals,
NURaSyounger
INGTB.C
providing self-care, and marrying
woman.
OM
DIF: Cognitive Level: Apply (Application)
17. A nurse explained that the elderly are twice as likely to die in a home fire as younger persons
and therefore suggested some safety measures. Which strategy would most likely have been
suggested by the nurse?
a. Have smoke detectors installed in the house
b. Invite a family member to sleep in the house at night
c. Practice escaping quickly from the house in case of an emergency
d. Program your phone so the fire department can be reached by pushing only one
button
ANS: A
Community health nurses making home visits can assess their elderly client’s home for fire
risk and teach fire safety, including the importance of home smoke detectors and fire
extinguishers. Inviting family members to spend the night, practicing a quick escape, and
programming one’s phone for the fire department are irrelevant if a smoke detector is not
installed to alert the elderly client that there is a fire in the home.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
18. An elderly gentleman was shoveling his snow when you arrived for a home visit. You notice
that when he comes inside he is very pale, is shivering, and seems a bit confused. His skin is
very cold when you touch it. Which action would be most appropriate for the nurse to take
first?
a. Apply warm moist towels to his head, neck, chest, and groin
b. Give him hot coffee with sugar to drink
c. Have him get in a tub of very hot water immediately
d. Call 911
ANS: A
Initial management is to prevent further loss of heat. Rewarming of the core temperature at a
safe, slow rate is important to avoid lethal side effects. The reason for rewarming the core first
is to prevent vasodilation that would place the individual in ventricular fibrillation. Measures
that can be taken are: (1) remove the individual from the cold area as soon as possible; (2) add
more clothing, especially to the head (e.g., use a hat or scarf); (3) provide a warm sweetened
drink (no coffee or tea); and (4) apply mild heat to the head, neck, chest, and groin areas using
hot water bottles or warm moist towels. Medical help is imperative, and hospitalization may
be needed depending on the stage of hypothermia.
DIF: Cognitive Level: Apply (Application)
19. A male nurse is enjoying a very hot summer day at the zoo when he notices a family
approaching. An elderly member of the family is moving very slowly and being scolded by
another adult, saying “You are not sick. Let’s keep moving.” The nurse touches the elderly
adult who has a flushed face and notices clammy and moist skin. What should the nurse say to
the adult?
a. “I’m a nurse, and your family member needs to go to the emergency department
NURSINGTB.COM
right now.”
b. “I’m a nurse, and your family member has heat stroke. I’m calling 911.”
c. “Take your family member to the air-conditioned restaurant, and have him drink a
cold soda immediately.”
d. “Take your family member to the air-conditioned restaurant, and let your family
rest for a while.”
ANS: D
There is not enough evidence to be quite sure what is wrong with the elderly adult, but clearly
the elderly person is suffering from being in the hot sun for a period of time. The elderly
adult—and probably the rest of the family as well—needs to be moved to a cooler
environment and be made to lie down and rest. Drinking chilled water (not soda with caffeine)
would also be helpful. In that cooler environment, the nurse can assess the situation to
determine whether further action should be taken.
DIF: Cognitive Level: Apply (Application)
20. A daughter tells the nurse that her mother is frequently confused, but what is really upsetting
is that she is incontinent during the night. “All I do is watch her and wash sheets,” the
daughter says. Which suggestion should the nurse provide to the daughter?
a. Explain about respite care or the need to ask other family members to help so the
daughter can have some time off.
b. It’s time to have her mother go into a nursing home where they can give her the
care she needs.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Refer the daughter to Adult Protective Services so responsibility for her mother’s
care may be assumed by an agency prepared for such tasks.
d. Teach the daughter how to establish a toileting routine for the mother to help
control the incontinence.
ANS: A
The best approach—because the daughter is willing to share her feelings with you—is to see
whether there is anyone else in the family to help so the daughter can be less overwhelmed. If
the mother has Alzheimer’s, any number of resources are available for respite for the
caregiver, support groups for both client and family, and daycare facilities for the client. Adult
Protective Services assists in cases of abuse. The daughter is stressed and may become an
abuser if assistance is not found. A toileting routine would probably not be successful during
the night. Although a nursing home is possible, many families cannot afford such care or do
not want a family member sent there.
DIF: Cognitive Level: Analyze (Analysis)
21. A wife, who had just come home after major abdominal surgery, explained to the home health
nurse that she was really worried about her husband. He had not been sleeping well or eating
well, seemed to have no energy, and did not seem to enjoy anything including activities he
used to love. Which suggestion should the nurse give to the client?
a. Ask what medications the husband is taking, because many medications can affect
mood
b. Explain her husband has probably been worried sick about her and the surgery, and
she should reassure him frequently that she is OK
c. Point out that many people get sad during the winter months and he should be fine
when spring arrives, but in
put full-spectrum
light bulbs in all the
NUthe
RSmeantime
INGTB.C
M
O
household lamps
d. Share that her husband seems depressed and that they should see his doctor
immediately
ANS: D
Depressed people may experience several or all symptoms: changes in appetite or weight;
changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt; and
repeated thoughts of death or suicide. If any of these symptoms exist, the client should be
referred to a physician for diagnosis. A physician can only make a diagnosis of clinical
depression in the presence of five or more of the symptoms mentioned above.
DIF: Cognitive Level: Apply (Application)
22. A son explained to the home health nurse that since his mother died, his father did not seem to
have any interest in life and had even told his son he was considering suicide. Which would
be the most appropriate response by the nurse?
a. “If he really wants to kill himself, he will, and there really isn’t anything you can
do to stop him.”
b. “If you talk to him about it, you’re strengthening the idea.”
c. “People who talk about suicide rarely do it, so don’t worry.”
d. “Suicide is a serious concern; let’s talk to his doctor about what you’ve noticed.”
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Suicide is a serious health concern. Elder suicide is associated with depression, chronic
illness, physical impairment and conditions that significantly limit functioning or life
expectancy, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism.
Warning signs to watch for in the elderly are loss of interest in things or activities that are
usually found enjoyable; social isolation; self-care neglect; not following medical regimens
(e.g., going off diets, not taking prescriptions); experiencing or expecting a significant
personal loss (e.g., death of spouse or friend); feeling hopeless or worthless; putting affairs in
order; giving things away; making changes in a will; and stockpiling medications or obtaining
other lethal means for committing suicide. The most significant warning sign is any
expression of intent. Because the father is at high risk for suicide, the son must discuss the
problem with the father’s physician so that care can be obtained.
DIF: Cognitive Level: Apply (Application)
23. A wife explained to the nurse that her husband was becoming awfully forgetful, and now he’s
started getting lost on the way home from the golf club. She’s scared he may be getting
Alzheimer’s disease. Which would be most appropriate action for the nurse to take?
a. Ask the husband to explain why he thinks he got lost coming home
b. Explain that all elderly persons get a little forgetful and not to worry
c. Ask the husband to count backwards by 7 from 100
d. Hand the husband pencil and paper and ask him to draw a clock
ANS: D
Clients with Alzheimer’s disease are unable to draw a normal clock. The clock drawing test
has become one of the most widely used screening instruments in clinical and research
settings. It has been found to be an effective and easy-to-administer tool to screen for
dementia. This should be theNfirstRaction
by the
INGtaken
B.C
M nurse to screen the client for
U
S
T
O
Alzheimer’s disease and take appropriate action as necessary.
DIF: Cognitive Level: Apply (Application)
24. Which best explains why all family members should want their aged relatives to have a living
will?
a. To confirm that the attorney is serving as guardian and family members do not
have to be responsible
b. To fulfill the federal Patient Self-Determination Act requirements
c. To help family members know what their loved one does or does not want if he or
she becomes incapacitated
d. To keep physicians from writing a do-not-resuscitate order
ANS: C
A living will is a legal document that allows individuals to specify what type of medical
treatment they would or would not want if they became incapacitated or had an irreversible
terminal illness. Living wills can direct physicians to withhold life-sustaining procedures and
can assist family members in making decisions when they are unable to consult a comatose or
medically incompetent relative. The purpose of a living will is not to appoint an attorney as a
guardian. The Patient Self-Determination Act requires health care facilities that receive
Medicare and Medicaid funds to ask patients on admission if they possess an advance
directive; it does not require that patients complete one.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
25. “Do you have any advice?” a young woman asked. “I’m eating lunch with my dad but he
can’t hear and he won’t wear his hearing aid.” Which suggestion should be made by the
nurse?
a. Encourage your dad to wear his hearing aid—if only for you
b. Find a very quiet place with good lighting and very little background noise for
lunch
c. Repeat yourself several times using exactly the same words and gestures
d. Talk very loudly while facing him directly
ANS: B
Suggestions include to find a quiet place to talk to help reduce background noise, especially in
restaurants and social gatherings; stand in good lighting and use facial expressions or gestures
to give clues; face the person and talk clearly; speak a little more loudly than normal, but do
not shout; and repeat yourself if necessary, using different words.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which situations best describe when a person would most likely be very unhappy and perhaps
ill after retirement? (Select all that apply.)
a. If their family total income is now less than when he or she was employed
b. If the retirement was involuntary
c. If the person’s self-image was based on job role and status
d. If the person has no outside interests or leisure activities
e. If his or her spouse did not
input
NUappreciate
RSINGT
B.Cinto
OMtheir schedules or activities
f. If the person believes others are now taking credit for his or her achievements
ANS: B, C, D, E
Retirement can be a happy occasion when it is planned and the person has many activities to
which to devote time and energy. Retirement is often a happy occasion when planned and
voluntary; however, the opposite may be true if it is involuntary. When older adults retire,
they inevitably must cope with a change in social status; this may be difficult for people
whose self-concept was based on job status. For retirees who are married, the spouse must
also adjust to the changes related to retirement. For elders who have no hobbies or interests,
this extra leisure time may be a source of boredom. Family income being less is not
necessarily a stressor as many job-related expenses also disappear.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse always reviewed the medications taken by elderly clients on each home visit. Which
best explains the rationale for the nurse’s action? (Select all that apply.)
a. Age-related changes and polypharmacy make elderly clients vulnerable to drug
interactions and dangerous adverse reactions.
b. Elderly clients are known to sue if medications taken do not make them feel better,
and lawsuits are to be avoided, if possible.
c. Folk or herbal medicines are often the same as the generic medications prescribed
by health care providers, so elderly often have overdoses.
d. Older adults are known to consume many over-the-counter medications, as well as
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
folk or herbal remedies.
e. The elderly are known to be particularly noncompliant with pharmaceutical
prescriptions.
f. With the high prevalence of chronic diseases, elderly clients are taking a large
number of medications.
ANS: A, D, F
The high prevalence of chronic diseases in the elderly population causes this group to use a
large number of medications. Older adults in the United States are responsible for more than
one third of total outpatient spending on prescription drugs. Older adults also consume many
over-the-counter medications, as well as “folk” or herbal remedies which are not typically
prescribed by health care providers. The elderly population is vulnerable to the effects of
drugs because of normal aging changes and age-related differences in pharmacokinetics and
pharmacodynamics. Polypharmacy may also make older adults vulnerable to drug interactions
and dangerous adverse reactions. It is unlikely that elderly clients will seek legal action if a
medication does not make them feel better. The elderly are not known to be any more
noncompliant with taking medications than the other segments of the population.
DIF: Cognitive Level: Apply (Application)
3. An elderly woman shared that she had six different physicians, each focusing on one
particular health problem. Which would be of immediate concern for the home health nurse?
(Select all that apply.)
a. Whether the client has a family physician who was coordinating her care
b. Whether the physicians communicate with each other
c. If each physician was prescribing medications, what drug interactions might be
occurring?
NURSINGTB.COM
d. Were all these health care providers
licensed physicians?
e. Who was helping her with transportation to all these physicians?
f. Would all these physician visits add up to more than what Medicare would
reimburse the client?
ANS: A, C
The client needs a family physician or a nurse case manager who is coordinating her care and
ensuring that the medications are not having interaction effects. A pharmacist might also do
this, but the client may be using several different pharmacies. Errors associated with
preventable adverse drug events occur most often at the stages of prescribing and monitoring
(i.e., the same medication[s], or different medications for the same condition, being prescribed
by different health providers).
DIF: Cognitive Level: Apply (Application)
4. Which would be a problem for an older adult with a hearing loss? (Select all that apply.)
a. Difficulty in finding a hearing aid that is unobtrusive
b. Embarrassment at having to wear a hearing aid
c. Hearing is not part of a routine health screening
d. Long delays in getting an appointment to see an audiologist or otolaryngologist
e. Medicare does not cover the costs of hearing aids
f. The adult may withdraw, become isolated, and depressed
ANS: E, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In general, Medicare does not cover the costs of hearing aids; Part A covers hospitalization
and Part B covers physician and outpatient services, qualified therapies, durable medical
equipment, and some home health care services. Consequences of hearing loss may include
withdrawal, isolation, and depression. Because of advances in technology, hearing aids are
much smaller and less obvious than they previously have been. This leads to less
embarrassment and noticeability for those who use them. Because loss of hearing is one of the
most common conditions affecting older adults, it should be screened for as a part of routine
health screening. There are typically not long delays in seeing a specialist for referral.
DIF: Cognitive Level: Understand (Comprehension)
5. A woman admitted, “I did fall once, but it was an accident that I’m sure won’t happen again.”
Which responses would be most appropriate for the nurse? (Select all that apply.)
a. “Are you getting lots of calcium and vitamin D? Are you drinking milk or taking
calcium pills?”
b. “Do you have a couple glasses of wine each evening to relax you before you go to
bed?”
c. “Do you live in a one-story house and are your floors even without rugs to trip you
up?”
d. “Let me give you some balance and leg muscle exercises to practice at home each
day.”
e. “Remember that if you start to fall, fall sideways if you can to minimize injury.”
f. “Review what medications you are taking.”
ANS: A, C, D, F
Simple exercises that strengthen leg muscles and exercises that can improve balance are
recommended to be done daily.
of calcium and vitamin D, obtaining a
NUAdequate
RSINGTamounts
B.COM
bone density test, and taking medications that are available for slowing bone loss are activities
that can help prevent falls. Seniors can also improve their environment to reduce their risk of
falling by checking floor surfaces and curb heights; identifying weather-related problems
before venturing outside; wearing supportive, low-heeled shoes; making sure that rooms are
well lit; and ensuring that safety equipment is installed in bathrooms and stairwells. In the
event of a fall, if the senior remembers to fall forward or backward or to land on their hands to
break a fall, it will lessen the risk of hip fracture. Uneven surfaces such as sidewalks, curbs, or
floor elevations; wet or slippery ground; and climbing up on household items not intended for
climbing can result in loss of footing or loss of traction. Drinking alcoholic beverages
increases the risk of falling because alcohol slows reflexes and response time; causes
dizziness, sleepiness, or light-headedness; and alters balance. Medications such as blood
pressure pills, heart medicines, diuretics, and tranquilizers may increase the risk of falling.
DIF: Cognitive Level: Apply (Application)
6. A family member tells the nurse that she is worried about her grandmother driving. Which
would be most appropriate for the nurse to suggest? (Select all that apply.)
a. Avoid rush hour traffic.
b. Buy and drive a very large heavy car.
c. Do not converse with any passengers.
d. Drive more slowly.
e. Drive only during daylight.
f. Leave the radio turned off.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A, C, E, F
Some interventions older adults could implement are limiting their driving to daylight hours
and good weather conditions, planning their trips to avoid rush hour, not listening to the radio,
and avoiding talking with passengers. Purchasing a large, heavy car and driving more slowly
are not appropriate actions to assist an elderly person with driving.
DIF: Cognitive Level: Apply (Application)
7. A son did not know what to get his mother for her birthday. She refused most gifts, saying
they were just something more for her to take care of. Assuming the mother did not have
these, which would be a very helpful gift? (Select all that apply.)
a. Purchase a new front door with a large peephole so she can see who is ringing the
doorbell
b. Arrange for Social Security check to be deposited directly into the bank
c. Add bars on all the house windows for added security
d. Buy a shredder for the mother to use on all personal documents
e. Install caller ID on her telephone
f. Have strong deadbolts installed on all outside doors
ANS: A, B, D, E, F
Measures can be taken to lessen the risk of crime happening to the elderly person. In the
home, safety measures include making sure that door and window locks are strong. The elder
should note who is at the door before opening the door. The elder can get caller ID service for
the telephone; if no number or individual is identified, the elder may choose not to answer the
call. Identity theft is on the increase, and elderly individuals are particularly vulnerable. To
avoid this problem, Social Security and monthly pension checks should be deposited directly
NURSIN
GTisB.C
into a bank account. Any information
that
sent O
toMthe home with credit card offers, personal
information, and so forth should be shredded so that the information cannot be used illegally.
Bars on doors and windows need to be installed with caution, because they may increase the
risk of harm in the event public officials need to access the home as a result of fire or need to
gain access to assist the elderly person who may be injured from a fall or may be ill.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 20: Family Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which definition of family would be the most useful for the nurse practicing in the
community?
a. A group of persons with shared convictions
b. A social unit interacting with the larger society
c. People descended from a common ancestor
d. Persons related either by blood or by legal contract (marriage)
e. Whoever the family says is in their family
ANS: E
Although some believe even these definitions are too narrow, the widest definitions are “the
members of the family are self-defined” and “the family is who they say they are.”
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse was teaching a class on good hygiene at a local daycare center when one child
volunteered, “I have two mommies.” Which would be the most appropriate response by the
nurse?
a. “Don’t tell anyone; that’s a secret.”
b. “That’s nice—why did you share that?”
c. “Yes, some children have two mommies, some have a mommy and a daddy, and
some just have daddies. Some people only have one grown-up to love them.”
NURmommy?”
SINGTB.COM
d. “Which mommy is your real
ANS: C
The Human Rights Campaign (2009) urges that health professions acknowledge all types of
families including gay, lesbian, and even grandparents as heads of family.
DIF: Cognitive Level: Apply (Application)
3. Which statement best describes how a family can meet the needs of society?
a. By living and existing in the wider community
b. By meeting the needs of the individual family members
c. Through procreation and socialization
d. Through productivity seen in employment positions
ANS: C
The family fulfills two important purposes. The first is to meet the needs of society, and the
second is to meet the needs of individual family members. The family meets the needs of
society through procreation and socialization of family members.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes what is meant by cohabitation?
a. A living arrangement in which one adult is employed and the other is unemployed
b. A living arrangement in which an unmarried couple in a long-term relationship
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
lives together
c. A living arrangement between two members of the same sex
d. A living arrangement between two single mothers with children
ANS: B
The most comprehensive definition of cohabitation is a living arrangement in which an
unmarried couple live together in a long-term relationship that resembles a marriage. One of
the key aspects of this definition is the long-term relationship which is not mentioned in the
other definitions.
DIF: Cognitive Level: Remember (Knowledge)
5. Which best describes what proportion of children live in a single-parent family?
a. Fewer than 10%
b. 11% to 15%
c. 16% to 20%
d. 21% to 26%
e. More than 30%
ANS: E
In 2012, 34% of all U.S. children lived in single-parent homes.
DIF: Cognitive Level: Remember (Knowledge)
6. When making a home visit, a nurse is usually expected to focus attention on the ill family
member. But whom would the nurse possibly focus on instead?
a. The children who are being affected by the stress of the situation
b. The ill family member’s N
primary
RSIcaregiver
U
NGTB.COM
c. The spouse of the ill family member
d. The neighbors of the family who may be able to help
ANS: B
Changes in family patterns, fears, emotional responses, and expectations of individual family
members can be assessed in the family interview. Special needs of the primary caretaker (i.e.,
often the spouse, daughter, or daughter-in-law) must be assessed.
DIF: Cognitive Level: Understand (Comprehension)
7. Which is a major barrier to a nurse caring for the family as a whole?
a. Families often don’t want to know what is wrong with their loved one.
b. Nurses don’t know how to care for families.
c. Reimbursement is paid only for services given to an individual.
d. The family often isn’t available when the nurse is giving care.
ANS: C
As a result of the current era of cost containment, constraints on the community health nurse
will increase. Reimbursement is almost entirely calculated for services rendered to the
individual and thus is a major constraint toward moving toward planning care for the family
as a unit.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
8. A nurse is completing a first assessment interview with a family after entering the family’s
apartment for the first time. Which would be crucial for the nurse to remember?
a. Analyze the power relationships before focusing on needed information
b. Be on best behavior with manners and courtesy, starting with a self-introduction
c. Determine as soon as possible who makes decisions within the family
d. Evaluate the safety of the immediate environment for self and the family
ANS: B
Manners are common social behaviors that set the tone for the interview and begin the
development of a therapeutic relationship. The nurse introduces himself or herself by name
and title and always addresses the client and family members by name (i.e., Mr., Mrs., or Ms.,
unless otherwise directed by client).
DIF: Cognitive Level: Apply (Application)
9. Beyond gathering needed information for future interventions, which purpose is served when
the nurse interviews the family?
a. Assessing the safety of the immediate environment before further planning can be
done
b. Establishing a process for the nurse and the family to make decisions
c. Engaging in focused planned conversation, which has healing potential in itself
d. Focusing on giving compliments to make the family feel good about themselves
ANS: C
The second key element in the interview is the therapeutic conversation. This type of
conversation is focused and planned and engages the family. The nurse must listen and
remember that even one sentence has the potential to heal or help a family member. Every
NURSIN
GT
B.COM
encounter, whether brief or extended,
has
“healing
potential.”
DIF: Cognitive Level: Understand (Comprehension)
10. Which question is crucial to ask very early in a family interview?
a. “Do you see any way this problem could have been avoided—so future problems
could be prevented?”
b. “What do you all, as a family hope to achieve during your time with me?”
c. “What would you like me to do for you today?”
d. “Would you like to know my perception of what our goals together should be?”
ANS: B
Therapeutic questions are key questions that the nurse uses to facilitate the interview. One
important basic theme is to determine the family’s expectations of the interview or home visit.
DIF: Cognitive Level: Understand (Comprehension)
11. A young son was so physically fidgety that his mother was seriously embarrassed by his
inability to be quiet and involved in the interview. Which comment by the nurse would be the
most helpful?
a. “Isn’t it marvelous how much energy your son has?”
b. “Is there something your son could be doing for you that would use some of that
energy?”
c. “Is your son always so fidgety? Have you discussed his behavior with his
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
pediatrician?”
d. “Why don’t you let your son go to his room until we’re finished?”
ANS: A
Sending the son to his room might be seen as punitive and would remove him from being
informed about interventions planned and decisions made. A compliment reinforces family
strengths and tends to further progress toward open trusting relationships. The comment took
a flaw (physically fidgeting) and reframed it as an asset (high energy).
DIF: Cognitive Level: Apply (Application)
12. The current school year is now over, and the school health nurse spends time summarizing the
records of all the children who had come into the school health office during the past school
year. Which best explains the rationale for this action?
a. Because analysis can help establish priorities for future health programs
b. Because annual reports are expected by the school board
c. Because it’s very personally rewarding to see all the help one has given throughout
the year
d. Because the nurse has to justify the school health office budget for each year
ANS: A
Community health nurses (CHNs) are employed in ambulatory care centers, occupational
health and school sites, housing complexes, daycare programs, residential treatment and
substance abuse programs, and other official and nonofficial agencies. At each of these sites,
CHNs meet families and can assess and intervene at the family and community levels. The
challenge is to focus not only on individual students but extend practice to the whole school
community of children. Fiscal constraints hold the nurse accountable for the best delegation of
M health nurse, on the basis of the most
scarce resources. In times of N
limited
the O
school
URSIbudgets,
NGTB.C
frequent problems presented in the office, can draw conclusions as to what are the major
health needs of children in the community. On the basis of those conclusions, health programs
can be planned to maximize health promotion and disease prevention in the school.
DIF: Cognitive Level: Apply (Application)
13. Which best describes why a nurse would ask about the meals of all family members, rather
than focus on a nutritional history for the postmyocardial infarction patient?
a. It is assumed that all family members eat the same food at the same time each day.
b. Lifestyle choices among family members are usually consistent.
c. Many parents eat whatever their children don’t rather than throw away good food,
so the nurse should know what the children eat.
d. The nurse was afraid to assume that whoever cooked would only prepare one meal
for everyone to share.
ANS: B
The family remains the focus because families experience similar risk factors (i.e.,
physiological, behavioral, and environmental). Family health practices influence lifestyle
habits among family members. Consequently, although family members may or may not eat
together, they will have a tendency to make similar choices.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
14. A 36-year-old woman had diabetes diagnosed at a free health-screening program at a large
employer. Which should be emphasized by the nurse when helping the woman make an
appointment at the diabetic clinic for follow-up testing and treatment?
a. “Bring a food diary of everything you’ve eaten for one week with you to the
appointment to help with future meal planning.”
b. “It’s really not that hard to learn how to inject insulin, and it really doesn’t hurt.”
c. “Please encourage all your family members, including your parents, to be tested
for diabetes as well.”
d. “They’ll teach you how to manage your meals and medications to stay healthy.”
ANS: C
Although the nurse might make any of these comments, it is particularly important that the
rest of the family also get tested. Any problem that affects one or more family members
probably affects other family members and the family as a whole. Commonalities in risk
factors and diseases shared by family members can lead to case finding within the family.
Because families often choose similar foods and engage in similar lifestyle behaviors, they all
are at similar risk for problems such as diabetes. The earlier the diagnosis and treatment, the
more likely it is that secondary problems can be avoided.
DIF: Cognitive Level: Apply (Application)
15. Record data demonstrated that there were a very large number of children in the school
district whose insurance plan was the Children’s Health Insurance Program (CHIP). Which
conclusion would be accurate for the nurse to make?
a. There are a large number of parents who know how to abuse government
programs.
b. There are a large number of homeless families.
N RSINGTB.COM
c. There are a large number ofUunemployed
poverty-stricken families.
d. There are a large number of working, low-income parents.
ANS: D
CHIP has greatly increased access to health care for many low-income children. The majority
of these children live in families with working, low-income parents.
DIF: Cognitive Level: Apply (Application)
16. A nurse needed to help a child who was not behaving consistently with the requirements of
the new preschool program that began that fall. Which action would be most appropriate for
the nurse to perform?
a. Meet with the child each day to let the child have a safe play environment without
the regular program frustrations
b. Meet with the child’s parents to discuss how their parenting may need to change to
help improve their child’s behavior at school
c. Meet with the child’s teacher to brainstorm ways to help the child cope with school
requirements
d. Point out to the child that if behavior doesn’t improve, the child won’t be able to
play with all the other children at the school
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The teacher can be assumed to be an expert in dealing with small children. If the problem is
defined as a child not behaving within expectations, the most effective approach would be to
discuss with the parents how to help the child. Systems theory provides direction in
understanding how health care providers can expand family capacity by changing parenting
and therefore changing child behaviors.
DIF: Cognitive Level: Analyze (Analysis)
17. A family came in to discuss a problem with one of their children. Which family behavior
would be concerning to the nurse?
a. Each family member made supportive comments about each other.
b. Every Sunday the family attends religious services together.
c. Family members made humorous comments about their life together.
d. The family seemed to rather quickly determine priorities for action.
e. The family wanted the nurse to decide what they should do.
ANS: E
Traits of a healthy family include open communication, ability to establish priorities, being
supportive of each other, sharing a religious core, having a sense of humor, and knowing
when to seek help. However, healthy families also engage in decision-making and do not want
others to make decisions for them.
DIF: Cognitive Level: Apply (Application)
18. Which are examples of the internal structure of the family?
a. Ethnicity and race
b. Extended family members
c. Gender and rank order ofNbirth
URSINGTB.COM
d. Social class and religion
ANS: C
Internal structure of the family refers to such items as family composition, gender, rank order
(by age and sex), subsystems through which the family functions, and boundaries or who is in
and who is not in the family system. Extended family members are part of the external
structure.
DIF: Cognitive Level: Understand (Comprehension)
19. A man had been in an extended-care facility for 5 weeks and was now home. His wife tells the
nurse, “He’s trying to take up where he left off but we’ve adapted to not having him home. He
keeps thinking things will be just as they were when he left, but they aren’t.” Which would be
the most appropriate response by the nurse?
a. “Are the changes making him uncomfortable or are the rest of you
uncomfortable?”
b. “Do you want me to talk to him and try to explain?”
c. “How can we make things as they were before he left?”
d. “You all adapted to running the house without him; it will be challenging now to
adapt back.”
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Family functional assessment, or how family members behave toward one another, is divided
into two categories. The first is instrumental functioning, which refers to routine activities of
daily living. This area takes on important meaning for the family when one member of the
family becomes ill or disabled and changes were made. When the family member is better, the
family must again adapt to changes, even if the change is to return to the original mode of
functioning. It will help the family to be able to recognize the problem; labeling it makes it
more manageable.
DIF: Cognitive Level: Apply (Application)
20. Each evening, a newly disabled man becomes angry when his wife, just home from her new
full-time job, does not have dinner on the table at 6 PM. Which action would be most
appropriate for the nurse to take?
a. Allow the wife to express her frustration and anger to you
b. Explain to the husband that he is going to have to begin learning how to cook
c. Help all family members recognize that long-time roles are being changed and
change is uncomfortable for everyone
d. Suggest to the children who are old enough that they prepare some simple meals
during the week with the mother doing the fancy cooking only on weekends
ANS: C
Roles refer to established patterns of behavior for a family. It takes other family members to
keep a person in a particular role. Traditional roles are being challenged and are evolving with
economic changes. Formal roles may come into conflict with roles set by family members.
The husband has major life changes to which to adjust, as do all the other family members.
His anger is a symptom of the painfulness of major life changes. The nurse can help the
family members recognize the
in preparation
N problem
R I G
B.C M for addressing the issues.
U S N T
O
DIF: Cognitive Level: Apply (Application)
21. A mother says to the nurse, “I know I should be feeling an empty nest sadness now that our
youngest has left for college—but mainly I’m dying to turn his room into my craft room. Do
you think that’s normal for a mom? I really do love my kids.” Which would be the most
appropriate response by the nurse?
a. “Hmm, that is unusual. Would you like me to make an appointment with a
psychologist for you?”
b. “Maybe you’ve always wanted to be an artist and now you can, so enjoy the
feeling—and the room!”
c. “You’re probably trying to put a positive spin on the situation to keep feelings of
sadness at bay.”
d. “Very normal; you’ve launched your family and now you can devote attention to
your own life and preferences—such as crafts.”
e. “Would you like to talk about how you feel?”
ANS: D
To assess the family, the community health nurse must comprehend developmental phases
and the struggles that families experience while going through them. The mother is
recognizing the stage of launching family that occurs when the youngest child leaves home.
The development requirement of this stage of life includes establishment of independent
identities for parents—such as focusing on becoming a crafts person.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
22. A nurse asked a family if they’d work with her to create a family genogram. The mother
asked, “Why would you want to know so much about our family?” Which would be the most
appropriate response by the nurse?
a. “A genogram helps you see how some problems run in families. Your children will
need to know this.”
b. “If you’re willing to share, we can discuss family history and possibly some
hereditary health issues.”
c. “Please be assured you don’t have to answer any question you don’t want to
answer.”
d. “Why would you want to keep your family members secret? Is there some
problem?”
ANS: B
A genogram is an excellent opening to the discussion of family history and possible hereditary
health problems. It may also point to a need for health education. Some families may be
sensitive to the sharing of such information, but obviously any patient can answer with
however much or little he or she wishes to share.
DIF: Cognitive Level: Apply (Application)
23. A nurse asked of a family, “Could each of you tell me what you typically do during the
week?” Which would the nurse most likely say to follow up such an open-ended question?
a. “Could you tell me about what you do at your job?”
b. “Do you believe those choices are the best use of your free time?”
c. “How do you feel about those activities?”
NURlike
B.COM
SIto
NGdoTdifferently?”
d. “Is there anything you would
ANS: A
Both of these questions pertain to data collection for the family health tree. The family health
tree can be used in planning positive familial influences on risk factors such as diet, exercise,
coping with stress, or pressure to have a physical examination.
DIF: Cognitive Level: Apply (Application)
24. The nurse has started to complete a family health tree. Which question would be most helpful
as the nurse works with the family to promote their health?
a. “Can you tell me the cause of death of your older relatives back several
generations?”
b. “Do you know of any chronic health problems any of your relatives or their
spouses have had?”
c. “What concerns do you have about your family’s health?”
d. “What do your family members do to keep in shape and handle stress?”
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The family health tree is based on the genogram of the current generations—that is, parents,
their children, and their own parents. Spouses and past generations aren’t included. The
family health tree provides a mechanism for recording the family’s medical and health
histories. The nurse should note causes of death of deceased family members, genetically
linked diseases, and lifestyle-related risk factors (i.e., by asking what family members do to
“handle stress” and “keep in shape”). The family health tree can be used in planning positive
familial influences on risk factors such as diet, exercise, coping with stress, or pressure to
have a physical examination.
DIF: Cognitive Level: Apply (Application)
25. A nurse was creating an ecomap for a family, which consisted of a 3-year-old girl, an
8-year-old boy, and their mother. Which question would be useful for the nurse to ask?
a. “Are you involved with any groups or resources in the community?”
b. “Can you tell me about your extended family wherever they live?”
c. “Have you thought about what would happen if you needed help?”
d. “What were the causes of death for your older family members?”
ANS: A
The ecomap is another classic tool that is used to depict a family’s linkages to their
suprasystems. The nurse can note people, institutions, and agencies significant to the family
with some notations as to the nature of the ties that exist. Knowing what resources the family
is currently able to assess will help the nurse know what resources to suggest to the family.
DIF: Cognitive Level: Apply (Application)
26. A family agreed to bring all the children into the clinic at one time to begin to catch up on the
NU
RSdidn’t
INGT
B.C
OMappointment. Which conclusion by the
children’s immunizations, but
they
keep
their
nurse would be most accurate?
a. Obtaining immunizations might have been the nurse’s goal, not the family’s.
b. Some barrier or restraint interfered with the family’s ability to come.
c. The family had other, more important priorities.
d. The nurse didn’t adequately emphasize the importance of obtaining
immunizations.
ANS: B
Families most frequently served by the community health nurse are disadvantaged in that they
are unable to buy health care from the private sector. However, constraints to obtaining
needed health and social services are well documented and may come from characteristics of
health and social services rather than individual family limitations. The nurse should note
those constraints that prevent full use of the resource such as hours of service, distance and
transportation, availability of interpreters, and criteria for receiving services.
DIF: Cognitive Level: Apply (Application)
27. Which theoretical approach would be most useful to the nurse who wants to improve
patient-provider communication and address the gap between what providers discuss and what
families want to know about?
a. Ecological framework
b. Network therapy theory
c. The Kentucky Partnership model
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Transaction model
ANS: A
The ecological framework is a blend of systems and developmental theory with an
individual’s understanding of his or her environment. Kogan and others investigated
parent–health care provider discussions of family and community health risks during
well-child examinations, as well as the gaps in issues discussed by the practitioner and the
information the parent desired. The results indicate the need for better communication and
education between health care providers and clients.
DIF: Cognitive Level: Understand (Comprehension)
28. Which is an appropriate conclusion to draw from research based on network theory?
a. Nurses can help at-risk populations access or build support systems.
b. Problems in our health care system are worsened by specialization and
fragmentation.
c. Social class places limitations on access to health care.
d. The family is culturally anchored in American beliefs.
ANS: A
Network theory involves changing the network of families, be it extended family or friends,
who tend to maintain a dysfunctional status quo in the nuclear family. The nurse can help the
family replace or expand their network with other resources from the wider system that would
be able to provide more support and enhance family functioning.
DIF: Cognitive Level: Understand (Comprehension)
29. Which best describes an unexpected
the decrease
in funding to traditional public and
N R Iresult
G ofB.C
M
U S N T
O
private forms of health care?
a. Emergency departments where patients can’t be turned away are overwhelmed
with patients needing nonemergency care.
b. Grants are increasingly being requested to pay for care.
c. More people don’t receive needed health care in a timely manner.
d. Programs are developed as a result of community efforts.
ANS: D
Most of the choices are expected consequences of decreased funding. What is unexpected is
the increase in the number and type of models being created, as traditional public and private
models of health care decline because of funding and shrinking resources. The programs
develop in part as the result of community efforts.
DIF: Cognitive Level: Understand (Comprehension)
30. What has research suggested is a barrier to college students eating healthy?
a. Lack of access to an exercise facility
b. Lack of access to a primary care provider
c. Lack of knowledge of the benefits of healthy eating
d. Lack of knowledge related to food preparation
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Young adults, though identified as underinsured and having limited access to primary care,
are identified as a group knowledgeable about the benefits of healthy eating. This age group
(20 to 31) has been identified in numerous national surveys to not regularly engage in healthy
eating habits especially eating below the recommended daily servings of fruits and vegetables
and a diet high in fast foods. Earlier studies among college students identified the following
barriers: cost, stress, lack of knowledge related to food preparation, and peer influence and
lack of time to balance busy lives.
DIF: Cognitive Level: Remember (Knowledge)
MULTIPLE RESPONSE
1. Which factors make family nursing particularly challenging? (Select all that apply.)
a. The health care system primarily focuses on care of individuals.
b. Insurance reimbursement focuses on illness care and treatment of individuals.
c. Family members are not always consistent in what they tell the nurse.
d. More variables to be considered when completing an assessment
e. Number of chronic comorbidities
f. Theories related to working with families do not exist.
ANS: A, B
Families have challenging health care needs that are not usually addressed by the health care
system. Instead, the health care system most frequently addresses the individual. The text
describes frameworks for meeting family health needs: family theory, systems theory,
structural–functional conceptual framework, and developmental theory.
DIF: Cognitive Level: Understand
N R(Comprehension)
I G B.C
U S N T
OM
2. Which best describes why it is crucial that nurses who focus on the care of individual patients
also be able to work with families? (Select all that apply.)
a. Anytime a person is ill, his or her whole family is affected.
b. By understanding the family, understanding of the individual is improved.
c. Families often are very demanding if they feel their loved one isn’t receiving the
best care possible.
d. Individuals depend on their families for care and support.
e. Most important decisions are made by families as a whole, not individuals.
f. Risks caused by genetics or environment affect the whole family, not just the
individual.
ANS: A, B, D, F
Reasons that it is important for nurses to work with families include that the family is a
resource in giving care to its members and working together on health promotion and wellness
activities; any dysfunction (illness, injury, separation) that affects one family member will
affect the whole family; the nurse can often identify a health problem that involves risks for
the entire family. Finally, understanding the whole family helps the nurse understand and
provide more holistic care to the individual.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 21: Populations Affected by Disabilities
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which is an accurate definition of impairment?
a. A disadvantage resulting from a disability that prevents fulfillment of an expected
role
b. A restriction or inability to perform an activity in a normal manner
c. A problem in body function or structure
d. A defect that affects society on a macro level
ANS: C
Disability is an umbrella term describing impairments, activity limitations, and participation
restrictions. An impairment is a problem in bodily function or structure. A handicap is a
disadvantage resulting from an impairment or disability that prevents fulfillment of an
expected role. In a comparison of these concepts, an impairment affects a human organ on a
micro level; disability affects a person on an individual level; and a handicap involves society
on a macro level of analysis.
DIF: Cognitive Level: Remember (Knowledge)
2. Which problem depends on the responses of other people and therefore cannot be measured?
a. Disability
b. Handicap
c. Impairment
NURSINGTB.COM
d. Injury
ANS: B
In comparing these concepts, an impairment affects a human organ on a micro level; disability
affects a person on an individual level; and a handicap involves society on a macro level of
analysis. Table 21.1 points out that both impairment and disability may be objective and
measurable, whereas handicap is neither, because it is an experience related to the responses
of other people.
DIF: Cognitive Level: Understand (Comprehension)
3. Which statement regarding developmental disabilities is accurate?
a. Those with developmental disabilities exhibit limitations before 18 years of age.
b. Those with developmental disabilities see improvement in their functional ability
as they age.
c. Developmental disabilities are diagnosed before 1 year of age.
d. Developmental disabilities result in a physical handicap.
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Developmental disabilities encompass those conditions that are manifested by limitation
before the legal age of adulthood, which is 18. This includes issues that limit or present
challenges to the performance of activities of daily living (ADLs). Developmental disabilities
encompass those lifelong conditions that are chronic in nature and may incorporate either or
both intellectual and physical disabilities. Developmental disabilities can be diagnosed at any
point in time during childhood. A handicap is not a characteristic of a person, but rather a
description of the relationship between the person and the environment; a handicap results
when a person with an impairment cannot fulfill a normal life role in society on a macro level
of analysis.
DIF: Cognitive Level: Understand (Comprehension)
4. Which insight is being stressed by advocacy groups regarding persons with disabilities today?
a. Disability results when physical and social barriers in the environment prevent a
person from taking equal part in community life.
b. Handicapped persons have as much right to social support as nonhandicapped
persons.
c. It is recognized that an individual may be limited by an environmental barrier in
society.
d. Impairment is a result of society’s reaction more than mental or physical condition.
ANS: A
Nearly all definitions identify an individual as disabled on the basis of a physical or mental
impairment that limits the person’s ability to perform an important activity. The
complementary possibility—that the individual is limited by a barrier in society or the
environment—is never considered. Advocacy groups, such as the Committee on a National
Agenda for the Prevention ofNDisabilities,
RSINGTstress
B.Cthat
Menvironment and the reactions of others
U
O
are as crucial as the actual physical or mental limitation.
DIF: Cognitive Level: Understand (Comprehension)
5. Which concern can a nurse as a citizen help address?
a. Advocating for removal of environmental and social barriers to needed services
b. Continuing to engage in political action to increase funding for care for the
handicapped
c. Recognizing that it is better to offer to help than to wait for a person with
handicaps to have to ask for assistance
d. Needing to not stare or ask personal questions of a person with a disability
ANS: A
The Committee on a National Agenda for the Prevention of Disabilities model states disability
occurs when a person’s physical or mental limitations, in interaction with physical and social
barriers in the environment, prevent the person from taking equal part in the normal life of the
community. Confronting environmental and social barriers to needed services can frustrate
and exhaust many people with disabilities and their families. The nurse—as a citizen and a
concerned professional—can advocate for removal of such barriers. This issue is the most
important for the nurse to address, allowing the nurse to partner with clients and families
affected by disabilities to remedy barriers that negatively affect quality of life for this
population.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
6. A nurse is completing an assessment of a client who states that his chronic obstructive
pulmonary disease (COPD) has worsened, and he is no longer able to do his own grocery
shopping. Which stage of the NADP model is the client experiencing?
a. Pathology
b. Impairment
c. Functional limitation
d. Disability
ANS: D
The NAPD model provides an alternative framework for viewing four related and distinct
stages in the disabling process. Pathology at the cellular and tissue levels may produce
impairment in structure or function at the organ level. An individual with an impairment may
experience a functional limitation, which restricts their ability to perform an action within the
normal range. The functional limitation may result in a disability when certain socially
defined activities and roles cannot be performed. Although the model appears to indicate
unidirectional progression from pathology to impairment, to functional limitation, to
disability, stepwise or linear progression may not occur. Disability prevention efforts can limit
or reduce many of the risk factors or stages in the disabling process.
DIF: Cognitive Level: Apply (Application)
7. A young man rolled his wheelchair up the ramp into the clinic to the desk where the intake
nurse greeted him. After welcoming him to the clinic, which should be the initial question
asked by the nurse?
a. “Are you a vet home from the war?”
b. “Can I help you into the treatment room to see the nurse practitioner?”
NURSyou
INtoGhelp
TB.C
OM
c. “Do you have any family with
today?”
d. “What brings you to the clinic today?”
ANS: D
The client should be asked what is needed just as any other client would be. A veteran would
more probably be at a Veterans Affairs (VA) clinic, and there is nothing in the statement to
imply that the clinic is part of the VA medical system. Because the man made it into the
clinic, it is doubtful he would need help into the treatment room. Not all persons live with
families. The handicap may be unrelated to why he is at the clinic. He may be ill or merely
need immunization or other health promotion activity.
DIF: Cognitive Level: Analyze (Analysis)
8. A young woman rolled her wheelchair up the ramp into the clinic to the desk where the intake
nurse greeted her. Which should be the nurse’s first response?
a. “How can I help you?”
b. “Who came with you today?”
c. Compliment her on her skill with the wheelchair
d. Sit so the nurse is at wheelchair level with the young woman
ANS: D
Nurses who demonstrate understanding of the issues confronting people with disabilities
should approach them at wheelchair level, listening to understand. Moving to wheelchair level
should be the first action that the nurse takes before beginning a conversation with the client.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
9. Which best describes the proportion of the U.S. population that is made up of persons with a
long-lasting condition or disability?
a. The number is about 5% and increasing.
b. The number is about 10% and stable.
c. The proportion is about 15% and stable.
d. The proportion is almost 20% and increasing.
ANS: D
In 2012, approximately 18.7 of those aged 5 years and older had a long-lasting condition or
disability. As acquired age-related conditions occur during the lifespan, disability prevalence
and disability severity levels rise with aging. In the United States, there is a shifting
demographic of individuals living beyond the age of 65. Further, it is important for health care
policy makers and health care providers to recognize that the prevalence of disability is
increasing.
DIF: Cognitive Level: Remember (Knowledge)
10. Which best describes the prevalence of disabilities in U.S. children under age 15?
a. About 5%
b. About 10%
c. About 15%
d. About 20%
ANS: B
More than 8% of U.S. children
of 15 M
have some kind of disability and about
NUunder
RSIthe
Gage
B.C
N
T
O
half of them were classified as having severe disabilities.
DIF: Cognitive Level: Understand (Comprehension)
11. A nurse is caring for an individual with disabilities. Which would put this client at risk for the
fatal four?
a. A history of falls
b. Immobility
c. Anorexia
d. A history of constipation
ANS: D
The term fatal four refers to four common medical conditions that could result in
complications and fatality more frequently for the IDD population and other PWD. Nurses
and primary care providers should be knowledgeable about the fatal four, which includes (1)
constipation/bowel obstruction, (2) aspiration/gastroesophageal reflux disease (GERD), (3)
dehydration, and (4) seizures, as complications related to these conditions could result in
death if not assessed, diagnosed, and treated swiftly (Smith and Escude, 2015). The etiology
of the fatal four includes polypharmacy, improper positioning, obesity, and dysphagia.
DIF: Cognitive Level: Apply (Application)
12. Which describes the most important need of every school-aged child with a disability?
a. A teacher who understands the child’s needs
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. An advocate within the school system
c. An assessment with comparison with developmental milestones
d. An individualized education plan (IEP)
ANS: D
A child should have all of the above items, an advocate in the school nurse, a teacher who
understands, an assessment including comparison with developmental milestones, as all of
these are components of an IEP with goals, cooperatively developed with the parents, to help
the child succeed in school. The IEP describes the goals, as well as any special support needed
to help achieve them. The IEP is the most comprehensive answer.
DIF: Cognitive Level: Understand (Comprehension)
13. Which best describes the current perspective on how communities should treat persons with
disabilities (PWDs)?
a. Be supportive of PWDs and try to reduce environmental barriers
b. Maximize opportunities for PWDs to work and otherwise contribute to community
life
c. PWDs have civil rights just as other citizens do
d. Recognize that PWDs deserve our support both financially and otherwise
ANS: B
Contemporary disability policy minimizes this disadvantaged view and maximizes
opportunities for PWDs to live productively in their communities. Early American public
policy viewed PWDs as “deserving poor” who required governmental protection and
provision, with little capacity for self-support or independence.
DIF: Cognitive Level: Understand
NUR(Comprehension)
SINGTB.COM
14. A professional strongly encouraged institutionalization, so the parents could focus on care of
their other family members. Which suggestion would be appropriate for the nurse to make to
the parents?
a. As the expert pointed out, institutionalization will reduce family stress.
b. The child has a right to an education in the least-restrictive setting.
c. The child will eventually adapt to whatever choice the parents make.
d. The choice of what to do is entirely the parents’.
ANS: B
It is a given that it is the parents’ choice. As an advocate for the child, the nurse can explain
that children have a legal right to an appropriate public education based on the child’s needs
in the least-restrictive setting. This right is based on the Individuals with Disabilities Act
(IDEA).
DIF: Cognitive Level: Apply (Application)
15. A man came for follow-up care to the free clinic, explaining that he had applied for a job
based on his education and years of previous work experience, but, being in a wheelchair, he
was turned down. Which response would be most appropriate for the nurse?
a. “If you know you can do the job, go to the free legal aid clinic for assistance. The
employer may not know the law.”
b. “No one would want to hire a handicapped person, so you can continue to come
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
here for free care.”
c. “Because it can be expensive to obtain the necessary equipment to help you do that
job, the employer has every right to refuse to hire you.”
d. “The law says, if a handicapped person applies, he or she has to get hired even if
an able-bodied person also applies.”
ANS: A
The Americans with Disabilities Act (ADA) became law in 1990. This landmark civil
rights-styled legislation prohibits discrimination toward people with disabilities in everyday
activities by guaranteeing equal opportunities for people with disabilities related to
employment, transportation, public accommodations, public services, and
telecommunications. A qualified individual with a disability must meet legitimate skill,
experience, education, or other requirements of an employment position. The person must be
able to perform the essential functions of the job, such as those contained within a job
description, with or without reasonable accommodations.
DIF: Cognitive Level: Apply (Application)
16. Which problem was the Ticket to Work and Work Incentives Improvement Act (TWWIIA)
designed to address?
a. Employers trying to avoid hiring persons with disabilities
b. Employers resenting being forced to hire persons with disabilities
c. Persons with disabilities not being able to receive on-the-job training
d. Persons with disabilities not seeking employment for fear of losing their health
care and other governmental supports
ANS: D
NURScould
INGqualify
Typically, people with disabilities
TB.Cfor
OMsuch benefits as health care, income
assistance programs, and personal care attendant services only if they chose not to work. To
address employment and benefit issues for persons with disabilities, in December 1999, the
TWWIIA was signed into law. The TWWIIA reduced people with disabilities’ disincentives
to work by increasing access to vocational services and provided new methods for retaining
health insurance after returning to work.
DIF: Cognitive Level: Understand (Comprehension)
17. Which statement about Supplemental Security Income (SSI) and Social Security Disability
Insurance (SSDI) is correct?
a. SSI is funded through disability trust fund monies.
b. To qualify for SSDI, the person with disabilities must have limited income and
resources.
c. SSDI recipients receive Medicaid health benefits.
d. Persons with disabilities who receive SSI may receive a state supplement.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
SSI is funded through general tax revenues, whereas SSDI is funded through disability trust
fund monies (Social Security taxes paid by workers, employers, and self-employed workers).
To qualify for SSDI, the person with disabilities must be “insured” through Federal Insurance
Contributions Act (FICA) earnings of self, parents, and/or spouse, and to qualify for SSI, the
person with disabilities must have limited income and resources. SSDI recipients receive
Medicare health benefits, and SSI recipients receive Medicaid health benefits. Some states
may elect to pay a state supplement to some persons with disabilities in SSI programs,
whereas in SSDI programs persons with disabilities are never provided with state
supplements.
DIF: Cognitive Level: Understand (Comprehension)
18. Which best describes the prevalence of autism in the United States?
a. The prevalence of autism has increased in the past decade.
b. The prevalence of autism has decreased in the past decade.
c. The prevalence of autism has remained stable in the past decade.
d. Because the etiology is unknown, it is difficult to determine the prevalence of
autism.
ANS: A
It has been estimated that about 1 in 88 children (or slightly more than 1.1%) have autism.
Alarmingly, between 2000 and 2010, autism’s prevalence increased 119%, with estimates at 1
in 68 births. Autism has no known etiology, but more frequently occurs among older parents.
DIF: Cognitive Level: Understand (Comprehension)
19. A nurse came limping into work with a huge cast on her right leg and asked to have an
IN
GTrequire
B.COdriving.
M
URS
assignment for a week or twoNthat
did
not
The nurse said, “I never realized
how difficult it is to get some places without two good legs. Now I know how persons with
disabilities must feel!” Which would be the most appropriate response from the nursing
supervisor?
a. “I’m sure you’ll be even more understanding and supportive now.”
b. “Not really; you’ll be out of that cast in a few weeks.”
c. “What a great opportunity to attend some support groups for people with
disabilities and share with us which ones are most helpful.”
d. “Why don’t you just take some sick leave rather than try to work with that leg
cast?”
ANS: B
Those who have a temporary disability have a very different experience than those who are
permanently disabled. Although they may experience frustrations, they view it as a temporary
problem and a temporary setback. The other responses address this temporary disability as if it
is similar to a permanent disability, which it clearly is not.
DIF: Cognitive Level: Apply (Application)
20. A mother has recently learned that her infant has been diagnosed with spina bifida. Which
nutrient was lacking during gestation?
a. Calcium
b. Vitamin K
c. Folic acid
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Vitamin D
ANS: C
SB occurs when there is failure of the neural tube to close during the 28 day of gestation. SB
is associated with deficits in motor, sensory, and physical differences that may be largely
prevented with proper folic acid intake during gestation. Adequate folic acid supplementation
is important for prevention of neural tube development.
DIF: Cognitive Level: Apply (Application)
21. A nurse eagerly explained to a long-term disabled male client the most recent relevant
research related to his care. The client, rather than express appreciation, said, “I prefer to have
my care given this way.” The nurse explained that research suggested an alternative approach
was more clinically effective, but the client said, “I am more comfortable during the day if my
care is given this way.” Which action should be taken by the nurse?
a. Accept that the client knows what works best
b. Ask the nursing supervisor to review the research with the client
c. Give evidence-based care according to current research findings
d. Negotiate a compromise between patient preferences and research-based approach
to care
ANS: A
A person who lives with a disability commonly becomes an expert at knowing what works
best for his or her body. The nurse must ask the client what works best for him or her and
what goals the client is pursuing. Research is based on probabilities of effectiveness with large
groups, but individuals may have a different unique reaction to any intervention.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
22. Which best describes why some advocacy groups have taken a strong stand against
physician-assisted suicide?
a. Ethical belief that life is always preferable to death
b. Emphasis that there is always hope for a research breakthrough or discovery of a
new treatment intervention
c. Fear that some persons may be “encouraged” to accept an early death merely
because they are not valued by society for their contributions
d. Helping someone die is murder, plain, and simple
ANS: C
Because people have previously been killed because they had a disability, some advocacy
groups, such as Not Dead Yet, have taken a strong stance against physician-assisted suicide,
fearing it will lead to the early or forced death of people with disability. Ethical and personal
beliefs and emphasizing the hope for a new treatment have not been stands taken by advocacy
groups against physician-assisted suicide.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. A nurse is caring for an individual with intellectual and developmental disabilities (IDD).
Which findings would be most concerning to the nurse? (Select all that apply.)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
e.
f.
Poor skin turgor
Decreased appetite
Increased urination
No bowel movement for the past 3 days
Symptoms of choking after taking a sip of water
Recent seizure
ANS: A, D, E, F
The term fatal four refers to four common medical conditions that could result in
complications and fatality more frequently for the IDD population and other PWD. Nurses
and primary care providers should be knowledgeable about the fatal four, which includes (1)
constipation/bowel obstruction—as evidenced by no bowel movement for the past 3 days, (2)
aspiration/gastroesophageal reflux disease (GERD)—as evidenced by choking on a sip of
water, (3) dehydration—as evidenced by poor skin turgor, and (4) seizures—as complications
related to these conditions could result in death if not assessed, diagnosed, and treated swiftly
(Smith and Escude, 2015).
DIF: Cognitive Level: Analyze (Analysis)
2. Which are strategies the nurse should practice to provide effective care for persons with
disabilities? (Select all that apply.)
a. Apologize for slips of the tongue such as saying “Do you see?” to a blind person.
b. Don’t assume the client has a physical or cognitive deficit until you have validated
it.
c. Allocate additional time for care.
d. Take hold of a blind person’s arm to assist them in dangerous situations, such as
crossing a busy street. N R I G B.C M
U S Nfindings
T related
O to the person’s disability.
e. Volunteer the most recent research
f. Adopt the client’s perspective as to what works best without bias.
ANS: B, C, F
The acronym developed that spells ADVOCATE can help remind and guide the nurse of
essential principles that are integral to the care of PWD. A—Advocate, D—Deficits,
V—Vocation, O—Outcomes, C—Communicate, A—Assess, T—Transition, E—Empower.
Effective strategies include not making assumptions about deficits before they have been
validated; allocating additional time for care as necessary; adopting the client’s perspective as
to what works best without bias. Ineffective strategies include apologizing for errors, offering
expert opinions or advise, and grabbing the arm of a person who is blind.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 22: Veterans Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which person meets the legal definition of a veteran?
a. A 32-year-old male who has been dishonorably discharged from the Army
b. A 50-year-old female who retired from the Navy
c. A 65-year-old male who served in the National Guard
d. A 22-year-old female who is currently serving in the Air Force
ANS: B
Legally, a veteran is an individual who has served in the active military, naval, or air service
and who was discharged or released under conditions other than dishonorable. Any individual
who completed service for any branch of armed forces is a veteran as long as they were not
dishonorably discharged. Personnel serving in the National Guard are considered to be
part-time employees and not active duty, full-time personnel.
DIF: Cognitive Level: Understand (Comprehension)
2. Which is the largest branch of the U.S. military?
a. Navy
b. Marine Corps
c. Coast Guard
d. Army
ANS: D
NURSINGTB.COM
The U.S. Army is the largest branch of the military, making up 39% of all military personnel.
Other branches of the service include the Air Force, the Navy, the Marine Corps, and the
Coast Guard.
DIF: Cognitive Level: Remember (Knowledge)
3. A client is describing the time period that he served in the National Guard. Which statement
would he be most likely to make?
a. “I completed monthly drills and 2-week annual trainings.”
b. “I achieved the rank of officer and was promoted to the U.S. Army.”
c. “I served overseas based on decisions made by the federal government.”
d. “I selected Japan as my destination for my overseas tour of duty.”
ANS: A
Personnel serving in the National Guard or Reserves are considered part-time employees. The
key difference among them is that the Reserves report to the federal government, whereas the
National Guard is administered by each state (e.g., the Pennsylvania National Guard is called
into action by the governor of Pennsylvania). These individuals serve no more than 39 days a
year, unless called into action. Usually, their service consists of monthly drills and 2-week
annual trainings. Reservists may be called very suddenly to active duty (full-time) for
deployments, requiring that they leave their family, regular job, and community for a time.
The National Guard and Army are two separate entities—promotion does not change the
military that is being served.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
4. A veteran is receiving veteran’s health care benefits. Which department directly coordinates
these benefits?
a. Veterans Benefits Administration (VBA)
b. Veterans Health Administration (VHA)
c. U.S. Department of Veterans Affairs (VA)
d. Civilian Health and Medical Program of the Department of Veteran’s Affairs
(CHAMPVA)
ANS: B
The Department of Veterans Affairs has three subdivisions: the VHA, the Veterans Benefits
Administration (VBA), and the National Cemetery Administration. The VHA provides all
types of health care in every setting, including inpatient, outpatient, and long-term care. The
VBA is an administrative arm responsible for unemployment and pension payments, home
loans, vocational training, and educational benefits. The Civilian Health and Medical Program
of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some
health care services for eligible civilian beneficiaries are covered by the VA.
DIF: Cognitive Level: Apply (Application)
5. A nurse is interviewing a client to determine if she is eligible for VA benefits. Which question
would assist the nurse in determining the requirement of service?
a. “Did you serve active duty for 24 consecutive months?”
b. “Which branch of the military service did you serve?”
c. “Were you dishonorably discharged?”
NUR
d. “How long has it been since
SIleft
NGthe
TB.C
OM
you
military?”
ANS: A
Veterans—and sometimes their survivors and dependents—are eligible for VA benefits when
they fulfill two requirements related to service and separation. (1) Service: they must have
served in active duty for 24 consecutive months or for a full period of call (Reserves and
Guard). There are some exceptions to the length of service minimum, the most important
being when a person is discharged for disability incurred or aggravated in the line of duty. (2)
Separation: they must have been separated under any condition other than dishonorable.
DIF: Cognitive Level: Apply (Application)
6. A client reports hearing loss and tinnitus following military duty in the Gulf War. Which term
would best describe this client’s injury?
a. Posttraumatic stress disorder
b. Polytrauma
c. Traumatic brain injury
d. Service-connected disability
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
A service-connected disability is a disease or injury that was incurred as a result of or during
the veteran’s active duty, or one that was aggravated by military service. Posttraumatic stress
disorder is a mental illness that develops in some individuals who have experienced a
shocking, frightening, or dangerous event. A traumatic brain injury is a disruption of brain
function caused by an external mechanical force, including blunt force trauma, penetration by
a foreign object, acceleration or deceleration movements, and pressure waves from explosive
blasts. The term polytrauma refers to two or more injuries sustained in the same incident,
affecting multiple body parts or organ systems, and resulting in various kinds of impairments
and functional disabilities. Polytrauma is often the result of a blast-related event and
frequently includes TBI.
DIF: Cognitive Level: Apply (Application)
7. A veteran tells the nurse that he hates the VA health insurance program and wishes that he
would be allowed to see the local doctor instead of traveling to the VA clinic. Which
statement would be most appropriate to be made by the nurse?
a. “I will check to see if your local doctor can be added to the list of approved
providers.”
b. “Yes, you pay premiums for this health insurance and should be able to have a
choose what providers you see.”
c. “The VA does not provide health insurance, rather this is a benefit that you receive
for compensation for your service to our country.”
d. “The VA provides different benefit plans. Let me see if the local doctor is a
provider on a different benefit plan.”
ANS: C
Many veterans do not realizeNthatRtheir
at their M
VA hospitals and clinics is not a type of
INcare
GTB.C
U
S
O
health insurance. Instead, it is a benefit that they receive in compensation for their duty and
service to the country. The difference between health insurance and VA health benefits is
twofold. First, veterans do not have to “pay into” their VA benefits the way one would pay
premiums for a health insurance plan. Second, the “coverage” received in the form of VA
benefits is not transferable to other non-VA providers, except through formal contracts
deemed appropriate by the VA and its providers.
DIF: Cognitive Level: Apply (Application)
8. A veteran has been diagnosed with an immersion foot injury. Which finding should the nurse
anticipate when completing an assessment on the client?
a. A foot that is deformed
b. A foot that is unable to tolerate immersion in water
c. A foot that the client is unable to bear weight on
d. A foot that has occasional numbness
ANS: D
The major cold injuries veterans suffer include frostbite, nonfreezing cold tissue damage,
immersion foot (formerly called trench foot), and hypothermia. Cold injuries may result in
long-term health problems, including the following signs and symptoms (at the site of
exposure): changes in muscle, skin, nails, ligaments, and bones; skin cancer in frostbite scars;
neurological injury with symptoms such as bouts of pain in the extremities, hot or cold
tingling sensations, and numbness; vascular injury with Raynaud phenomenon with symptoms
such as extremities becoming painful and white or discolored when cold.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
9. A veteran has recently been diagnosed with posttraumatic stress disorder (PTSD). Which
information obtained from the client during a health history would align with this diagnosis?
a. The client reports that he has a history of hypertension and hyperlipidemia.
b. The client states that he served as a sniper during the Gulf War.
c. The client states that he was stationed in Japan.
d. The client reports that his wife has a substance abuse problem.
ANS: B
PTSD is a mental illness that develops in some individuals who have experienced a shocking,
frightening, or dangerous event. Factors that contribute to an individual developing PTSD
include getting injured or seeing another person injured, viewing a dead body, feeling
helpless, having little or no social support after a traumatic event, dealing with extra stress
after the event (e.g., loss of a loved one, pain and injury), or having a history of mental illness
or substance abuse.
DIF: Cognitive Level: Apply (Application)
10. Which statement about military sexual trauma (MST) is accurate?
a. MST is more common among male veterans.
b. The majority of women who report MST state the perpetrator was an intimate
partner.
c. An Army veteran is at greatest risk to report MST.
d. Insomnia is more severe among veterans who report a history of MST.
ANS: D
NURSINGTB.COM
MST is more common among women veterans, with 32.4% reporting MST compared with
4.6% of their male counterparts (Klingensmith et al, 2014). It is estimated that in one of seven
women who report MST, the trauma was perpetrated by an intimate partner (Mercado et al,
2015). Insomnia is more common and more severe among veterans who report a history of
MST (Jenkins et al, 2015). One of the risk factors/characteristics of veterans experiencing
MST is being a Navy veteran, not Army.
DIF: Cognitive Level: Understand (Comprehension)
11. A nurse is caring for a veteran who has suffered a polytraumatic injury. Which would be the
primary consideration for the nurse when working with this client?
a. Use of an assistive device for ambulation may be necessary.
b. Diagnosis of posttraumatic stress disorder will be likely.
c. Physical and cognitive abilities to complete ADLs independently may be lacking.
d. A psychiatric referral will be needed.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The term polytrauma refers to two or more injuries sustained in the same incident, affecting
multiple body parts or organ systems, and resulting in various kinds of impairments and
functional disabilities. Polytrauma is often the result of a blast-related event, and frequently
includes TBI. For example, a soldier who has lost a limb, suffered a TBI, and lost his eyesight
from a rocket-propelled grenade attack is said to have a polytraumatic injury. Care for
veterans with these injuries is especially complicated because of the presence of several
overlapping physical and cognitive impairments affecting their ability to perform ADLs. The
primary consideration would relate to the client’s impairments in completing ADLs.
DIF: Cognitive Level: Analyze (Analysis)
12. Which is the most prevalent type of substance use problem among male and female veterans?
a. Binge drinking
b. Overuse of prescription drugs
c. Marijuana use
d. Use of smokeless tobacco
ANS: A
Binge drinking and cigarette smoking are the most prevalent types of substance use problems
among male and female veterans, affecting about 11% of the veteran population, with
disorders more common among males younger than 25 years of age. Substance use disorders
(SUDs) involve a pattern of use of alcohol, tobacco, and illegal and prescription drugs that
results in marked distress and/or impairment (American Psychiatric Association [APA],
2013).
DIF: Cognitive Level: Remember (Knowledge)
NUwho
RSserved
INGTinB.C
OM Which exposure is the client most
13. A nurse is caring for a veteran
Vietnam.
likely to report?
a. Agent Orange
b. Chromium
c. Mustard gas
d. Burn pits
ANS: A
Vietnam veterans suffer health disorders related to exposure to Agent Orange—an herbicide
used to kill the vegetation that provided cover for the enemy. Gulf War and GWOT veterans
were exposed to a number of health threats in the desert, including chromium, burn pits, and
heat stroke or heat exhaustion. WWII veterans who were in the Battle of the Bulge, fought in
December 1944 through January 1945, were exposed to extreme cold and may have sustained
cold injuries. Some volunteers were exposed to mustard gas experiments, in which the DoD
evaluated equipment for their protection against mustard gas attacks. About 4000 soldiers
were subjected to severe, full-body exposures during testing.
DIF: Cognitive Level: Apply (Application)
14. A veteran has been diagnosed with chronic multisymptom illness. Which would most likely
be part of the client’s health history?
a. History of active duty service during the Vietnam War
b. Unexplained cognitive dysfunction
c. History of severe hypertension
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Frequent episodes of dysuria
ANS: B
Approximately 250,000 veterans of the 1991 Gulf War (about 25% to 32%) returned home
with multiple varied, unexplained symptoms, including fatigue, dizziness, headaches,
cognitive dysfunction, musculoskeletal pain, respiratory problems, rashes, and diarrhea.
Popular media of the time referred to the disorder as Gulf War Syndrome or Gulf War Illness,
although today the VHA refers to this cluster of symptoms as chronic multisymptom illness
(CMI).
DIF: Cognitive Level: Apply (Application)
15. Which veteran is most likely to experience homelessness?
a. A 40-year-old single female
b. A recently divorced 25-year-old male
c. A recently divorced 30-year-old female
d. A 35-year-old single male
ANS: D
The majority of homeless veterans are single males between the ages of 31 and 50. Only 9%
of homeless veterans are females. Marital status is not reported as one of the risk factors that
relate to incidence of homelessness.
DIF: Cognitive Level: Understand (Comprehension)
16. A nurse is assessing a female veteran for military sexual trauma (MST). Which would be the
most appropriate question for the nurse to ask?
a. During your military service,
NURwere
INyou
GTever
B.Craped?
S
OM
b. Did anyone ever use force or threat of force to have sexual contact with you
against your will?
c. Can you describe any incidents of sexual harassment that you have been involved
in?
d. How long did you serve in the military?
ANS: B
Because of stigma and shame, many veterans will not volunteer information regarding sexual
trauma exposure. When screening for history of MST, it is best to avoid words that are
emotionally or politically loaded (e.g., “rape”) or words that are poorly defined (e.g., “sexual
harassment”). Nonjudgmental, descriptive general questions are recommended, such as: Did
anyone ever use force or threat of force to have sexual contact with you against your will?
DIF: Cognitive Level: Apply (Application)
17. A veteran is receiving treatment for posttraumatic stress disorder (PTSD). As part of the
therapy, the veteran identifies negative thoughts and emotions while focusing on specific
sounds and movements. Which trauma-focused therapy is the client receiving?
a. Cognitive processing therapy
b. Prolonged exposure therapy
c. Eye movement desensitization and reprocessing
d. Cognitive behavioral therapy
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
There are variations of trauma-focused therapies. These include (1) prolonged exposure
therapy (where the individual is repeatedly questioned by the therapist about the trauma to
encourage control of the thoughts and feelings to reduce fear of the memories); (2) cognitive
processing therapy, which involves talking with the therapist about the negative thoughts and
beliefs and development of strategies to manage the recollection of the trauma in a way that is
less upsetting; and (3) eye movement desensitization and reprocessing, which involves
identification of the negative thoughts, emotions, and feelings while focusing on specific
sounds or movements, helping the brain work through the traumatic memories. Friedman
noted that the most successful interventions include cognitive-behavioral therapy and
medication (e.g., selective serotonin reuptake inhibitors such as sertraline [Zoloft] and
paroxetine [Paxil]).
DIF: Cognitive Level: Apply (Application)
18. Which best describes the role of the suicide prevention coordinator (SPC) at the VHA center?
a. Serve as a hotline responder for the National Veterans Crisis Line
b. Create a suicide prevention safety plan for the client
c. Provide counseling for suicidal veterans
d. Assist veterans to access timely mental health care
ANS: D
A suicide prevention coordinator (SPC) works at every VHA center. The SPC’s primary role
is to help veterans access timely mental health care, particularly in times of crises, and to
assist health care treatment teams with managing the care of suicidal veterans. SPC’s maintain
weekly contact with the veteran and ensure that the veteran’s treatment team works with him
or her to develop a suicide prevention safety plan that helps the veteran cope with suicidal
ideation. The National Veterans
Crisis
provides
NUR
INLine
GTB.C
M veterans with immediate access to
S
O
mental health crisis intervention and support 24 hours a day/7 days a week. Hotline
responders are not SPC’s, instead they are trained in suicide prevention and crisis intervention
and assist callers by initiating dispatch of emergency services to callers in imminent suicidal
crisis and refer veterans to VA suicide prevention coordinators to ensure that veterans are
connected to local mental health care.
DIF: Cognitive Level: Understand (Comprehension)
19. A veteran has received special training to provide recovery-oriented support to other veterans
within the VHA health system. Which role will the veteran most likely fulfill?
a. Peer counselor
b. Suicide hotline responder
c. Suicide prevention coordinator
d. Peer support specialist
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Peer support specialists are veterans who have been trained to provide recovery-oriented
support and outreach that encourages other veterans to utilize VHA health services,
particularly mental health, to assist with their recovery. The suicide prevention coordinator’s
primary role is to help veterans access timely mental health care, particularly in times of
crises, and to assist health care treatment teams with managing the care of suicidal veterans.
Hotline responders are trained in suicide prevention and crisis intervention and assist callers
by initiating dispatch of emergency services to callers in imminent suicidal crisis and refer
veterans to VA suicide prevention coordinators to ensure that veterans are connected to local
mental health care.
DIF: Cognitive Level: Apply (Application)
20. A clinic nurse is completing a patient intake interview with a noncommissioned veteran who
has recently transitioned to civilian life. Which would be the most appropriate for the nurse to
ask to assess how the veteran is transitioning from military to civilian life?
a. Have you been able to use your military experience to find a civilian job?
b. Have you been able to find a leadership position in a local company?
c. What hobbies have you been able to enjoy since leaving the military?
d. What support have you recently received from the Veterans Benefits
Administration?
ANS: A
Veterans who were noncommissioned are typically high school graduates who often held
nonleadership positions. They are more likely to experience a negative transition, as they may
lack the guidance, experience, and knowledge needed to prepare for separating from the
military. Some veterans can transition to a civilian job similar or identical to their military job;
however, this is not true for all
Veterans
continue to have difficulty
NUservice
RSINmembers.
GTB.CO
M
translating their job experience, qualifications, and training to the civilian job market. The
Veterans Benefits Administration (VBA) is an administrative arm responsible for
unemployment and pension payments, home loans, vocational training, and educational
benefits.
DIF: Cognitive Level: Analyze (Analysis)
MULTIPLE RESPONSE
1. Which best describes the military culture? (Select all that apply.)
a. A strong sense of service
b. Altruism
c. Egalitarianism
d. A hierarchal class system
e. Problem-focused actions
f. Solutions-focused actions
ANS: A, D, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Military culture is one of structure and uniformity; it is governed by rules and standards.
Though each branch of the military has a different mission, common core values and norms
direct the behavior of all military members. These values include leadership, teamwork,
loyalty, hierarchy, obedience, and discipline. Common norms among military personnel are a
strong sense of service, a hierarchal class system, solutions-focused actions, unique dialogue
and expressions, and a reluctance to show weakness.
DIF: Cognitive Level: Remember (Knowledge)
2. A spouse of a veteran inquires as to if he will qualify for the Civilian Health and Medical
Program of the Department of Veteran’s Affairs (CHAMPVA). Which describes what criteria
will need to be met? (Select all that apply.)
a. The veteran has been rated permanently and totally disabled for a
service-connected disability by a VA regional office
b. The spouse is a survivor of a veteran who died from a VA-rated service-connected
disability
c. The veteran has been diagnosed with PTSD by a VA regional office
d. The spouse is a survivor of a veteran who died in the line of duty
e. The spouse has been diagnosed with a terminal illness
f. The veteran has been diagnosed with a terminal illness
ANS: A, B, D
The Civilian Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA) is a program in which the costs of some health care services for eligible civilian
beneficiaries are covered by the VA. According to Benefits.gov (2017), to be eligible for
CHAMPVA benefits and services, individuals must be in one of these categories: the spouse
or child of a veteran who hasNbeen
RSrated
INGpermanently
B.COM and totally disabled for a
U
T
service-connected disability by a VA regional office; the surviving spouse or child of a
veteran who died from a VA-rated service-connected disability; the surviving spouse or child
of a veteran who was at the time of death rated permanently and totally disabled from a
service-connected disability; the surviving spouse or child of a military member who died in
the line of duty, not because of misconduct (in most of these cases, these family members are
eligible for TRICARE, not CHAMPVA).
DIF: Cognitive Level: Apply (Application)
3. A veteran has been diagnosed with a mild traumatic brain injury (mTBI). Which symptoms
would most likely be reported to the nurse? (Select all that apply.)
a. Diarrhea
b. Headaches
c. Appetite loss
d. Dizziness
e. Increased thirst
f. Memory problems
ANS: B, D, F
Symptoms of mTBIs can include headaches, tinnitus, sleep disorders, irritability, memory
problems, mood and anxiety disorders, suicidality, chronic pain, and dizziness or balance
problems (Johnson et al., 2013).
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. A veteran reports to the nurse that she believes that she may be suffering from PTSD. Which
would the nurse anticipate the client experiencing during the past month? (Select all that
apply.)
a. Restless leg syndrome
b. Difficulty sleeping
c. Death of a parent
d. Heightened awareness of her surroundings
e. Negative feelings about oneself
f. Avoiding communication with others from her troop
ANS: B, E, F
To be diagnosed with PTSD, an individual must have experienced a “stressor criterion,”
which means that the person has been exposed to an event that is considered traumatic
(Friedman, 2016). In addition, an adult must experience all of these symptoms for at least a
month: at least one reexperiencing symptom (e.g., flashbacks, bad dreams, frightening
thoughts); at least one avoidance symptom (e.g., staying away from places, events, or objects
that are reminders of the experience; avoiding thoughts or feelings related to the event); at
least two arousal and reactivity symptoms (e.g., being easily startled, feeling tense or on edge,
difficulty sleeping, angry outbursts); at least two cognition and mood symptoms (e.g., trouble
remembering key features of the event, negative thoughts about oneself or the world, distorted
feelings of guilt or blame, loss of interest in enjoyable activities) (NIMH, 2017).
DIF: Cognitive Level: Apply (Application)
5. Which statements about veteran suicide are accurate? (Select all that apply.)
a. Veteran suicides most likely occur from prescription drug overdose.
Neach
RSday
ING
TB.C
OM
b. An average of 50 veterans U
die
by suicide.
c. The suicide rate of veterans is higher than that of the general population.
d. The majority of veterans who die from suicide are age 50 or older.
e. The age group that has the highest suicide rate among female veterans is age 18 to
29 years old.
f. The age group that has the highest suicide rate among male veterans is age over
age 50.
ANS: C, D, E
Among male veterans, suicide rates were highest in the 18 to 29 and 75 and older age groups,
whereas suicide rates for females were highest in the 18 to 29 age group. An average of 20
veterans died by suicide each day. Veterans accounted for 18% of all deaths by suicide among
U.S. adults although veterans only account for 8.5% of the U.S. population. Risk for suicide
was 21% higher among veterans compared with U.S. civilian adults after adjusting for
differences in age and gender. Approximately 67% of all veteran suicides resulted from
firearm injuries. Approximately 65% of all veterans who died by suicide were age 50 or older.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 23: Homeless Populations
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A family will most likely lose their primary nighttime residence within the next week. Which
term best describes their situation in relation to homelessness?
a. Homeless under other federal statutes
b. Literally homeless
c. Imminent risk of homelessness
d. Fleeing/attempting to flee intimate partner violence
ANS: C
The U.S. Department of Housing and Urban Development has issued regulations that
summarized the statutory definitions in four descriptive categories. These four categories with
their respective definitions include: Literally homeless: Individuals and families who lack a
fixed, regular, and adequate nighttime residence, including a subset for individuals who
resided in an emergency shelter or a place not meant for human habitation and who are exiting
an institution where he or she temporarily resided; Imminent risk of homeless: Individuals and
families who will imminently lose their primary nighttime residence; Homeless under other
federal statutes: Unaccompanied youth and families with children and youth who are defined
as homeless under other federal statutes who do not otherwise qualify as homeless under this
definition; and Fleeing/attempting to flee DV: Individuals and families who are fleeing or are
attempting to flee, DV, dating violence, sexual assault, stalking, or other dangerous or
life-threatening conditions that relate to violence against the individual or a family member.
N R I G B.COM
U (Knowledge)
S N T
DIF: Cognitive Level: Remember
2. Which best describes the recent trends in homelessness?
a. The number of homeless individuals in school is decreasing.
b. The number of homeless individuals is increasing.
c. The number of homeless families is increasing.
d. The number of homeless families is decreasing.
ANS: D
The U.S. Department of Housing and Urban Development reported the following numbers of
people in the total population and subpopulations who used shelters or transitional housing
between October 1, 2015 and September 30, 2016: 355,212 individuals, a decrease of less
than 1% between 2015 and 2016; 194,716 people in families with children, a decrease of 5%
between 2015 and 2016.
DIF: Cognitive Level: Understand (Comprehension)
3. On the basis of all the work done by social scientists, approximately how many homeless
persons should be expected and tolerated in our society?
a. No more than 5%
b. No more than 10%
c. No more than 15%
d. There should not be homeless persons in America.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
Kozol (1988) argued: “We would be wise to avoid the numbers game. Any search for the
‘right number’ carries the assumption that we may at last arrived at an acceptable number.
There is no acceptable number. Whether the number is 1 million or 4 million, there are too
many homeless people in America.”
DIF: Cognitive Level: Remember (Knowledge)
4. Which represents the largest group of homeless adults?
a. Minorities
b. Disabled
c. Females
d. Males
ANS: D
Among all sheltered homeless adults in 2015, approximately 62.1% were men; 37.9% were
women. The sheltered homeless population is younger than the general population. Most
homeless adults were between 31 and 50 years of age; 22.3% were less than 18 years of age;
and 4% were older than 62. In the general population, 18% were over age of 62. Minorities
comprised 61.9% of the total sheltered population. Adults with disabilities were over three
times more likely to be experiencing sheltered homelessness than adults without disabilities.
DIF: Cognitive Level: Remember (Knowledge)
5. Which best describes the problem with the Section 8 housing program?
a. Direct access to an apartment in a public housing facility is faster and easier.
b. Most renters prefer the program to make direct payment to apartment owners
willing to rent to them. NURSINGTB.COM
c. Section 8 housing is essentially slum housing, and no one wants to live there.
d. Supply is vastly less than the demand.
ANS: D
Although these programs are intended to alleviate housing problems for low-income renters,
the demand for these assisted housing programs has far exceeded the supply. Section 8
housing does not provide direct access to an apartment in a public housing facility or provide
payment directly from the program to apartment owners. Section 8 housing provides
affordable housing through the U.S. Department of Housing and Urban Development and is
not slum housing.
DIF: Cognitive Level: Understand (Comprehension)
6. Which best describes what happens when persons who work full-time and receive the typical
minimum wage seek an apartment?
a. Few clean and decent low-rent apartments exist.
b. People do not like to rent to low-income persons.
c. To afford housing, they need a job that pays at least three times minimum wage.
d. There are not many trailer parks near their employment.
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
An increasing number of low income people end up paying much more than they can afford
for rent. Since 2007, the number of renters who pay more than half of their income for rent
has increased dramatically.
DIF: Cognitive Level: Understand (Comprehension)
7. Which factor would prevent a homeless person from accepting employment adequate to pay
for housing?
a. Could not complete an employment application because of lack of mailing address
b. Hope for a better position than the service positions available
c. Lack of adequate resources to pay for other necessities
d. Prefer to receive a handout than to have to work
ANS: C
There are homeless people who are able to function in the workforce. The lack of affordable
housing in combination with insufficient income results in people having to spend much of
their income on rent and leaves them without adequate resources for other necessities, such as
food, clothing, and health care. This situation substantially increases their risk for
homelessness.
DIF: Cognitive Level: Remember (Knowledge)
8. Which group of people is most likely to experience homelessness?
a. Those who have a supportive family
b. Those who have recently become unemployed
c. Those who have substance abuse problems
d. Those who frequently change jobs
ANS: C
NURSINGTB.COM
Some people experiencing homelessness have individual characteristics that, in interaction
with the structural conditions of a shortage of affordable housing and insufficient income,
perpetuate their homeless conditions. Supportive services for these people are deficient in
quality and quantity. Some people need services to work and earn money. They are able to
function in the workforce, whereas others need services to maintain their housing status.
Included in this latter group are people whose serious chronic mental health and/or substance
abuse problems preclude their functioning in the workforce and whose behaviors interfere
frequently with their ability to obtain housing stability. People in this group need income
assistance and comprehensive and accessible behavioral and physical health care.
DIF: Cognitive Level: Apply (Application)
9. Which best describes how health care professionals are involved in the problem of
homelessness?
a. Homeless persons make everyone uncomfortable when they beg for handouts.
b. Homeless persons often live in emergency departments and clinics.
c. Poverty leads to crimes, and health care professionals can be attacked and robbed
outside health care facilities.
d. Serious illnesses or disability creates high medical bills, which may lead to
homelessness.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In 2013, of households with an annual income less than $25,000, 21.6% had no health
insurance. Lack of health insurance is a significant factor in creating homelessness. A serious
illness or disability can lead to a downward spiral as a result of job loss, use of savings to pay
for care, and inability to pay rent.
DIF: Cognitive Level: Analyze (Analysis)
10. Which factors are most likely to contribute to homelessness?
a. Intimate partner violence and substance abuse
b. Scarcity of support systems and recent job loss
c. Shortage of affordable housing and insufficient income
d. Substance abuse and serious mental illness
ANS: C
The text addresses three broad factors: (1) shortage of affordable housing, (2) insufficient
income, and (3) scarcity of supportive services as societal conditions that contribute to
homelessness rather than cause homelessness. Intimate partner violence, substance abuse, and
serious mental illness are not identified as the broad factor contributing to homelessness.
DIF: Cognitive Level: Understand (Comprehension)
11. Which underlying factor most likely contributes to homelessness?
a. Substance abuse
b. Unemployment
c. Posttraumatic stress syndrome (PTSD)
d. Depression
ANS: A
NURSINGTB.COM
The text states that persons as active agents do make decisions that result in homelessness.
These choices result in a shortage of affordable housing, insufficient income, and scarcity of
supportive services as societal conditions that contribute to homelessness rather than cause
homelessness. However, these decisions are made in highly contextualized conditions,
frequently in the midst of mental illness or addiction to alcohol and/or other substances.
Substance abuse may in turn lead to unemployment which causes insufficient income.
Additionally, PTSD and severe mental illness can cause substance abuse to occur.
DIF: Cognitive Level: Understand (Comprehension)
12. Which individual would be described as being “doubled up”?
a. An individual who has two chronic conditions
b. An individual who has recently been released from prison
c. An individual who maintains two jobs to avoid being homeless
d. An individual who is forced to live with friends
ANS: D
An individual may be considered to be homeless if that person is “doubled up,” a term that
refers to a situation where individuals are unable to maintain their housing situation and are
forced to stay with a series of friends and/or extended family members. The other responses
do not accurately describe being “doubled up.”
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
13. Which person will have the most difficulty in obtaining adequate support services to find a
long-term home?
a. An alcoholic homeless person
b. A homeless person who has a limited support system and is unemployed
c. A homeless person who has a mental illness and is an alcoholic
d. A mentally ill homeless person
ANS: C
For a sizable proportion of the homeless, severe mental illness exists along with the problems
of alcohol or other types of substance use. Like physical health problems, serious mental
illnesses and minor emotional problems occur more frequently among the homeless
population than in the general population. High rates of alcohol and drug use exacerbate the
existing acute and chronic physical and mental health problems. These coexisting problems
can make it harder to assist the homeless person.
DIF: Cognitive Level: Apply (Application)
14. Which best describes a major difference between women who have always had shelter and
women who have been homeless?
a. Educational opportunities and attainment
b. History of gender relationships (marriages, divorces)
c. Level of involvement with physical and/or sexual abuse
d. Skills necessary for paid employment
ANS: C
Research has revealed the extraordinary histories involving substance abuse, criminal activity,
serious mental health concerns, marital dissolution, escape from intimate partner violence,
NURSING
M loss, and poor physical health that
housing accidents, limited employment
options
TB.CorOjob
prevented gainful employment, among women experiencing homelessness. High numbers of
homeless women report histories of foster placement as children and exposure to violence as
both children and adults. This research has not documented the differences in educational
opportunities, gender relationships, and skills necessary for paid employment.
DIF: Cognitive Level: Understand (Comprehension)
15. Which factor is the primary motivator for young (homeless) women engaging in survival sex?
a. Peer influence
b. Pursuit of drugs
c. Coercion by perpetrators
d. Desperation to meet basic needs
ANS: D
Young (homeless) women involved in survival sex (participating in sexual acts in exchange
for money, food, lodging, clothing, or drugs) are motivated primarily by desperation to meet
basic needs, including a place to stay, food, and money, and one third mentioned that peers
commonly were influential in decisions to engage in survival sex. Others were influenced by
coercion (10%) or pursuit of drugs (10%) (Warf et al., 2013).
DIF: Cognitive Level: Remember (Knowledge)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
16. A school nurse was asked to see Lisa, a student in the fourth grade who was rumored to be
living in a car with her mother. Which would most likely have caused the teacher to become
concerned?
a. Lisa is not always respectful of the teacher.
b. Lisa has not been doing her homework.
c. Lisa is developmentally delayed.
d. Lisa has behaved in a sexually inappropriate manner.
ANS: C
Homeless children experience STDs, physical and sexual abuse, skin disorders, anemia, drug
and alcohol abuse, and unintentional injuries at higher rates than children in the general
population. All children are not always respectful and do not always have their homework
done and may act out behaviors seen on television.
DIF: Cognitive Level: Apply (Application)
17. The male home health nurse parked his marked car in preparation for visiting the next client
when a young female walked over to the car and asked him if he would like to have some fun.
Which provides the best explanation for this behavior?
a. The girl was skipping school and wanted money for entertainment.
b. The male nurse was extremely young and attractive and looked like he had money.
c. The girl may have hoped a nurse would give her enough money to eat.
d. Young girls often engage in thrilling, if high-risk, behaviors.
ANS: C
Homeless youth experience sexually transmitted diseases, physical and sexual abuse, skin
disorders, anemia, drug and alcohol abuse, and unintentional injuries at higher rates than in
NURSsuicidal
INGTB.C
the general population. Depression,
ideation,
OM and disorders of behavior, personality,
or thought also occur at higher rates among homeless. Family disruption, school failures,
prostitution or “survival sex,” and involvement with the legal system indicate that homeless
social health is severely compromised. Thus, it is most likely that the girl is hoping that the
nurse would provide her enough money to eat.
DIF: Cognitive Level: Apply (Application)
18. Which person would be called chronically homeless?
a. A person has been homeless for more than a year
b. A person who lives with a roommate when between jobs
c. A person who has been staying with friends or family for an extended period of
time
d. A person has been residing each night in a homeless shelter for almost 3 months
ANS: A
The chronically homeless individual is defined as an unaccompanied adult who has been
homeless for an extended or numerous periods and has one or more disabling conditions.
DIF: Cognitive Level: Understand (Comprehension)
19. Which best describes the purpose of the Vulnerability Index?
a. To identify those most at risk of becoming homeless
b. To determine the underlying cause of homelessness among vulnerable populations
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. To identify and prioritize the need for housing among the homeless
d. To determine what resources should be provided for vulnerable populations
ANS: C
Homeless service providers, concerned about the high risk for mortality among “street”
homeless population constructed the Vulnerability Index, a screening tool for identifying and
prioritizing the need for housing.
DIF: Cognitive Level: Understand (Comprehension)
20. Which are the most frequent problems suffered by the chronically homeless?
a. Chronic conditions such as hypertension, bronchitis, and emphysema
b. HIV/AIDS and other sexually transmitted diseases, tuberculosis, and hepatitis C
c. Respiratory infections, trauma, and skin disorders
d. Severe mental illness and substance abuse disorders
ANS: D
Chronically homeless people may well have many physical conditions, but the primary
problems that lead to their homelessness are severe mental illness and substance use disorders.
DIF: Cognitive Level: Remember (Knowledge)
21. Which statement best reflects the model of justice U.S. health care is based on?
a. All people are entitled to minimum standards of care.
b. All people are responsible to help their neighbors.
c. All people have a right to whatever their own efforts allow them to purchase.
d. Like firefighting, police protection, libraries, and roads and highways, health care
must be supported by taxNmoney
good ofMall who need such services.
R IforGthe B.C
U S N T
O
ANS: C
Market justice has been the dominant model and purports that people are entitled to valued
ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover,
this model stresses individual responsibility, minimal collective action, and freedom from
collective obligations other than respect for another person’s fundamental rights. In contrast,
under a social justice model, all people are equally entitled to key ends (i.e., access to health
care and minimum standards of income). Consequently, all members of society must accept
collective burdens to provide a fair distribution of these ends.
DIF: Cognitive Level: Understand (Comprehension)
22. Which describes a dimension of the social determinants of health (SDH) defined within
Healthy People 2020?
a. Employment
b. Education
c. Gender
d. Income
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Five broad dimensions of SDH are defined within Healthy People 2020 as: (a) Economic
Stability, (b) Education, (c) Social and Community Context, (d) Health and Health Care, and
(e) Neighborhood and Built Environment. Each of these dimensions includes key issues that
identify more specific factors (U.S. Department Health and Human Services Healthy People
2020, 2013). Employment, gender, and income are not addressed as dimensions of the social
determinants of health within Healthy People 2020.
DIF: Cognitive Level: Remember (Knowledge)
23. Which best describes a downstream intervention to solve the problem of homelessness?
a. Improved use of community resources
b. Increased employment opportunities
c. Increased affordable housing
d. Improved treatment of mental illness
ANS: D
Building on McKinlay’s “river” metaphor, McKinlay and Marceau (2000) purport that
government and private efforts to address homeless health care problems largely focus on
“pulling the bodies out of the river of homelessness.” Such downstream interventions aimed at
treating or alleviating health care problems, such as physical disease and mental illnesses, are
worthy and needed. However, these interventions when used alone are far less adequate in
alleviating homeless people’s social health problems. To improve the social health of the
homeless, it is necessary to go upstream and focus on the primary contributors to
homelessness itself (i.e., lack of affordable housing, inadequate income, and insufficient
services).
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
24. A nurse is using an upstream intervention when working with the homeless population. Which
public health intervention will the nurse most likely use?
a. Case management
b. Outreach
c. Surveillance
d. Community organizing
ANS: D
Although nurses may use all interventions at all three levels, community/public health nurses
working more upstream, at the system level, employ collaboration, coalition building,
community organizing, advocacy, social marketing, and policy development and enforcement.
In contrast, community/public health nurses—working downstream with individuals, families,
or groups—use surveillance, disease and other health event investigation, outreach, screening,
case finding referral and follow-up, case management, delegated functions, health teaching,
counseling, and consultation.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which best describes the term “literally homeless”? (Select all that apply.)
a. Lacking a fixed, regular, and adequate nighttime residence
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b.
c.
d.
e.
f.
Lacking a family residence
Living in a place not typically used for human sleeping
Living in a temporary living accommodation such as a hotel
Living full-time in a recreational vehicle
Sleeping in an extended-care facility or hospital
ANS: A, C
Literally homeless is described as individuals and families who lack a fixed, regular, and
adequate nighttime residence and includes a subset for an individual who resided in an
emergency shelter or a place not meant for human habitation and who is exiting an institution
where he or she temporarily resided. The term “literally homeless” is not used to describe
those lacking a family residence, living in a temporary living accommodation such as a hotel
or recreational vehicle, or sleeping in an extended care facility or hospital.
DIF: Cognitive Level: Remember (Knowledge)
2. Which strategies have been used to improve the collection of prevalence data for the homeless
population? (Select all that apply.)
a. Urban Institute study
b. Homeless Assistance Report
c. Continuum of Care (CoC) concept
d. Homeless Information Management System (HMIS)
e. Census Bureau
f. Education for Homeless Children and Youth program
ANS: C, D
Two strategies used by the U.S. Department of Housing and Urban Development in the efforts
NURtoSreduce
INGThomelessness,
B.COM including improvement in collecting
to strengthen the nation’s efforts
prevalence data, are the CoC concept and the HMIS. The Census Bureau and Urban Institute
study were historically used to collect data on the homeless population. Data collection
improvements have been made since these studies were completed. The Department of
Education uses the Education for Homeless Children and Youth program to collect data on
homeless youth.
DIF: Cognitive Level: Remember (Knowledge)
3. Which best describes how the Continuum of Care (CoC) concept determines the number of
homeless? (Select all that apply.)
a. By asking local police departments to visit areas where the homeless hide and
report the number of people found there each March
b. By conducting a point-in-time (PIT) homeless persons count every other January
c. By making an educated guess based on anecdotal data
d. By completing a statistical analysis of the Census Bureau data
e. By reporting the number of homeless persons who use emergency shelters or
transitional housing during the year
f. By sending CoC personnel into the community to try to find hidden homeless
ANS: B, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
CoCs are local systems responsible for providing a range of housing and related services that
meet the U.S. Department of Housing and Urban Development guidelines for persons
experiencing homelessness. CoCs conduct PIT counts of homeless persons on one night in
January of every other year. In addition, CoCs are required to report the number of homeless
persons who use emergency shelters or transitional housing throughout each federal fiscal
year.
DIF: Cognitive Level: Understand (Comprehension)
4. Which disorders are experienced at a higher rate by homeless adults when compared with the
general population? (Select all that apply.)
a. Hepatitis
b. Diabetes
c. Asthma
d. HIV/AIDS
e. Hypertension
f. Alcoholism
ANS: C, E, F
Chronic disorders experienced at higher rates than in the general population include
hypertension; musculoskeletal disorder; gastrointestinal problems; respiratory problems
(asthma, chronic bronchitis, emphysema); neurological disorders, including seizures; and poor
dentition. Like physical health problems, serious mental illnesses and minor emotional
problems occur more frequently among the homeless population than in the general
population. High rates of alcohol and drug use exacerbate the existing acute and chronic
physical and mental health problems. The rates of hepatitis, diabetes, and HIV/AIDS are not
seen at a higher rate among the
population.
N homeless
R I Gadult
B.C
M
U S N T
O
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 24: Rural and Migrant Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes the recent population trend in rural America?
a. The number of residents in rural areas of the United States is at one of its lowest
levels ever recorded.
b. Urban population rates increased from 2010 to 2015 as agricultural opportunities
diminished.
c. Nonmetro population rates have been steadily increasing because of increasing job
growth.
d. Population growth or loss in rural areas varies widely depending on available
economic opportunities.
ANS: D
Although the urban growth rate has been steadily climbing since 1890, with numbers of urban
dwellers surpassing those in rural areas around 1920, the number of rural residents is the
highest in the country’s history (U.S. Department of Agriculture [USDA], 2016). In 2010 to
2015 population loss in nonmetro areas occurred in the United States as a whole. In 2014
nonmetro populations stabilized after 4 years of decline, likely related to improved rural
employment growth (USDA, 2016). Opportunities for population growth and economic
expansion vary widely from one nonmetro county to the next, and new regional patterns of
growth and decline have emerged in recent years.
DIF: Cognitive Level: Understand
N R(Comprehension)
I G B.C
U S N T
OM
2. Which best explains why there are so few hospitals in rural areas?
a. Few nurses and physicians enjoy the rural lifestyle.
b. Historically, hospitals began in large urban areas and have slowly expanded
outward but have not yet reached all rural areas.
c. Rural areas have very low population density.
d. Rural residents do not trust hospitals, preferring to receive care from neighbors and
friends.
ANS: C
Although 75% of U.S. counties are classified as rural, they contain only 20% of the U.S.
population. The population density is too low to support a large hospital. There are providers
available to serve the population and residents are accepting of health care services, but not as
many services are needed because of the lower population density.
DIF: Cognitive Level: Remember (Knowledge)
3. From which causes are rural residents twice as likely to die from in comparison with urban
residents?
a. Chronic diseases, especially cardiac problems and cancers
b. Diabetes from the higher incidence of obesity
c. Respiratory diseases (from pesticides and herbicides)
d. Unintentional injuries
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
Residents of rural areas are nearly twice as likely to die of unintentional injuries, including
motor vehicle accidents, when compared with their urban counterparts. The rates of chronic
diseases, diabetes, and respiratory diseases are more similar to that of urban residents.
DIF: Cognitive Level: Remember (Knowledge)
4. Which factor would cause a geographic area to be called a frontier area?
a. Arbitrary distinction recognizing the Great Plains, Intermountain areas, and Alaska
b. Geographically located in the West, specifically the Great Plains states
c. High death rate from use of guns (homicide or suicide)
d. Population of fewer than six persons per square mile
ANS: D
Areas are classified as rural for populations with fewer than 45 persons per square mile and as
frontier for geographic areas with fewer than six people per square mile. Many counties of the
Great Plains, Intermountain West, and Alaska are designated frontier. Not all mountain areas
are rural (the Appalachian mountain area is not), and geographic location alone does not make
an area rural.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best describes the purpose of the core-based statistical areas (CBSA) system?
a. To reflect trends in population distribution across the county
b. To differentiate between urban and metropolitan areas
c. To emphasize the importance of noncare areas
d. To report the demographic characteristics of those living in the area
ANS: A
NURSINGTB.COM
In June 2003, the Office of Management and Budget (OMB) released a new classification
scheme to better reflect trends in population distribution across the nation (OMB, 2016). The
MSA designation has been replaced by county-level core-based statistical areas (CBSAs) to
simplify the multilevel designations. Within CBSAs, metropolitan areas are those counties
that contain at least one urbanized area of 50,000 or more people. A micropolitan area
contains a cluster of 10,000 to 50,000 persons. Counties that are neither metropolitan nor
micropolitan are called “outside CBSAs,” also known as noncare areas (U.S. Census, 2013).
DIF: Cognitive Level: Understand (Comprehension)
6. Which compositional factor influences rural health needs?
a. Demographics of the people living in an area
b. Local environment
c. The geography of the area
d. The political and social institutions in the community
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
There is a growing emphasis on the distinction between context, which is defined by the
characteristics of places of residence, and composition, which is the collective health effects
that result from a concentration of persons with certain characteristics. Problems in rural areas
are compositional when they derive from individual characteristics of groups of people
residing in rural settings. Examples of compositional sources of health disparities include such
characteristics as age, education, income, ethnicity, and health behaviors. The environment,
geography, and political and social institutions are considered to be characteristics of place.
DIF: Cognitive Level: Remember (Knowledge)
7. Which describes what has been identified by public health experts as the number one priority
in rural areas?
a. Access to health care
b. Access to education
c. Access to telecommunications
d. Access to better-paying employment opportunities
ANS: A
In the Rural Healthy People 2020 survey, 80% of respondents listed access to health care as a
top rural priority. Although access to education, telecommunications, and well-paying
employment are important, they have not been identified as the number one priority in rural
areas.
DIF: Cognitive Level: Understand (Comprehension)
8. Which would be true for a county to be defined as having persistent poverty?
a. Being in poverty over the last 10 years
b. Being in poverty over theNlast
UR20
SIyears
NGTB.COM
c. Being in poverty over the last 25 years
d. Being in poverty over the last 30 years
ANS: D
Persistent poverty is defined as counties where the population has been in poverty over the
last 30 years.
DIF: Cognitive Level: Remember (Knowledge)
9. Which fact is noteworthy about adolescent males who are driving without a license in the
countryside?
a. Most had driver’s education classes but have not yet earned the money to pay for
their driver’s license test.
b. Most were Hispanic or black from a rural area.
c. Most were practiced in driving large farm machinery and were just going from one
section of the farm to another section.
d. Most were practicing their driving skills with their parent in the car.
ANS: B
Researchers studied the prevalence of unlicensed teenaged drivers compared with licensed
drivers and found that they were more likely black or Hispanic and live in rural areas. There is
not any research in the text that supports that the other responses are accurate.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
10. Which is particularly prevalent in rural areas (more so than in urban areas) of the South?
a. Falls and motor vehicle accidents
b. Less use of seatbelts and more drinking of alcohol
c. Obesity and sedentary lifestyle
d. Suicide and homicide
ANS: C
Rural residents in the southern states are more likely to be obese, smoke more heavily if they
do smoke, use smokeless tobacco, and engage in sedentary lifestyles. Rates of motor vehicle
accidents and suicide are higher in rural areas, although not necessarily the South.
Additionally, there is a decreased use of seatbelts and increased use of alcohol in rural areas;
however, the textbook mentions that these rates are higher in the rural West than in the rural
South. The rates of falls and homicide are not addressed in the textbook.
DIF: Cognitive Level: Remember (Knowledge)
11. Which statement best describes how firearm injuries are different in rural areas as compared
with urban areas?
a. In rural areas, firearm deaths occur more frequently because of purposeful, rather
than accidental, shooting.
b. In rural areas, firearm injuries occur more frequently in the home.
c. In rural areas, firearm injuries occur more frequently during official hunting
season, whereas the frequency does not vary in urban areas.
d. In rural areas, firearm injuries are more frequently fatal than in urban areas.
ANS: B
NURSINGTB.COM
In rural counties, nonfatal firearm injuries occur most often at home compared with urban
counties, where injuries occur most often in the streets.
DIF: Cognitive Level: Understand (Comprehension)
12. Which group is the fastest-growing component of the rural population?
a. Disabled adults
b. Elderly women
c. Hispanic children
d. Retirees
ANS: C
Today, the proportion of Hispanic children is the fastest-growing component of the rural
population, regardless of region.
DIF: Cognitive Level: Remember (Knowledge)
13. Which best explains why companies do not build work places in rural areas where people are
anxious to find full-time employment?
a. Employers need highly educated and skilled employees.
b. Managers do not want to be transferred into a rural area where they will not fit in
and will not be comfortable.
c. Rural persons do not work as hard as urban dwellers.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Smells emanating from farms are unacceptable to persons working inside.
ANS: A
Counties that have a low-wage economy have difficulty providing the infrastructure needed to
provide education for low-wage families. They therefore have difficulty attracting new
employers who might contribute to the economic development of a rural area but need a more
highly educated workforce. Rural workers are known for their strong work ethic, but they may
not have the educational skills that are necessary. Smells from farms is not a typical reason as
to why companies do not build in rural areas.
DIF: Cognitive Level: Understand (Comprehension)
14. Which employment opportunities are among the most dangerous?
a. Food processing, textiles, and transportation
b. Highway construction, ranching, and public utilities
c. Large mechanized factory positions
d. Mining, forestry, and fishing
ANS: D
Industries with the highest death rates were mining, agriculture, forestry, and fishing,
followed by construction, transportation, and public utilities.
DIF: Cognitive Level: Remember (Knowledge)
15. A public health nurse is working in a rural clinic. On the basis of risk, which would be the
priority group for care?
a. African American adults
b. Adolescents
NURSINGTB.COM
c. Elderly women who live alone
d. Migrant and seasonal farmworkers (MSFW)
ANS: D
In general, MSFW may have the poorest health of any aggregate in the United States, and the
least access to affordable health care. Eighty-five percent of the MSFW are Hispanic, Latino,
or African American.
DIF: Cognitive Level: Apply (Application)
16. As a concerned citizen and professional, a nurse encourages the local senators and
representatives to support expansion of health clinics for the poverty stricken. Which location
is in most desperate need?
a. Rural areas where migrant and seasonal farmworkers (MSFW) labor
b. Inner city poverty-stricken neighborhoods
c. Near elderly low-income housing units
d. Inside high schools in poverty-stricken neighborhoods
ANS: A
In general, MSFW may have the poorest health of any aggregate in the United States and the
least access to affordable health care. Thus, a location that serves this population would be
most important.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
17. Which is the most frequent cause of farm fatalities and nonfatal injuries?
a. Manure pits (methane poison)
b. Power take-off augers
c. Storage silos
d. Tractors
e. Very old and barely functioning trucks
ANS: D
Agricultural machinery is the most common cause of fatalities and nonfatal injuries of U.S.
agricultural workers, including on-farm fatalities among youth under 20 years of age (CDC,
NIOSH Program, 2012). Tractors contributed to 12% of the deaths. Fatalities on farms were
20.2 per 100,000 workers in 2012, with tractor overturns being the leading cause of death.
DIF: Cognitive Level: Remember (Knowledge)
18. Which statement best describes how working on a farm is different from working in a factory?
a. Factories have more dangerous dust than farming dust.
b. Farm chemicals are more immediately fatal than most industrial chemicals.
c. The worksite and the home are the same.
d. Workers on farms, unlike those in factories, can bring dangerous substances home
on their clothing, which expose their families.
ANS: C
Farming is unusual because the home and the worksite are the same. Several types of farming
activities are associated with higher-than-expected occurrences of acute and chronic
respiratory conditions. Individuals with long-term exposure to grain dusts, such as grain
NURSIhave
B.COM respiratory function and increased
elevator workers and dairy workers,
diminished
NGT
frequency of respiratory symptoms. Occupational asthma and more exotic fungal or toxic
gas-related conditions occur in higher frequency in agricultural than nonagricultural
populations. Exposure risks to children and spouses may be heightened when farmers wear
contaminated clothing and boots into the home, but the same can happen in several industries.
DIF: Cognitive Level: Understand (Comprehension)
19. A woman stumbled into the rural health clinic and explained that she had an incredible
headache. She was sweating and began vomiting into the wastebasket by the intake nurse’s
desk. Which diagnosis should be anticipated by the nurse?
a. Acute adult panic disorder
b. Acute alcohol intoxication
c. Acute appendicitis
d. Acute meningitis
e. Acute pesticide poisoning
ANS: E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Signs and symptoms of acute pesticide poisoning are fairly clear, and most health providers in
rural communities would recognize them. Common symptoms include headache, dizziness,
diaphoresis, nausea, and vomiting. If left untreated, those affected may experience a
progression of symptoms including dyspnea, bronchospasm, and muscle twitching. Deaths are
relatively uncommon, but they do occur. The nurse is reminded that not all farm laborers are
men. The symptoms that are being displayed are not typical of acute panic disorder, acute
alcohol intoxication, acute appendicitis, or acute meningitis.
DIF: Cognitive Level: Apply (Application)
20. A nurse is explaining why migrant farmworkers experience cultural barriers when trying to
receive care. Which would the nurse include in this explanation?
a. “As illegal immigrants, they are not eligible for tax-paid health care.”
b. “Families who travel in isolation seeking agricultural work do not mix with their
employers or other members of the community.”
c. “Mexicans who speak primarily Spanish and cannot understand English.”
d. “Usually perceived as outsiders, they are from many countries and cultures.”
ANS: D
Cultural, linguistic, economic, and mobility barriers all contribute to the nature and magnitude
of health problems observed in farmworkers. Cultural and linguistic barriers are the most
overt because many of the communities where farmworkers work consider them outsiders. A
common misconception among U.S. health care providers is that these farmworkers are from
Mexico, with Spanish as their primary language. Farmworkers originate from many
communities in Mexico, the Caribbean, and Central and South America, and they may speak
English, the language of their home country, or several languages.
N R I G B.COM
U S N T
DIF: Cognitive Level: Apply (Application)
21. A nurse was becoming very frustrated at the ongoing stream of farmworkers with respiratory
problems each spring. Which action should be taken by the nurse?
a. Provide community education on herbicides and other chemicals spread each
spring with information on self-protective measures, such as respirators.
b. Fight to get farmers to quit spreading chemicals on their fields each spring.
c. Suggest that farmers spray water on the fields immediately after the chemicals are
spread to reduce dust in the air.
d. Tell farm workers to obtain different employment.
e. Try to get farmers to reduce the amount of chemicals used on their fields.
ANS: A
Environmental health issues in rural communities, such as pesticide exposure or health
hazards from point-source factory emissions, are more effectively assessed and remedied on a
community level than on a case-by-case basis. Nurses’ involvement in helping people
understands health problems in a larger context can be the genesis of change. It is not realistic
to have farmers quit or reduce the spreading of chemicals, spray water on their fields after
chemical application, or ask them to obtain different employment. Nurses must work with
farmers so that they are able to use safe measures when applying the chemicals to their fields.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
22. A nurse was trying to decrease the amount of respiratory illness in the community. Which
approach should be used by the nurse?
a. Attend each farmworkers’ meeting and listen to how they perceive and discuss
their problems
b. Offer to teach the farmers’ spouses how to protect their families, such as having
the farmer shower and change clothes before coming into the house
c. Suggest the community work together to obtain a community college so
farmworkers could be educated for other employment opportunities
d. Teach children in the school system the importance of seeking employment in
cities rather than staying on the farm
ANS: A
Using informal networks in the community is essential. The involvement of informal
networks and local leaders in planning health interventions is crucial. To be able to do that,
the nurse must first listen to how the community perceives its problems.
DIF: Cognitive Level: Apply (Application)
23. Which best describes a proposed strategy to address the lack of health care professionals in
rural communities?
a. Advertise that there are more men than women in many rural areas to attract
female nurses who want to be wives and mothers
b. Offer free housing and office space to a professional who will come to live in the
community
c. Pay extremely high salaries to professionals willing to relocate
d. Support local students obtaining an education while continuing to live at home
ANS: D
NURSINGTB.COM
A solution proposed for the shortage of health care providers is for rural communities to
“grow their own.” A rural community, a group of small communities, or a county could
support local students attending college and recruit students currently attending professional
schools. The students make a commitment to work in the community in return for monetary
support for their educations.
DIF: Cognitive Level: Understand (Comprehension)
24. Which difference is found in parish nursing in a rural area as opposed to parish nursing in an
urban area?
a. Rural parish nurses are less likely to be involved in case management or care
coordination than their urban counterparts.
b. Rural residents are more grateful for the nurse’s assistance because there are so
few health resources in rural areas.
c. Rural residents are typically less committed to traditional values or a strong
religious faith.
d. Rural residents may discuss health concerns with the nurse wherever they meet,
whether in church or the local market.
ANS: D
In urban settings, contact with parishioners was primarily at the church, whereas contacts in
rural settings were most often in the home, on the phone, or in other community-based
settings.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
25. A nurse saw there was a need for a hospice facility in a rural area, because so many of the
residents were quite elderly and death was common. Which best explains why the community
would not immediately see the wisdom of the nurse’s suggestion?
a. Change is always difficult; the nurse just needs to keep reinforcing the need for
such a facility.
b. The nurse did not tell residents how much their taxes would need to go up to
support such a facility.
c. Residents were fearful of confronting death in such an open way.
d. Rural residents prefer to use their informal social support networks when help is
needed.
ANS: D
Limited availability and accessibility of formal health care resources in rural areas combined
with self-reliance and self-help traits of rural residents have resulted in the development of
strong rural community informal care and social support networks. Rural residents are more
apt to entrust care to established informal networks than to new formal care systems. It is
unlikely that creation of such a facility would impact their taxes. The nurse needs to partner
with the community to implement the change process while building upon the community’s
strengths, beliefs, and values systems.
DIF: Cognitive Level: Understand (Comprehension)
26. Which would most likely to be provided by a local health department in a rural community?
a. Collaborating with local health clinics to provide outreach services
b. Funding a local research N
URSINGTB.COM
project
c. Establishing the poverty guidelines for the area
d. Building a free-standing migrant health clinic
ANS: A
Uniquely positioned within rural communities, LHDs are a potential catalyst for addressing
the long-standing challenges associated with urban–rural health disparities. While focused on
improving the health of populations, LHDs provide a wide array of services focused on
assessing health status, mobilizing action to address health-related issues, and ensuring the
delivery of important health services in the community. The ability of rural health
departments to develop and cultivate partnerships is important for the integration of public
health within the larger health care delivery system. The local health department would be
more likely to collaborate with existing resources before building its own free-standing clinic.
Poverty guidelines are established by the federal government. It is unlikely that a local health
department in a rural area has funding available for research projects.
DIF: Cognitive Level: Understand (Comprehension)
27. Which best describes how the federal government tries to both encourage and support rural
health clinics under the Community Health Centers (CHC) program?
a. Allowing tax deductions for charitable contributions to rural health clinics (RHCs)
b. Donating equipment and supplies to establish such clinics
c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise
d. Requiring recipients to serve in a rural health clinic for 3 years in exchange for
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
financial assistance while in school
ANS: C
The CHC program, administered by the U.S. Public Health Service, benefits underserved
areas and populations. RHCs are designed to improve access to primary care. As an incentive
to rural communities to apply for RHCs, Medicare and Medicaid are reimbursed at a higher
rate than usual.
DIF: Cognitive Level: Understand (Comprehension)
28. Which best describes how Migrant Health Clinics (MHCs) under the Migrant Health Program
are often different from other clinics?
a. Care is restricted to those who can document that they are employed in agriculture.
b. They are much better funded than typical rural clinics.
c. Staff are typically bilingual and bicultural.
d. They welcome illegal immigrants to receive care.
ANS: C
The MHCs and the Migrant Health Program provide comprehensive nursing and medical care
and support services to migrant and seasonal farm workers and their families from many
countries in Latin America and the Caribbean. Bilingual, bicultural health personnel,
including lay outreach workers, use culturally appropriate protocols for providing primary
care, preventive health care, transportation, dental care, pharmaceuticals, and environmental
health. The funding at the MHC may not be any different than other rural clinics. Their
primary purpose is not to provide care to illegal immigrants, rather to migrant and seasonal
workers.
DIF: Cognitive Level: Understand
NUR(Comprehension)
SINGTB.COM
MULTIPLE RESPONSE
1. Which factors result in rural residents having less access to health care than urban dwellers?
(Select all that apply.)
a. Employment opportunities may be low paying and seasonal.
b. There are greater distances to travel and limited choice of health care providers.
c. Health care providers prefer to work in higher-paying urban settings.
d. Rural residents are less likely to have health insurance.
e. Rural persons’ economic resources are tied up in land, not easily accessible cash.
f. Rural persons believe in self-sufficiency and self-care, not asking others for help.
ANS: A, B, C, D
A recent Institute of Medicine study reported rural medical access problems in these areas,
with some hospital and pharmacy closures; greater distances to travel for physician services;
and limited, if any, choice of providers. Rural residents were more likely than urban residents
to lack insurance. In 2015, about 18% of the persons living in rural counties were at the
poverty level. Having economic resources invested in land and believing in self-sufficiency
and self-care are not reasons why rural residents have less access to health care than urban
dwellers.
DIF: Cognitive Level: Remember (Knowledge)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
2. In comparison with mental health care in urban areas, which best describes how mental health
care in rural areas differs? (Select all that apply.)
a. Access to care is more limited or not available at all locally.
b. Cost for treatment is typically reimbursed at a lower rate.
c. Depression is frequently not recognized or is not treated.
d. Ethnic and racial disparities exist.
e. Primary health care professionals accept responsibility for mental health treatment.
f. The suicide rate is notably higher.
ANS: A, C, E, F
Nationally, suicide is the 11th leading cause of death, but in rural America it is the second
leading cause of death. Decreased access to mental health services for treatment of depression
may contribute to these higher rates. Because of the lack of qualified mental health care
providers, rural residents often receive services from primary care providers. Ethnic and racial
disparities exist whether in urban or rural health care.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes why for-profit managed care organizations (MCOs) have not begun to
move into rural areas to increase the number of persons served? (Select all that apply.)
a. High startup and administrative costs are needed.
b. A large number of elderly are on Medicare or Medicaid, which results in low
reimbursement.
c. Managed care has not yet had time to go beyond major population centers.
d. MCOs are waiting until federal reimbursements for underserved rural health areas
become higher.
e. The population is too small and too spread out.
NURSINGTB.COM
f. Rural health areas are too geographically
unattractive and lack any recreational
possibilities for managers to want to work there.
ANS: A, B, C, E
MCOs recognize the risks to expanding into rural areas. Risks are probable high startup and
administrative costs. Managed care has yet to move into much of rural America because of
small dispersed populations, few visits per individual, and large numbers of elderly on
Medicare with low-level reimbursements that do not make the aggregate financially attractive
to MCOs. It is not likely that federal reimbursements for underserved rural health areas will
become higher. The lack of attractive living for managers has not been a reason why MCOs
have not moved into rural areas.
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse has written a research proposal studying how technology can be used in innovative
ways in rural areas to improve patient outcomes. Which should the nurse contact about
funding opportunities? (Select all that apply.)
a. Research Centers Program
b. Health and Human Services Department (HHS)
c. Health Resources and Services Administration (HRSA)
d. Federal Office of Rural Health Policy
e. Rural Health Research Gateway
f. The Center for Rural Health at a local university
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: A, D, F
The HRSA provides access to and support for research through the Research Centers
Program. The Research Centers Program is the only federal research program entirely
dedicated to producing policy-relevant research on health care and population health in rural
areas. Each research center has its own identity (although it may be part of a larger
organization), website, and core staff that include a disciplinary mix of health services
research, epidemiology, public health, geography, medicine, and mental health. Over the
4-year award cycle, each research center develops a portfolio of several research projects per
year in conjunction with input from the Federal Office of Rural Health Policy and other
experts. Universities across the country have created centers for rural health research. To
strengthen the dissemination of research results, the Rural Health Research Gateway is a
“one-stop shop” for the research centers, providing easy access to projects funded by ORHP
and summaries of research in progress. The Health and Human Services Department does not
provide funding for rural area research.
DIF: Cognitive Level: Apply (Application)
5. Which best describes why there are more long-term consequences (such as death) to a driver
injured in a truck accident in a rural area than a driver injured in a truck accident in an urban
area? (Select all that apply.)
a. Rural drivers are more likely to speed over long distances than urban drivers.
b. Rural drivers are not as skilled with vehicles as urban drivers, so they are more
severely injured in a crash.
c. The urban driver is taken immediately for care, whereas the rural driver might be
injured on an isolated field and not found by anyone for hours.
d. Urban drivers are more likely to use their seat belts than rural drivers.
e. Urban drivers are probably
NUrushed
RSINtoGan
emergency
TB.C
OM department, whereas the rural
driver lives far away from emergency services, often over bad roads and possibly
through severe weather.
f. Urban drivers trade their vehicles in rather frequently, whereas rural drivers keep
their vehicles for as long as they can make them run, so the vehicles are much less
roadworthy.
ANS: A, C, D, E
Getting patients from the place of injury to the trauma center within the “golden hour” is
frequently not possible in rural areas because distance, terrain, climatic conditions, and
communication methods produce barriers. Some rural facilities are more than 1 hour away by
air from the nearest trauma center or tertiary care hospital. Driving at high speeds, driving
long distances, driving in winter conditions, not using seat belts, and consuming alcohol have
been cited as contributing to greater levels of injury deaths and disability by rural residents in
the West. There is no evidence to suggest that rural drivers are not as skilled as urban drivers
or that their vehicles are less roadworthy.
DIF: Cognitive Level: Understand (Comprehension)
6. Which do expert rural nurses report as benefits of their work? (Select all that apply.)
a. Ability to develop close relationships and give holistic care
b. Being able to practice in the community where one lives
c. Constant challenges
d. Continual growth as an expert generalist
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
e. Higher salary than in urban areas
f. Intensity of purpose
ANS: A, B, C, D, F
Positive aspects of rural nursing include the ability to give holistic care, to know everyone
well, and to develop close relationships with the community and with coworkers. Autonomy,
professional status, and being valued by the agency and community have been reported
components of positive job satisfaction. The rural nurse is a generalist, and generalist is not
synonymous with boring. Interviews with rural nurses show that they feel an “intensity of
purpose” that makes rural nursing distinctive. Nurses living and practicing in the same place
have a strong sense of integration and continuity between practice and community.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 25: Populations Affected by Mental Illness
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which provides the best description of severe mental illness (SMI)?
a. Having been clearly diagnosed with at least two mental health disorders within the
past year
b. Having a diagnosable mental disorder with moderate functional behavior in a
specific area of lifestyle at any time during the past year
c. Being unable to function in society because of a mental illness
d. Being convicted of several impulsive crimes during the past year
ANS: B
SMI occurs in adults who currently or at any time during the past year have a diagnosable
mental, behavioral, or emotional disorder with moderate, severe, or extreme functional
behavior in specific areas of lifestyle. These mental health disorders afflicting persons who are
18 years of age or older present emotional or behavioral functioning that is so impaired as to
interfere substantially with their capacity to remain in the community without supportive
treatment or services of a long-term or indefinite duration.
DIF: Cognitive Level: Remember (Knowledge)
2. Which event occurred in 1965?
a. State mental hospitals were created.
b. The mentally ill were deinstitutionalized.
Nwas
RSdiscovered
INGTB.C
OM depression.
c. Electroconvulsive therapy U
to help
d. Community mental health centers for outpatient care were established.
ANS: B
Deinstitutionalization is the release of institutionalized people, especially mental health
patients, from an institution for placement and care in the community and was initiated in
1965. From 1955 to the mid-1980s, the number of patients in state facilities fell from 560,000
to 155,000 because patients moved back out into the communities. The Community Mental
Health Centers Act of 1964 provided federal support for mental health services. The act
supported measures to implement facilities to care for those who were mentally retarded and
to construct community mental health centers. The creation of state mental hospitals and the
discovery of electroconvulsive therapy occurred before 1965.
DIF: Cognitive Level: Remember (Knowledge)
3. Which best describes how brain imaging scans are being used?
a. To deliver electroconvulsive therapy to high-risk individuals
b. To help detect and diagnose medical disorders and illnesses
c. To help determine treatment options for mental disorders
d. To help determine the effects of psychotherapy
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Brain imaging scans, also called neuroimaging scans, are being used more and more to help
detect and diagnose a number of medical disorders and illnesses. Currently, the main use of
brain scans for mental disorders is in research studies to learn more about the disorders. These
researchers study healthy brain development, effects of mental illnesses, or effects of mental
health treatments on the brain. Brain neuroimaging helps researchers study healthy brain
development, effects of mental illnesses, or effects of mental health treatments on the brain.
DIF: Cognitive Level: Remember (Knowledge)
4. Which best describes how people with mental illness are viewed by the general public?
a. Individuals in need of assistance
b. Criminals who need to be institutionalized
c. Lazy, weak, and immoral
d. Contributing members of society
ANS: C
Throughout history, the symptoms of mental illness have been perceived as permanent,
dangerous, frightening, and shameful. People with a diagnosis of mental illness have been
described as lazy, idle, weak, immoral, irrational, and, too often, criminal.
DIF: Cognitive Level: Understand (Comprehension)
5. Which would be most upsetting for American families when their loved one, after serving in
Iraq or some other battlefield, returns home?
a. Many families, especially those with children, do not want guns in the house.
b. Reabsorbing them into the family structure is challenging and difficult.
c. The suicide rate is twice as high as among nonveteran adults.
NUAffairs
RSINmedical
GTB.Csystem
d. They must use the Veterans
OM for medical care.
ANS: C
Male veterans in communities are twice as likely to die by suicide as their civilian
counterparts. There is nothing to support that these veterans will have guns in their homes.
The veterans will be able to use the Veteran Affairs system for medical care and there may be
challenges with their return home, but that should not be as upsetting as the risk for suicide for
their loved one.
DIF: Cognitive Level: Understand (Comprehension)
6. Which was required by the Paul Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008?
a. That alcoholism be recognized as a disease and treatment be given in residential
facilities
b. That drug addiction be accepted as a mental health diagnosis and addicts be treated
rather than jailed when caught
c. That health insurance must cover treatment for mental illness on the same terms
and conditions as physical illness
d. That community clinics must treat clients for mental illness just as they treat
prisoners who have a physical illness
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity
Act was enacted. The law requires health insurance to cover treatment for mental illness on
the same terms and conditions as physical illness. This law does not require that alcoholism be
recognized as a disease, that drug addiction be accepted as a mental health diagnosis, or that
community clinics must treat clients for mental illness.
DIF: Cognitive Level: Understand (Comprehension)
7. Which mental illness is most frequently diagnosed among adults in the United States?
a. Acute stress disorder
b. Bipolar disorder
c. Depression
d. Schizophrenia
ANS: C
Depression is the most frequently diagnosed and one of the most disabling mental illnesses in
the United States. Depression affected approximately 16.1 million American adults, or about
6.7%, of the U.S. population age 18 and older, in the past year. Acute stress disorder, bipolar
disorder, and schizophrenia are not diagnosed as frequently as depression.
DIF: Cognitive Level: Remember (Knowledge)
8. Which best explains why having parity in insurance coverage does not always help persons
with depression?
a. Many persons find that the medications do not relieve symptoms.
b. Most depressed persons do not seek treatment.
c. Most depression is situational, and having insurance does not change the situation.
d. Psychotherapists will notNaccept
URSItheNG
TB.C
OM
low
reimbursement
offered by insurance
plans.
ANS: B
Although effective treatments and medications exist, most people (almost two thirds) with
depressive illness do not seek help. Parity in insurance coverage helps for depressed persons
who are encountering situational depression to receive services and promotes care being
provided by a variety of providers.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best summarizes the symptoms of a person with bipolar disorder?
a. Chronic, unrealistic, and exaggerated worry about life
b. Ongoing hallucinations and delusions
c. Changes in mood from depression to mania
d. A persistent abnormally elevated or irritable mood
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Bipolar disorder refers to a group of mood disorders that present with changes in mood from
depression to mania. The depressed phase is manifested by symptoms seen in major
depressive disorder. The manic phase is characterized by a persistent abnormally elevated or
irritable mood, impaired judgment, flight of ideas, pressured speech, grandiosity,
distractibility, excessive involvement in goal-directed activities, few hours sleeping, and
impulsivity. These symptoms may co-occur with psychotic features, such as hallucinations
and delusions. Generalized anxiety disorder is characterized by chronic, unrealistic, and
exaggerated worry and tension about one or more life circumstances lasting 6 months or
longer.
DIF: Cognitive Level: Understand (Comprehension)
10. A patient with severe panic attacks refuses to come to the mental health clinic to get help even
after being assured there is no charge for the initial assessment. Which provides the best
explanation for this behavior?
a. People know that the treatment is to confront your fears in small doses, and the
very idea is overwhelming and frightening.
b. Such persons have anticipatory anxiety, so they try to avoid situations that may
lead to a panic attack, such as leaving their house.
c. The recurring symptoms such as tachycardia, chest pain, nausea, and sweating are
seen as symptoms of a physical illness, not a mental illness.
d. They are too depressed to take action.
ANS: B
As the avoidance behavior intensifies, the client begins to withdraw further to avoid being in
places or situations from which escape may be difficult. Individuals with agoraphobia
frequently progress to the point
cannot leave
NUwhere
RSINthey
GTB.C
M their homes without experiencing
O
anxiety.
DIF: Cognitive Level: Apply (Application)
11. A person with obsessive-compulsive disorder (OCD) knows the ritual is senseless but is
unable to stop. Which best explains why he does not quit doing the ritual?
a. As rituals become habit, others will worry about the person if he or she suddenly
stops engaging in the ritual behavior.
b. Engaging in rituals allows the individual to feel in control.
c. If the compulsion is resisted, anxiety increases.
d. Rituals, even if nonsensical, are comforting and reassuring.
ANS: C
The person with OCD feels compelled to engage in some ritual to avoid a persistent
frightening thought, idea, image, or event. Obsessions are recurrent thoughts, emotions, or
impulses that cannot be dismissed. Compulsions are the rituals or behaviors that are
repeatedly performed to prevent, neutralize, or dispel the dreaded obsession. When the
individual tries to resist the compulsion, anxiety increases.
DIF: Cognitive Level: Apply (Application)
12. Which female would be at greatest risk for developing bulimia nervosa?
a. A 13-year-old who is constantly snacking on food from her backpack all day
b. A 14-year-old student who is known as a nerd
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. A 15-year-old cheerleader who wants to be a professional ballerina
d. An 11-year-old student with the highest Grade Point Average (GPA) in the school
ANS: C
Bulimia nervosa typically begins in adolescence or during the early 20s, usually in
conjunction with a diet. High school and college students, as well as members of certain
professions that emphasize weight and/or appearance (e.g., dancers, flight attendants,
cheerleaders, athletes, actors, models), are at a high risk. Based on these descriptors and the
typical characteristics of a person who has bulimia, the 15-year-old cheerleader demonstrates
the greatest risk.
DIF: Cognitive Level: Apply (Application)
13. Which female would be at greatest risk for developing anorexia nervosa?
a. A young woman who had been badly hurt in a car accident and is now living with
her grandparents but managing to retain her high school Grade Point Average
(GPA)
b. A young woman who is a fantastic athlete but acts out and does what she feels is
best, regardless of what others think
c. A “good girl,” obedient to her parents’ wishes, who always agrees with peers in
her clique and strives to do everything perfectly
d. A student under a lot of stress from family events at home but who has good
coping skills and recognizes that she is coping with major life changes
ANS: C
Risk factors for eating disorders are perfectionism, low self-esteem, stress, poor coping skills,
sexual/physical abuse, poor self-image, dependency on others’ opinions and deference to
NURSINreserved.
GTB.CBased
others’ wishes, and being emotionally
OM on these descriptors and the typical
characteristics of a person who has anorexia, the “good girl” demonstrates the greatest risk.
DIF: Cognitive Level: Apply (Application)
14. A nurse is picking up her child from nursery school when the daycare teacher says to her,
“One of the boys we care for does not seem able to sit still and listen, but is always running
around and getting into things. His parents are not worried. His mother said her brother was
the same way when he was a kid. Since you are a nurse, do you have any ideas on how I can
calm him down?” Which would be the most appropriate response by the nurse?
a. “I’m not a pediatric nurse; I really don’t know what to tell you.”
b. “I’m sorry you’re concerned, but being impulsive and very physically active is
quite normal for 3- to 4-year-old children.”
c. “Tell the parents he has to see the doctor as he’s not doing well in nursery school.”
d. “Why not suggest that it’s time for him to have a complete assessment and suggest
the physician call you for an update on how he is doing in nursery school?”
ANS: D
The three major characteristics of attention-deficit hyperactivity disorder/attention-deficit
disorder (ADHD/ADD) are inattention, hyperactivity, and impulsivity. Although parents may
notice symptoms and signs, it is often teachers who recognize the behaviors consistent with
ADHD/ADD and suggest referral for assessment and treatment. Suggesting a referral is the
most appropriate response for the nurse because of the symptoms that have been reported.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
15. A student said she wanted to discuss an issue with the nurse but that it was confidential.
Therefore, she asks the nurse to promise as a professional to keep this a secret. She then
shares that her roommate is very depressed; her older sister committed suicide, and she is
planning on killing herself if she does not pass her final examinations. Which action should be
taken by the nurse?
a. As a professional who made a promise, the nurse teaches the student how to
recognize if her roommate is getting ready to actually do it and the phone number
of the suicide hot line.
b. As secrecy was promised, the nurse can only encourage the student to encourage
her roommate to seek help.
c. The nurse should give the student brochures and information plus the suicide
hotline phone number to share with her roommate.
d. The nurse should stress that one cannot keep a secret when someone’s life is at
stake and immediately go to assess the roommate.
ANS: D
Suicide is preventable. Most people want to live but sometimes cannot see any other
alternative. Now that the nurse knows the roommate is talking about suicide, the nurse cannot
agree to keep the secret but must intervene and seek immediate help.
DIF: Cognitive Level: Apply (Application)
16. A college student visits the student health center and tells the nurse that his roommate is
talking about killing himself, has given some of his possessions away, and he believes the
roommate has a gun. Which action should be taken by the nurse?
URSIthis
NGstory;
TB.Cwhat
OMdoes he expect the nurse to do?
a. Ask the student why he isNtelling
b. Call the police immediately, and have the student tell them the story.
c. Call the roommate, and set up an appointment for him to come to the student
health center to discuss how things are going in his life right now.
d. Call the roommate, ask if he is thinking of killing himself, and, if so, how is he
thinking of doing that?
e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay
with him until emergency services arrive.
ANS: E
Whenever an individual exhibits suicide warning signs, nurses should refer the person to a
mental health clinic or provider as soon as possible. This may involve taking emergency
action by calling the local emergency services number in the community and staying with the
person until help arrives.
DIF: Cognitive Level: Apply (Application)
17. A family was very pleased with how well their child was doing now that he was on
medication. They congratulated the nurse on getting their child help and said they were so
impressed that the nurse was able to cure him. Which would be the most appropriate response
by the nurse?
a. Congratulate them on being so supportive to their child through this ordeal.
b. Stress that the medication is controlling the symptoms and their child will continue
to need their support.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Thank them for their recognition of the role you—and all nurses—play in
promoting health.
d. Verbalize your observations of how well their child is doing.
ANS: B
Psychotherapeutic medications do not cure mental illness; they act by controlling symptoms.
Thus, it is important for the nurse to stress to the family that the medication is controlling the
symptoms and the child needs their continued support. Both of these factors are important for
the long-term success and treatment of the child.
DIF: Cognitive Level: Apply (Application)
18. A patient had a distorted thought pattern, which led to very uncomfortable feelings and
inappropriate behaviors. Which type of therapy would most likely be successful?
a. Behavioral therapy
b. Cognitive-behavioral therapy
c. Family therapy
d. Group therapy
ANS: B
Cognitive-behavioral therapy may be used in individual, family, couples, or group therapy.
The goal is to identify and correct distorted thought patterns that can lead to troublesome
feelings and behaviors. In comparison, behavioral therapy uses learning principles to change
thought patterns and behaviors systematically; it is used to encourage the individual to learn
specific skills to obtain satisfaction. Family therapy involves problem-solving sessions with
members of the family. Group therapy involves a small group of people with similar problems
who, with the guidance of a therapist, discuss individual issues and help each other with
NURSINGTB.COM
problems.
DIF: Cognitive Level: Apply (Application)
19. Which best describes the change that was made to mental health care through the
implementation of the ACA?
a. Psychotherapy began to be considered part of mental health services.
b. Mental health services expanded to additional providers.
c. Spending limits were placed on mental health services.
d. Parity now exists for mental health services.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The Affordable Care Act (ACA) built on the 2008 Mental Health Parity and Addiction Equity
Act (Substance Abuse and Mental Health Services Administration [SAHMSA], 2017) to
extend federal parity protections to 62 million Americans with mental illnesses (USDHHS,
Office of the Assistant Secretary for Planning and Evaluation, 2013). This parity law aimed to
ensure that when coverage for mental health and substance use conditions is provided, it is
generally comparable to coverage for medical and surgical care. The ACA built on the parity
law by requiring coverage of mental health and substance use disorder benefits for millions of
Americans who currently lack these benefits. Mental and behavioral health services are
recognized as essential health benefits. Consequently, the ACA stipulated that all plans must
cover behavioral health treatment, such as psychotherapy and counseling; mental and
behavioral health inpatient services; and substance abuse treatment (HealthCare.gov, 2017).
Similarly, preexisting mental and behavioral health conditions are covered, and spending
limits aren’t allowed. Parity protections now exist for mental health services.
DIF: Cognitive Level: Understand (Comprehension)
20. A nurse is working in a community setting caring for persons with mental health problems
and their families. Which accurately describes how the nurse would fulfill the nursing role of
coordinator?
a. Being an advocate by writing letters to legislators demanding more resources for
care for the mentally ill
b. Encouraging all those involved to fight the community’s tendency to stigmatize the
mentally ill and their families
c. Assisting the mental health client in navigating community agencies
d. Establishing supportive interpersonal relationships with all those involved
ANS: C
N R I G B.C M
N T “navigate”
O
The nurse as coordinator helpsUtheS
consumer
the segmented web of agencies and
other service providers. Being an advocate and encouraging the community to overcome the
stigma of mental illness are both activities the nurse would fulfill through the role of activist.
Establishing supportive interpersonal relationships is fulfilled through the role of practitioner.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which behaviors best represent the definition of mental health? (Select all that apply.)
a. Currently enjoys receiving unemployment benefits
b. Frequent dates, although most relationships are short term
c. Happily married and successful parent of three children
d. Just promoted with more responsibilities and increased salary
e. Lives alone in a small apartment
f. Set up a memorial fund for research after death of a family member
ANS: C, D, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In 1999, the Surgeon General’s Report on Mental Health defined mental health as a state of
successful performance of mental function that results in productive activities, fulfilling
relationships with others, and an ability to adapt to change and cope with adversity. The
correct behaviors represent the ability to maintain employment and relationships, and to adapt
to change, including adversity. The incorrect responses demonstrate behaviors that do not
support mental health—enjoyment in receiving unemployment benefits, short-term
relationships, and living alone.
DIF: Cognitive Level: Understand (Comprehension)
2. Which are the causes of mental illness? (Select all that apply.)
a. Excessive amounts of brain serotonin, dopamine, and -aminobutyric acid
b. Genetic inheritance combined with neurochemical and metabolic changes
c. Living through a severe disaster, whether manmade or natural
d. Physiological abnormalities in the brain structure
e. Posttraumatic stress syndrome (PTSD)
f. Social isolation, rejection, and/or stress
ANS: B, C, D, E, F
Genetic expressions, combined with neurochemical and metabolic changes and environmental
insults, may result in the display of mental disorder characteristics. Evidence indicates that
structural brain abnormalities can be related to some mental illnesses, such as schizophrenia,
depression, and Alzheimer disease. Natural and manmade disasters, such as hurricanes,
floods, violence, terrorism, war, and the global economic crisis are profound stress-inducing
events that can lead to mental illness. Researchers reported high levels of PTSD among
survivors.
N R I G B.COM
U (Knowledge)
S N T
DIF: Cognitive Level: Remember
3. A nurse suspects that a client is depressed. Which symptoms are most likely being exhibited
by the client? (Select all that apply.)
a. Paranoia
b. Fatigue
c. Irritability
d. Difficulty concentrating
e. Hallucinations
f. Impulsivity
ANS: B, C, D
Symptoms of depression include the following: persistent sad, anxious, or “empty” feelings;
feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness;
irritability, restlessness; loss of interest in activities or hobbies once pleasurable, including
sex; fatigue and decreased energy; difficulty concentrating, remembering details, and making
decisions; insomnia, early-morning wakefulness, or excessive sleeping; overeating or appetite
loss; thoughts of suicide, suicide attempts; aches or pains, headaches, cramps, or digestive
problems that do not ease even with treatment.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 26: Communicable Disease
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which infection continues to increase in the United States?
a. Measles
b. Pertussis
c. Hepatitis A, B, and C
d. Sexually transmitted diseases (STDs)
ANS: D
Treatable STDs, such as gonorrhea, chlamydia, and syphilis, are still occurring at significant
rates. Gonorrhea had plateaued or declined until 2009 but increased steadily since that time.
Chlamydia, the most commonly reported bacterial disease in the United States, reached
1,441,789 cases in 2014, although some of this increase is thought to be the result of improved
screening for the infection,
DIF: Cognitive Level: Remember (Knowledge)
2. Which best describes what is happening with infectious diseases in the United States?
a. There is a continuing decrease in vector-borne infections.
b. There is a continuing increase in food-borne and waterborne infections.
c. Many airborne diseases are being spread by bioterrorists.
d. The rate of infection varies extensively by income and ethnic groups.
ANS: D
NURSINGTB.COM
Probably one of the most profound failures in infectious disease control in the United States
and elsewhere is that the successes are not equally distributed in the general population.
Infectious diseases continue to be differentially distributed by income and ethnic groups, and
the poor and minorities continue to experience the greater burden. There continues to be an
increase in vector-borne infections, but there has been a decrease in food-borne and
waterborne infections. There is concern that deadly pathogens will be weaponized by
terrorists.
DIF: Cognitive Level: Understand (Comprehension)
3. Which is a fairly recent surprise regarding infectious diseases in the United States?
a. Cervical cancer and coronary artery disease may be caused by infectious agents.
b. Epidemics such as the H1N1 flu continue to occur.
c. Mortality caused by infectious diseases continues to rise.
d. Some infectious diseases remain endemic in our society.
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Recent scientific discoveries on the infectious etiology of stomach ulcers, coronary artery
disease, and cervical cancer, for example, suggest that infectious agents may be responsible
for more morbidity and mortality than previously recognized. Mortality caused by infectious
diseases has decreased. Endemic refers to a disease that is regularly found among people in a
certain area. In our society today, there are no endemic infectious diseases. Advances in
public health and health care have made it easier to control infectious diseases such as H1N1
flu.
DIF: Cognitive Level: Understand (Comprehension)
4. A female client develops a fungal vaginal infection after being treated with antibiotics for
strep throat. Which component of the epidemiological triangle is primarily responsible?
a. Agent
b. Environment
c. Host
d. Interaction of agent and environment
ANS: C
Infectious diseases are the result of interaction among the human host, an infectious agent,
and the environment, which surrounds the human host and where transmission is occurring.
This interaction is pictured in the epidemiological triad of agent, host, and environment also
discussed in Chapter 5. The antibiotic therapy eliminated a specific pathological agent, but it
also may alter the balance of normally occurring organisms in the woman’s body, which
caused a change in the vaginal environment, allowing normally present fungi to proliferate,
resulting in a yeast infection.
DIF: Cognitive Level: Analyze (Analysis)
NURSINGTB.COM
5. Which statement is true concerning tuberculosis (TB) infections in the United States?
a. Subclinical cases of TB can occur in patients who fight off the infection and thus
are not a danger to themselves or others.
b. TB can be cured by a 6-month period of treatment with INH.
c. TB can only be caused by the Mycobacterium bovis bacillus.
d. Under certain conditions, susceptible hosts may be infected by the TB bacillus.
ANS: D
The principle of multicausation emphasizes that an infectious agent alone is not sufficient to
cause disease; the agent must be transmitted within a conducive environment to a susceptible
host. Mycobacterium tuberculosis kills cells. M. tuberculosis has low infectivity, low
pathogenicity, but high virulence if untreated.
DIF: Cognitive Level: Understand (Comprehension)
6. One child in a kindergarten room had a slight fever and did not eat lunch. Otherwise, the child
seemed OK. Three days later, several children were absent from kindergarten. Which best
describes what happened?
a. Another nursery school was offering the same child care at a much lower price.
b. Infectious diseases can be contagious before any diagnostic symptoms occur.
c. No way to tell; there are many reasons why parents keep children home.
d. Parents chose to protect their children from the child with a fever, so they kept
their children home for a few days.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: B
Frequently, the communicable period begins before symptoms are present. The communicable
period, or communicability, follows latency and begins with shedding of the agent. The
incubation period is the time from invasion to the time when disease symptoms first appear.
Thus, even if parents kept their children away from the child with the fever, this could
possibly be ineffective because their children may have already been exposed before the child
exhibited symptoms. It is unlikely that the children suddenly changed schools. Although, there
may be many reasons why parents keep their children home from school, in this situation
there is a specific reason that can be identified.
DIF: Cognitive Level: Apply (Application)
7. A daycare center asked the nurse to come because they had several children out as a result of
chickenpox. Which statement should the nurse make to the staff?
a. “Chickenpox has low infectivity, so few children will get sick.”
b. “Chickenpox has low pathogenicity, so the children won’t be sick enough to stay
home if the parents really need to go to work.”
c. “Chickenpox has low virulence, so the children will be back at the daycare center
in a week or so.”
d. “Adults never catch chickenpox, so the staff are safe and may continue working.”
ANS: C
Other considerations for understanding the action of agents include their power to invade and
infect large numbers of people (infectivity), their ability to produce disease in those infected
with the agent (pathogenicity), and their ability to produce serious disease in their hosts
(virulence). When the above concepts are applied, the chickenpox virus has high infectivity,
high pathogenicity, and veryN
low
URvirulence.
SINGTB.COM
DIF: Cognitive Level: Apply (Application)
8. A city that depended on tourist dollars had feedback that tourists were saying they were never
returning because of the constant mosquito bites. Which action should be taken by the city?
a. Do not have any tourist events at dawn or dusk.
b. Have everyone in town search for and remove any standing stagnant water.
c. Give free bug repellent to each tourist.
d. Tell tourists to avoid wearing bright colors.
ANS: B
Knowing the reservoirs for infectious agents is important, because, in some cases,
transmission can be controlled by eliminating the reservoir, such as eliminating the standing
water where mosquitoes breed. The other interventions, not having events at dusk or dawn,
providing bug repellent, and wearing bright colors are ways the tourists can cope with the
mosquitos that are present, but they do not eliminate the breeding and presence of the
mosquitos.
DIF: Cognitive Level: Apply (Application)
9. The daily patrons of a local town restaurant became ill with nausea, vomiting, and diarrhea.
Without knowing the cause, which action should be taken immediately to help avoid future
problems?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
Establish a series of cooking classes for all citizens
Have a citywide campaign to cover your mouth when sneezing
Use bleach to clean the entire restaurant
Strongly emphasize the importance of proper hand washing to staff
ANS: D
Agents leave the human host through a portal of exit and invade through a portal of entry.
Portals of exit include respiratory secretions, vaginal secretions, semen, saliva, lesion
exudates, blood, and feces. Portals of entry are associated with the portal of exit and include
the respiratory passages, mucous membranes, skin and blood vessels, oral cavity, and the
placenta. Because it was food poisoning of some sort, until the cause is known, it can be
assumed to probably be a fecal-oral transmission. Thus, the interventions of cooking classes,
covering your mouth when sneezing, and using bleach to clean the entire restaurant would be
ineffective. Therefore, staff need to again be reminded of the importance of careful hand
washing after using the facilities.
DIF: Cognitive Level: Apply (Application)
10. Which best describes why clinical areas are so careful to ensure sanitization of surfaces and
equipment between each patient?
a. To avoid direct patient-to-patient transmission of infection
b. To provide a clean environment for clients and staff
c. To decrease transmission by fomites
d. To decrease transmission by vectors
ANS: C
Indirect transmission is the spread of infection through a vehicle of transmission outside the
NURfomites
host. These may be contaminated
vectors.
SINGTorB.C
OM Fomites can be any inanimate object,
material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a
contaminated tissue).
DIF: Cognitive Level: Understand (Comprehension)
11. Which is the first step in preventing further spread of a particular sexually transmitted disease
(STD)?
a. Have a citywide free screening program in all high schools and colleges
b. Provide public education about safe sex from abstinence to monogamous
relationships
c. Require all public facilities to sanitize all restrooms with a stronger, more effective
agent
d. Treat each infected person with the appropriate pharmaceutical agent
ANS: D
Antiinfective drugs, such as antibiotics, antivirals, antiretrovirals, and antimalarials, play
important roles in controlling infectious diseases. Not only do they permit recovery of the
infected person, but they also play a major role in preventing transmission of the pathogens to
another. The first step in preventing transmission of tuberculosis and syphilis is to treat the
infected person with antibiotics. Because the question asks about further spread, infection in a
person has been diagnosed, so education is needed, but it is too late for that person. Adults not
in school also are infected with STDs. A stronger, more effective sanitizing agent would not
be the most effective strategy to prevent spread of STDs.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
12. A case of severe acute respiratory syndrome (SARS) was diagnosed immediately on signs of
illness at a tourist site in China. Which action should be taken to protect the badly needed
income from tourist dollars?
a. Close the airports and refuse to let the tourists in the area leave
b. Begin to immunize everyone in the immediate area with protective vaccine as soon
as possible
c. Quarantine the ill person and use isolation techniques when providing care
d. Screen everyone in the area by requiring a blood and urine sample
ANS: C
Quarantine is an enforced isolation or restriction of movement of those who have been
exposed to an infectious agent during the incubation period; this is another method of
controlling the reservoir. Quarantine was used effectively during the outbreak of SARS in
2003, when some hospitals required that their staff exposed to SARS patients remain at the
hospital until proved to be symptom free at the end of the incubation period. Immunization
and screening would not protect the population from exposure to this infectious disease. It is
likely that others besides tourists could be exposed or infected by this disease, thus, closing
airports would be ineffective in controlling the spread of the disease.
DIF: Cognitive Level: Apply (Application)
13. A patient walks into a community clinic complaining of severe intestinal cramps and diarrhea.
Which action can be taken to protect the staff at the clinic?
a. Refuse to see anyone that sick as clinics have a different mission than secondary
NURSIillNGTB.COM
and tertiary care of the obviously
b. Send the patient immediately to the closest hospital emergency department
c. Treat the patient with broad-spectrum antibiotics and lots of fluids
d. Use universal precautions with all patients regardless of the situation
ANS: D
The Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called
universal precautions, to prevent transmission of diseases found in blood and other body
fluids. These guidelines were developed because infected people may be asymptomatic and
have no knowledge of their conditions; therefore, health care workers must assume that all
patients are infectious and protect themselves, other health care workers, and other patients.
Refusing to treat the patient, sending the patient to an emergency department, or treating the
patient with antibiotics and fluids would not be appropriate measures to protect the staff.
DIF: Cognitive Level: Apply (Application)
14. During an outbreak in the hospital, all staff members were given immunoglobulin if they were
not already immune to the disease. Which type of immunity will the staff who received the
immunoglobulin have?
a. Active immunity
b. Long-lasting immunity
c. Natural immunity
d. Passive immunity
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
Passive immunity is the temporary resistance that has been donated to the host through
transfusions of plasma proteins, immunoglobulins, or antitoxins, or transplacentally from
mother to neonate. Passive immunity lasts only as long as these substances remain in the
bloodstream. Active immunity is when the body produces its own antibodies against an
antigen, from either infection with the pathogen or introduction of the pathogen in a vaccine.
DIF: Cognitive Level: Apply (Application)
15. The nurse could not find a vaccine in the refrigerator. The unopened vaccine vial had been put
in a storage cabinet with the other medications. The nurse drew up the appropriate dose in the
syringe and then put the vial of vaccine in the refrigerator. Which would be the most likely
result?
a. The client will have immunity to the disease after the vaccination
b. Primary vaccine failure
c. Secondary vaccine failure
d. The injection will not feel so cold to the client
ANS: B
Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be
caused by improper storage that may render the vaccines ineffective, improper administration
route, or exposure of light-sensitive vaccines to light. Secondary vaccine failure is the waning
of immunity following an initial immune response, often occurring with immunosuppressed
and organ transplant patients in whom the immune memory is essentially destroyed. Although
the injection will not feel so cold to the client, the problem that will result is primary vaccine
failure.
URSINGTB.COM
DIF: Cognitive Level: Apply N
(Application)
16. A school had tried very hard to uphold the requirement for all children to be vaccinated.
However, state law allowed parents to exempt their child if they had a religious reason for
refusal. Two children have been diagnosed with chickenpox. Which will be the most likely
result?
a. Adults as well as children in the neighborhood will get chickenpox.
b. All the children who played with the two sick children will probably get
chickenpox.
c. All the unimmunized children will probably come down with chickenpox.
d. Few children will get chickenpox because of herd immunity.
ANS: D
Herd immunity is a state in which those not immune to an infectious agent will be protected if
a certain proportion (generally considered to be 80%) of the population has been vaccinated or
is otherwise immune. Because most children in the school are immune, it will be difficult for
the chickenpox to spread.
DIF: Cognitive Level: Apply (Application)
17. A community health clinic put a tax levy on the ballot. An angry man asks a nurse, “How can
you ask me to pay taxes to buy immunizations for parents who do not want to pay for their
kids to get their shots?” Which is the most appropriate response by the nurse?
a. “Don’t you think ethically we should help if we can?”
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. “For many of us, our faith says we have to treat our neighbor as ourselves.”
c. “Only by getting almost everyone immunized can we prevent epidemics that can
hurt us all.”
d. “The law requires childhood immunizations, and, if parents can’t afford it, you and
I will have to help pay.”
ANS: C
Herd immunity is a state in which those not immune to an infectious agent will be protected if
a certain proportion (generally considered to be 80%) of the population has been vaccinated or
is otherwise immune. If most persons are immune, it will be difficult for an infectious disease
to spread.
DIF: Cognitive Level: Apply (Application)
18. Which statement best explains how infectious diseases are different from any other health
problem?
a. Infectious diseases are easier to treat by using pharmaceuticals.
b. Infectious diseases are more prevalent now than in the past.
c. Infectious diseases are acute illnesses that catch clients unprepared.
d. Infectious diseases have the potential to spread, creating a community emergency.
ANS: D
Because of their potential to spread and cause communitywide or worldwide emergencies,
infectious diseases require organized, public efforts for their prevention and control. Most
human diseases (e.g., cancer or diabetes) can be classified as personal health problems.
Individuals with a personal health problem can be treated by the health care system one
person at a time. By contrast, infectious diseases are categorized as public or community
NURSINGTB.COM
health problems.
DIF: Cognitive Level: Understand (Comprehension)
19. Which would be one of the first steps in attempting to control a disease?
a. Create an appropriate screening test for widespread use
b. Define what the disease looks like in confirmed or probable cases
c. Determine the disease’s portal of entry and portal of exit
d. Measure the extent of its spread geographically
ANS: B
Standardized definitions of diseases are necessary for public health monitoring and
surveillance across all levels of government. Diseases are defined and classified according to
confirmed cases, probable cases, laboratory-confirmed cases, clinically compatible cases,
epidemiologically linked cases, genetic typing, and clinical case definition. Once defined,
disease occurrence can be compared across time, populations, and geographic areas, and
appropriate control efforts can be implemented.
DIF: Cognitive Level: Understand (Comprehension)
20. The charge nurse notes that two patients had communicable infectious diseases and were
treated appropriately. Which action should be taken next by the nurse?
a. Depends on your state health department’s requirements
b. Report the two cases to the Centers for Disease Control and Prevention (CDC)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Report the two cases to your regional health department
d. Send the information for inclusion in the Morbidity and Mortality Weekly Report
ANS: A
Because state health departments have the responsibility for monitoring and controlling
communicable diseases within their respective states, they determine which diseases will be
reported within their jurisdiction. Because the state health department requirements will
dictate what action is taken next, it may not be necessary to report the cases to the CDC,
regional health department, or to the Morbidity and Mortality Weekly Report.
DIF: Cognitive Level: Apply (Application)
21. Parents have requested that their child be brought up to date on appropriate immunizations.
After reviewing the child’s medical history, the nurse prepares to give the two immunizations.
What additional action should be taken by the nurse before administration of the
immunization?
a. Ask if there is any chance the girl child could be pregnant
b. Ask the child if she consents to the immunizations
c. Assess whether the child has a fever or other illness that would require the
immunization be postponed
d. Explain the pros and cons of obtaining immunizations to the parents
e. Give the parents the Vaccine Information Statement (VIS)
ANS: E
The Centers for Disease Control and Prevention produces VISs that explain the benefits and
risks of vaccine to vaccine recipients, their parents, or their legal representatives. Federal law
requires that VISs be handed out whenever (before each dose) certain vaccinations are given.
NURSIhad
M
Because the parents have previously
childOreceive
immunizations, they clearly have
NGthe
TB.C
chosen to continue with immunizations so they do not need to hear the pros and cons of
children being immunized. Children cannot give consent, only assent, to procedures. Because
the child is a minor, the child’s parents make the decisions.
DIF: Cognitive Level: Apply (Application)
22. A nurse is planning primary prevention activities related to the emergence of tuberculosis
(TB) in the local community. Which activity would the nurse implement?
a. Offer screening tests for TB in the community
b. Discuss the referral process with community members diagnosed with TB
c. Educate community members about TB infection and transmission
d. Monitor medication compliance for community members diagnosed with TB
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Primary prevention of communicable diseases involves measures to prevent transmission of
an infectious agent and to prevent pathology in the person exposed to an infection.
Community education is part of primary prevention. Secondary prevention consists of
activities to detect infections early and effectively treat persons who are infected. These
actions prevent not only progression of the infectious disease but also transmission of the
pathogen to others. Reporting infectious diseases, investigating contacts, notifying partners,
finding new cases, and isolating infected people also are examples of secondary prevention.
Tertiary prevention includes activities involved in caring for persons with an infectious
disease to ensure that they are cured or that their quality of life is maintained. Perhaps the
most important part of the treatment process is to ensure that people take their antimicrobial
agents completely and effectively.
DIF: Cognitive Level: Apply (Application)
23. An 11-year-old boy is at the community health clinic for his well-child visit. The child’s
mother states she has heard that there is a HPV vaccine available for boys and wonders when
her child should receive this vaccine. Which would be the most appropriate response by the
nurse?
a. “Let me check to see if we have the vaccine on hand, as boys receive a different
vaccine than girls.”
b. “The HPV vaccine has not yet been found to be safe and effective for boys, so I
would recommend waiting another year.”
c. “The HPV vaccine should be given to boys after they start puberty, so the age of
administration will vary.”
d. “The HPV vaccine should be given to your son at his visit today and will need to
be administered two more times.”
ANS: D
NURSINGTB.COM
Currently, the CDC recommends that both boys and girls between 11 and 12 years of age be
immunized against HPV. Education is critical, because research shows that young women are
three times more likely to undergo immunization if it is strongly recommended by their health
care providers. Furthermore, even partial immunization, both at the individual level and
within a community, has been very effective in reducing overall prevalence of HPV through
the effects of herd immunity. Nurses can be central to reduction of a number of cancers by
encouraging widespread use of the HPV vaccine for both males and females as recommended
by the CDC.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which best explains why the Vaccine Adverse Event Reporting System (VAERS) was
originally legislated? (Select all that apply.)
a. To ensure that data are used to educate health care professionals on proper vaccine
administration
b. To conduct media campaigns to help convince parents to bring their children in to
receive appropriate immunizations
c. To determine whether changes should be made in procedures or biological agents
d. To illustrate, using actual data, that vaccines are widely given to healthy people
with almost no side effects
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
e. To monitor actual and potential vaccine-related problems
f. To provide assistance to families who experience a vaccine-related injury
ANS: C, E
No drug is perfectly safe or effective. The VAERS allows for the monitoring of actual and
potential vaccine-related problems. Changes are made on the basis of the collected data. For
example, whole cell pertussis vaccine was changed to an acellular pertussis vaccine because
of adverse side effects. To monitor actual and potential vaccine-related problems, health care
providers must report specific postvaccination “adverse events” to the VAERS. The National
Vaccine Injury Compensation Program reviews all VAERS reports and provides assistance
for individuals and families who experience a vaccine-related injury, including disability and
death. The VAERS does not provide education to health care professionals on proper vaccine
administration or conduct media campaigns to help convince parents to bring their children in
to receive appropriate immunizations. Vaccines can produce a variety of responses, both
positive and negative. Thus, side effects can occur in healthy people.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 27: Substance Abuse
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which preventable health problem is the cause of more deaths, illnesses, and disabilities than
any other?
a. Use of tobacco
b. Obesity
c. Sexually transmitted diseases (STDs)
d. Substance abuse
ANS: D
Perhaps no other health-related condition has as many far-reaching consequences in
contemporary Western society as substance abuse. These consequences include a wide range
of social, psychological, physical, economic, and political problems. Drug abuse and
addiction have negative consequences for individuals, families, and communities. Estimates
of the total overall costs of substance abuse in the United States, including productivity and
health- and crime-related costs exceed $700 billion annually. This includes approximately
$193 billion for illicit drugs, $295 billion for tobacco, and $224 billion for alcohol. These
numbers in dollars do not describe the extent of public health and safety implications.
DIF: Cognitive Level: Remember (Knowledge)
2. A female student was extremely upset over her test results. She thought she had studied
thoroughly, but her test grade would be totally unacceptable to her parents. Her friend said,
NURStest.
INYou’ll
GTB.C
M
“Come on, it’s just the first course
doO
better on the next one. Let’s go out and have
a drink. You’ll feel much better.” After the first drink, how will the upset student most likely
feel?
a. A bit nauseous
b. More relaxed and comfortable
c. Ready to have a second
d. Very thirsty
ANS: B
If one expects a certain effect, such as relief, one is more likely to feel it after use of a drug.
The satisfied expectancies may set up neural pathways that are interpreted as pleasurable. It is
unlikely that the student will feel nauseous or very thirsty after the first drink. The student
may feel ready to have a second, but that would be related to the relaxation and comfort
experienced with the first drink.
DIF: Cognitive Level: Apply (Application)
3. Which mood-altering substances are considered acceptable to use by current Western society?
a. Alcohol
b. Amphetamines
c. Barbiturates
d. Nicotine
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In general, alcohol use has gained more social acceptance than other drug use. Because of the
known harmful effects of tobacco, it is not acceptable to use tobacco products, which contain
nicotine. The use of amphetamines and barbiturates are not acceptable in Western society.
DIF: Cognitive Level: Remember (Knowledge)
4. Which best explains why most states have the legal drinking age set at 21 years old?
a. At 21 years of age, most Americans consider a person an adult.
b. College is completed, and employment has begun by 21 years of age.
c. Most 21-year-olds are self-supporting and no longer dependent on parents.
d. The alcohol-related death rate rose alarmingly when drinking age was lowered to
18 years.
ANS: D
Alcohol use was highest during the 1980s, when states lowered the drinking age to 18 years of
age. Lawmakers became alarmed at the increased rate of drinking and the increased number of
alcohol-related deaths among 18- to 25-year-olds after lowering the drinking age and therefore
reversed the decision. During the late 1980s, alcohol use declined after the minimum drinking
age was reinstated to 21 years of age. Thus, the significance of the legal drinking age of 21
has to do with the problems experienced when the legal drinking age was lowered to 18, not
that 21-year-olds are considered to be “adults”, employed, or self-supporting by this age.
DIF: Cognitive Level: Understand (Comprehension)
5. Which best explains what experts believe is the causative factor in the decline in total alcohol
consumption?
a. Americans prefer less dangerous mood-altering substances
NURSIand
b. Increased “sin” taxes on alcohol
NGtobacco
TB.Cnationwide
OM
c. Less social tolerance and no-drinking-while-driving campaigns
d. So many movies about teenaged drinking make alcohol look adolescent
ANS: C
The decline in alcohol consumption through the 1990s and into the 21st century is attributed
to less tolerant national attitudes toward drinking, increased societal and legal pressure and
action against drinking and driving, and increased health concerns among Americans. The
decline does not have to do with Americans choosing other mood-altering substances,
increased taxation, or the media.
DIF: Cognitive Level: Understand (Comprehension)
6. Which legislation has increased funding for treatment and rehabilitation for substance abuse?
a. Drug Abuse Prevention and Control Act
b. Anti-Drug Abuse Acts of 1986 and 1988
c. Omnibus Transportation Employee Testing Act
d. Harrison Narcotic Act of 1914
ANS: B
The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and
rehabilitation and also stiffened penalties for drug offenses; the 1988 act created the Office of
National Drug Control Policy.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Remember (Knowledge)
7. Which age group has the highest prevalence of binge drinking and heavy drinking?
a. Adults aged 45 to 65 years
b. Adult business persons, aged 25 to 45 years
c. Both genders of depressed elderly, aged 65 years and up
d. Young adults aged 18 to 25 years
ANS: D
Nearly 66.7 million of persons aged 12 or older participated in binge drinking. Heavy
drinking was reported by 6.5% of the population aged 12 or older, or 17.3 million people.
Among young adults aged 18 to 25 in 2015, the rate of binge drinking was 39%. The rate of
alcohol use among youths aged 12 to 17 was 9.6% in 2015. Youth binge and heavy drinking
rates in 2011 were 7.4 and 1.5%, respectively. Binge and heavy drinking is less likely to occur
in adults aged 25 to 65 years or the elderly who are 65 years old and older.
DIF: Cognitive Level: Remember (Knowledge)
8. Which is the most commonly used illegal mood-altering substance?
a. Cocaine or crack ecstasy
b. Heroin
c. Marijuana
d. Methamphetamine or speed
ANS: C
Marijuana was the most commonly used illicit drug. In 2015, there were 22.2 million current
users. The proportion of people aged 12 or older who were current marijuana users in 2015
was similar in proportion to 2014,
higher
NURSbut
INitGwas
TB.C
OMthan the percentages from 2012 to 2013.
DIF: Cognitive Level: Remember (Knowledge)
9. Which best explains why experts are now distinguishing between use and misuse?
a. It is easier to discuss use than to accuse persons of being drug addicts.
b. Expansion of drug treatment programs has prevented some people from becoming
totally addicted.
c. Persons using prescription drugs are “users,” not “misusers.”
d. Some persons may use drugs and not become dependent on them.
ANS: D
Research has revealed that problems associated with substance use may or may not relate to
classically or clinically defined dependence or addiction. Many are turning to recovery before
they have developed physiological dependence. Thus, many in the field have begun to
differentiate between use and misuse (misuse being interchangeable with abuse), and these
terms now appear in the literature. Drug treatment programs are far fewer than the need.
DIF: Cognitive Level: Understand (Comprehension)
10. Which trend in illicit drug use is being seen among adults over age 50?
a. The rate of illicit drug use increased until 2011 but has shown a recent decline.
b. The rate of illicit drug use has remained stable for the past several years.
c. The rate of illicit drug use is increasing.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. The rate of illicit drug use is decreasing.
ANS: C
Among adults aged 50 to 64, the rate of illicit drug use increased from 2.7% to 6.0% in 2013;
for those ages 50 to 54, the rate increased from 3.4% to 7.9% in 2013. Among those aged 55
to 59, the rate of current illicit drug use increased from 1.9% in 2002 to 5.7% in 2013. In those
aged 60 to 64, the rate of current illicit drug use increased from 1.1% in 2003 and 2004 to
3.9% in 2013 (USDHHS, 2014).
DIF: Cognitive Level: Understand (Comprehension)
11. Which drug is being widely manufactured within the United States?
a. Cocaine
b. Heroin
c. Marijuana
d. Methamphetamine
ANS: D
Marijuana is grown, not manufactured. Methamphetamine is easily made from the fertilizer
anhydrous ammonia. Cocaine and heroin are grown elsewhere and smuggled into the United
States.
DIF: Cognitive Level: Remember (Knowledge)
12. In which way is methamphetamine different from and more dangerous than other
mood-altering substances?
a. The drug itself is highly combustible, so both makers and users have suffered
severe burns when injecting
NUit.
RSINGTB.COM
b. Methamphetamine helps users become more productive and energetic, so people
find it helpful at work and home and want to continue using it.
c. It provides more pleasurable effects more quickly than other mood-altering drugs,
so persons become addicted more quickly.
d. Severe neurological changes occur in the brain very quickly, often even with the
first dose.
ANS: D
Methamphetamine appears to damage the brain in ways that are different from, and more
severe than, damage from using other drugs. Currently, there is a rudimentary understanding
of ways it affects the brain, but it is known that profound neurological changes occur even
with first administration. Methamphetamine is highly combustible, and makers have suffered
severe burns when manufacturing it. The pleasurable effects of methamphetamine lead to
users having increased energy, a sense of euphoria, and increased productivity. However, it
also causes an increased heart rate, insomnia, excessive talking, excitation, aggressive
behaviors, anxiety, convulsions, paranoia, and brain damage. Prolonged use results in
tolerance and physiological dependence. Because of the physiological dependence, users may
feel powerless in having a choice in whether they use the drug or not. Its increased popularity
is related to it appearing in mass quantities because of the ease in which fertilizer anhydrous
ammonia can be converted to methamphetamine.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
13. A woman was bragging about her 12-year-old son who was quiet and spent a lot of his time in
his room building model airplanes, and gluing and painting pieces. Which may be concerning
to the nurse?
a. Being preadolescent, he needs education on sexual growth and development.
b. He may be inhaling fumes from the aerosol paints and glues.
c. Twelve-year-olds are not usually quiet; he needs a mental health consult.
d. Twelve-year-olds need physical exercise, and he is not getting any sitting around.
ANS: B
Inhalants are fumes from a range of substances such as glues, aerosols, butane, and paint
thinner. These products are inexpensive, legal, and easy to obtain, making them attractive to
younger adolescents who have less access to illicit drugs. The nurse should first consider the
age and safety of the child. Thus, it is appropriate for the nurse to consider that the child may
be inhaling the fumes while working with these products. This should be the immediate
concern of the nurse. Once this issue has been addressed, the nurse may want to consider the
child’s need for additional physical activity, limited interactions with peers, and need for
education about growth and development.
DIF: Cognitive Level: Apply (Application)
14. From who is a person aged 12 or older most likely to obtain pain relievers for nonmedical
use?
a. Free from a friend or relative
b. Purchased from a friend or relative
c. Through a prescription from a physician
d. Purchased on the Internet
ANS: A
NURSINGTB.COM
Among persons aged 12 or older in 2012 to 2013 who used pain relievers nonmedically in the
past 12 months, 53.0% obtained the drug they used most recently from a friend or relative for
free; 10.6% bought the drug from a friend or relative, and another 21.2% reported that they
obtained the drug through a prescription from one doctor. An annual average of 4.3% people
got pain relievers from a drug dealer or other stranger, and 0.1% bought them on the Internet
(USDHHS Substance Abuse and Mental Health Services Administration, 2017).
DIF: Cognitive Level: Remember (Knowledge)
15. Which best describes why it is crucial to never use the label of “addiction”?
a. Labeling invites ridicule by other people.
b. Labeling someone avoids actually taking action to correct the behavior.
c. Labels have a tendency to remain throughout the person’s life.
d. Labels influence self-perception, and behavior will begin to fulfill the label.
ANS: D
It is becoming increasingly evident that specific interventions may be needed for each
separate addictive problem (e.g., overeating and gambling). Moreover, in each specific group,
there is wide individual diversity.
DIF: Cognitive Level: Understand (Comprehension)
16. Which best explains why anyone would ever experiment with an illegal substance?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
As a way of rebelling against parental authority
Because it is forbidden
For the thrill of it—without getting caught
Friends are encouraging it
ANS: D
Users often describe a progression that began with initiation through social interactions.
Particularly among adolescents and young adults, evidence suggests that substance use and
abuse often occur in the context of social interactions. Thus, it is likely that friends are
encouraging it. This response is more likely than experimentation because of getting a thrill,
doing something that is forbidden, or a way to rebel against parental authority.
DIF: Cognitive Level: Understand (Comprehension)
17. A man had managed not to drink for over 2 years, but today, when he was told his position
was being eliminated, he drank himself into a stupor. Which approach should the nurse take
with this client?
a. Admit the man is an alcoholic and always will be
b. Consider the relapse a learning opportunity and discuss options for coping with
problems
c. Have him arrested for disorderly conduct in the hope that jail will get his attention
and scare him into avoiding future use
d. Suggest inpatient treatment, where he will not be able to access alcohol
ANS: B
Abstinence is difficult to maintain on a long-term basis. Therefore, an important area is
relapse prevention, which aims to prepare the client for the relapse situation in the hope of
NUimpact
RSINonGrecovery.
preventing it or minimizing its
TB.COMRelapses are reframed as learning
opportunities, and the client makes plans for coping with negative mood states, meeting the
challenge of craving, and stopping a relapse quickly if it should occur.
DIF: Cognitive Level: Apply (Application)
18. Which is crucial during the detoxification phase of the addiction process?
a. Controlling the environment, so drugs cannot be obtained
b. Maintaining a therapeutic relationship with the client
c. Maintaining communication with the client’s family
d. Managing the acute withdrawal symptoms
ANS: D
Detoxification is best described as a short-term treatment intervention designed to manage
acute withdrawal from the substance. It involves medical management to reduce the adverse
side effects of the substance and help stabilize the client. Addressing acute withdrawal
symptoms is of utmost importance in detoxification.
DIF: Cognitive Level: Understand (Comprehension)
19. Which best explains why drug abusers so often relapse?
a. Drugs are widely available.
b. They lack a supportive environment.
c. They remember how fantastic they feel immediately after using.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Drugs make them feel better about life.
ANS: B
Because many abusers lack a supportive environment, the potential for relapse is increased.
The availability of drugs, remembering the immediate fantastic feeling of using, or feeling
better about life while using are not the primary explanations for why drug abusers relapse.
DIF: Cognitive Level: Understand (Comprehension)
20. Which is the treatment of choice for treating heroin addicts during withdrawal?
a. Acamprosate
b. Benzodiazepines
c. Methadone
d. Naltrexone
ANS: C
Methadone is the treatment of choice in withdrawal from heroin or other opiates. As a
detoxification agent, methadone is dispensed over an 8-day period in a tapering dose. Dosage
is dependent on the degree of opiate withdrawal symptoms present. Benzodiazepines are used
for alcohol withdrawal, and Antabuse is no longer used. Naltrexone may be used to
supplement methadone.
DIF: Cognitive Level: Understand (Comprehension)
21. Which is the drug of choice for treating persons with alcohol withdrawal?
a. Antabuse
b. Benzodiazepines
c. Methadone
NURSINGTB.COM
d. Naltrexone
ANS: B
Benzodiazepines are considered effective tools for alcohol withdrawal because they decrease
the likelihood of seizures and delirium. The use of Antabuse is rare today because of serious
safety issues. Naltrexone is a long-acting narcotic antagonist traditionally used as an adjunct
in the treatment of opiate dependence. Methadone is the treatment of choice in withdrawal
from heroin or other opiates.
DIF: Cognitive Level: Understand (Comprehension)
22. A client has refused to stop drinking alcohol. Which action should be taken by the nurse?
a. Ask a physician to admit the patient to the acute care hospital.
b. Attempt harm reduction to help the client reduce drinking.
c. Cease giving care because the client is totally noncompliant.
d. Seek to have the patient admitted as a mental health client.
ANS: B
Harm reduction remains controversial although some see it as a paradigm shift with the
potential to significantly improve treatment results. Harm reduction is often the only option
that will preserve a therapeutic relationship when people continue to use or drink
problematically. Attempting the use of harm reduction is preferred over admitting the patient
to an acute care hospital, ceasing to provide care, or having the patient admitted as a mental
health client.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
23. “I don’t understand,” the woman said. “It’s my husband who is the alcoholic, not me. Why are
you asking me to get involved in his treatment?” Which is the most appropriate response by
the nurse?
a. “You are codependent. You will need to learn how to function independently.”
b. “You are an enabler covering up for your husband, and you have to learn how not
to do that.”
c. “You are as ill as he is, just in a different way. You also need treatment.”
d. “You have been hurt by his drinking; you will need support as you try to help your
husband stop drinking.”
ANS: D
The family has suffered the effects of substance abuse emotionally, socially, economically,
physically, and spiritually. The family’s wounds must be acknowledged and treated for the
substance abuser to return to an environment supportive of recovery. Although the wife may
be a codependent or an enabler, labeling her will not help her learn to change and help her
husband change.
DIF: Cognitive Level: Apply (Application)
24. A 14-year-old girl came with her family to the clinic as her father picked up his medication.
The girl became anxious and said she had to go home soon to clean the house and start dinner.
Which would the nurse most likely suspect from this interaction?
a. As Freud pointed out, girls try to take over the wife role with their dad.
b. The girl did not want to admit her dad was a drug addict and was trying to get
NURenvironment.
SINGTB.COM
away from an uncomfortable
c. The girl is taking on the role of hero with responsibility for caretaking functions.
d. The girl was afraid she would be seen with her dad, a known drug addict, in a
public place.
ANS: C
In the case of substance abuse, a major purpose of the system is to deny the substance abuse
of the affected family member and keep it a “shameful” family secret. Generally, ego
boundaries between the family members are weakened or nonexistent, with enmeshment of
the members and an intolerance of individual differences. Rules are rigid and communication
is unbalanced; the dynamics are either always conflicting or always superficially pleasant.
Children may become involved in a “role reversal” in which they act as caretakers of their
parents.
DIF: Cognitive Level: Apply (Application)
25. Which best explains what children of alcoholics do when they become adults with families?
a. They do not touch alcohol because they know the problems it brings.
b. They do not use alcohol but may use other drugs.
c. They manage to use alcohol in social situations but not otherwise.
d. They themselves are at high risk for becoming alcoholics.
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Children from dysfunctional families often carry these roles and coping mechanisms into
adult life, with many becoming substance abusers or partners of substance abusers. The
children of alcoholics also have higher risk for many other behavior and emotional problems.
DIF: Cognitive Level: Understand (Comprehension)
26. Which best describes a professional enabler?
a. A spouse who has been enabling an abuser for several years
b. A physician who provides narcotic analgesics to patients on a regular basis
c. A clergyman who offers to take an abuser to an Alcoholics Anonymous meeting
d. A child who is a caretaker for her substance abusing mother
ANS: B
Health care professionals also can contribute to the initiation and continuation of substance
abuse and dependency in various ways, becoming professional enablers. One obvious way is
the physician’s role in prescribing psychoactive medications. The medical model advocates
the treatment of symptoms by medication. The relief of pain, anxiety, and insomnia is not an
exception. The addictive potential of narcotic analgesics and antianxiety agents is often
ignored if quick symptom relief is the main goal. Long-term goals for the treatment of
medical problems and nonmedication management of pain and anxiety are more thoughtful
approaches.
DIF: Cognitive Level: Apply (Application)
27. A young teenager was habitually engaging in binge drinking with friends on weekends.
Which would be a long-term concern of this behavior?
a. He might have to drive to get together with them and then drive home after
NURSINGTB.COM
drinking.
b. Legal drug use almost always precedes use of illegal drugs.
c. Obesity is a major health problem, and alcohol is very high in calories.
d. The teenager’s parents are obviously a dysfunctional family.
ANS: B
All of the answers could be reasons for concern, although young teenagers are too young to
drive. Parents are not necessarily dysfunctional on the basis of just the information given.
Although obesity is an issue, a more immediate concern would be the fact that use of legal
substances (e.g., tobacco, alcohol) almost always precedes use of illegal drugs.
DIF: Cognitive Level: Apply (Application)
28. Which best explains why health professionals and educators are stressing total abstinence of
drugs instead of teaching appropriate social use?
a. Federal funds are available to schools if abstinence is stressed.
b. If students perceive a drug as harmful, fewer actually try it.
c. It is easier to avoid a substance altogether than to try to control the dose.
d. This education is consistent with our American culture.
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Primary prevention for adolescents is typically focused on education aimed toward complete
abstinence. Education plays an important role. A striking feature is the strong adverse
relationship between perceived risk and drug use. For all drugs, with no change in drug
availability, when students perceive a drug as harmful, fewer students actually use it. Thus, it
is important for health professionals and educators to stress total abstinence. Federal funding
is not available to schools if abstinence is stressed. This type of education stressing an
abstinence only perspective is not consistent with the American culture.
DIF: Cognitive Level: Understand (Comprehension)
29. A registered nurse is discovered stealing a patient’s narcotic medication for personal use.
Which is most likely to happen to the nurse?
a. The nurse can be sued by the patient for pain and suffering (because the patient did
not get the medication prescribed).
b. The nurse who shows acceptance of a drug problem may be allowed limited
practice under supervision while undergoing treatment and monitoring.
c. The nurse will go to jail like any criminal caught stealing.
d. The nurse will lose employment, as well as the license allowing professional
practice.
ANS: B
Physicians, nurses, dentists, and pharmacists are vulnerable to substance abuse; alcohol or
narcotic use is most common. Their increased access to drugs, belief in pharmaceutical
solutions, and work-related stress place them at increased risk for substance abuse. Typically,
they gain access to drugs through their work settings by diverting medications for their own
use or by abusing drugs obtained by prescription. State regulatory boards discover the abuse
by these health care professionals
theft orMwhen the effects of their substance abuse
NURafter
INdrug
GTB.C
S
impair their professional functioning. Most statesO
have rehabilitation programs for health care
professionals that consist of treatment and monitoring. They are allowed to retain their
professional licenses during treatment. The threatened loss of their professional license to
practice may be a good motivator to break through their denial of the problem and encourage
them to seek treatment.
DIF: Cognitive Level: Apply (Application)
30. After his family and employer confronted a man with all the problems his drinking was
causing, he agreed to go into treatment. However, the wife asks, “But if we are forcing him to
go into treatment, won’t he just resent us and keep on drinking?” Which would be the most
appropriate response by the nurse?
a. “He may resent you, but the relationship between the two of you was being ruined
by his drinking anyway.”
b. “Isn’t this better until waiting until he has lost his job and you’re forced to seek a
divorce?”
c. “Treatment can still be effective, even if you’re forcing him into it.”
d. “You’re right; it’s harder to treat the problem when the person is being forced into
treatment, but what choice did you have?”
ANS: C
Although individuals who are forced to enter treatment may not be willing to admit the
severity of the abuse, they can still benefit from exposure to the treatment program and
eventually begin recovery. Treatment does not need to be voluntary to be effective.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
31. A family was dependent on the dad for financial support, and now he is in treatment for
alcoholism. The wife asks you how long this will take. Which would be the most appropriate
response by the nurse?
a. “Don’t worry about length of time. Focus on helping him avoid alcohol.”
b. “It all depends on how badly he wants to hold the family together as opposed to
enjoying the relief of drinking again.”
c. “Once an alcoholic, always an alcoholic. He’ll have to avoid liquor the rest of his
life.”
d. “Remaining in treatment is crucial; it must last long enough to produce stable
behavioral changes.”
ANS: D
Remaining in treatment for an adequate time is crucial for treatment effectiveness. It must last
long enough to produce stable behavioral changes.
DIF: Cognitive Level: Understand (Comprehension)
32. Which behavior is a warning that a person is no longer just using a drug’s recreationally but is
abusing drugs and becoming addicted?
a. The person decides to try a new drug, claiming to be curious.
b. The person is using the drug more frequently than before.
c. The person joins a friend in using drugs in a social situation.
d. The person is less able to control frequency and amount of indulging.
ANS: D
NURSINGTB.COM
A major step from initiation to continued use to abuse is the stage of transition. Transition is
seen when there is a change in total consumption, frequency, and occasions of use. Drug use
is now more than just social use, with the person beginning to lose control.
DIF: Cognitive Level: Understand (Comprehension)
MULTIPLE RESPONSE
1. A client has recently been diagnosed with a substance use disorder. Which criteria would be
used to diagnose a client with this disorder? (Select all that apply.)
a. Withdrawal symptoms
b. Tolerance of the substance
c. Social problems related to use of the substance
d. Experimentation with new substances
e. Repeated attempts to control use of the substance without success
f. Neglect of major roles in order to use the substance
ANS: A, B, C, E, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The American Psychiatric Association (APA), in the DSM-5, no longer uses the terms
substance abuse and substance dependence. Rather, it refers to substance use disorders, which
are defined as mild, moderate, or severe to indicate the level of severity, which is determined
by the number of diagnostic criteria met by an individual (Hasin et al., 2014). The presence of
2 or more of 11 criteria now indicate substance use disorder: hazardous use;
social/interpersonal problems related to use; neglected major roles to use; legal problems;
withdrawal (but not for inhalant or hallucinogen disorders); tolerance; used larger
amounts/longer; repeated attempts to quit/control use; much time spend using;
physical/psychological problems related to use; and activities given up to use (Hasin et al,
2014).
DIF: Cognitive Level: Apply (Application)
2. A nurse plans to implement interventions at the community level to address substance use
disorders. Which interventions would the nurse likely implement? (Select all that apply.)
a. Support law enforcement measures to limit access to and distribution of addictive
substances (e.g., street drugs)
b. Provide educational programs at schools and penal institutions
c. Facilitate mutual help groups (e.g., Alcoholics Anonymous, Narcotics
Anonymous, Cocaine Anonymous, Al-Anon)
d. Support the development of specialty courts/problem-solving courts (drug courts,
veteran courts)
e. Create radio public service communications concerning the risks of substance
abuse and the availability of treatment
f. Assist in the formation of national associations such as the National Council on
Alcoholism and Drug Dependence
ANS: A, B, E
NURSINGTB.COM
A nurse may intervene at multiple levels (individual and family, community, and state and
federal). At the individual and family level, the nurse provides education, treatment, and
facilitates mutual help groups such as Alcoholics Anonymous. At the community level, the
nurse supports law enforcement measures to limit access to the distribution of addictive
substances, implements educational programs at schools and penal institutions, and creates
television and radio public service communications concerning the risks of substance abuse
and the availability of treatment. At the state and federal level, the nurse assists with
formation of national associations such as the National Council on Alcoholism and Drug
Dependence and supports the creation of specialty courts/problem-solving courts (drug courts,
veteran courts).
DIF: Cognitive Level: Apply (Application)
3. A man was told by his boss that his work had really gone downhill recently and he had to
improve or the boss would have to let him go. His wife had moved out of the apartment.
Obviously, the drug use was causing problems. Which would cause the man to continue to
use? (Select all that apply.)
a. He had paid a lot for this stuff so he had just finished using what he had and then
he had quit.
b. He rationalized he was just hitting a rough spot and, as soon as he got over his
wife’s betrayal, he would quit using and his job would be fine.
c. He tried to quit, but the withdrawal symptoms were so severe he could not.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. He verbalized quitting, but his new friends scoffed at him.
e. His boss clearly did not understand what he was dealing with and had not a clue
f.
what pressure he was under—so ignoring him was the only option.
He knew drug use made him legally handicapped so his boss could not fire him
even if he wanted to.
ANS: A, B, C, D
In the transition stage from substance use to substance abuse, there may be clear evidence that
there are adverse effects. Rationalizations that deny the seriousness and consequences of the
substance use are commonly constructed. Unpleasant physical and emotional withdrawal
symptoms are strong motivators to continue use. Being in an environment where others are
using will encourage the person to continue using to fit in (peer pressure). The boss clearly
understands what is going on, which is why the situation has been addressed. It is unlikely
that the drug would make him legally handicapped.
DIF: Cognitive Level: Apply (Application)
4. Which way(s) can physicians enable drug abuse? (Select all that apply.)
a. Prescribing psychoactive medications to a new patient who was claiming anxiety
and insomnia
b. Prescribing psychoactive medications to make a patient feel better during a time of
situational stress
c. Prescribing nonrefillable small doses of psychoactive medications in response to
short-term problems
d. Refusing to prescribe psychoactive medications even if the patient has severe pain
so the patient must seek self-medication with illegal substances or alcohol
e. Suggesting psychoactive medications for pain relief after surgical treatment
NURSINGTB.COM
f. With drugs so available, the
physician can use drugs for a temporary problem;
feeling relief may lead to self-addiction.
ANS: A, B, D, F
Health care professionals also can contribute to the initiation and continuation of substance
abuse and dependency in various ways. One obvious way is the physician’s role in prescribing
psychoactive medications. The medical model advocates the treatment of symptoms by
medication. The relief of pain, anxiety, and insomnia is not an exception. The addictive
potential of narcotic analgesics and antianxiety agents is often ignored if quick symptom relief
is the main goal. Undermedication or refusal to use “addictive” medicines can lead susceptible
clients to self-medicate with illegal drugs or alcohol. A new patient requiring medications
may raise suspicion, because drug abusers may go to many different physicians seeking
prescriptions. It is not appropriate for psychoactive medications to be suggested for pain relief
after surgical treatment.
DIF: Cognitive Level: Understand (Comprehension)
5. Which are basic components of 12-step programs to help treat addictive behaviors such as
alcoholism? (Select all that apply.)
a. A willingness to change
b. Attempts to make amends for wrongs done to others
c. Daily attendance at a self-support group meeting
d. Open recognition of weaknesses and request for help from others
e. Public explanation of sins and future plans for resisting temptation
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
f.
Recognition of personal strengths and weaknesses
ANS: A, B, F
Mutual help groups are associations that are voluntarily formed and operate through
face-to-face supportive interaction focusing on a mutual goal. They are usually organized by
recovering substance abusers or those recovering from compulsive behavior patterns. The first
mutual help group was Alcoholics Anonymous (AA). The early AA members developed 12
steps to guide the recovery process. Basic tenets of 12-step programs include an inventory of
past shortcomings and strengths, willingness to change, and making amends. Daily
attendance, open recognition of weaknesses and request for help from others, and a public
explanation of sins and future plans for resisting temptation are not part of 12-step programs.
DIF: Cognitive Level: Understand (Comprehension)
6. An African American male was addicted to drugs, received treatment, and now needs to resist
abusing drugs again. Which barriers exist for this individual? (Select all that apply.)
a. Being arrested when caught rather than receiving treatment
b. Difficulty obtaining employment
c. Easy access to illegal drugs in the community
d. Economic rewards for selling or distributing drugs to others
e. Family demands, including children being physically active and noisy
f. Pressure from drug-using friends to join them in social events
ANS: A, B, C, D, F
Barriers to treating substance abuse and addiction problems in African Americans include
poverty, underemployment, and unemployment; prevalence of both drugs and liquor stores
within the community; allure and economic rewards of selling drugs; more likely to be
NURtoS“change
INGTB.C
arrested than treated; and unable
people
OMand places” as advocated by 12-step
programs. Family demands, including children being physically active and noisy, have not
been identified as a common barrier in the African American population.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 28: Violence
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which statement about homicide in 2015 is accurate?
a. Almost 80% of homicide victims were male.
b. Approximately 70% of victims were killed by someone they knew.
c. Approximately 25% of the offenders were female.
d. Almost 75% of the murder victims were black, when race could be identified.
ANS: A
In the United States, homicide claimed the lives of 15,695 individuals in 2015; over 10,000
deaths involved the use of firearms. Of note, almost 80% of the murder victims were male and
90% of the offenders were male. When race of the murder victims could be determined, 53%
were black, 44% were white, and 2.8% were other races. Approximately 50% of victims were
killed by someone they knew.
DIF: Cognitive Level: Understand (Comprehension)
2. Which best describes the typical perpetrator of homicide?
a. A person trying to engage in rape with the woman fighting back
b. A person who wanted money and she refused to give it to him
c. A stranger
d. An intimate partner
ANS: D
NURSINGTB.COM
Approximately 50% of the victims were killed by someone they knew. Notably 37% of
female murder victims are killed by an intimate partner. Thus, the typical perpetrator would
be an intimate partner. It would be less likely to be a stranger, someone who wanted money,
or someone trying to engage in rape.
DIF: Cognitive Level: Understand (Comprehension)
3. A nurse is assessing a client for suicide risk. Which question would the nurse most likely ask
the client?
a. “How often do you use consume alcohol or other legal or illegal substances?”
b. “How much sleep do you get each night?”
c. “Do you have any children?”
d. “ How long have you lived at your current residence?”
ANS: A
Nurses have an important role in identifying individuals who are at risk for suicide. Risk
factors for suicide include: history of depression or other psychiatric disorders, alcohol and/or
substance abuse, physical illness, past history of attempted suicide, past history of violence,
age, environmental stressors.
DIF: Cognitive Level: Analyze (Analysis)
4. For which group is suicide the second leading cause of death?
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
a.
b.
c.
d.
People aged 15 to 25 years
People aged 10 to 34 years
People aged 34 to 54 years
People over age 65 years
ANS: B
In 2014, suicide was the second leading cause of death for those between the ages of 10 and
34 years, and it is the fourth leading cause of death in people aged 34 to 54 years.
DIF: Cognitive Level: Remember (Knowledge)
5. A woman was seen in the emergency department with a greenstick broken arm and chest
bruises. She explained she fell up a staircase at home while carrying laundry to the bedrooms.
Besides assessing for other injuries, which action should be taken by the nurse?
a. Ask about and educate regarding intimate partner violence (IPV)
b. Assess for use of alcohol or other drugs that might have been a causative factor in
the fall
c. Get the patient an x-ray examination to determine location and severity of the
break
d. Immediately apply ice and immobilize in a sling
ANS: A
Intimate partner violence (IPV) includes four different types of behavior: physical violence,
sexual violence, psychological aggression, and stalking. IPV is often repetitive, progressive,
and escalates in frequency and severity. IPV crosses all ethnic, racial, socioeconomic, and
educational lines. Thus, the nurse must assess for IPV.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
6. A woman is in the emergency department for the fifth time this year, each time with more
severe injuries. Which is the primary responsibility of the nurse?
a. Insist she be discharged to a safe shelter where the perpetrator cannot find her
b. Provide information regarding safe shelters and sources of support
c. Report the assault and battery to the local police department so the perpetrator is
arrested for the crime
d. Treat the injuries and inform the woman she may be killed if she stays with the
perpetrator
ANS: B
Working with victims of intimate partner violence (IPV) requires the nurse to establish
rapport and trust; deal with issues of confidentiality honestly; provide current information
regarding shelters and sources of support; and recognize and accept that clients may “choose”
to stay in an abusive relationship. Because the nurse wants to establish rapport and trust, it
would not be in the best interest of building this relationship if the nurse insist that she go to a
safe shelter (rather the nurse should provide her the necessary information) or inform the
woman she may be killed (rather the nurse should recognize and accept that the client may
“choose” to stay in an abusive relationship). Additionally, the nurse should recognize that
even if the assault is reported, it may be denied by the woman and will not result in an arrest
of the perpetrator.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
7. A 4-year-old child is seen in the emergency department with a spiral fracture of the right arm.
X-ray examination shows previously broken and healed bones. Which is the immediate
responsibility of the nurse?
a. Call social services to immediately set up foster care for the child
b. Provide information about parenting and anger management classes
c. Report the child abuse to the local legal authorities
d. Try to establish rapport and trust with the child’s family
ANS: C
Spiral fractures are only possible from abuse, because they require a wringing motion to
occur. When working with victims of child abuse, the primary obligation of all health care
providers is to protect the child. The abuse must be reported as a legal and ethical obligation.
DIF: Cognitive Level: Apply (Application)
8. A man was crying and said, “I didn’t mean to do it. She just got me so angry I lost control. It
will never happen again.” The woman said, “It was my fault. I shouldn’t have upset him.”
Then, looking at the nurse, the woman added, “Please don’t report this. It will never happen
again.” Which is the most appropriate response by the nurse?
a. “Abusers don’t stop unless intervention occurs. I have to report it.”
b. “If you’re sure it won’t happen again, I’ll let it go this time.”
c. “Legally, I’m required to put this in the medical record.”
d. “The decision is up to the physician, not me.”
ANS: A
It is a common myth that abusers will stop the abuse on their own. Professional intervention is
required to break the cycle ofNabuse.
way
to effectively begin breaking the cycle of
URSIThe
NGonly
TB.C
OM
abuse is to report the incident. The nurse has a professional responsibility to report the abuse,
just as the physician does. Documenting the information in the medical record will not initiate
stopping the cycle of abuse.
DIF: Cognitive Level: Apply (Application)
9. Which best describes the incidence of abuse among pregnant women?
a. It is too difficult to determine the actual incidence of abuse among this population.
b. It is estimated that approximately 1 out of every 10 women experiences abuse.
c. Approximately one out of every six women has been abused by a partner.
d. Abuse does not occur among pregnant women.
ANS: C
Pregnancy does not protect women from the danger of abuse. Indeed, pregnancy may increase
stress within the family and provoke the first instances of battering. It is estimated that one in
six pregnant women have been abused by a partner.
DIF: Cognitive Level: Understand (Comprehension)
10. A rape victim says to the nurse, “He said he loved me; he had been so nice; he said he wanted
to show me how much he loved me. And then he.…” Which is the most appropriate response
by the nurse?
a. “Anyone can lose control; I’m sure he’ll never do it again.”
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. “I’m not sure he loves you; he may just have wanted easy sex.”
c. “Rape isn’t about love or even sex; it’s about power and control.”
d. “You shouldn’t have gone up to his room alone when the two of you had both been
drinking.”
ANS: C
Intimate partner violence is a crime of power and control. It is important the nurse is aware of
the myths around IPV which include: victims deserve the abuse, victims can change the
abusers’ behavior, and abusers will stop the abuse on their own without professional
intervention.
DIF: Cognitive Level: Apply (Application)
11. A female student is at a fraternity party where alcohol is flowing freely, the music is loud, and
people are dancing and talking. Most people seem to be having a great time. What action
should the student take, if anything, when she overhears two men talking about having put
ketamine in a girl’s drink?
a. First get out of there, call the campus police, and then report what was heard
b. Nothing, because she had no idea which woman was targeted or even if she drank
what was given to her
c. Talk to the two men about the dangers and side effects of ketamine
d. Watch to see if any young women pass out or are otherwise impaired
ANS: A
The text talks about date rape drugs, also known as predator drugs, including ketamine. The
first priority is to keep oneself safe, so leaving would be prudent. Ideally, the police will allow
the report to be made without sharing who reported the potential problem. Doing nothing,
NURyoung
M party will not protect the females at the
talking to the men, and watching
SINGwomen
TB.CatOthe
party from unknowingly consuming the ketamine.
DIF: Cognitive Level: Analyze (Analysis)
12. A nurse is developing secondary prevention strategies to reduce violence for individuals in the
community. Which strategy would the nurse most likely select to implement?
a. Providing counseling services for victims of violence
b. Offering parenting classes at a local high school
c. Educating children on methods of conflict resolution
d. Creating of a safety plan for victims of violence
ANS: D
The public health nurse develops prevention strategies using the three levels of prevention:
primary (promotion of optimal parenting and family wellness), secondary (diagnosis of and
service for families in stress), and tertiary (reeducation and rehabilitation of violent families).
Creation of a safety plan for victims of violence demonstrates the use of secondary
prevention. Providing counseling services for victims of violence is done by using tertiary
prevention. Primary prevention is used when educating children on the methods of conflict
resolution and offering parenting classes at a local high school.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
13. The 7-year-old boy’s hands were badly burnt; it was suspected that his mother had forced his
hands into boiling hot water after she caught him masturbating. The staff did not want the
mother to be allowed near the boy. Which statement would be made by the nurse to encourage
the staff to interact more objectively with the mother?
a. “If we won’t let the mom near, who does the child have for support at this painful
time?”
b. “Most abusers were themselves abused as children and need help to learn how to
be a more effective parent.”
c. “The child may feel responsible; we have to let the mother fix their relationship.”
d. “We need to encourage the mother to continue parenting him or the boy will
become a ward of the state.”
ANS: B
Most child maltreatment occurs within the family. Maltreatment is more commonly seen in
families who are under a great deal of stress, are living in poverty or isolation, or when a
family member has a history of violence. Child maltreatment can have serious long-term
effects. Thus, it is most important that the staff provide support to the mother. The purpose of
allowing the mother with the child is not for additional support for the child or mother, rather
the recognition that the mother may have a history of abuse as well and needs assistance to
change the patterns of behavior that have been learned through her own life experience.
DIF: Cognitive Level: Apply (Application)
14. A 6-month-old infant was brought in unresponsive by both parents. X-ray examination
showed evidence of shaken baby syndrome. Which person is most likely responsible?
a. The babysitter
b. The dad
NURSINGTB.COM
c. The grandparents
d. The mom
ANS: B
In approximately 70% of abusive head trauma cases, also known as shaken baby syndrome, a
male is the perpetrator.
DIF: Cognitive Level: Apply (Application)
15. An 80-year-old woman lived with her eldest daughter, the daughter’s husband, and their three
children. On this visit, the nurse noted the woman looked dehydrated and seemed depressed.
Both wrists were red and scabbed. When asked if she was all right, the woman protested she
was fine and her daughter took good care of her. Which action should be taken by the nurse?
a. Begin the paperwork to have the elderly woman put in a nursing home
b. Discuss respite care and other stress relief measures with the daughter
c. Report the elder abuse to the state department of aging
d. Review with the total family how to share responsibilities for the woman’s care
ANS: B
Working with victims of elder abuse, the nurse must establish rapport and trust. The nurse
should remember that competent adults have the right to make decisions about their own care,
including staying in an abusive situation. The nurse should support the family in examining
potential respite care options and support groups for the elderly woman and her caregivers.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
16. Which best explains why more nurses do not report violence against themselves to
authorities?
a. Assumption that the nurse somehow “asked for it” by not being cautious enough or
alert enough to avoid it
b. Assumption that nothing would be done about the situation anyway
c. Assumption that nurses can accept anything, from taking blame to being
scapegoats for when outcomes are not positive
d. Assumption that patients and families cannot be held responsible; being assaulted
is part of the job
ANS: D
Workplace violence tends to be higher in some service-oriented work environments, including
health care. In the health care field, frequent areas for the occurrence of violence include
emergency departments, psychiatric units, geriatric units, and waiting rooms. Nurses and
nursing assistants who work directly with patients are often at risk. Nurses who work in public
health roles are not immune to violence because their work may bring them in direct contact
with individuals prone to violent behavior.
DIF: Cognitive Level: Understand (Comprehension)
17. Where is youth violence most likely to occur?
a. At home
b. At recreational facilities
c. In inner city schools
d. In fast-food facilities where young adults are employed
ANS: C
NURSINGTB.COM
Youth-related violence is more concentrated in minority communities and inner cities, causing
a disproportionate burden on these communities. Children are often not taught peaceful ways
of resolving differences and learn by default from what they observe on television, in movies,
and through video games. Consequently, schools have become a common site for violence.
DIF: Cognitive Level: Remember (Knowledge)
18. Which best describes why all citizens should care about young people joining gangs?
a. Gangs are beginning to be seen in suburban areas.
b. Gangs are responsible for destroying lives and property in inner cities.
c. Gangs use violence to control neighborhoods.
d. Gangs help give the young person protection, respect, and sense of belonging.
ANS: C
Gangs are increasingly responsible for crimes and violence throughout the United States.
Gangs use violence to control neighborhoods and increase their illegal money-making
activities which include robbery, fraud, drug trafficking, prostitution, and human trafficking.
Gangs exist throughout the country, in urban and suburban areas. Destruction of lives and
property is not the major reason why citizens should be concerned with gangs. Although
gangs do give young persons protection, respect, and sense of belonging, the major concern
would be the amount of crime that is associated with gangs.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
19. Which best describes why hate crimes involving violence are often considered worse than
other crimes involving violence?
a. Because hate crimes cannot be avoided because one cannot change one’s race or
religious or sexual orientation
b. Because hate crimes often are committed by groups rather than individuals
c. Because more damage is typically done in a hate crime than in a typical assault and
battery
d. Because the crime is personal, attacking the victim’s identity
ANS: D
Hate crimes are crimes based on an individual’s race, sexual orientation, religious beliefs,
ethnic background, or national origin. Hate crimes may include rape, sexual or physical
assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate
crimes attack an individual’s identity, the emotional effects are compounded.
DIF: Cognitive Level: Understand (Comprehension)
20. Which must be involved for an act to be considered a terrorist act?
a. A commitment to a political or religious belief
b. An attempt to force compliance with a particular set of religious or political beliefs
and behaviors
c. Fear, intimidation, and violence
d. Violence resulting in plural deaths
ANS: C
All terrorist acts include threeNkey
INGTB.COM fear, and intimidation.
URSelements—violence,
DIF: Cognitive Level: Remember (Knowledge)
21. A male strong firearms advocate stressed his guns were for self-protection, and he wanted all
criminals to know his family had loaded guns in their home. Which best explains why a nurse
would not support his actions?
a. Criminals carry more powerful and illegal guns.
b. Guns in the home typically result in dead family members and friends.
c. His children may be less careful than the adults in the family.
d. Less trained individuals might think the guns were unloaded.
ANS: B
Although some persons suggest that firearms provide protection, substantial evidence
indicates that firearms increase the likelihood of homicide or, even more commonly, suicide
(Weinberger et al., 2015). It is important for health care professionals to be comfortable
speaking with their patients in a nonjudgmental manner about firearms, provide patients with
factual information about firearms relevant to their health and the health of those around them,
fully answer their patients’ questions, and advise them on safe gun protection.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
1. Although violence seems endemic in human society, which causative factors could be reduced
if society agreed action was necessary? (Select all that apply.)
a. Access to firearms
b. Alcohol and other drug abuse
c. Mental illness
d. Intolerance of those with a different religious ideology
e. Video games, television shows, and movies
f. Pacifism as a belief system
ANS: A, B, C, D, E
Pacifism is a belief in peaceful resolution of conflicts and refusal to participate in war. All
other factors are universally recognized factors that contribute to violence. These factors are
poverty, unemployment, economic dependency; polydrug and alcohol abuse; mental illness;
media influence (e.g., violent video games, television shows, and movies); access to firearms;
political and/or religious ideology; and intolerance and ignorance.
DIF: Cognitive Level: Remember (Knowledge)
2. In which clinical areas are nurses most at risk for workplace violence? (Select all that apply.)
a. Acute care/intensive care units
b. Community health clinics
c. Emergency departments
d. Geriatric units
e. Psychiatric units
f. Rehabilitation units
ANS: C, D, E
NURfrequent
B.C
In the health care field, the most
areas
for
the occurrence of violence are the
SINGT
OM
emergency departments, psychiatric units, geriatric units, and waiting rooms.
DIF: Cognitive Level: Remember (Knowledge)
3. Which actions would public health professionals want to use as primary prevention against
widespread community violence? (Select all that apply.)
a. Women seen in emergency departments should be asked about abuse
b. Courses for prisoners about avoiding violence and resolving conflict
c. Classes on parenting and supportive follow-up for new parents
d. Courses on anger management and conflict resolution
e. Community media campaigns to decrease acceptance of violence
f. Home visits to elderly clients should include screening for elder abuse
ANS: C, D, E
The goal of primary prevention is to stop violence, abuse, or neglect before it occurs.
Education plays a major part in primary prevention and may include parenting and family
wellness, and anger management or conflict resolution. Professionals should increase their
awareness of violence, identification of cases, and provision of early treatment. The nurse can
work in or with the community to educate citizens about the problem of violence, potential
causes of violence, and available community services. Screening is secondary prevention, and
courses for those already known to be violent are tertiary prevention.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
4. Which actions should a nurse take to ensure personal safety when engaging in home visits?
(Select all that apply.)
a. Always sit between the client and the exit, and, when in doubt, leave the situation
b. Be sure of the correct address and always have a GPS system
c. Carry a cell phone and drive in a well-maintained car with a full gas tank
d. Have enough money that you can buy your way out of trouble
e. Only accept assignments within a few blocks of your own home
f. Take self-protection courses such as karate and carry a weapon for your own
defense
ANS: A, C
Plan ahead with the correct address, directions, and information about who will be in the
home; tell the office where you will be and check in regularly; carry a cell phone, possibly a
pager, and a small amount of money; dress for function and mobility, wear a name tag, and be
sure your vehicle is in good repair with a full gas tank and emergency equipment. Carrying a
weapon typically results in the weapon being used against you.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 29: Natural and Man-Made Disasters
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which U.S. agency is responsible for overseeing the actions of protecting against, responding
to, recovering from, and preventing the effects of disaster?
a. American Red Cross (ARC)
b. The Department of Homeland Security (DHS)
c. Federal Emergency Management Agency (FEMA)
d. The National Incident Management System (NIMS)
ANS: D
Because of the recognition of the need to be prepared, programs have been created to address
the national, state, and local management of disasters. President George W. Bush established
the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of
government and nongovernmental agencies to work seamlessly to prevent, protect against,
respond to, recover from, and prevent the effects of disasters (Federal Emergency
Management Agency, 2017a). The ARC is not a governmental agency. It is chartered by
Congress to provide disaster relief. It works in partnership with FEMA, DHS, the Centers for
Disease Control and Prevention, and other local, state, and federal agencies to provide and
manage needed services. The DHS was established to realign the existing agencies, groups,
and organizations into a single department, focusing on protecting the American people and
their homeland. The mission of the FEMA is to support citizens and first responders to ensure
that, as a nation, everyone works together to build, sustain, and improve the capacity to
prepare for, protect against, respond
recover
N R Ito, G
B.Cfrom,
M and mitigate all hazards.
U S N T
O
DIF: Cognitive Level: Remember (Knowledge)
2. Which statement best describes how a disaster is the same as or different from an emergency?
a. A disaster is personal, whereas an emergency is communitywide.
b. An emergency is personal, whereas a disaster is communitywide.
c. Both emergencies and disasters are devastating.
d. Both emergencies and disasters are failures resulting in extensive insurance claims.
ANS: B
A disaster is any event that causes a level of destruction, death, or injury that affects the
abilities of the community to respond to the incident using available resources. Emergencies
differ from disasters in that the agency, community, family, or individual can manage an
emergency using their own resources. However, a disaster event may be beyond the ability of
the community to respond to and recover from the incident using its own resources. Disasters
frequently require assistance from outside the immediate community. The type of emergency
or disaster will determine the level of devastation or need for extensive insurance claims to be
filed.
DIF: Cognitive Level: Understand (Comprehension)
3. A hospital emergency department received a call that multiple casualties were on their way,
primarily burns from a large factory fire. Which action should the hospital take immediately?
a. Ask the governor of the state to declare the area a disaster area so state help can be
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
obtained
b. Call surrounding hospitals to set up burn units, because there will be too many
patients for one hospital to manage
c. Call in physicians and nursing staff who are experts in burn care
d. Get in touch with the American Red Cross to assist families of the victims
ANS: C
A multiple casualty event is one in which more than two but fewer than 100 individuals are
involved. Until more is known, only staff expert in burn care need be asked for assistance.
Only a mass casualty event with 100 or more individuals involved requires community or
state involvement.
DIF: Cognitive Level: Apply (Application)
4. Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with
possible smoke inhalation problems. Which best describes how these patients are different
from the first patients to arrive?
a. Burn patients probably have skin damage, whereas the firefighters have lung
damage.
b. Burn patients will need extensive care over time, whereas the firefighters can
probably stay the night with oxygen treatment and then be discharged.
c. The burn patients were direct victims, whereas the firefighters are indirect victims.
d. The second set of victims may have scarring, shortness of breath, and persistent
hoarseness for the next few days.
ANS: C
Both sets of victims would have inhaled smoke and have lung damage. The treatment and
NURSby
INthe
GTamount
B.COof
M damage, which may vary from victim to
length of stay would be determined
victim. Both sets of victims, depending on the severity of the burns, may have scarring,
shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an
individual who is immediately affected by the event; the indirect victim may be a family
member or friend of the victim or a first responder.
DIF: Cognitive Level: Apply (Application)
5. Which do terrorists hope to accomplish by causing mass destruction and violence toward
innocent persons going about their daily lives?
a. Create fear to intimidate and coerce to accomplish a political goal
b. Encourage others with similar beliefs to join them and their cause
c. Obtain publicity for themselves and their goals
d. Obtain increased negotiating power and respect
ANS: A
The U.S. Code of Federal Regulations defines terrorism as “violent acts or acts dangerous to
human life that appear to be intended to intimidate or coerce the civilian population or to
influence the policy or conduct of a government.”
DIF: Cognitive Level: Understand (Comprehension)
6. Which type of maps is crucial to be included in any disaster plan?
a. Communication map showing telephone wires and cell phone towers
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b. Geographic map showing, for example, roads, highways, and train routes
c. Resource map showing potential resources in persons and supplies
d. Response maps showing sites of first responders, such as fire stations and police
stations
ANS: C
A resource map is a geographic map that outlines the resources that would be available in or
near the area affected by a potential disaster (e.g., potential shelter sites, potential medical
sources, and location of equipment that might be needed).
DIF: Cognitive Level: Remember (Knowledge)
7. When does disaster management begin?
a. Before a disaster occurs
b. Immediately after the disaster
c. Throughout the disaster period
d. When the disaster begins
ANS: A
When one is aware of the types and characteristics of disasters, the question then becomes:
What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster
management requires an interdisciplinary, collaborative team effort and involves a network of
agencies and individuals to develop a disaster plan that covers the multiple elements necessary
for an effective plan. Communities can respond more quickly, more effectively, and with less
confusion if the efforts needed in the event of a disaster have been anticipated and plans for
meeting them have been identified. The results of planning are that more lives are saved and
less property is damaged. Planning ensures that resources are available and that roles and
NUand
RSI
M
responsibilities of all personnel
agencies,
bothOofficial
and unofficial, are delineated.
NGTB.C
DIF: Cognitive Level: Remember (Knowledge)
8. Who is responsible for ensuring the safety and welfare of communities?
a. Federal government
b. Federal Emergency Management Agency
c. Local government
d. State government
ANS: C
The local government is responsible for the safety and welfare of its citizens. Emergencies
and disaster incidents are handled at the lowest possible organizational and jurisdictional
level.
DIF: Cognitive Level: Remember (Knowledge)
9. Which agency should develop a community disaster plan, have emergency drills to test the
plan, and determine the proper response?
a. Federal Emergency Management Agency (FEMA)
b. Office of Emergency Management
c. State Disaster Office
d. The National Disaster Relief Agency
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The local Office of Emergency Management involves representatives from all official and
unofficial agencies in developing the community disaster plan; developing scenarios to test
the plan through drills; and assessing the scope, intensity, and number of casualties (once an
incident has occurred) to initiate the proper response. The mission of the FEMA is to support
citizens and first responders to ensure that, as a nation, everyone works together to build,
sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and
mitigate all hazards. There is no specific government agency called the State Disaster Office
or the National Disaster Relief Agency.
DIF: Cognitive Level: Remember (Knowledge)
10. When would the National Guard become involved in a disaster?
a. When the Federal Emergency Management Agency requests such assistance
b. When the local government requests help keeping order in the community
c. When the president has declared the area a national disaster
d. When the state has been asked to help an overwhelmed community
ANS: D
When a disaster overwhelms the local community’s resources, then the state’s department or
office of emergency management is called for assistance. Before an event, state officials
provide technical support for prevention, preparedness, response, and recovery. State officials
are on scene at disaster events to facilitate coordination of state resources and to disseminate
information. In some cases, the National Guard may be called in to aid the community.
DIF: Cognitive Level: Understand (Comprehension)
11. Which best describes the mission of the U.S. Department of Homeland Security (DHS)?
NU
RSINGgroups,
a. To consolidate all existing
TB.Cand
OMorganizations into a single
agencies,
department
b. To distribute federal financial aid to disaster-stricken areas
c. To enable appropriate response to assist a state having a disaster
d. To prevent terrorism and ensure resilience to disasters
ANS: D
There are five homeland security missions: prevent terrorism and enhance security, secure and
manage U.S. borders, enforce and administer immigration laws, safeguard and secure
cyberspace, and ensure resilience to disasters. This agency was created to realign the existing
agencies, groups, and organizations into a single department, focusing on protecting the
American people and their homeland, but this is not the mission of the agency. The Federal
Emergency Management Agency distributes federal financial aid to disaster-stricken areas and
is responsible to enable the appropriate response to assist a state having a disaster.
DIF: Cognitive Level: Understand (Comprehension)
12. Which action should be taken during a biological attack?
a. Close doors and windows and turn off all ventilation
b. Seek medical attention if you become sick
c. Develop a family emergency plan
d. Keep a written record of everything that you have eaten
ANS: B
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
During a biological attack one should: move away quickly, wash with soap and water, contact
authorities, listen to the media for official instructions, and seek medical attention if you
become sick. If a chemical attack were occurring, the first action would be to close doors and
windows. In the case of a biological attack, one should move quickly away from the area. A
family emergency plan should be developed well in advance of a biological attack. Unless
directed by the authorities, it should not be necessary in any type of an attack to keep a written
record of everything that is eaten.
DIF: Cognitive Level: Understand (Comprehension)
13. Which statement best describes how the American Red Cross (ARC) is different from the
Federal Emergency Management Agency (FEMA) or the National Incident Management
System?
a. Funding includes only voluntary contributions.
b. It emphasizes being prepared for emergencies, not just reacting to them.
c. It has only volunteers as staff.
d. It is a nongovernmental volunteer agency.
ANS: D
The ARC is not a governmental agency. The ARC, however, is chartered by Congress to
provide disaster relief. It works in partnership with FEMA, the Department of Health and
Human Services, the Centers for Disease Control and Prevention, and other federal agencies
to provide and manage needed services. The ARC receives federal money as well as voluntary
contributions. The ARC has both paid and volunteer staff. All of these agencies focus on
preparation for disasters (not emergencies) as well as reacting after they occur.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
14. Who should create a disaster plan including emergency supplies and where to meet in case of
an emergency?
a. All families
b. All government officials
c. All public health employees
d. Members of Congress and the Supreme Court
ANS: A
The American Red Cross publishes many pamphlets and educational materials to help
individuals, families, neighborhoods, schools, and businesses prepare for potential disasters.
The key actions it recommends are: (1) identify potential disaster events, (2) create a disaster
plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4)
practice and maintain the plan. The disaster plan should include an emergency
communications plan, a predetermined meeting place for family members or significant
others, and plans for care of pets in the event that evacuation is required.
DIF: Cognitive Level: Remember (Knowledge)
15. Which best describes how a community will know whether its disaster plan is adequate?
a. After a disaster occurs and reports of deaths and injuries are fairly accurate
b. By following practice drills involving various feasible scenarios as an initial step
of planning
c. When federal experts have reviewed and approved the plan
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. When state officials have reviewed and approved the plan
ANS: B
For a plan to be effective, it must be tested by having different disaster scenario drills. The
more times realistic scenarios are created to test the plan in actual practice sessions, and not
just tabletop or paper drills, the more problems with the plan will be identified and solutions
for those problems can be found. Without practice drills, plans may have many unrecognized
faults and, as a result, many more individuals may be harmed and communities damaged
when an actual disaster occurs.
DIF: Cognitive Level: Understand (Comprehension)
16. An earthquake has hit and buildings are knocked down; people are injured and crying for
help. Looters have already started grabbing essential resources. Which action should the
community take first?
a. Send in ambulances to transport injured persons to medical facilities
b. Send in media personnel to share the event and begin efforts to obtain donations
for the injured
c. Send in medical personnel to administer first aid and triage the injured
d. Send in law officials to secure the area and ensure the safety of the victims
ANS: D
Before search and rescue should begin, safety must be considered. In some instances, if a
criminal action is suspected, law officials will be among the first to respond to secure the area
and possibly gather evidence. While the area is being checked and then cleared of potential
threats, a staging area can be set up at or near the site of the incident to direct onsite activities.
Search and rescue of victims can begin once clearance is given, a disaster triage area is
NUtreatment
RSINGarea
established, and an emergency
is set
TB.C
OMup to provide first aid until transportation
for victims to hospitals or health care facilities for treatment can be coordinated.
DIF: Cognitive Level: Apply (Application)
17. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse
noted he had cuts, abrasions, and an open (bone was seen) fractured arm. Which action should
be taken next?
a. Put a green tag on his shirt and he can get in line to wait his turn for medical
treatment
b. Put a yellow tag on his shirt and then await transport to a medical facility
c. Put a black tag on his shirt and give him a chair to rest in until something can be
done
d. Put a green tag on his shirt and ask him to use his good arm to help others make it
to the staging area
ANS: B
Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and
abrasions) who can wait several hours before they receive treatment; yellow is for those with
systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g.,
simple fractures); red is considered top priority or immediate and is for those with
life-threatening conditions but who can be stabilized and have a high probability of survival
(e.g., amputations); and black is for the deceased or for those whose injuries are so extensive
that nothing can be done to save them (e.g., multiple severe injuries).
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Apply (Application)
18. Which step should the nurse take first when triaging a victim of a disaster?
a. Assess mental status
b. Assess perfusion
c. Assess respirations
d. Assess blood pressure
ANS: C
To assess an individual within the 1-minute guideline, the START system uses three
characteristics. First, respirations are checked; then perfusion by pinching the nail bed and
observing the reaction; and, last, mental status is checked by asking the individual a question.
Assessing blood pressure is not part of the 1-minute guideline.
DIF: Cognitive Level: Understand (Comprehension)
19. Which disaster would most likely cause the most long-lasting mental health concerns for its
victims?
a. For the fourth year in a row a flood hit an area, demolishing several houses, but
families heard the warning siren and evacuated in time.
b. A forest fire was deliberately set but was not a major concern until the fire
suddenly changed direction and people attempting to evacuate at the last minute
were burned in their cars.
c. A tsunami hit the beach with unbelievable force, water sweeping over the entire
harbor, although most boats had been moved to deep water.
d. A volcano erupted and lava destroyed the main road to the village where several
NU
RSinIN
TB.COM
houses burned, but no one
died
theGeruption.
ANS: B
Research has identified four keys to gauging the mental health impact of such events, any two
of which may result in severe, lasting, and pervasive psychological effects. The key factors
are: (1) extreme and widespread property damage; (2) serious and ongoing financial
problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life;
and (4) when human intent caused the disaster. Because the fire was deliberately set and lives
were lost, that disaster will be more disruptive than disasters when only property was
damaged.
DIF: Cognitive Level: Apply (Application)
20. Which type of behaviors would a nurse expect to see when a disaster first strikes a
community?
a. A sense of all being okay and that one can rebuild and go on
b. Anger and despair that help being offered is insufficient, slow, and inadequate
c. Everyone trying to help strangers, as well as their neighbors, survive
d. People involved sharing their stories and reliving what occurred
ANS: C
The classic four phases of a community’s reaction to a disaster are the heroic phase,
honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase,
nearly everyone feels the need to rush to help people survive the disaster.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
21. A friend who was raped and beaten appeared to be coping well. However, she recently
dropped out of school and shared with the nurse that she is having nightmares where it
happens all over again, and these nightmares are becoming impossible to live with. Which
would be the concern of the nurse?
a. A late psychological reaction of despair and hopelessness
b. Depression that no one rescued her and saved her from the traumatic event
c. Guilt and concern over what she could possibly have done to invite such an event
d. Posttraumatic stress syndrome disorder (PTSD)
ANS: D
PTSD is a psychiatric disorder that can occur after an individual’s experiencing or witnessing
a life-threatening event. People who suffer from PTSD often relive the experience through
nightmares and flashbacks. The social and psychological symptoms can be severe enough,
and last long enough, to significantly impair a person’s daily life.
DIF: Cognitive Level: Apply (Application)
22. As a nurse and a citizen, what is the nurse’s additional responsibility in relation to disasters?
a. Assume the nurse will be asked to volunteer to assist the American Red Cross with
helping care for disaster victims
b. Be aware if there is an unusual increase in the number of people seeking care with
similar symptoms
c. Expect and plan for the possibility of being called to report to work for additional
work efforts in caring for the sick and injured
B.C
M
d. Expect to be a role modelNin
UR
SINGTfor
preparing
andOreacting
to a disaster
ANS: B
As a nurse, one is expected to be informed regarding the Guidelines for Early Detection for
Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular
disease, an unusual number of persons seeking care with similar complaints, clusters of
patients from a single location, or a person presenting with an uncommon disease.
DIF: Cognitive Level: Understand (Comprehension)
23. Which set of symptoms would be unexpected after a disaster?
a. Confusion, disorientation, indecisiveness, and memory loss
b. Depression, fear, or just numbness
c. Fatigue with headaches, nausea, and dizziness
d. Irritable, suspicious, argumentative, and inappropriate
e. No unusual feelings or behavior
ANS: E
Common responses to disasters include all sorts of cognitive, emotional, physical, and
behavioral symptoms. Therefore, to have no unusual feelings or behavior would indeed be
unexpected.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
MULTIPLE RESPONSE
1. Which disasters are considered natech (natural-technological) disasters? (Select all that
apply.)
a. Constant rain led to mud slides, and whole neighborhoods were buried.
b. An earthquake caused structural collapse of bridges and highways in the area.
c. People stampeded out of the overcrowded arena, trampling people who had fallen.
d. River flooding resulted in overflow of the sewage plant and contaminated drinking
water throughout the city.
e. The tsunami washed out all the power and telephone lines throughout the
downtown area of the city.
f. Volcanic eruption covered the town with ash, making it difficult to breathe.
ANS: A, B, D, E
Disasters are identified as natural, man-made, or a combination of both. A natech disaster is a
natural disaster that creates or results in a widespread technological problem. Examples of
natech disasters would include whole neighborhoods being buried by mudslides, earthquakes
causing structural collapse of roadways or bridges, river flooding resulting in an overflow of
the sewage plant and contaminated drinking water, and a tsunami washing out all of the power
and telephone lines. People stampeding out of a crowded arena do not involve a disaster that
results in a widespread technological problem, nor does a volcanic eruption that makes it hard
to breathe.
DIF: Cognitive Level: Apply (Application)
2. Which best describes why earthquakes would be more frightening than floods to many people,
even though both can cause extensive damage? (Select all that apply.)
INearthquakes.
GTB.COM
URSin
a. Death rate and scope are N
higher
b. There is a higher frequency of earthquakes.
c. Imminence of earthquakes is unknown.
d. It is not possible to prevent an earthquake.
e. The intensity of earthquakes is higher.
f. The predictability of earthquakes is lower.
ANS: C, D, F
Death rate, intensity, and frequency depend on location and other factors. Hawaii, for
example, has frequent earthquakes with little damage resulting. However, earthquakes cannot
be predicted or prevented, whereas flooding can usually be predicted and most communities
have taken steps to avoid or at least lessen the damage from floods. The frequency or intensity
of earthquakes is not higher than that of flooding.
DIF: Cognitive Level: Remember (Knowledge)
3. Which are the responsibilities of the Centers for Disease Control and Prevention (CDC) in
relation to disasters? (Select all that apply.)
a. Contacting family members with up-to-date information regarding victims and
their condition
b. Coordinating local services to prevent duplication and fragmentation
c. Delivering first aid and arranging for prescription medications that were lost to be
replaced
d. Detecting disease outbreaks, their cause, and risk factors, and implementing
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
interventions for control
e. Ensuring that drinking water, food, shelter, and medical care are available to
victims
f. Setting up safe and comfortable disaster shelters (emergency housing) for families
ANS: D, E
After the rescue of survivors has been accomplished, the Department of Health and Human
Services (HHS), the CDC—which is responsible to the HHS—steps in to ensure that clean
drinking water, food, shelter, and medical care are available for those affected. Preparedness
includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of
biological agents, food-borne diseases, and communicable diseases) in the community by
physicians and nurses in local health care facilities or private offices and clinics. Public health
officials then have the responsibility of detecting outbreaks, determining the cause of illness,
identifying the risk factors for the population, implementing interventions to control the
outbreak, and informing the public of the health risks and preventive measures that need to be
taken. Many of the other choices are actually services offered by the American Red Cross.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 31: Occupational Health
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. An occupational health nurse (OHN) works in a state that requires continuing education units
per year for renewing a nursing license. Which course would probably be most helpful in the
role?
a. Diversity and Human Caring
b. Ergonomics and Toxicology
c. Evaluating Risks and Personnel Management
d. Health Assessment and Home Health Care
ANS: B
Any of the programs might be helpful, but only Ergonomics and Toxicology are inherent in
the science needed to function in occupational health. Evaluating Risks is relevant to the job
description, but many OHNs are the only professionals in the area, so there are no personnel
to manage. Health Assessment is relevant, but rarely would a home visit be made for health
care; rather a referral would be done.
DIF: Cognitive Level: Apply (Application)
2. Which best explains why job opportunities for occupational health nurses (OHNs) have
continued to expand?
a. Federal legislation has required an OHN at any site with more than 50 employees.
b. Legislation has required employers to engage in certain tasks, and nurses were the
N R I G B.COM
most expert at those tasks. U S N T
c. Nurses have done an excellent job of describing the role and its benefits to the
media.
d. Nurses are able to document cost savings to employers.
ANS: D
The cost-effectiveness of providing health care to employees achieved recognition, and by
1912, following implementation workers' compensation legislation, 38 nurses were employed
by business firms. As businesses seek ways to maximize the value of their dollars spent on
health care services, OHNs and other health professionals face an opportunity from being able
to demonstrate that cost-effective, quality health programs do improve the health of
employees and their dependents, positively influencing their company’s attempts to control
rising health care costs.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best explains why occupational health nurses (OHNs) felt a need to create the Factory
Nurses Conference?
a. All the other specialties in nursing had created their own conferences and groups.
b. Creating their own group would be less expensive to maintain membership than
joining the American Nurses Association (ANA).
c. Funding was made available by large employers for the nurses to meet.
d. Most OHNs practiced alone and wanted to be able to interact with peers.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: D
Few specialties existed at the time the Factory Nurses Conference was created. Industrial
nurses were practicing in single-nurse settings and recognized the benefit of uniting as a group
for the purpose of sharing ideas with peers practicing in the same nursing arena. External
funding was not available. This group was open only to graduate, state-registered nurses
affiliated with the ANA.
DIF: Cognitive Level: Understand (Comprehension)
4. Which led to a vast increase in the number of occupational health nurses?
a. Increasing autonomy and salaries of nurses in that role
b. Increasing industrialization of all societies
c. Society demanding improvements in safety for all workers
d. The health of workers involved in manufacturing during World War II was crucial
ANS: D
Industrial nurses provide health care and make nursing decisions within the scope of practice
determined by state law. The focus of health care for employees changed as a result of many
factors, including the impact of the two world wars. During World War I, the government
demanded health services for workers at factories and shipyards holding defense contracts. In
1942, during WWII, the U.S. Surgeon General told an audience of nurses that the health
conservation of the “industrial army” was the most urgent civilian need during the war. Not
all societies have industrialized.
DIF: Cognitive Level: Understand (Comprehension)
5. Which entity has been most active in creating change and alternative approaches in health care
NURSINGTB.COM
delivery?
a. Consumers
b. Corporations
c. Health care professionals
d. State legislators
ANS: B
Corporations have become driving forces in shaping the development of alternative
approaches to health care. Businesses, that is, employers, have consistently fought to keep
health care costs down and to maximize the value of their dollars spent on health care
services. Corporations have taken the most active force in health care delivery in comparison
to consumers, health care professionals, and state legislators.
DIF: Cognitive Level: Remember (Knowledge)
6. Which is one of the most challenging areas for the occupational health nurse (OHN)?
a. Allocating time between direct service to employees and management tasks
b. Collaborating with other worksite professionals and retaining leadership in the
arena of employee health
c. Managing ethical conflicts between responsibilities to management and
responsibilities to employees
d. Maintaining competence through attending conferences and maintaining services
when the nurse (sole provider) is absent
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
ANS: C
The OHN is a worker advocate and has the responsibility to uphold professional standards and
codes. The OHN is also responsible to management, is usually compensated by management,
and must practice within a framework of company policies and guidelines. Ethical dilemmas
arise because the nurse is loyal to both workers and management.
DIF: Cognitive Level: Understand (Comprehension)
7. If not at a meeting or giving an educational program, which best describes why an
occupational health nurse (OHN) would be absent from the health station during the nurse’s
employment hours?
a. The nurse is reviewing position descriptions in the main company office.
b. The nurse is in the management office to use the company computer.
c. The nurse planned a walk-through of the workplace.
d. The nurse is taking a quick bathroom break.
ANS: C
Performing “walk-throughs” in the workplace on a regular basis, recognizing potential and
existing hazards, and maintaining communications with safety and industrial hygiene
resources to prevent illness and injury from occurring will continue to be critical work for the
OHN. It is unlikely that the nurse is reviewing position descriptions in the main company
office or using a company computer when these are tasks that could most likely be done in the
health station. It is also unlikely that the nurse is taking a quick bathroom break.
DIF: Cognitive Level: Understand (Comprehension)
8. An occupational health nurse (OHN) reminds employees to put on their safety glasses and use
NURSIWhich
other personal protective equipment.
levelOofMprevention is being implemented?
NGTB.C
a. Primary
b. Secondary
c. Tertiary
d. Health promotion
ANS: A
The OHN uses a variety of primary prevention methods, with one-on-one interaction as an
important strategy for evaluating risk reduction behavior for individuals. Understanding
appropriate engineering and administrative controls and personal protective equipment
specific to preventing workplace health hazard exposures is one of the responsibilities of the
OHN. Secondary prevention strategies are aimed at early diagnosis, early treatment
interventions, and attempts to limit disability. On a tertiary level, the OHN plays a key role in
the rehabilitation and restoration of the worker to an optimal level of functioning. Health
promotion is not a level of prevention.
DIF: Cognitive Level: Apply (Application)
9. Which argument would the occupational health nurse (OHN) use when trying to convince a
large employer of the need for a breast cancer education program?
a. It will be excellent media coverage for the employer, especially if the public is
invited.
b. A large number of female employees of childbearing age may be interested.
c. This program would help balance all the male-oriented programs.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Women employees who believe their employers are interested in their well-being
are more productive and satisfied.
ANS: D
Women who believe their employers are interested in the well-being of themselves and their
families are more apt to be productive and satisfied employees. Thus, the large employer can
demonstrate this belief by offering a breast cancer education program. The primary purpose of
offering this program would not be to provide media coverage for the employer, spark the
interest of the female employees, or help balance the male-oriented programs.
DIF: Cognitive Level: Understand (Comprehension)
10. An employee had recently had a heart attack and was just discharged from the hospital. Which
would be an appropriate action for the nurse to take?
a. Plan a party for when the client is able to return to the workplace
b. Develop a program on exercise and nutrition for all employees
c. Determine appropriate temporary, perhaps part-time, responsibilities to ease the
employee’s reentry to the workplace
d. Advocate for improvements in the food being offered by the vending machines in
the employees’ lounge
ANS: C
The nurse may work with the employer to create a transitional duty pool. The goal is to
provide temporary work that is less physically demanding in nature than the employee’s
regular work. This facilitates the employee’s return to the workplace earlier than if required to
wait until full strength and health are regained.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
11. A nurse had 5 years of experience in a community health clinic when she accepted a position
in occupational health. Which best explains how the nurse will know what to do in this new
setting?
a. On the basis of past experience, she can focus on relevant aspects and adapt
protocols as deemed necessary
b. By focusing immediately on critical aspects and determining priorities in the
setting
c. By following company procedures and relying on assessment checklists and
clinical protocols
d. By using extensive previous experience, the nurse can grasp situations quickly and
initiate appropriate action(s)
ANS: C
As a newcomer to the site, although experienced in other areas of nursing, the nurse would
probably have sufficient experience to recognize a range of practice issues and function
comfortably in such roles as clinician and case manager. But to be competent in the new role,
the nurse should follow company procedures and rely on assessment checklists and clinical
protocols to provide treatment. To go beyond that (i.e., adapt protocols and immediately
recognize what is relevant in these new situations) will require experience in the new role.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
12. Which best describes what the Occupational Safety and Health Act of 1970 requires?
a. All employees are eligible for a free health examination before beginning
employment.
b. Employers are required to make suggestions on standards for improving worker
safety.
c. Employers have the right to request an Occupational Safety and Health
Administration (OSHA) inspection for ways to improve worksite safety.
d. Employers must keep the worksite free from recognized hazards.
ANS: D
OSHA promulgates occupational health and safety standards, which are published in the Code
of Federal Regulations and updated on a regular basis. Having access to the most recent
publication of these standards is a crucial responsibility of the occupational health nurse
(OHN). The OHN must be knowledgeable of Title 29 of the Code and other sections that
apply to specific hazards in the workplace.
DIF: Cognitive Level: Remember (Knowledge)
13. Which best describes what the Code of Federal Regulations, especially Title 29, requires of
the occupational health nurse (OHN)?
a. All employees must be trained in first aid.
b. Postwork-related injuries, illnesses, and death records must be recorded yearly.
c. The OHN must serve as an emergency warden, helping employees to the
emergency exit in a safe manner.
d. The Occupational Safety and Health Administration (OSHA) inspector must make
a worksite inspection on an annual basis.
ANS: B
NURSINGTB.COM
OSHA has record-keeping requirements that mandate the employer to keep records of
work-related injuries, illnesses, and deaths. These records must be posted in the workplace for
1 month per year and made available for review by OSHA at any time. In many cases, the
OHN has full responsibility for compliance with this standard.
DIF: Cognitive Level: Understand (Comprehension)
14. Which responsibility does the occupational health nurse (OHN) have in relation to an injured
employee and the Workers’ Compensation Act?
a. To assist the employee in obtaining legal representation to negotiate a financial
settlement
b. To assist the employer to work out a settlement with the employee to avoid legal
suits against the employer
c. To file a claim for the employee with Workers’ Compensation to ensure continued
full salary until the employee is able to return to work
d. To work with the employee to keep the employee informed, limit disability, and
provide opportunity for rapid return to employment
ANS: D
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The Workers’ Compensation Act protects the employer if the compensation received by the
employee precludes legal suits against the employer. Workers receive an average of 66% of
their take-home pay before taxes. The OHN educates the employee regarding benefits under
the Workers’ Compensation Act and is often the one who files the claim. The goal is to limit
the worker’s disability and provide an opportunity for early return to work through
appropriate workplace accommodations.
DIF: Cognitive Level: Understand (Comprehension)
15. A candidate’s resume demonstrates a perfect fit for a position, but one glance showed the
candidate was wheelchair bound. Which suggestion should the nurse make to the employer?
a. Be as polite as possible, but point out how difficult it would be to fulfill job
responsibilities while confined to a wheelchair
b. Be sure that another candidate is more qualified and “fits more closely with our
company goals”
c. Employ the candidate and rearrange the work area for easy access and exit for
someone in a wheelchair
d. Point out that other employees would probably not be kind to someone in a
wheelchair who is unable to join in many of the physical recreational activities
ANS: C
The Americans with Disabilities Act prohibits discrimination on the basis of disability. The
core of this law requires employers to adjust facilities and practices for the purpose of making
“reasonable accommodations” to enhance opportunities for individuals with disabilities. The
occupational health nurse has the duty to provide or facilitate reasonable accommodations
based on the nurse’s familiarity with the physical requirements of jobs in the workplace. If
this candidate was indeed theNperfect
the position,
RSIfit
GforTB.C
M not hiring the candidate because of
U
N
O
the disability would be considered discrimination. If other employees are not kind to this
candidate after the candidate is hired, they will likely face reprimand by the employer.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which are current challenges for occupational health nurses? (Select all that apply.)
a. Changes in employee demographics including gender, ethnicity, and age
b. Expansion in sites offering care using new, creative approaches
c. Increased affordability of health care services
d. Increase in managed care plans with need for case managers
e. Moving from large manufacturing facilities to smaller, service-based businesses
f. Ongoing need to demonstrate cost-effectiveness of services rendered
ANS: A, D, E, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
At the beginning of the 21st century, sweeping transformations in industry are influencing the
direction of occupational health nursing. These transformations include changing workforce
demographics, rising health care costs, diversity of health care systems with the integration of
managed care, influence of the world economy, shift in production from goods to services,
and proliferation of advanced technologies. The focus of U.S. industry is moving away from
large manufacturing facilities to smaller, service-based businesses. The increasing availability
of older workers, women, minorities, and immigrants will have far-reaching implications for
employers and pose specific challenges for occupational health professionals. Rather than
expanding, health care facilities are consolidating in the ongoing quest to give care more
economically. Health care costs are rising and are not becoming more affordable.
DIF: Cognitive Level: Understand (Comprehension)
2. In which ways are occupational health nurses (OHNs) role models of good community health
nursing? (Select all that apply.)
a. The majority of OHNs are prepared at the baccalaureate level or higher.
b. OHNs actively influence policy in health and safety within a particular area.
c. OHNs are skilled at assessing both people and their home environment.
d. OHNs focus on health promotion and avoidance of injury or disease.
e. OHNs plan and implement health programs for populations of employees.
f. OHNs work closely with physicians in planning and implementing care for
individuals and families.
ANS: A, B, D, E
OHNs focus on the promotion, prevention, and restoration of health within the context of a
safe and healthy work environment. Focus includes prevention of adverse health effects from
occupational and environmental
hazards.
NUR
INGApproximately
B.COM 70% of occupational health nurses
S
T
work alone, making decisions regarding health and safety issues, influencing policy in health
and safety, and planning and implementing myriad health programs. Nearly 70% of nurses
practicing in occupational health are prepared at the baccalaureate level or higher. OHNs do
not usually make home visits. Most collaboration is done with occupational health
professionals, such as industrial hygienists and ergonomists, rather than physicians.
DIF: Cognitive Level: Understand (Comprehension)
3. An occupational health nurse (OHN) is walking through a hospital. Which observations would
be concerning to the nurse? (Select all that apply.)
a. A nurse shares that the floor census is at capacity.
b. A wet floor without a warning sign or a dry walk area on one side
c. A nurse starts an IV without using gloves.
d. An electric bed gives a shock when touched.
e. Some biological substance on the floor and wall has not been cleaned.
f. Volume has been turned very high on several TV sets, necessitating very loud
verbal interactions.
ANS: B, C, D, E, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The OHN should identify work-related agents and exposures that are potentially hazardous so
problems can be prevented. Some of the hazards found in the hospital that the nurse would
want to note include biological-infectious hazards, such as may be found in bodily fluids;
chemical hazards such as unlabeled medications or solutions; enviromechanical hazards,
including any environmental hazards that could cause an accident such as slippery floors; and
physical hazards such as noise, which can cause tissue trauma, or electrical equipment with a
short so that persons get shocked when they touch it. The census of the floor would not be of
concern to the nurse.
DIF: Cognitive Level: Apply (Application)
4. An occupational health nurse has been asked to perform a complete physical examination,
including drug testing, on both a prospective and a current employee. Which best describes
the purposes of these examinations? (Select all that apply.)
a. To measure the strength of organs that may be affected by workplace
responsibilities
b. To document changes that may have occurred while the employee engaged in
particular processes or in a particular work area
c. To establish a baseline before the employee is exposed to possible workplace
hazards
d. To help decide whether or not to hire the prospective employee
e. To update employee records and fill in any missing information
f. To warn the employer about specific weaknesses or disabilities in the prospective
employee
ANS: A, B, C
The preplacement evaluationNis performed
RSINGTbefore
B.COthe
M worker begins employment in a new
U
company or is placed in a different job. The evaluation is a baseline examination that consists
of a health history, an occupational health history, and a physical assessment that should
target the type of work that the employee will be performing. The preplacement examination
may also include medical tests to determine specific organ functions that may be affected by
exposure to existing agents in the employee’s workplace. Examinations of individuals
transferring to other jobs are critical to document any changes in health that may have
occurred while the employee was working in a specific area or with a specific process.
Preplacement health examinations by law will be permitted only if phrased in terms of the
applicant’s general ability to perform job-related functions rather than in terms of any
disability and only after a job offer has been made. The examination must be job related and
consistently conducted for all applicants performing similar work.
DIF: Cognitive Level: Apply (Application)
5. A nurse tells a friend that he has recently changed jobs and will now be an occupational health
nurse. Which places is the nurse most likely to be working? (Select all that apply.)
a. Factory
b. Outpatient cardiac rehabilitation
c. Hospital employee health
d. College/University
e. Public health department
f. Residential group home
ANS: A, C, D, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
As workplaces have continued to change over the past few decades, the role of the
occupational health nurse has become even more diversified and complex. Occupational
health nurses work in a variety of settings including manufacturing such as meat packing,
food production, battery manufacturing, and textiles; hospital employee health institutions;
and service industries such as banking and government and academic centers. Nurses who
work in outpatient cardiac rehabilitation, public health departments, and residential group
homes are working in community health settings, but not occupational health.
DIF: Cognitive Level: Apply (Application)
6. Which competencies should occupational health nurses be able to fulfill? (Select all that
apply.)
a. Completing thorough physical assessments of employees
b. Understanding of the business climate
c. Managing total worker health independently as appropriate
d. Knowing relevant federal, state, and local regulations
e. Adhering to the principles of professional practice
f. Practicing culturally appropriate nursing care
ANS: B, C, E, F
According to the American Association of Occupational Health Nurses, occupational and
environmental health nurses should be able to fulfill the following competency categories:
manages total worker health independently and with other team members; adheres to
principles of professional practice; demonstrates understanding of the business climate and its
impact on the health of the community; practices culturally appropriate, evidence-based
nursing care within licensed scope of practice. The occupational health is not responsible for
thorough physical assessments
or for M
knowing relevant federal, state, and local
NUofRemployees
INGTB.C
S
O
regulations.
DIF: Cognitive Level: Understand (Comprehension)
7. Which best explains how occupational health nursing differs from other nursing specialties?
(Select all that apply.)
a. Occupational health nursing has a major focus on the environment.
b. Occupational health nurses are required to have a master’s degree in occupational
health.
c. Occupational health nurses are more autonomous and work independently.
d. Occupational health nurses have a primary emphasis on health promotion and
disease prevention.
e. Occupational health nurses may work with unions, as well as management groups.
f. Occupational health nurses work in the community.
ANS: A, C, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The occupational health nurse (OHN) focuses on the workplace environment, examining the
environment for hazards. Within the worksite, 70% of occupational health nurses work alone.
The nurse often meets with unions representing the employees, as well as management. The
roles and responsibilities of the OHN must be clearly articulated to lay people, managers,
workers, union representatives, and colleagues. The nurse may interact with occupational
medicine professionals, industrial hygienists, safety professionals, employee assistance
counselors, personnel professionals, and union representatives. Nurses who work in
occupational health settings are not required to have a master’s degree in occupational health.
It is hoped that all nurses emphasize health promotion and disease prevention. Several
specialties such as home health nursing and school nursing also work in the community.
DIF: Cognitive Level: Understand (Comprehension)
8. Which best explains why employers are putting more effort into ensuring a safe environment
for their employees? (Select all that apply.)
a. To avoid National Institute for Occupational Safety and Health (NIOSH)
inspections
b. To be sure employees are “on the job”
c. To provide good public relations, which can be seen as being a good community
citizen
d. Safety is an ethical and moral responsibility
e. To prevent expensive lawsuits when someone is hurt or injured
f. The Occupational Safety and Health Administration (OSHA) can give penalties,
fines, and sentences for safety violations
ANS: E, F
The Occupational Safety andNHealth
1970 identifies
the roles of the various
RSIAct
GofTB.C
M
U
N
O
government agencies, provides for the establishment of federal occupational safety and health
standards, and identifies a structure of penalties, fines, and sentences for violations of
regulations. Inspections are a responsibility of OSHA, not NIOSH. The Workers’
Compensation Act helps protect employers against lawsuits, but any citizen can sue anyone at
any time, so it is less expensive to keep the environment and the employee as safe as possible.
Although having a safe environment shows good public relations and is an ethical and moral
responsibility, these are not the main reasons why more effort has been put into ensuring a
safe environment for employees.
DIF: Cognitive Level: Understand (Comprehension)
9. Which best describes when the nurse can share confidential information about an employee’s
health with others? (Select all that apply.)
a. If needed for workers’ compensation documents
b. If a life-threatening emergency occurs
c. If authorized by the employee to specific recipients, such as insurance companies
or health care providers
d. If requested by the employer for management purposes
e. In compliance with governmental laws and regulation
f. In educational programs so others can avoid similar injuries and risks
ANS: A, B, C, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Occupational health nurses sometimes experience ethical dilemmas because of dual
responsibility to both their employer and employees. In dealing with health information, the
employee has a right to privacy and should “be protected from unauthorized and inappropriate
disclosure of personal information” (AAOHN, 2004, p. 1). However, exceptions to legal
protection of health information may require the nurse to provide health-related records
without the worker’s knowledge or consent. These exceptions are cases in which public
benefit from disclosure outweighs loss of individual privacy. Specific circumstances include
life-threatening emergencies; workers’ compensation situations in which state regulations
limiting information to carriers and/or employers are followed; examination for drug and
alcohol testing in some circumstances; compliance with government regulations;
OSHA-mandated surveillance and/or occupational injury or illness evaluations; and other
situations as required by law (e.g., public health purposes, law enforcement, judicial
proceedings, or court order). The nurse is unable to share confidential information about an
employee’s health with the employer for management purposes or during an educational
program.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 32: Forensic and Correctional Nursing
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes how the prevalence of violence and violent crimes has changed the
professional practice of health care providers?
a. Vulnerable groups are now assessed for evidence of abuse.
b. The focus has now shifted from patient care toward more personal safety.
c. It is now recognized that new specialties continue to be created.
d. Each patient is now routinely screened for violence.
ANS: D
All persons should be assessed for evidence of abuse, not just vulnerable groups. Screening
for violence is now considered to be a minimum standard of care for all clients.
DIF: Cognitive Level: Understand (Comprehension)
2. If a forensic nurse was employed in the most widely recognized subspecialty in forensic
nursing, which would be the nurse’s primary tasks?
a. Be employed by insurance companies to review and interpret medical records
b. Complete the death certificate, including causes of death
c. Do a history and physical assessment and collect evidence
d. Review the crime scene for insights with police officers
ANS: C
NUR(SANE)
Sexual assault forensic examiner
the most
SINGTisB.C
OM widely recognized subspecialty in
forensic nursing. The SANE assesses and documents detailed examination findings, collects
forensic evidence related to a reported crime, and frequently testifies as an expert witness at
subsequent trials.
DIF: Cognitive Level: Understand (Comprehension)
3. A forensic nurse is responsible for conducting a thorough examination, including a history,
performing a physical assessment, and collecting forensic evidence on a female client
following a rape. In which subspecialty of forensic nursing is this nurse practicing?
a. Sexual assault nurse examiner (SANE)
b. Nurse coroner
c. Legal nurse consultant
d. Forensic nurse death investigator
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
A SANE is a specially trained registered nurse who applies the nursing process during
forensic examinations to victims or perpetrators of sexual assault. The SANE collects forensic
evidence related to a reported crime and frequently testifies as an expert witness at subsequent
trials. If the client is medically stable, the SANE is responsible for conducting a thorough
examination, including obtaining a history, performing the physical assessment, and collecting
forensic evidence. The nurse coroner would be responsible for ensuring that appropriate
measures were taken to perform death investigations and certify death certificates. Legal nurse
consultants provide assistance within the legal system using specialized nursing knowledge
and expertise when interactions of law and health issues arise. The forensic nurse death
investigator evaluates the death scene from a holistic nursing perspective and might interpret
the scene differently.
DIF: Cognitive Level: Understand (Comprehension)
4. Which cause of death on a death certificate would need correction by the forensic nurse?
a. Accident
b. Homicide
c. Natural
d. Suicide
e. Untimely
ANS: E
The National Association of Medical Examiners identifies five acceptable options for
recording manner of death: (1) natural, (2) accident, (3) suicide, (4) homicide, and (5)
undetermined.
DIF: Cognitive Level: Remember (Knowledge)
NURSINGTB.COM
5. Which skill can a forensic nurse, serving in the elected office of coroner, bring to the situation
compared with other professionals?
a. Extensive knowledge of medicine
b. Knowledge of the law
c. Previous experience in testifying in court
d. Superb communication and empathy skills
ANS: D
Nurse coroners exhibit communication skills when dealing with grieving families. Nurses are
educated in therapeutic communication and practice those skills in any setting. Nurses are
acutely aware of the importance of using open-ended questions, attentively listening, and
being fully present with family and friends.
DIF: Cognitive Level: Understand (Comprehension)
6. The legal nurse consultant (LNC) was surprised to find that former friends were no longer
interested in a colleague relationship and one even accused the LNC of trashing clinical
nursing practice in the courtroom. Which would be the best response by the LNC?
a. “I’ve just accepted a position that pays an incredible amount more than staff
nursing in a hospital.”
b. “I’m not part of clinical nursing; I’m part of the legal system now.”
c. “I’m defending the expertise and experience of skilled nursing clinicians by
helping remove dangerous practitioners from the field.”
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. “I’m helping clients who were hurt by poor practice to obtain revenge.”
ANS: C
Some practitioners have differing opinions regarding LNCs and nurse attorneys. They may be
perceived as either defending the profession or prosecuting peers by testifying against
professional colleagues. Many law firms hire LNCs to review and interpret medical records
and charts, provide objective opinions based on standards of care, and possibly to testify in
court as expert witnesses. LNCs are able to provide the link between clinical nursing and the
legal system to help keep the practice field safe from dangerous practitioners. In contrast,
meticulous practitioners who are wrongfully accused of negligence will be defended. The
salary of the position does not address the accusation of the LNCs former friends. The
purpose of LNCs is not to help clients obtain revenge if they were harmed by poor care.
DIF: Cognitive Level: Apply (Application)
7. The legal nurse consultant (LNC) was asked to submit an affidavit to both the prosecutor’s
and the defendant’s office. Which information needs to be included?
a. List of all literature reviewed in preparation for being paid as an expert witness
b. Notarized signature on a summary of the LNC’s education and clinical experience
c. Summary of nurse’s educational and experiential credentials and an analysis of the
case
d. An opinion under oath as to what happened in the crime situation
ANS: C
The LNC may submit an affidavit, which is a written statement explaining the expert’s
credentials, background, and licensing or certification(s). It also provides a list of the
materials read and considered in the case, and the findings of the review are summarized into
NURSINGTB.COM
a case analysis.
DIF: Cognitive Level: Apply (Application)
8. The legal nurse consultant (LNC) felt more than a little stressed after being cross-examined by
both the prosecuting attorney and the defendant’s attorney in intricate detail at a deposition.
Which action should be taken next by the LNC?
a. Get together with friends and share the experience
b. Go out and have a stiff drink to relax and get over the stress
c. Pray the case does not go to trial when the LNC will have to go through all this
again
d. Review the written transcript for accuracy
ANS: D
During the deposition, the LNC will present the facts of the case and be questioned by
attorneys from both sides. This process may be quite lengthy and stressful. It is essential that
the LNC be prepared, having reviewed the case and all related materials very thoroughly.
Following this process, the LNC will be given a written transcript of the deposition; this needs
to be carefully reviewed for accuracy. It is not appropriate for the LNC to share this
experience with friends. Consumption of alcohol will not help the nurse address the stressors
that are being encountered. Reviewing the transcript for accuracy should decrease the level of
stress experienced by the nurse and decrease the worry about this case going to trial.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
9. The female nurse was called to the emergency department (ED) to help with a woman who
had been beaten and raped. Which are the nurse’s responsibilities as a forensic nurse?
a. Discuss with police officers what is known and what needs to be known to close
the case
b. Initiate the proper collection, preservation, and chain of custody of evidence with
appropriate documentation
c. Serve as chaperone while the physician completes the physical examination
d. Be empathetic and supportive to the victim
ANS: B
It is imperative that ED registered nurses identify forensic cases and initiate the proper
collection, preservation, and chain of custody of evidence and provide accurate documentation
for this unique population. This collection of evidence plays an important role in the
investigation of crimes and can have a major impact on legal decisions. Accurate collection of
evidence is the primary responsibility of the nurse and needs to be completed before any
additional action is taken. The recognition, collection, and documentation collected within the
emergency department may play an important role in the investigation of crimes and can have
a major impact on legal decisions. It is important for the nurse to collect the necessary
evidence whereas it is the responsibility of the legal system to prosecute and close the case.
The primary role of the female forensic nurse would not be to serve as a chaperone to the
physician or provide support to the victim.
DIF: Cognitive Level: Apply (Application)
10. An emergency department nurse was not sure whether there was enough evidence one way or
the other to suspect child abuse with a child client, because there was not much evidence of
NURS
INGT
B.COMchild. Which would be the forensic
physical harm. The forensic nurse
agreed
to see the
nurse’s primary focus?
a. Ask the child whether the family has any secrets
b. Assess for old injuries or injuries in the process of healing
c. Observe the child’s appearance and behavior and how the child interacted with
other children and adults
d. Question the parents concerning the child and any discipline problems
ANS: C
The nurse obtains a thorough history and assessment, focusing on several facets of abuse and
neglect. These include child–parent interaction, the child’s appearance and behavior,
child–child interaction, and the environment.
DIF: Cognitive Level: Apply (Application)
11. Which is most likely to physically abuse elderly Americans?
a. A partner or spouse
b. A caregiver
c. A stranger
d. An adult child
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
In a study by Acierno et al. (2009), 1.6% of subjects report physical mistreatment, with family
members accounting for 76% of the mistreatment, and specifically 57% was conducted by a
partner or spouse.
DIF: Cognitive Level: Remember (Knowledge)
12. Which is the most common form of elder abuse?
a. Emotional abuse by caregivers
b. Financial abuse when resources are used without the elder’s consent
c. Neglect by self or caregivers
d. Physical mistreatment resulting in injuries
ANS: C
Neglect is the most common form of elder abuse, whether it is caregiver neglect or
self-neglect. Neglect is more likely to occur than emotional abuse, financial abuse, or physical
mistreatment resulting in injuries.
DIF: Cognitive Level: Remember (Knowledge)
13. Which describes a responsibility of the forensic psychiatric nurse?
a. Assisting with the deposition
b. Collecting evidence to be used in future legal proceedings
c. Judging intent or diminished capacity of the client during the incident
d. Preparing to testify in court
ANS: C
Forensic psychiatric nurses collect evidence by determining intent or diminished capacity in
the client’s thinking at the time
the
incident.
To do
NUofRS
IN
GTB.C
M this, they often spend several hours
O
interviewing and observing the client, carefully documenting conversations and observations.
DIF: Cognitive Level: Understand (Comprehension)
14. A prisoner was bleeding where another inmate had attacked him with a fork. Which would be
the correctional nurse’s first and most crucial responsibility?
a. Perform a complete physical assessment, specifically looking for internal injuries
b. Maintain an escape route to help ensure personal safety
c. Report the incident to administration, indicating who was responsible for injuring
the inmate
d. Stop the bleeding, apply an antibiotic, and bandage the wound
ANS: B
Unlike any other care setting, clients are inmates, and care is negotiated and provided with
recognition of safety and security issues for the nurse. The nurse must maintain an escape
route, should a situation of personal violence be imminent. If the nurse is able to maintain an
escape route, the nurse would then be able to complete a physical assessment, stop the
bleeding, and then report the incident to administration.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
15. A 14-year-old was found guilty of beating and raping a 73-year-old neighbor. The prosecutor
had successfully argued for the child to be tried as an adult. The jury is considering a long
adult prison term. Which would the nurse most likely suggest when called on as an expert
witness?
a. The child must be mentally ill to have done such a thing and should be in a mental
hospital.
b. The child should be in a juvenile facility to avoid the high risk of sexual assaults,
beatings, and suicide in adult prison.
c. The child should be given a long adult prison sentence to protect society from such
a predator.
d. The child must be given an opportunity to complete high school while incarcerated
in the adult prison.
ANS: B
Adult correctional facilities are not generally equipped to deal with the challenges of
adolescent development. Adolescents in an adult correctional facility are the highest at risk
than any other group. Juveniles in adult correctional facilities are 36 times more likely than
the adult population to commit suicide. Thus, it is in the best interest of the adolescent to be
placed in a juvenile facility. The placement of an adult prison or mental hospital would not be
in the best interest of this child.
DIF: Cognitive Level: Apply (Application)
16. The correctional nurse was completing an admission physical for a newly incarcerated
prisoner. The nurse realized the prisoner was talking to someone other than the nurse. Which
does the nurse need to remember?
a. Cell phones, including those with ear phones, are commonplace among everyone.
N RSINGTB.COM
b. It is common for persons toUtalk
to themselves or think out loud.
c. Prisons have become the residence for a very large number of persons who have
mental illnesses.
d. Prisoners get very lonely and often talk to mirrors or inanimate objects.
ANS: C
In the late 1950s and early 1960s, deinstitutionalization moved people with mental illness out
of state hospitals into communities that were often ill-prepared to care for them. As a result,
many people with a mental illness reside in nursing homes, residential homes, prisons, or jails.
People with mental illness are often jailed for crimes committed in response to the symptoms
of mental illness. Approximately 34% of state inmates, 24% of federal inmates, and 17% of
jail inmates received treatment for mental health problems. Thus, it is highly likely that this
prisoner has a mental illness. It is less likely that the prisoner is using a cell phone or
purposefully talking to himself.
DIF: Cognitive Level: Apply (Application)
17. Which is considered appropriate preparation for engaging in forensic nursing specialty
practice?
a. Adequate number of continuing education credits plus licensure as a registered
nurse
b. Baccalaureate nursing program and previous community health experience
c. College-based educational program including supervised clinical hours and
internship
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Interest in and willingness to be employed in the field
ANS: C
Simply completing a continuing education course is not adequate. Several colleges and
universities offer a variety of programs to educate practitioners. During the formal programs
of study, the student usually completes a minimum specified number of supervised clinical
hours; a clinical internship or fellowship also may be required.
DIF: Cognitive Level: Understand (Comprehension)
18. A correctional nurse was preparing to give an inmate his psychotropic drug when the prisoner
hit the nurse’s arm, sending the medication flying, and yelled, “No more. I’m not taking that
poison anymore!” The prisoner is obviously mentally ill. Which action should be taken by the
nurse?
a. Inject the medication rather than debate taking the oral pill with the inmate
b. Recognize the prisoner’s right to refuse treatment
c. Throw the medication away, obtain another pill, and try to persuade the prisoner to
take the drug
d. Force the medication down the prisoner’s throat with the assistance of two prison
guards
ANS: B
Nurses practicing in correctional settings must recognize that involuntary medical treatment is
not undertaken until after internal review and judicial proceedings.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
NURSINGTB.COM
1. With whom would the forensic nurse primarily interact during the day in addition to clients?
(Select all that apply.)
a. Case managers
b. Officers of the court
c. Physicians
d. Police officers
e. Psychologists
f. Social workers
ANS: B, D
The International Association of Forensic Nurses explains that forensic nursing is the practice
of nursing where the health and legal systems intersect (ANA, 2009). Thus, the forensic
nurse’s role provides a vital link between the health care system, the investigative process,
and courts of law (Lynch, 2011). Officers of the court and police officers would be two key
populations with whom the nurse would interact. The nurse would be less likely to interact
with case managers, physicians, psychologists, and social workers.
DIF: Cognitive Level: Understand (Comprehension)
2. Which would most likely be the result of a medicolegal death investigation? (Select all that
apply.)
a. Clarification of the unnatural circumstances in which death occurred
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
b.
c.
d.
e.
f.
Court testimony as to cause of death based on evidence
Consultation with defendant’s attorney for a fee
Consultation with prosecuting attorneys for a fee
Death certificate with cause and manner of death
Permission to use deceased organs for transplant
ANS: A, E
Medicolegal death investigations are usually conducted to clarify the sudden, unexpected, and
often nonnatural circumstances in which death occurred. One of the outcomes of death
investigation is death certificates. Outcomes of medicolegal death investigations do not
typically involve court testimony, consultation with the defending or prosecuting attorneys for
a fee, or permission to use the deceased organs for transplant.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes how a legal nurse consultant (LNC) would best prepare for testifying in
court as an expert witness? (Select all that apply.)
a. By carefully analyzing the client’s medical record and related documents
b. By creating a PowerPoint slide presentation to help educate the jury
c. By helping to examine all the witnesses in preparation for the court trial
d. By personally doing or observing the autopsy on the deceased
e. By preparing charts and tables illustrating the important legal points
f. By summarizing the literature regarding the standard of care
ANS: A, F
LNCs perform many different services and activities, including organizing and analyzing
medical records and related materials; preparing chronologies of health care events; and
B.CtheOMLNC be prepared, having reviewed the
identifying standards of care.NItUisRessential
SINGTthat
case and all related materials very thoroughly. The LNC would probably not create a
PowerPoint slide presentation, examine all witnesses in preparation for the trial, personally
complete the autopsy, or prepare charts and tables to illustrate the important legal points.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best explains why the infection rate of communicable diseases is so high among
persons who are incarcerated? (Select all that apply.)
a. Airborne transmission of disease because of lack of cleanliness
b. Ignorance by staff about how infectious diseases are transmitted
c. Engagement in tattooing and drug use
d. Lack of access to health care while incarcerated
e. Failure to use condoms during sexual intercourse
f. Poor nutrition and lack of exercise while incarcerated
ANS: C, E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The high rate of communicable disease in this population is associated with high-risk
behaviors common among inmates, including current and previous drug use, unprotected
sexual intercourse, and tattooing. Most prisoners receive a health screening at admission.
Prisoners have a constitutional right to receive adequate and timely health care. Adequate food
and exercise are available as the goal is to ensure a safe, secure, and humane environment for
inmates. Most communicable diseases that are experienced by incarcerated individuals are not
spread via airborne transmission. The prison and legal system are aware of how these diseases
are transmitted, but some of these high-risk behaviors that this population engages in occur
when they are not incarcerated.
DIF: Cognitive Level: Understand (Comprehension)
5. Which statements about women in prison are correct? (Select all that apply.)
a. Women prisoners with a mental health diagnosis are likely to have reported a
history of abuse.
b. Women prisoners receive similar quality of health care when compared to men.
c. Women prisoners are likely to be victims of violence while incarcerated.
d. Women prisoners are likely not provided routine gynecological care when entering
the correctional facility.
e. Women prisoners should receive education about healthy eating and regular
physical activity.
f. Women prisoners should receive counseling about parenting skills.
ANS: A, D, F
Approximately 8 in 10 women with a prior mental health diagnosis reported physical or
sexual abuse before imprisonment: 57.2% were physically abused and 39% sexually abused
(CSOSA, 2014). Unfortunately,
health
providers
NUR
INcare
GTB.C
M in correctional facilities have limited
S
O
experience and training to meet the health care needs of women in prison, and quality of care
is adversely affected. The National Commission on Correctional Health Care (NCCHC, 2014)
confirms that routine gynecological examinations are not consistently apart of health
screening for women upon entry into a correctional facility or a routine part of ongoing health
care. Comprehensive health care services should be available to incarcerated women that give
special consideration to the reproductive health needs of women, the high rate of victimization
among incarcerated women, counseling related to parenting issues, and accessibility to drug
or alcohol treatment. The text does not address violence related to women while incarcerated
or that women prisoners need information specific to healthy eating and regular exercise.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 33: Faith Community Nursing
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes when faith communities first began to be involved with health and
healing?
a. In 1998, when parish nursing was first officially recognized
b. In the time of Jesus and similar religious leaders of the early years AD
c. Throughout history, faith communities provided basic health care
d. When parish nursing began in the Lutheran Church in the 1980s
ANS: C
The majority of the world’s populations belong to organized faith communities. All of these
religions have traditions and rituals related to health and healing. Throughout history,
religious communities have provided care for the indigent and disenfranchised, meeting basic
human needs of food and clothing and basic health care. Thus, parish nursing began before
time of Jesus. The Old Testament discusses Shalom, or God’s desire for health and wholeness
for the Earth and its people.
DIF: Cognitive Level: Understand (Comprehension)
2. Which has been confirmed by research regarding the relationship between religion,
spirituality, and health?
a. Essentially, religion gives persons a sense of hope.
b. Faith communities help by praying for ill persons during services.
NURSItoNbe
GTactive
B.CO
M
c. Healthy persons have a tendency
within their faith communities.
d. Persons who attend services have decreased anxiety, depression, and stress.
ANS: D
Individuals who reported intrinsic religion (internalized or regularly practiced) and regular
attendance at a religious service reported decreased stress. In 147 studies, it was found that
there was an inverse relationship between religiosity and depression. The authors found
evidence in another 49 studies that indicated people who practiced religious coping had lower
levels of anxiety, depression, and stress and coped more positively with many chronic
diseases.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best explains why the name of parish nursing was changed to faith community nursing
by the American Nurses Association (ANA)?
a. To allow nurses to use the title “congregational nurse” or “church nurse” rather
than “parish nurse”
b. To allow nurses who were not religious to accept practice positions
c. To decrease the emphasis on the church
d. To emphasize the community setting of the specialty
e. To reflect the diversity now found in the specialty
ANS: E
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The ANA revised the standards in 2012, providing a clearer definition of the practice,
including advanced nursing practice and changing the name of the specialty from parish nurse
to faith community nurse. While acknowledging the importance of the Judeo-Christian basis
of the practice, the authors believed the change better reflected the diversity now found in the
specialty.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes how the practice of faith community nurses is different from the practice
of other nurse specialists?
a. Advanced education is required before attempting such a challenging role.
b. Practice setting is in a building dedicated to a purpose other than health care.
c. The nurse is a member of the same community where the nurse practices.
d. The central focus of the practice is the spiritual dimension.
ANS: D
A key element of the philosophical basis of parish nursing is the spiritual dimension, which is
central to the practice. All specialties require advanced education and are often practiced in
non–health-oriented settings, such as workplaces, schools, or client homes.
DIF: Cognitive Level: Understand (Comprehension)
5. On which level of care do most faith community nurses (FCNs) focus?
a. Hospice care
b. Primary
c. Secondary
d. Tertiary
ANS: B
NURSINGTB.COM
The FCN practice focuses on health promotion and wellness, which is primary intervention. It
holds the spiritual dimension central to health and healing within the context of the faith
community.
DIF: Cognitive Level: Understand (Comprehension)
6. Which best describes how the faith community nurse, as a health educator, decides which
educational programs to offer the faith community?
a. Based on feedback from the local public health department nursing professionals
b. Based on what will help implement the Healthy People 2020 goals
c. Based on what is consistent with the health laws of scripture or holy books
d. Based on the health status and needs of faith community members
ANS: D
Although any response could be the basis of a program, the program should address the needs
of the local faith community. Educational efforts are planned on the basis of the church
community’s priorities consistent with Healthy People 2020 objectives. Because the faith
community membership includes people across the life span, church-based educational
programs can address all 10 major health indicators. Early in the development of a parish
nurse program, and periodically thereafter, the parish nurse should assess the health status and
needs of the congregation members to determine educational priorities.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
DIF: Cognitive Level: Understand (Comprehension)
7. As a health advocate, which does the faith community nurse (FCN) need to know?
a. Community resources available in the community
b. Educational needs of the community
c. Recruitment strategies
d. Understanding of spirituality
ANS: A
In the role of health advocate, the FCN facilitates clients’ efforts in obtaining needed health
services. The FCN uses referral skills and knowledge of community resources to guide
individuals as they access available resources. The nurse may, with the client’s approval,
provide referrals to resources. The FCN recognizes the difficulties encountered by vulnerable
populations within the faith community and helps them maneuver the health care maze to
access needed resources. Knowing the educational needs of the community is necessary for
the FCN to fulfill the role of health educator. As the coordinator of volunteers, the FCN
should be aware of how to recruit, train, and direct volunteers to work with the FCN program
or health ministry. It is necessary for the FCN to understand spirituality in order to effectively
fulfill the role of integrator of health and healing.
DIF: Cognitive Level: Understand (Comprehension)
8. Which reality would cause difficult ethical conflicts for a faith community nurse?
a. Best clinical practice may suggest behaviors contrary to the faith community’s
values and beliefs.
b. Individuals might pressure the nurse to make medical decisions for them.
c. Persons do not always follow the nurse’s advice as to appropriate actions.
URSIthe
NGfaith
TB.C
OM
d. Some political maneuversNwithin
community
have implications for the
nurse’s practice.
ANS: A
The nurse must understand the policies and beliefs of the congregation related to specific
health issues. Church doctrine may guide members to adopt values and beliefs that are in
conflict with current health care recommendations, such as issues of homosexuality,
infertility, birth control, or sex education for youth. The parish nurse must understand that the
politics of working within the faith system require acceptance of individual and system values
and beliefs.
DIF: Cognitive Level: Understand (Comprehension)
9. The faith community nurse (FCN) finds the faith community’s needs overwhelming. Which
best describes how the nurse can best meet the community’s many needs?
a. Discover appropriate resources already existing in the community
b. Help the community members meet their own needs independently of the nurse or
other assistance
c. Recruit, train, and direct volunteers to implement needed programs
d. Suggest the faith community recruit more parish nurses to help
ANS: C
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
It would be fantastic if existing resources already in the community could meet the needs of
the faith community within which the FCN is working, but that would be extremely unlikely.
The role of coordinator of volunteers includes recruiting, training, and directing volunteers to
work with the FCN program or health ministry. The nurse may work with other nurses and lay
people within the congregation. The FCN program may encompass all programs related to the
health of the church community.
DIF: Cognitive Level: Apply (Application)
10. A nurse established a new parent support group where new parents meet to share problems
and solutions. After about 3 months, fewer people were attending. Which action should the
nurse take next?
a. Accept that the new parents may now be comfortable in their role and no longer
need a support group
b. Bring in outside experts to give presentations on specific infancy development
issues
c. Change the format of the group meetings to include more time for socialization
d. Suggest an ongoing educational program on infant and child development to renew
interest in attending the group
ANS: A
It is also important to remember that groups usually have an anticipated “life expectancy.”
After the needs of the groups are met through education or support, there may no longer be a
need for a particular support group. The FCN should document the history of the group and
move forward toward new goals.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
11. Which best describes why it is crucial that the faith community nurse (FCN) have at least a
baccalaureate degree, as well as several years of experience in clinical practice, in addition to
formal education in the role?
a. To ensure continued prestige and relatively high salary for the role
b. To be autonomous with self-direction and independent decision-making
c. To enable the FCN to assess the faith community and prioritize its needs
d. To function in varied settings from the religious building to the clients’ homes
ANS: B
Incredible diversity and autonomy are found in faith community nursing. The self-direction
and independent decision-making required by the autonomous roles of the FCN require a
highly educated nurse experienced in clinical nursing and community-based nursing practice.
Typically, there is not a high salary associated with the role of FCN. The autonomy and
independent decision-making required in this role allow the nurse to be able to effectively
assess the community and function in a variety of settings.
DIF: Cognitive Level: Understand (Comprehension)
12. In which area would the faith community nurse (FCN) most desire more education to continue
in the role?
a. Basic community health nursing practice, especially in finding and accessing
resources
b. Spiritual assessment skills and acquiring theological knowledge
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Use of spirituality in faith healing
d. Physical assessment, pathophysiology, and pharmacology
ANS: B
Many FCNs find the need for further education to develop spiritual assessment skills, acquire
theological knowledge, and learn the nurse’s role in healing.
DIF: Cognitive Level: Understand (Comprehension)
13. Which symptom would the faith community nurse (FCN) expect to see when caring for a
client with the diagnosis of spiritual distress?
a. Hopelessness, isolation, and loneliness
b. Intense need for prayer and support
c. Loss of faith
d. Withdrawal from stress and the environment
ANS: A
FCNs provide nursing interventions related to the nursing diagnosis as connected to spiritual
distress (e.g., loneliness, isolation, and hopelessness).
DIF: Cognitive Level: Understand (Comprehension)
14. A new faith community nurse (FCN) met with a client who was dying. The client asked the
FCN to pray for her out loud. The FCN had an active prayer life, but privately—not out loud
relating to someone else. Which would be the best response by the nurse?
a. Deliberately misunderstand the request and promise to pray for the client when
you are at home each evening
b. Look for a religious bookNnearby,
and hope
RSIopen
GTit,
B.C
M there is something there the
U
N
O
nurse can use
c. Offer to share the client’s request with the faith community’s leader, as well as ask
the faith community to pray for the client
d. Share a traditional prayer that the nurse had previously memorized for personal use
ANS: D
It is good to offer to pray for the client and to ask the faith community’s leader and the faith
community to pray for the client. But the request was immediate, so the best response is to use
the faith’s traditional prayers, which the parish nurse has memorized. If nothing comes to
mind, the FCN can use a book of the faith to find a prayer that is suitable. A guideline to
follow is to keep the prayer simple and offer the request to the client’s higher power.
DIF: Cognitive Level: Apply (Application)
15. Which ethical issue is often a concern to a faith community nurse (FCN)?
a. The client’s right to confidentiality if a client repents and confesses sin to the nurse
b. Following the Health Insurance Portability and Accountability Act (HIPAA)
requirements
c. The nurse’s legal responsibility to the faith community leader
d. Setting up appropriate medical records of care given in case of a later legal suit
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Confidentiality issues have the potential to be problematic in a church community. Church
members can ask how someone is doing. Another church member would respond with
whatever they have heard. The FCN cannot respond in an equally open way but must maintain
confidentiality. In the role of health minister, the parish nurse may receive private and
sensitive information. Congregation members should not relate information in the form of
confession or repentance; however, the connection with the church ministry team may put the
nurse in a position to hear this type of sensitive information. The nurse must protect the
client’s right to confidentiality. The nurse should share confidential information with other
church ministry leaders (or prayer groups) only when given permission by the client. FCN
programs within faith communities generally are not required to follow HIPAA guidelines
related to medical records and confidentiality because churches are not in the category of
identified health care providers.
DIF: Cognitive Level: Understand (Comprehension)
16. A nurse was a volunteer in a faith community when a police officer asked for specific
information related to a member’s behavior and mental health. The faith community nurse
(FCN) told the police officer, “I’m a part-time volunteer; I’m not paid. Besides, I have
client-professional privileges so I can’t share information with you.” Which will most likely
be the outcome of this encounter?
a. The Health Insurance Portability and Accountability Act (HIPAA) will require the
nurse to maintain confidentiality.
b. The matter will be referred to the faith community leader for resolution.
c. The nurse is still accountable and has no legal right not to disclose information
requested by a legal authority.
d. The police officer will have to accept the nurse’s refusal to share information.
ANS: C
NURSINGTB.COM
Volunteers in a church are held to the same degree of accountability as are paid employees.
Ministers, both ordained and nonordained, may be required to disclose confidential
information in court. FCNs, as nonordained ministers, do not have client-professional
privilege. Thus, HIPAA does not apply as the information has been requested by a police
officer and there is not client-professional privilege involved. The faith community leader is
not able to offer a resolution to this problem as client-professional privilege does not exist in
this situation. Because there is not client-professional privilege, the police officer does not
need to accept the nurse’s refusal to share information.
DIF: Cognitive Level: Apply (Application)
17. On the basis of what a faith community nurse (FCN) believed was best practice, she wanted to
share various methods of dealing with infertility. However, the tradition of the church was
that childbirth was in the hands of God and it was inappropriate to use artificial means of
becoming pregnant. Which action should be taken by the nurse?
a. Ask to be excused from the situation if a couple wants to obtain information
inconsistent with the church’s teaching
b. Follow the teaching of the church and keep quiet; there are worse fates in life than
infertility
c. Suggest that a client consider adoption and suggest an appropriate adoption agency
d. Tell the client all the various methods used in cases of infertility
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The FCN’s roles include understanding the scope of practice for parish nurses related to
ethical practice and the values and beliefs of the community served. The nurse must
understand his or her own beliefs and values that are in conflict with the faith community’s
beliefs. It is necessary that the parish nurse know when to seek help, when to refer, and when
to remove himself or herself from the ethical decision-making process.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which interventions would be appropriate for a faith community nurse who bases care on the
CIRCLE Model of Spiritual Care? (Select all that apply.)
a. Giving a mini sermon based on the specific client problem
b. Listening and showing respect without any actual intervention
c. Suggesting to the client what would be an appropriate response to the situation
d. Showing love and empathy toward the client and the situation
e. Calling the client by name during the conversation
f. Allowing time for prayer during the client interaction
ANS: D, E, F
Faith community nurses should avoid giving sermons or preaching religion to clients.
Listening without any intervention is not possible, because listening in and of itself can be
therapeutic. Clients retain their autonomy, so nurses can give information but cannot suggest
to clients what their decision should be. Appropriate emotional interventions include working
with feelings, showing love, and using appropriate touch and empathy. Calling a patient by
name is part of showing caring during the interaction. Intuition includes allowing time for
NURSand
INencourages
GTB.COM
prayer and sacrament and supports
religious activities.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Chapter 34: Home Health and Hospice
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse is going to visit a client who needs assistance with personal hygiene and feeding.
Which suggestion should be made to the family?
a. “I’ll teach you how to care for your family member to keep him comfortable or, if
you can afford it, you can employ an aide.”
b. “It’s important that he try to take care of himself and, if he can’t or won’t, he’ll
have to deal with the consequences.”
c. “Reimbursement is available for a nurse to come to the house each day if you
would like this assistance.”
d. “You can always have your family member readmitted to the hospital for care.”
ANS: A
The only thing the nurse can do if the care needed is maintenance and assistance with
activities of daily living is suggest a home health aide if the family can afford it, or teach the
family how to help the client. Currently, most reimbursement for nursing services is based on
the patient’s need for skilled nursing. On each patient visit, the nurse must document that the
care provided is of a skilled nature that requires the knowledge and assessment skills of a
nurse and must verify that the patient or a family member could not provide the same level of
care.
DIF: Cognitive Level: Apply (Application)
N R I G B.C M
U S N Tby starting
O a home health managed care agency.
2. A nurse was considering self-employment
Which risk is the nurse taking, particularly in the beginning?
a. Because the nurse is a newcomer, most patient referrals may go to other, more
long-term agencies.
b. Managed care agencies assume the risk of providing all needed care within the
amount budgeted.
c. Most clients would not know the nurse and therefore would be unaware of the
nurse’s agency.
d. Other nurses may envy the successful nurse and withdraw their friendship and
support.
ANS: B
Managed care agencies contract with payers, such as insurance companies, to provide
specified services to the enrolled clients at a predetermined price. Managed care agencies
receive payment before offering services and are responsible for taking the financial risk of
providing care to patients within the budgeted allotment. The nurse will not need to worry
about patient referrals or personally knowing the clients before referral as this home care
agency is part of a managed care group that has enrolled clients that need services. Envy from
other nurses is not a risk faced by the nurse starting this business endeavor.
DIF: Cognitive Level: Apply (Application)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
3. Although it was uncomfortable, a home health nurse finally learned to discuss finances with
the client and family on the very first visit. Visits had to be reimbursed. Now that she is
working for a different agency, funding was no longer such a concern. Which offers the best
explanation for this change?
a. Because the nurse was an unpaid volunteer professional, visits made by that nurse
had no cost to the agency.
b. Only clients of high socioeconomic class were admitted for care, so the agency
was always immediately reimbursed for care rendered.
c. Taxpayers fund official (i.e., public) home health agencies for care not reimbursed
by third parties.
d. The new agency has a large foundation that funds its activities from investment
profits.
ANS: C
Taxpayers fund official (i.e., public) home health agencies, but they also receive
reimbursement from third-party payers such as Medicare, Medicaid, and private insurance
companies. This additional taxpayer funding eliminates the stressor as to who will be paying
for the nursing visits for both the client and the home health agency. The nurse is not working
as an unpaid professional volunteer for this agency. The clients served by the official agency
are not likely of a high socioeconomic class and the agency most likely does not have a large
foundation to assist with paying for services that are provided.
DIF: Cognitive Level: Apply (Application)
4. Which best explains why home health care agencies that are part of national chains are doing
better in the competitive marketplace than individually owned agencies?
a. There is better media coverage and a nationally known “name” recognized by
NURSINGTB.COM
prospective clients.
b. They are able to offer lower quality care using less well-prepared caregivers to
ensure maximum profit.
c. The chief executive officer usually has extensive experience and makes wise
decisions.
d. There are lower administrative costs and easier negotiating when buying in bulk.
ANS: D
Agencies within chains have a financial advantage over single agencies. The chains have
lower administrative costs because a larger single corporate structure provides many services.
For example, a multiagency corporation has greater purchasing power for supplies and
equipment because they purchase a larger volume. A single corporate office can provide
administrative services such as payroll and employee benefits for all chain employees, thereby
reducing duplication of these services. It is unlikely that they are doing better because they
receive better media coverage, offer less quality care, or have a more experienced chief
executive officer.
DIF: Cognitive Level: Understand (Comprehension)
5. Which is required for an agency to receive reimbursement for care given from Medicare?
a. Application for recognition including signing a contract with the federal
government
b. Application for reimbursement from Medicare using the appropriate federal forms
c. Demonstrating meeting federal quality standards for Medicare-covered services
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. Providing specialty care such as physical therapy
ANS: C
Certified home health agencies meet federal standards; therefore they are able to receive
Medicare payments for services provided to eligible individuals. Not all home health agencies
are certified.
DIF: Cognitive Level: Understand (Comprehension)
6. Which 66-year-old client who needs skilled nursing care would be eligible for home health
care reimbursement by Medicare?
a. A client who always worked for the state and enjoys going to the neighborhood
coffee shop on a daily basis
b. A client who needs his wounds cared for every day, including weekends, and
needs the nurse to visit at 8 AM every day
c. A client who is a loner and has no one to assist him except for the home care
agency
d. A client who is homebound and has a very strong support system
e. A client who is an illegal immigrant who has lived in the United States for 25
years but begged the nurse not to tell
ANS: D
Medicare pays for short-term, skilled health care on a part-time or intermittent-care basis for
persons aged 65 years or older who are eligible under Title XVIII of the Social Security Act.
If family and caregiver support is available in the home to care for the patient between nurse
visits, the patient is eligible.
DIF: Cognitive Level: Apply N
(Application)
URSINGTB.COM
7. Which best explains the purpose of the Outcome and Assessment Information Set (OASIS)?
a. To analyze the cost-effectiveness of health agencies
b. To evaluate and improve clinical performance quality
c. To measure and publicize hospital data on outcomes such as death rates
d. To survey patient satisfaction with care received from health agencies
ANS: B
OASIS is a data set that measures outcomes of adult home care patients to monitor
outcome-based quality improvement. These items are used to monitor outcomes, plan patient
care, provide reports on patient characteristics for each agency, and evaluate and improve
clinical performance. The use of OASIS is mandatory for all Medicare and Medicaid patients
receiving skilled care. The primary purpose of OASIS is not to analyze the cost-effectiveness
of health agencies. This data set does not publicize hospital data or survey patient satisfaction
of care from the health agencies.
DIF: Cognitive Level: Understand (Comprehension)
8. Which is the major assumption of Albrecht’s conceptual model?
a. Nurses are the only appropriate case managers for home health patients.
b. Quality is best measured by using data from assessments, interventions, and
outcomes.
c. Patient outcomes depend primarily on the education and experience of the nurse.
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
d. The most important outcome measure is the cost-effectiveness of the care given.
ANS: C
An underlying premise of Albrecht’s conceptual model is that professional satisfaction and
effective patient outcomes depend on the education and experience of the home health nurse.
Within the Albrecht nursing model, the three major elements for measuring the quality of
home health care patient outcomes include structural, process, and outcome elements.
Although nurses are usually the case managers, Medicare pays for skilled services, including
occupational therapy and physical therapy. If nursing is not involved, the skilled professional
would be the case manager.
DIF: Cognitive Level: Understand (Comprehension)
9. In addition to factual data such as name, address, and diagnosis, which information is crucial
to the nurse when a referral is received?
a. The amount of reimbursement the agency will receive for a visit
b. The family’s reaction to the suggestion that a nurse visit in their home
c. The purpose of the referral for a home visit
d. The patient’s agreement with the home visit referral
ANS: C
The nurse prepares for the home visit by reviewing the referral form including the purpose of
the visit, the geographic residence of the family, and any other pertinent information.
DIF: Cognitive Level: Understand (Comprehension)
10. Which is the primary task to be accomplished during the initial telephone contact between the
home health nurse and the client?
NURSINGTB.COM
a. Make sure that the name, address, telephone, and other data are accurate
b. Confirm that the nurse will be a guest in their home so socialization can occur
c. Allow the client to give permission and agree to a time for a home visit
d. Warn the family that the nurse will always need to immediately see the proof of
insurance before proceeding further
ANS: C
The nurse contacts the client and informs him or her about the service referral. The first
telephone contact with the client or family consists of an exchange of essential information,
including an introduction by the nurse, identification of the agency that received the referral,
and the purpose of the visit. After the initial exchange of information, the nurse informs the
client of his or her desire to make the home visit, the client gives permission, and the group
sets a mutually acceptable time for the visit. The nurse is a guest in the client’s home but not
in the usual social sense. Public health nurses who are reimbursed by tax dollars may not
require evidence of insurance coverage.
DIF: Cognitive Level: Understand (Comprehension)
11. Which action should the home health nurse take to get in touch with a client if the client
apparently has no telephone?
a. Determine whether the client has family members in the area who might be able to
get in touch with the client to ask the client to call the agency
b. Go to the client’s address and discuss making a home visit with the client
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. Send a formal letter asking the client to call the agency for an appointment
d. Tell the referral source you cannot accept referrals without usable telephone
numbers, so this client was not visited
ANS: B
Not all clients have a telephone. If that is the case, the nurse should check the referral for a
telephone number where messages can be left. It is also worthwhile to contact the health care
provider who made the referral to see whether the telephone number was omitted
unintentionally. If the client does not have a telephone, the nurse may choose to make a
drop-in visit. This type of visit consists of an unannounced visit to the client’s home, during
which the nurse explains the purpose of the referral, receives the client’s permission for the
visit, and appoints a time for a future visit with the client. The client may agree to the first
visit while the nurse is there. It may be very difficult to determine if the client has family
members in the area to relay information to the client. Sending a formal letter would not get to
the client who needs services in a timely manner.
DIF: Cognitive Level: Understand (Comprehension)
12. Which is the best use of the nurse’s time while en route to the client’s home?
a. Assess the surrounding neighborhood and the exterior of the client’s home
b. Begin the client record using a computer or oral recording device
c. Look for appropriate places to obtain food, fuel, or rest stops for the nurse
d. Consider if another home health agency would be closer to the client’s home
ANS: A
An environmental assessment begins as the nurse leaves the agency and travels to the client’s
home. While driving, the nurse should observe the area surrounding the client’s home. It
NUaRcomputer
would not be appropriate to use
or oral
recording device while driving. Although
SINGTB.C
OM
the nurse should be conducting an environmental assessment, the nurse should be considering
the needs of the client during this assessment and not his/her own needs. The nurse would not
want to refer the client to another agency if the client has already selected this agency.
DIF: Cognitive Level: Understand (Comprehension)
13. Which is the most important task to be accomplished during the initial home visit?
a. Assess the client and the family
b. Discuss social topics
c. Educate the client and the family regarding the health problem
d. Establish rapport and trust
ANS: D
Many clients in need of nursing visits do not trust the health care system and are
uncomfortable with the representative from an agency visiting their home. The nurse must
build a trust relationship early in the visit or the client will not allow additional visits.
Beginning with social topics is often a helpful tool to help establish trust and rapport. After
rapport and trust have been established, the nurse can assess the client and family and provide
education. Discussion of social topics would not be the primary task to accomplish during any
nurse–client interaction.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
14. Which best describes the documentation that the nurse should expect to complete during the
home visit?
a. Creation of a carefully laid out nursing care plan for future visits
b. Documentation of assessment data and care given demonstrating the nurse’s
effectiveness
c. Necessary documentation will depend on the agency policies and forms
d. Completed Medicare forms per the Health Care Financing Administration (HCFA)
regulations for reimbursement
ANS: D
Most home health nurses would probably identify documentation issues as the most
frustrating part of providing home health care. Medicare holds a prominent position as a home
health care payer; therefore, the HCFA’s regulations determine the home health industry’s
documentation. Correct and accurate completion of required Medicare forms is the key to
reimbursement. The forms require documentation of the nurse’s care given.
DIF: Cognitive Level: Understand (Comprehension)
15. A new home health nurse realized that what was being observed and now being said by the
client were very inconsistent with what had been documented while the client was
hospitalized. Which conclusion should be drawn by the nurse?
a. The amount of support available is different from what was stated earlier.
b. The client had difficulty distinguishing truth from falsehood.
c. The client had to admit the truth when it was obvious to the nurse.
d. The family was embarrassed by their living situation.
ANS: A
NURSINbetween
GTB.Cinformation
It is not unusual to find inconsistencies
the patient provides during
OM
hospitalization concerning the amount of physical and emotional support available to the
patient in the home and the amount of help actually available to the patient in the home. The
nurse validates or modifies the referral information to reflect the actual home situation. The
client’s perception of support and the actual support provided may be different. Thus, it is
unlikely that the client was trying to lie about or was embarrassed by the situation.
DIF: Cognitive Level: Apply (Application)
16. Which should be included when the nurse writes a proposed treatment plan for a home health
client?
a. Outline of specific client goals with measurable outcomes
b. Specific nursing interventions to treat identified client problems
c. Type of services needed and frequency of visits by each discipline
d. Typical nursing care plan information from assessment to evaluation
ANS: C
There are differences between the treatment plan and the nursing care plan. The plan of
treatment includes the type of home health services received, the projected frequency of visits
by each discipline, and the necessary interventions. The nursing care plan addresses specific
nursing interventions designed to treat the patient’s actual or potential problems and includes
identified goals with measurable outcomes.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
17. A client was quite ill and the family was doing their best. After careful assessment and
diagnosis, the home health nurse was setting priorities for care. Which should be the basis for
deciding which intervention to implement first?
a. Address the problem that is easiest to fix first, so the client and family could see
some success fairly quickly
b. Address the most serious problem first for the client’s long-term health
c. Address the problem that is partly causing other problems first
d. Address the problem that the client and family think should be addressed first
ANS: D
The plan, including short-term and long-term goals, is developed in consultation with the
client and the family. To maximize the plan’s success, it is important that the patient and
family are involved in the planning process and that they access community resources. Thus,
it is most important to address the problem that the client and family think should be
addressed first. The other problems can be addressed after meeting the immediate needs of the
client and family.
DIF: Cognitive Level: Apply (Application)
18. A nurse shared information with a family concerning a community resource, including a
brochure with telephone number. The family agreed to follow up. Which demonstrates to the
nurse that the family wants to use those resources?
a. If the agency calls the nurse to share that they will be offering services to the
family
b. If the family always agrees with the nurse’s suggestions
c. If the family asks the nurse to please call and set up the service
NupRthe
SIservice
NGTB.COM
d. If the family calls and sets U
ANS: D
Under the Health Insurance Portability and Accountability Act, it is doubtful any agency
would suddenly call to share such information with the nurse. If the family always agrees with
the nurse’s suggestion, it may be cultural rather than actual interest in the suggestion.
Although the family may prefer the nurse do all the work of calling and setting up services,
they may do so simply because they are not really that interested and they can always cancel
later. However, if the family calls and sets up the service, it demonstrates commitment to the
plan to use those resources.
DIF: Cognitive Level: Apply (Application)
19. A nurse had shared a great deal of information with a new client. Time had passed, but the
nurse had more to share and was energetically doing so. Which should the nurse use as a
guide to determine when to stop teaching and plan the next visit?
a. After about an hour
b. Depends on what other visits the nurse had scheduled that day
c. When the client or family members start fidgeting
d. When the client begins to look tired
e. When the client demonstrates symptoms of sensory overload
ANS: A
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
The average visit should not exceed 1 hour. The client receives a great deal of information
during that hour, and the nurse collects a great deal of information. Most clients are tired at
the end of a 1-hour visit and often cannot retain additional information.
DIF: Cognitive Level: Understand (Comprehension)
20. A client needed a great deal of care. During a morning visit, the nurse shared information with
the client’s caregiver and demonstrated technical procedures. Which is most important for the
nurse to assess?
a. Client response to the procedures
b. How the client thought the goals were being achieved
c. If the client and the caregiver retained all the information the nurse gave
d. The skill and comfort level of the client’s caregiver
ANS: D
The home health nurse spends much of the visit assessing the skills of the caregiver. The
home health nurse instructs the caregiver in the correct procedures for providing care and in
recognizing the signs and symptoms of problems that must be reported to the health care
provider. The goal of the home health nurse’s instruction is to provide the caregiver with the
skills necessary to care for the patient successfully in the home without intervention of the
nurse. Information not retained can be repeated.
DIF: Cognitive Level: Apply (Application)
21. Which is the primary factor in how a hospice nurse makes decisions while giving care in the
client’s home, surrounded by the client’s family?
a. To allow the patient a comfortable, pain-free death
NUthe
RSwhole
INGTfamily
B.CO
M they are not hastening the
b. To assure the caregiver and
that
client’s death by anything they do to keep the client comfortable
c. To encourage the family to grieve and confront the reality of the client being
terminal
d. To prevent a decline in the caregiver’s health
ANS: D
Although the nurse tries to do everything possible for the client, the caregiver, and the whole
family, the nurse must prevent a decline in the caregiver’s health. Although the dying patient
is the focus of all skilled nursing care, the experienced home care nurse knows that a careful
assessment of the caregiver’s mental and physical health is important. The spouse, lover,
children, friends, and neighbors who have made the commitment to stay until the end need the
nurse’s time and attention as much as, if not more than, the patient. Although the patient’s
wishes are important, all decisions regarding care are made considering the health of the
caregivers. Encouragement of the family to grieve and confront the reality of the client being
terminal would not be a primary factor in how the nurse makes decisions.
DIF: Cognitive Level: Understand (Comprehension)
22. A hospice patient is taking rather strong narcotics with good pain control, but today the
patient’s family tells the nurse that the client does not want to become addicted. Which is the
best response by the nurse?
a. “But you’re dying, what difference will it make if you become addicted?”
b. “You can try not to take so much so frequently if you are concerned.”
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
c. “You may develop tolerance but you can’t be addicted when you’re using the
medication for pain control.”
d. “You need strong narcotics to control your pain; we want to keep you
comfortable.”
e. “We’ll keep you comfortable using some nonnarcotic drugs if that is what you
prefer.”
ANS: C
The key to successful pain control for the terminally ill is to convince patients to take their
medications on a regular basis. Many patients, especially the elderly, are afraid of becoming
“junkies” or “druggies” and want to delay using pain medication until they “get really bad.”
Many people believe that using these medications signals “the end of the line,” and they are
amazed to learn that patients do well while receiving this drug for months, even years, before
death occurs. Almost every family must learn that addiction is not the same as tolerance and
that their physicians will not “cut off their supply if they take too much.”
DIF: Cognitive Level: Apply (Application)
23. A client was admitted to home care and was dismayed to find the nurse discussing such
uncomfortable topics as advance directives, living will, and durable power of attorney. Which
is the most appropriate response by the nurse?
a. “Don’t be concerned; this is just routine.”
b. “I’m sorry, but the state law says I have to ask you to fill out these forms.”
c. “You get to make decisions about your care, but if, for any reason, you can’t do
this, these forms will tell us what you want us to do.”
d. “Your physician asked us to discuss these with you.”
ANS: C
NURSINGTB.COM
Medicare-certified health care agencies must ask patients about advance directives and
provide patients with the advance directive form if the patient is interested in completing the
document.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which statements about home health care are accurate? (Select all that apply.)
a. Home health care is just as effective as care provided in the hospital setting.
b. Home health care is typically more affordable than care provided in a skilled
c.
d.
e.
f.
nursing facility.
IV therapy can be provided through home health care.
Care for clients facing a terminal illness is provided through home health care.
The goal of home health care care is for clients to die with dignity.
The goal of home health care is for clients to regain as much independence as
possible.
ANS: A, B, C, F
NURSINGTB.COM
Community Public Health Nursing 7th Edition Nies Test Bank
Home health care is typically more affordable than and just as effective as care that people
receive in a hospital or skilled nursing facility. Examples of home health care services include
wound care, education, IV therapy, nutrition therapy, follow-up with a patient after discharge
from the hospital, and monitoring of an unstable or chronic illness. The goal of home health
care is to help people get better in their own homes to regain as much independence as
possible (Medicare.gov, 2016a). Hospice care focuses on caring for people facing a terminal
illness when the goal is no longer curing the disease (National Hospice and Palliative Care
Organization [NHPCO], 2016). The goal of hospice care is that each person will die pain free
and with dignity.
DIF: Cognitive Level: Understand (Comprehension)
2. Which best describes why home health care has continued to grow until very recently? (Select
all that apply.)
a. Consumers prefer home care, so they will personally pay for it.
b. Demographics—there are more elderly persons in U.S. society.
c. Home care does not cost much more than institutional care.
d. Insurance companies are encouraging home care.
e. Medicare is encouraging home care rather than institutional care.
f. Physicians prefer to visit clients in their homes rather than institutions.
ANS: B, D, E
Home care is less expensive than institutionalized care. Physicians rarely make home visits.
Consumers cannot usually afford to personally pay for home care. The rapid growth of the
home health market reflects the increasing proportion of people aged 65 years and older; the
lower average cost of home health care compared with institutional costs; active insurer
support; and Medicare promotion
N RofIhome
G health
B.C care
M as an alternative to institutionalization.
U S N T
O
DIF: Cognitive Level: Understand (Comprehension)
3. In which ways is a hospice nurse different from any other nurse who provides care to a client
in the context of their family and home environment? (Select all that apply.)
a. Hospice nurses approach care in a holistic fashion.
b. Hospice nurses continue to support the family after the client has died.
c. Hospice nurses focus more on care and comfort than cure and control.
d. Hospice nurses are expert in both physical and psychosocial care.
e. Hospice nurses are more skilled at pharmaceutical pain management.
f. Some hospice nurses see patients at home and others in institutions.
ANS: B, C
Nurses who work with the terminally ill seek to enhance the patient’s quality of life by
focusing on relieving suffering throughout the illness, supporting the patient and family
through the dying process, and providing grief support to the family after the patient has died.
When the patient becomes terminally ill, the focus shifts from cure to comfort care. Hospice
and palliative nursing care is provided in a variety of settings including hospitals, nursing
homes, residential homes, and palliative care clinics. Ideally, all nurses approach care
holistically and are expert in pain management and both physical and psychosocial care.
DIF: Cognitive Level: Understand (Comprehension)
NURSINGTB.COM