Public Health Exam 1

A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing? a. Its autonomy and independence b. Its focus on acute care and immediately visible outcomes c. Its collaboration with other health care professionals d. Its flexibility and higher wages

ANS: A Public health nursing is known for its autonomy and independence. In many instances, there are limited other health care professionals and staff with whom to interact. In-patient acute care nurses focus on acute care with outcomes known fairly quickly. Acute care nurses collaborate frequently with other health care professionals. Depending on the position there may be more flexibility, but typically public health nurses do not receive higher wages.

The Elizabethan Poor Law of 1601 is similar to which current law? a. Welfare b. Food stamps c. Medicaid d. Medicare

ANS: C The Elizabethan Poor Law guaranteed medical care for poor, blind, and "lame" individuals. This minimal care was generally provided in almshouses supported by local government similar to Medicaid assistance. Welfare and food stamps do not provide for medical care. Medicare provides medical care to primarily the elderly population.

How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate? a. Economic and political wars resulted in frequent death and injuries. b. Incredible plagues consistently and constantly swept the European continent. c. Migration and urbanization resulted in increased demand for care. d. Caregivers could easily find other employment, so they demanded to be paid.

ANS: C Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care. The Industrial Revolution was a time of great advances in technology, transportation, and communication, not a time of economic and political unrest or a time where incredible plagues occurred in Europe. Caregivers during this time period were typically poorly educated and untrained, so there was not an issue related to wages or employment.

A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed? a. Establishing schools of nursing b. Developing vaccines to administer to large numbers of people c. Collecting vital statistics and improving sanitation d. Developing public housing and almshouses

ANS: C Collecting vital statistics and improving sanitation are examples of activities from the early colonial America. Establishing schools of nursing, developing vaccines to administer to large numbers of people, and developing public housing and almshouses all happened after the colonial period.

Why did American citizens become interested in establishing government-sponsored boards of health? a. They were afraid of infectious diseases such as yellow fever. b. The government could force the poverty-stricken to accept care. c. Such boards could tax and thereby ensure adequate funds to pay for care. d. Such a system would allow for accurate records of births and deaths.

ANS: A Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health. The threat of disease was the impetus for creation of the boards of establishing boards of health. The primary interest of the boards of health was to provide public health services for the entire population and not only those who were poverty-stricken. The primary purpose of the boards of health was not to collect accurate vital statistics or receive tax dollars rather its purpose was to ensure the health of the population.

A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely have implemented? a. Setting policy on quarantine legislation for immigrants b. Establishing hospital-based programs to care for the sick at home c. Identifying and improving environmental conditions d. Providing health care for merchant seamen

ANS: D Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities. Quarantine legislation was enacted by legislation during this time period, but the nurse would not have been responsible for setting these policies. Nursing care for clients in the home began in the first half of the 1800s through a variety of agencies including the Ladies' Benevolent Society of Charleston South Carolina. Identifying and improving environmental conditions was a focus of the public boards of health, not necessarily specifically a role of the nurse.

What was the outcome of the Shattuck Report? a. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated. b. Environmental sanitation efforts became an immediate priority. c. Guidelines for modern public health organizations were eventually developed. d. Local and state governments established boards of health after its publication.

ANS: C It took 19 years for the first of Shattuck's recommendations to be implemented, but his report was the first effort to create a modern public health organization. This report called for broad changes to improve the public's health to take place; however, these changes did not happen immediately after publication. They took 19 years to be implemented in the first state of Massachusetts. The report included establishment of a state health department and local health boards in every town, sanitary surveys, and food, drug, and communicable disease control, but none of these changes happened quickly.

Which nurse is famous for creating public health nursing in the United States? a. Florence Nightingale b. Frances Root c. Lillian Wald d. Mrs. Solomon Loeb

ANS: C Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades. Mrs. Solomon Loeb was a wealthy layperson who assisted Mary Brewster in the establishment of the Henry Street Nurses Settlement. Francis Root was the first trained nurse in the United States who was salaried as a visiting nurse. Florence Nightingale had many accomplishments, but none of these occurred in the United States.

Which of the following would have been the focus of a school nurse in the early 20th century? a. Investigating causes of absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an autonomous practice d. Providing medical treatment to enable children to return to school

ANS: A Early school nursing focused on investigating causes of absenteeism. Providing medical treatment was the responsibility of physicians. School nurses did not teach in the schools nor were they part of an autonomous practice during this time period.

A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which accomplishments of today were started within this organization? a. Requiring that public health nurses have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing public health nursing competencies d. Opening the Henry Street Settlement

ANS: B The National Organization for Public Health Nursing sought to improve the educational and services standards of public health nursing. The Henry Street Settlement was already in existence and was opened by Lillian Wald and Mary Brewster. The baccalaureate degree in nursing was not developed yet. Public health nursing competencies were developed by the Quad Council.

Why were nurses so unprepared for public health nursing in the early 20th century? a. Public health nursing had not yet been created as a field .b. No one would teach the nurses how to engage in public health activities. c. Nightingale's textbook did not include content on public health nursing. d. Nurses were educated in diploma schools, which emphasized care of hospital clients.

ANS: D Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for home visiting. The specialty of public health nursing practice was developed in the early 1800s. There was not a lack of teachers for this activity, rather the focus of nursing care was in the acute care setting and not in the community. Nightingale did not have a published textbook.

A nurse is considering joining the American Public Health Association (APHA). What information about this organization should be considered when making this decision? a. APHA focuses on the public health concerns of the medical profession. b. APHA represents concerns of nursing specialty practices. c. APHA provides a national forum for nurses to discuss their public health concerns. d. APHA focuses on providing health promotion education to the public.

ANS: C APHA was formed to facilitate interprofessional efforts and promote the "practical application of public hygiene." The Public Health Nursing Section within APHA provides nurses with a national forum to discuss their concerns and strategies within the larger context of the major public health organization. It also serves as a focus of leadership and policy development for community/public health nursing. The focus of public health concerns of the APHA is broader than only the medical profession. The APHA focuses on concerns of public health nurses, not all nursing specialty practice. The APHA focuses on practical application of public hygiene, which is broader than only health promotion education.

Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders? a. Creating such a service was the morally correct thing to do b. Employing nurses directly was less expensive than paying taxes to the city for the same purpose c. Having the company's nurses make home visits increased worker morale d. Public health nurses visits led to fewer policyholder deaths and lowers company costs

ANS: D Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of children under the age of 3 years. The insurance company attributed this improvement and the associated reduced costs to the work of visiting nurses. There was limited funding in the early 20th century to extending nursing services in the community; thus, home visiting was a very expensive service to provide. Although Metropolitan Life Insurance Company may have increased worker morale that was not the primary reason for continuation of the program.

Which client would have been most likely to receive care from the Frontier Nursing Service? a. An injured soldier b. A homebound, elderly male c. A woman in labor d. A child with a broken femur

ANS: C The Frontier Nursing Service nurses were trained in nursing, public health, and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality. Care for soldiers, elderly, and children was not the focus of the care provided by the Frontier Nursing Service.

A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? a. Comprehensive assessment and planning done in the community b. Documented needs of the local community c. Federal funding for priority diseases or groups d. Nursing staff's expertise and skills

ANS: C Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort is focused locally. A need in the community may be identified through community assessment, planning, and looking at needs in the community; however, without funding there will not be a way to create necessary programming. The expertise of the staff should not be the determining factor when deciding on programming in the community.

A nursing student during World War II would likely join which group? a. The US Public Health Service b. The Marine Nurse Corps c. The Frontier Nursing Service d. The Cadet Nurse Corps

ANS: D The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels. The U.S. Public Health Service began to use nurses during World War I to establish a public health nursing program for military outposts. The Marine Hospital Service was established well before World War II in 1798. The Frontier Nursing Service was established by Mary Breckinridge in 1925 and provided health care to the rural and often inaccessible populations in the Appalachian region of southeastern Kentucky.

A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice

ANS: B The Healthy People 2020 documents propose a national strategy to significantly improve the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. The disarray resulting from reduced political support, financing, and effectiveness is described in The Future of Public Health. The Scope and Standards of Public Health Nursing Practice describes the processes of assessment, analysis, and planning that are carried out by the public health nurse. The Patient Protection and Affordable Care Act improved access to health insurance for Americans.

A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts? a. To promote the nursing profession b. To increase funding for public health nursing c. To address the concerns of nurses d. To help improve health care access

ANS: D Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life. Health care reform has a larger scope than only the profession of nursing and public health nursing. It addresses the concerns of nurses as well as many other health care professions.

How did Florence Nightingale help bring about community health nursing? (Select all that apply.) a. She convinced socially prominent wealthy women to volunteer to give care. b. She focused on all soldiers and their environment. c. She interacted with each individual person, assessing his or her needs and acting to meet those needs. d. She kept careful records on what was done and what were the results.

ANS: B,D Nightingale progressively improved the soldiers' health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes. While Nightingale was part of a wealthy family, the role of nurses during this time period was typically fulfilled by poor women. The focus of Nightingale's care was to identify health care needs and interventions that influenced the health of the entire population, not individuals.

A nurse working with Mary Breckinridge would have likely assisted in what activity? (Select all that apply.) a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Ensuring positive outcomes for pregnancies among women in the Appalachian region

ANS: B,D Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of the Southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement. Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky, not the Rockies.

How did nursing education change in the 1950s? (Select all that apply.) a. Baccalaureate nursing programs typically included public health nursing concepts. b. Diploma schools of nursing continued to expand their student numbers. c. Junior and community colleges began offering nursing programs. d. Nurses were strongly encouraged to have a scientific basis for their practice. e. Post diploma training was initiated nationwide.

ANS: A,C In the 1950s, public health nursing became a required part of most baccalaureate nursing education programs. In 1952, nursing education programs began in junior and community colleges. Associate degree programs began to expand their enrollments, not diploma schools. The need for evidence-based practice continues to grow but was not a change in the 1950s. In 1914 Mary Adelaide Nutting, working with the Henry Street Settlement, began the first course for post-diploma school training in public health nursing at Teachers College in New York City.

How did health care and its delivery change during the 1980s? (Select all that apply.) a. Funding to public health increased as funding for acute hospital care decreased. b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco. c. Nurse practitioners were increasingly used to provide care. d. Public health programs suffered reduced political support, financing, and effectiveness.

ANS: B, C, D During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.

Which statement best describes community-based nursing? a. A practice in which care is provided for individuals and families. b. Providing care with a focus on the group's needs. c. Giving care with a focus on the aggregate's needs. d. A value system in which all clients receive optimal care.

ANS: A By definition, community-based nursing is a setting-specific practice in which care is provided for "sick" individuals and families where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and continuous care. These nurses may be generalists or specialists in maternal-infant, pediatric, adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems.

Which statement best describes the goal of community-oriented nursing? a. Providing care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. To preserve, protect, promote, or maintain health and prevent disease

ANS: D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions. These definitions are not specific to community-oriented nursing.

Which of the following is the primary focus of public health nursing? a. Families and groups b. Illness-oriented care c. Individuals within the family unit d. Health care of communities and populations

ANS: D In public health nursing, the primary focus is on the health care of communities and populations rather than on individuals, groups, and families. The goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population within it. Community-based nurses deal primarily with illness-oriented care of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the focus of practice is on individual or family-centered illness care.

Which of the following is responsible for the dramatic increase in life expectancy during the 20th century? a. Technology increases in the field of medical laboratory research b. Advances in surgical techniques and procedures c. Sanitation and other population-based prevention programs d. Use of antibiotics to fight infections

ANS: C There has to be indisputable evidence collected over time that public health policies and programs were primarily responsible for increasing the average life span from 47 in 1900 to 78.6 years in 2017, an increase of approximately 60% in just over a century plus through improvements in (1) sanitation, (2) clean water supplies, (3) making workplaces safer, (4) improving food and drug safety, (5) immunizing children, and (6) improving nutrition, hygiene, and housing. Although people are excited when a new drug is discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant gains in the health of populations that have come largely from public health accomplishments.

A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Provide free health care to all citizens b. To increase the number of individuals with access to effective health care benefits c. Lower the cost of health care to the American populationd. To lessen the governmental burden of providing health care to Americans

ANS: B The central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number of people with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on the American government are serious concerns, they are not the primary focus of ACA.

What is the basic assumption stated by Healthy People 2010 as it relates to public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority in government planning and funding. c. The health of individuals cannot be separated from the health of the community. d. The government is responsible for lengthening the life span of Americans.

ANS: C The major premise of Healthy People 2010 was that the health of the individual cannot be entirely separate from the health of the larger community. Public health practice focuses on the community as a whole, and the effect of the community's health status (resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices is the directive for lengthening life span not the role of the government.

Which of the following actions would most likely be performed by a public health nurse? a. Asking community leaders what interventions should be chosen b. Assessing the community and deciding on appropriate interventions c. Using data from the main health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment

ANS: D Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. The interventions of asking community leaders which interventions should be chosen, assessing the community and deciding on appropriate interventions, and using data from health care institutions do not demonstrate the engagement of the community when making decisions about what the community actually wants and needs.

Which public health nurse most clearly fulfills the responsibilities of this role? a. The nurse who met with several groups to discuss community recreation issues b. The nurse who spent the day attending meetings of various health agencies c. The nurse who talked to several people about their particular health concerns d. The nurse who watched the city council meeting on local cable television

ANS: B Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. A major challenge for the future is the need for public health nursing specialists to be more aggressive in working collaboratively with various groups in the community as well as professional colleagues in institutional settings to deal with barriers to health. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

Which of the following best defines aggregate? a. A large group of persons b. A collection of individuals and families c. A collection of people who share one or more characteristics d. Another name for demographic group

ANS: C An aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of a community can be defined in terms of either geography (e.g., a county, a group of counties, or a state) or a special interest (e.g., children attending a particular school). These members make up a population. The term population may be used interchangeably with the term aggregate. A large group of persons, a collection of individuals and families, and another name for demographic group are not accurate definitions of the term aggregate.

Which question asked by a novice nurse would be the most reflective of an understanding of the role of a public health nurse? a. "Which groups are at the greatest risk for problems?" b. "Which patients should I see first as I begin my day?" c. "With which physicians will I be most closely collaborating?" d. "With which nursing assistants will I partner the most?"

ANS: A Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals rather than a community-oriented perspective.

Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care

ANS: C Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment, policy development. Scientific knowledge-based care is not a core function of public health. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.

When talking to a women's group at the senior citizens' center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a. Ensure that the women did not expect the nurse to solve their problem. b. Demonstrate that the nurse understood the women's concerns and needs. c. Express empathy, support, and concern. d. Help the women engage in political action.

ANS: D Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyond merely understanding the women's concern, and instead mobilizes them to take action. This action does not demonstrate the nurse showing empathy rather the nurse is empowering these women.

The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a. To increase the group's self-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups

ANS: D Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a "with the people"—not a "to the people" or "for the people"—approach to planning. There is an imperative to work with members of the community to carry out core public health functions. The purpose of meeting with community groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them to act for themselves to solve the problems they are facing. The first task of working with the group should occur before addressing maintaining communication links.

The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals

ANS: D The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent components of a decision that the nurse might consider in determining the needs of the aggregate.

Which of the following actions best represents public health nursing? a. Assessing the effectiveness of the high school health clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic

ANS: A A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. Caring for clients and their families focuses on individuals and families and not on the entire population. Public health focuses on care of populations.

Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed

ANS: A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance to this population that may or may not be helpful or welcomed.

Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.) a. Economic turmoil and demand for high-technology care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism

ANS: B, C, D As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a stronger commitment to population-focused services, rather it has occurred as overall health needs have become the focus of care.

Which of the following actions demonstrate effective public health nursing practice in the community? (Select all that apply.) a. Epidemiologic investigations examine the environment for health hazards. b. New services are organized where particular vulnerable populations live. c. Partnerships are established with community coalitions. d. Staff members at the public health agency continue to increase in number. e. Staffing walk in clinics for low income families

ANS: A, B, C Evidence that public health nurses are practicing effectively in the community would include organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Neither increasing the number of staff nor acting as staff in the delivery of acute and/or chronic care has a relationship to the effectiveness of public health nursing practice.

Why are nurses increasingly providing care in clients' homes rather than in hospitals? (Select all that apply.) a. Home care is less expensive. b. It is much more efficient to give care in the home. c. Nurses prefer to give home care with individual attention. d. People prefer to receive care in their homes rather than in hospitals.

ANS: A,D An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

A public health agency is planning to implement the electronic health record. (Which is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. There is no evidence that an electronic health record improves client compliance with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies.

Which statement best describes the cost of health care in the United States? a. Health care costs are kept low, and the indicators of health are among the best worldwide. b. Health care costs are low which has resulted in poor health outcomes. c. Health care costs are the highest in the world, but the indicators of health are not the best worldwide. d. Health care costs and indicators of health are the highest in the world.

ANS: C Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic product, the indicators of what constitutes good health do not document that Americans are really getting their money's worth. Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor in comparison to other countries who spend less money on health care.

A nurse is explaining the health care system in the United States to a group of health care providers visiting from South America. How would the nurse best describe the current health care system? a. "It is a logical, rational approach to meeting expressed needs while still trying to control costs." b. "It is a centralized system that provides care in hospitals." c. "It is divided primarily into two components: private health care and public health care." d. "It is the best in the world with outstanding research and high-technology care available to all."

ANS: CHealth care in the United States consists of a private or personal care system and a public health system, with overlap between the two. The United States health care system is one of the most expensive systems in the world that does not do a good job at controlling costs. Care is provided through an enormous range of facilities and providers, including hospitals, physicians' and dentists' offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clinics. Although there is great research and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health care disparities exist among multiple populations making this system not available to all.

Which statement best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals, families, and the community. Health care is made available to them with their full participation and is provided at a cost that the community and country can afford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, not primary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitative services. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted all citizens of the world to live socially and economically productive lives.

How does managed care (MC) attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary-care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers who agree to comply with the care approaches established through a case management approach, not through a point of service list of individual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve different populations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather a case management approach is used to control costs.

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. "Let's go through these medications and see which ones we can delete." b. "You can get these medicines at this clinic for free." c. "Let's see if we can get some help from Medicare to help you pay for these medications." d. "These medications are important. Do your best to pay for them."

ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figure it out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before looking into receiving the medications for free as there may be other barriers which limit the abilities to get these medications at a discounted cost.

A nurse is determining which health care services must be offered at a local public health clinic. Which factor is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations from Healthy People 2020 d. Services mandated by the state government

ANS: D At the local level, health departments provide care that is mandated by state and federal regulations. Data available from the most recent community assessment, suggestions from community members about need, and recommendations from Healthy People 2020 could all be used. However, funding for these types of programs may not be available. The services that are mandated by the state government will be funded and allow the clinic to be able to provide these services.

A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the nurse make about this population? a. They have difficulty accessing health care due to a shortage of primary-care providers. b. They most likely receive health insurance through Medicare. c. They are unable to access health care due to the implementation of the Affordable Care Act. d. They have access to affordable health care insurance.

ANS: D Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only 2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly different in Massachusetts than in other areas of the country. Low-income populations are eligible for Medicaid services, not Medicare. The program in Massachusetts became a model for the Affordable Care Act.

A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the client to in order to receive care? a. Managed care b. Community health center c. Emergency department d. Physician office

ANS: B There is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide a broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and dentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people of all ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specific network of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergency departments and physician offices are not the best place for an individual without health insurance to receive care. Both are expensive and do not provide the necessary resources for the individual to possibly receive health insurance.

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers' complaints and general unhappiness d. Increased pressure to decrease overlap in services

ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both important factors to consider; however, this is not the reason why increased collaboration has occurred. There has not been an increase in taxpayer complaints or unhappiness that has caused these changes to occur.

Minority nurses represented about 30.1 percent of the RN population. What is this an example of? a. Projection b. Disparity c. Racism d. A sentinel event

ANS: B Disparities are racial or ethnic differences in the quality of health care or representation of a faction of the population, not based on access or clinical needs, preferences, or appropriateness of an intervention. Projection is an estimate or forecast of a future situation based on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that one's own race is superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the patient.

A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency would want to achieve accreditation? (Select all that apply.) a. To improve health programming and services b. To improve community relationships c. To improve performance and quality d. To improve management e. To decrease cost of health care

ANS: B, C, D The purpose of accreditation for public health departments is to assist and identify quality health department performance and quality, and it develops leadership, improve management, and improve community relationships. Neither the improvement of health care programming and services nor minimizing health care costs is a reason why a public health agency would want to achieve accreditation.

What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Foreign-born immigrant population is increasing. b. Hispanics are the largest minority group population. c. Leading causes of death are from infectious diseases. d. Mortality for both genders in all age groups declined. e. Unintentional injuries are among the top 10 causes of death.

ANS: A, B, D, E The nation's foreign-born population is growing, and it is projected that from now until 2050 the largest population growth will be due to immigrants and their children. Although African Americans used to be the largest minority group, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined. The leading causes of death have changed from infectious diseases to chronic and degenerative diseases with unintentional injuries being among the top 10.

Which of the following statements is accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. People often spend a considerable amount of their own money on complementary therapies. d. The gap between the richest and poorest is widening. e. The composition of families and living patterns are changing.

ANS: A, C, D, E Several social trends that influence health care include changing lifestyles, a growing appreciation of the quality of life, the changing composition of families and living patterns, changing household incomes, and a revised definition of quality health care. People often spend a considerable amount of their own money for these types of therapies because few are covered by insurance. It is obvious that the gap between the richest and poorest is widening because of the percent wage increase in the higher income levels. Americans spend considerable money on health care, nutrition, and fitness, because health is seen as an irreplaceable commodity. To be healthy, people must take care of themselves.

Which of the following provides evidence that the US health care system is in crisis? (Select all that apply.) a. Health insurance is an expensive benefit for employers to provide. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors. e. Consumers want lower costs and high-quality health care without limits.

ANS: A, C, E Consumers want lower costs and high-quality health care without limits and with an improved ability to choose providers and services of their choice while employers are typically the purchasers of health care; they want to be able to obtain basic health care plans at reasonable costs for their employees. Many employers have seen their profits diminish as they put more money into providing adequate health care coverage for employees. Nurses working long hours pose a serious threat to patient safety because fatigue slows reaction time, saps energy, and diminishes attention to detail. The Institute of Medicine's (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. The report makes it clear that the majority of medical errors today were not produced by provider negligence, lack of education, or lack of training.

A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state's citizens c. Employing and supervising school health nurses d. Establishing and maintaining child immunization clinics e. Providing education regarding established health codes

ANS: A, B, E State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in areas such as ongoing assessment of health needs. Employing and supervising school health nurses occur at the local level, and many times within a specific school. Provision of child immunization clinics occurs at the local level.

Which of the following is the best brief definition of community? a. A geographic area or political division under common leadership b. A group sharing a common bond such as a profession or occupation c. A group working together to confront a common problem d. A social group with common goals within a geographic area

ANS: D According to WHO, a community is "A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future." The correct answer includes aspects of people, place, and function or aims. In addition to sharing geographic boundaries and leadership, a community also has common values and interests. In addition to sharing a common bond, members within a community have to interact with one another. A group working together to confront a common problem only addresses the aspect of function; it does not address people or place.

A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse? a. Providing care to an active caseload of 50 families in the neighborhood b. Inviting all the parents of asthmatic children in the school to meet together for mutual support c. Sharing assessment findings and health goals with every community group that will listen d. Writing articles for the local newspaper highlighting the various programs and services of the local health department

ANS: C Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals. Although it is not possible to know the nurse's goals from the nurse's behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesn't necessarily help eligible clients access care.

Persons often point out that smokers choose to light their cigarettes; alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses don't simply focus on helping persons who engage in poor health behaviors to behave appropriately? a. Addicts don't have the willpower to change their behavior. b. It is too rewarding to continue the behavior for a person to be able to change. c. Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change. d. Society must offer healthy choices, offer support, and practice helpful policies.

ANS: D Change for the benefit of the community client often must occur at several levels, ranging from the individual to society as a whole. Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide healthy choices. Most individuals cannot change their habits alone; they require the support of family members, friends, community health care systems, and relevant social policies. Change in society is helpful for addicts to change their behavior. Many times, certain aspects of society limit an individual's ability to make change on their own. Laws and policies within society must support individuals to make healthy lifestyle choices.

A nurse is focusing on the process dimension of a community's health. Which of the following interventions will the nurse most likely implement? a. Assessing the health care services available in a community b. Establishing screening programs to diagnose diseases as early as possible so that the treatment can begin c. Implementing health promotion activities such as education programs d. Planning for new programs to be developed based on identified needs

ANS: C When the emphasis is on the process dimension—usually the level of intervention of the nurse in community health—the best strategy is usually health promotion, such as various primary prevention strategies. The other responses represent the structure dimension of the community. Structure is defined as the services and resources within the community. This includes service use patterns, treatment data from various health agencies, and provider-to-client ratios.

A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action? a. A change in the distribution or redistribution of power and influence b. An increase in awareness of the importance of health c. Continued ongoing interest in community health activities d. Improved family functioning and involvement in health activities

ANS: A Collaborative practice models involving the community and nurses in joint decision-making and specific nursing roles are required. Nurses must remember that collaboration means shared roles and a cooperative effort in which participants want to work together. These participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision-making. This means sharing not only the power but also the responsibility for the outcomes of the intervention. By having the community members involved in creating the health change, it is likely they will have an increased awareness of the importance of health, an ongoing interest in the health of the community. These things should occur because the community is more educated about its health because of its involvement. Being involved will not necessarily result in improved family functioning, so this consequence will most likely not occur.

During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community's strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a. To ensure that others agree with the nurse's plans for interventions b. To confirm the nurse's initial findings and conclusions c. To encourage community partners to feel they "own" the data d. To generate non-statistical data such as values, beliefs, and perceived needs

ANS: D Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community's knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation. Interviews with key informants provide data; the purpose is not to ensure agreement with the nurse's plan or confirm findings. The key informants are formal or informal leaders within the community, and although they may have information to share about the community, it may not be important that they feel that they "own" the data.

A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment? a. To allow participant observation by the nurse b. To ensure that the nurse would care about her intervention outcomes c. To maximize convenience and minimize commuting time for the nurse d. To save gasoline in these difficult economic times

ANS: A Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations and church life and reading the newspaper give the nurse "observations" of the community's life. The nurse should care about the interventions that are performed regardless of where the nurse lives. The priority is that the nurse is knowledgeable of and can observe the community, the assignment does not have to do with the convenience of the nurse.

A community health nurse drives through an assigned community before visiting the community groups scheduled for the day. The nurse then drives through the community again that evening before going home. Which of the following best describes the nurse's reason for driving through the community twice in the same day? a. On the second trip, the nurse can carefully confirm the results of the first assessment. b. Repeating the experience ensures that the nurse absorbed all the relevant details. c. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. d. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.

ANS: C When doing a windshield survey as part of community assessment, the nurse should observe two times: one during the day when people are at work and children are at school and a second time in the evening after work is done and school is out. It is likely that different things are occurring in the community when the nurse drives through the community at different times. Therefore, it is likely that the nurse will learn more about the community by doing this and not necessarily confirm previous findings. If the nurse was interested in writing down the results of the findings, the nurse could use public transportation or ride in a car with another nurse driving for more efficient documentation of her findings; this would not necessarily occur by the nurse driving through the community in the evening.

Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity? a. To avoid confronting the community until the nurse is thoroughly oriented b. To become familiar with previous goals and priorities of the agency c. To help get a better understanding of the assigned community d. To save time and effort and perhaps have new insights

ANS: D The nurse uses previously gathered data because it saves time and effort. Many sources of data are readily available and useful for secondary analysis. Being familiar with the community before the assessment is important; however, being thoroughly oriented is not necessary. The nurse should become familiar with the community, not the goals and priorities of the agency. It is helpful for the nurse to better understand the community, but the main reason is to save time and avoid duplication of data that may already exist.

A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? a. A problem that affects the most disadvantaged residents in the community b. A problem that is very easy and inexpensive to address c. A problem that is of high concern to the community d. A problem in an area in which the nurse has a great deal of expertise

ANS: C Choice of priority must depend on the community's awareness of the problem—and their motivation to improve it. Other bases for choosing include determining which individuals would be most affected, what benefits to the community would result, what might happen if the problem is not resolved, how much it might cost to address the problem, and how much support for or opposition to the problem seem likely based on community values and priorities. Rather than examining the issues from the perspective of the most disadvantaged residents, the nurse should look at the problem which affects most individuals in the community who may or may not be disadvantaged. The cost of the problem will need to be addressed, but if the problem is not a priority to the community, the agency may be wasting money addressing a problem that the community does not care to solve. If the nurse is unfamiliar with interventions to solve the problem, the nurse should collaborate with others to solve the problem. The priority should be the needs of the community, not the needs of the nurse.

Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? a. All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition. b. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class. c. 95% of children will be immunized by 1 year of age. d. There will be a 25% reduction in health disparities by 2015.

ANS: B Objectives must be precise, behaviorally stated, and measurable. The response that describes mothers receiving nutrition counseling represents a specific, measureable behavior as an objective. Treatment in an acute care setting is not part of a community-oriented care plan. The objective that 95% of children will be immunized by 1 year does not precisely state which children (in a county? in the country?) and does not state which immunizations. (Some are not appropriate to give to children who are only 1-year-old.) A 25% reduction by 2015 is a goal, not an objective.

During which of the following activities is the nurse in community health acting as a partner in change? a. Administering vaccinations to preschoolers b. Analyzing community problems to determine the best interventions c. Establishing an elder-care center for older adults living with family members who work d. Teaching anger management skills to a group of teens in a halfway house

ANS: D Content-focused roles often are considered change agent roles, whereas process roles are called change partner roles. Change partner roles include those of enabler-catalyst, teacher of problem-solving skills, and activist agent. Teaching anger management skills to a group of teens in a halfway house demonstrates the use of a change partner role of teacher of problem-solving skills. Change agent roles stress gathering and analyzing facts and implementing programs. The nurse establishing an elder-care center is acting as a change agent. The nurses administering vaccinations and analyzing community problems are carrying out other nursing roles.

A nurse is assessing a community's openness to change. Which of the following variables indicate that the community is ready? a. Commitment to current processes and policies b. High socioeconomic status in the community as a whole c. Long history of dependence on the community health agency and its staff d. Minimal level of social participation by community members

ANS: B The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents. Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. A community that is open to change is likely to be open to changing current processes rather than focusing on tradition. Communities that are open to change typically have a high level of social participation by its residents.

A nurse is working toward an objective to "increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care." During which of the following phases of the nursing process would determination of the objective occur? a. Assessment phase b. Planning phase c. Implementation phase d. Evaluation phase

ANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established, and goal-attaining activities are identified. Assessment involves getting to know and understand the community as the client. Implementation involves the work and activities aimed at achieving the goals and objectives. Evaluation is the appraisal of the goals and objectives that have been created

A nurse is assessing the status of a community's health. Which of the following will the nurse examine? a. Community awareness b. Health facilities c. Health care manpower d. Vital statistics

ANS: D The status of community health involving biological indicators is often measured by traditional morbidity and mortality rates, life-expectancy indices, and risk-factor profiles. Vital statistics are measures of community health status. Health care manpower (e.g., nurses, physicians) and health facilities (e.g., hospitals, clinics) are measures of community health structure. Community awareness is a measure of the process.

A nurse is assessing the structure of a community's health. Which of the following data will the nurse examine? a. The community's commitment to health b. Health-risk profiles of selected aggregates c. Statistics of morbidity and mortality in comparison with similar communities d. Treatment and service use patterns from local health agencies and care providers

ANS: D Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios. The community's commitment to health is part of the process dimension of the community. Health risk profiles and vital statistics are part of the status dimension of the community.

A community health nurse encourages members of the community to partner and assist in creating health programs. Which of the following best describes the rationale for this action? (Select all that apply.) a. Partnering results in increased effectiveness b. Involving community members results in contributions of time and money into the program c. Having many partners results in increased publicity for the program d. Participating in planning results in having a vested interest in the outcome e. Involving community partners ensures increased support by the populace

ANS: A,D The primary reason community partnership is crucial is that community members and professionals who are active participants in a collaborative decision-making process have a vested interest in the success of efforts to improve the health of their community. The significance and effectiveness of partnership in improving community health are supported by a growing body of literature. Community partners do contribute time and money into programs and most likely will increase the publicity for the program; however, this should not be the primary reason for including them in the partnership. Increased populace support is not necessarily assured by community partnerships. Through the partnership, it is likely that the program will have increased success and better outcomes, which should be the primary objective of the nurse

A community health nurse is beginning to work with a newly assigned community. Which of the following would be appropriate actions for the nurse to take to help ensure acceptance? (Select all that apply.) a. Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies) b. Attending community events such as festivals or fairs and interacting with participants c. Becoming involved in and contributing to volunteer community organizations d. Completing a comprehensive physical assessment on nearby neighbors e. Arranging to meet with the community's governing body

ANS: A, B, E Gaining entry or acceptance into the community is perhaps the biggest challenge in assessment. The nurse is usually an outsider and often represents an established health care system that is neither known nor trusted by community members, who may therefore react with indifference or even active hostility. Entry into the community is critical. Often the nurse can gain entry by taking part in community events, visiting people in formal leadership positions, and clarifying community members' perceptions of health needs. While an activity such as volunteering is a positive action, it is not the most efficient way to become involved in the wider community. Completing physical assessments on individuals is an individual-based, not community-based intervention and would not be anticipated to be performed by the community health nurse.

A nurse is deciding which alternative interventions should be implemented. Which of the following factors must be considered by the nurse when making this decision? (Select all that apply.) a. The expected effect or outcome of each possible intervention b. How interested others are in helping in any particular intervention c. The nurse's own interest in implementing each intervention d. The likelihood that the intervention will resolve the problem e. Change process required to achieve stated objective

ANS: A, B, D, E The nurse can list each possible intervention and then consider the resources or barriers to that particular interventio n, the expected effect of each choice, the likelihood that the activity will help meet the objective and resolve the problem, whether others can be educated to implement the intervention, and the change process necessary to complete the objective. The primary interest should be the concern of the community, not the nurse's personal interests.

A nurse wants to determine whether health problems have been improved and interventions have been appropriate and successful over a period of time. Which of the following data should the nurse examine? (Select all that apply.) a. Changes in staffing patterns in the health agency b. Demographic data c. Education and school statistics d. Environmental factors e. Utilization of health services

ANS: B, D, E To see the outcomes of chosen interventions, the nurse would examine changes in demographics, socioeconomic factors, environmental factors, health status, and/or use of health services. Changing in staffing patterns and education and school statistics would not be impacted by a change in the health problems in the community. Epidemiologic data and trends would be the best sources to examine to evaluate the change.

Which of the following activities are considered to be part of the core competencies for public health professionals? (Select all that apply.) a. Defining variables relevant to current public health problems b. Obtaining and interpreting information regarding risks and benefits to the community c. Implementing nursing care and subsequent evaluation outcomes d. Maintaining public health departments throughout the United States e. Focusing on health concerns of the individuals residing within the community

ANS: A,B Eleven core competencies for the nurse and other health providers working in the community have been defined by the Council on Linkages Between Academia and Public Health Practice. Defining variables relevant to current public health problems and obtaining and interpreting information regarding risks and benefits to the community are two of the eleven core competencies. Implementing nursing care focuses on care for individuals and not the community; it is not one of the core competencies. Public health nurses have various roles within the community, they may or may not work for a public health department. It is not within the scope of public health nurses to be responsible to maintain these departments.

A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be the effective key informants for the nurse? (Select all that apply.) a. Community's immigrant group activist b. Federal senators and representatives c. Health board members d. The town mayor e. Local Clergy

ANS: A, D, E Informant interviews, which consist of directed talks with selected members of a community about community members or groups and events, are basic to effective data collection. Talking to key informants is a critical part of the community assessment. Key informants are not always those who have a formal title or position. Key informants often have an informal role within the community. Examples of informal key informants would include a member of a minority group who is listened to by other members of the group, a church leader, and a parent who is active and vocal about the school health curriculum. Key informants should be formal or informal leaders within the community. Based on the information provided, it is not known if the federal senators, representatives, and health board members fulfill these roles within the community.

The following people enter the health clinic together: an unmarried man and his 1-year-old son, an unmarried woman with a year-old daughter, and the man's married brother, who is separated from his wife. During the assessment, it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the "family?" a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c. There is no family here, only three adults sharing resources between themselves and two biologically related children. d. The family includes whoever the adults state are family members.

ANS: D Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A "family" may range from the traditional nuclear model with extended family to such "postmodern" family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends. The incorrect answers have the nurse determining who is and who is not part of a family. This is not an appropriate action for the nurse to take, rather the nurse should let the client describe and define his or her family.

The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. "How many children do you have, and who is the father of each?" b. "Is there a register of families who are members of this commune?" c. "Tell me about your significant other." d. "Who are the members of your and your child's family?"

ANS: D The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning. Asking who the father of each child is does not help define the family; the client needs to define the family. Knowing if there is or is not a register of families on the commune does not help the client define her own family. The client may or may not include the significant other in her definition of a family, so this may not assist in making this determination.

In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System

ANS: C Family structure refers to the organization of the family. This defines the roles and positions of the family members. The family functions refer to the activities and purposes of the family. The family as a system accomplishes activities that serve the individual and society. Family dynamics refers to the interactions and relationships within the family.

Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

ANS: A The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the 21st century exciting and challenging. All family units have functions (activities and purposes) and structure (organization). These functions and structures may be very different among family members, but they do exist. All clients are part of a family, even if they define their family as only themselves. Nurses should be open-minded and recognize that all families are different and a "traditional" family structure may mean something different to different individuals.

A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the family's strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional

ANS: B Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the family's strengths gives the nurse assets on which to draw in planning care. The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used.

The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The family's basic needs are being met. c. The couple's in-laws are unavailable to share their expertise about childcare. d. The married couple is excited about their first baby.

ANS: B In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

A nurse focuses on the care of the individual while viewing the client's family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurse's view represent? a. Client b. Component of society c. Context d. System

ANS: C Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the "family as context" concept, the family serves as either a resource or a stressor to individual health and illness. When family is the client, the family is placed first, and individuals are second. The family is seen as the sum of individual family members. When family is the system, the focus is on the family as the client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts. When the family is seen as a component of society, it is seen as one of many institutions of society, along with health, education, religious, or financial institutions.

A nurse asks a family member, "What has changed between you and your spouse since your child's head injury?" Which of the following focuses of the family is the nurse assessing? a. The context b. The client c. A system d. A component of society

ANS: C When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions. When family is the client, the family is placed first, and individuals are second. The family is seen as the sum of individual family members. When the family is seen as a component of society, it is seen as one of many institutions of society, along with health, education, religious, or financial institutions. When family is the context, the individual is placed first and the family second. In the "family as context" concept, the family serves as either a resource or a stressor to individual health and illness.

Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental b. Exosystems c. Bioecological systems d. Family systems

ANS: D The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory. In this theory, the emphasis is on the whole rather than on individuals. Families are viewed from both a subsystem and a suprasystem approach. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. The definition of exosystems is found within the bioecological systems theory; these are the external environments that have an indirect influence on the family.

A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a. Family systems b. Bioecological systems c. Family developmental d. Family nursing

ANS: C The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

A new mother is a full-time college student who lives with her parents, because the baby's father has been imprisoned related to theft and drug abuse. The infant's grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this family's needs? a. Developmental b. Family nursing c. Bioecological d. Systems

ANS: A Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case, the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughter's (and grandchild's) needs. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Family nursing theory

ANS: A The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family

ANS: B Making referrals when appropriate is part of the termination phase as the nurse ends the relationship with the family. It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure. If sessions with the nurse were to increase, it would be unlikely that the relationship was going to be soon terminated or ended. Formative evaluation occurs throughout the relationship and is ongoing; an evaluation that would be done at the closure of the relationship would be summative. It would be appropriate for the nurse to extend an invitation for follow-up, not refuse additional communication.

A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

ANS: B It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times, late afternoon or evening appointments are necessary to accommodate the needs of the family. It is probably most important that the immediate, not necessarily the extended, family is present. If the nurse is making an appointment with a family, it would be part of the role of the nurse, and it would be within the scope of the nurse's practice to make time to complete home visits. The nurse may need to be creative in how to best meet the needs of the family to arrange a meeting. The larger barrier is finding a common time, not distance of the family member.

Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurse's plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurse's plan. d. Nurse has informed family how to complete the required actions.

ANS: B Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The family must have the skills and commitment necessary and to complete the developed plan. The plan cannot be the nurse's choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.

Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy

ANS: D Government actions that have a direct or indirect effect on families are called family policy. The range of social policy decisions that affect families is vast, such as health care access and coverage, low-income housing, social security, welfare, food stamps, pension plans, affirmative action, and education. Family planning is only one example of family policy that can have a direct or indirect effect on families. Family funding may occur through programs administered by the government, but these programs are developed from family policy. Family policy is broader than only addressing legislative action.

A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss

ANS: D The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job. The Health Insurance Portability and Accountability Act (HIPAA) allows for families to retain health insurance after resigning from employment. HIPAA prevents family information from being shared with colleagues unless they have a need to know based on the care they are providing for the family. The provision of Medicaid is not part of the Family Medical Leave legislation.

A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

ANS: D Limited communication or certain family members dominating the conversation can be suggestive of problems within the family. Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, and expressions of a religious core or other value system, and each member being allowed some privacy.

The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepares food will probably prepare meals based on the diet plan for all the family. d. The family member who prepares food will probably prepare special meals for the newly discharged member.

ANS: B Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. However, if family members are supportive, they will want to try to help the ill member. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill member's needs without making drastic changes in the overall eating patterns of the family. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. If the family member who prepares the meals does not attempt to make some changes, it would not be therapeutic for the family member who is ill.

A nurse has just met a family and is completing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a. Confirm the reason for the appointment. b. Demonstrate cultural awareness. c. Take time to build trust. d. Understand the family dynamics.

ANS: C The family assessment process is interactive. As the nurse is evaluating the family, the family is evaluating the nurse. Too much disclosure during the early contacts between the family and nurse may scare the family away. The nurse should slow the process down and take time to build trust. Components of building trust with the family would include confirming the reason for the appointment so that the family knows the nature of the visit and demonstrating cultural awareness during interactions. As the nurse completes the family assessment, the nurse will note the dynamics of the family; understanding the family dynamics is not important before engaging in self-disclosure.

A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d. Survey families in the community to determine whether they eat clay and how much clay they eat.

ANS: A Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. If the family members are eating clay, it demonstrates that a problem already exists. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.