NUR 412 Midterm

A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing:
Community-based nursing
community -oriented nursing
institutional nursing
Public health nursing

A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing:
Community-based nursing
community -oriented nursing
institutional nursing
Public health nursing

Community-based nursing
The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting.

Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is:
Community oriented nursing
Community based nursing
Public health nursing
Tertiary health nursing

Community based nursing

In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community.

A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of:
Community based nursing
Community oriented nursing
Institutional nursing
Public health nursing

Community based nursing

The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic.

The public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? SATA
Assisting communities to implement and evaluate plans and projects
Building constituencies to work with the community
Collecting, analyzing, and disseminating information
Evaluating the social, economic, and environmental characteristics of the population
Questioning the availability of health services to the community

Evaluating the social, economic, and environmental characteristics of the population

Questioning the availability of health services to the community

In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when:

individual results are compared with established standards for children of the same age group
program characteristics are assessed for their effectiveness in making the school population healthier
referral is provided for a child identified with delayed psychomotor development.
treatment is initiated for a child with an identified learning disability.

individual results are compared with established standards for children of the same age group

Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its
population of children healthier by evaluating the characteristics of the facility, program, and environment for their
effectiveness in achieving the goal.

Public health nursing is a specialty with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in:
Drug treatments for diabetes
Populations with the highest rate of diabetes
Educational material for individual with diabetes
New technology for diabetic care

Populations with the highest rate of diabetes

The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting.

A state agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored elder care programs. The public health core function applied is:
Assurance
Policy development
Primary prevention
Public transportation

Assurance
The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. The assurance function makes sure that the activities assigned during the policy development or planning phase are carried out. 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. Primary prevention does not focus on provision of services and a part of assurance is assisting communities to obtain necessary services such as transportation.

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:
Community oriented care
Community based care
Secondary care
Tertiary care

Community oriented care
Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients. Regardless of whether the client is a person, a family, or a group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as safe food, water, air, and buildings. Community-based care is nursing care that is provided in a setting. A smoking cessation clinic is an example of primary prevention, not secondary or tertiary.

In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain:
A holistic treatment plan
A specific clinical diagnosis
Individual dietary interventions for cardiovascular disorders
The prevalence rate of cardiovascular disorders among various groups

The prevalence rate of cardiovascular disorders among various groups

A public health nurse in a community clinic engaged in population-focused practice would ask the following questions:

What is the prevalence rate of the diagnosis or condition among various age, race, and gender groups?
Which subpopulations have the highest rates of untreated diagnosis or condition?
What programs could reduce the problem of untreated diagnosis/condition and decrease the risk for further morbidity and mortality?

Which subpopulations have the highest rates of untreated diagnosis or condition?

Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status.

A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the public health core function of:
Assessment
Assurance
Policy development
Research

Assessment

The three public health core functions are assessment, policy development, and assurance. 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. Assurance is making sure that essential community-oriented health services are available. These services might include providing essential personal health services for those who would otherwise not receive them. Assurance also includes making sure that a competent public health and personal health care workforce is available

A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is:
Community
Community as client
Individual as client
Partnership

Community as client

When the community is the client, the results of nursing interventions should produce changes that affect the community as a whole, such as reducing the spread of sexually transmitted diseases (STDs). Although the nurse may work with individuals, families or other interacting groups, aggregates, institutions, or communities, or within a population, the resulting changes are intended to affect the whole community. The community health nurse is not providing care to an individual in this circumstance. It would be ideal if there were some form of partnership in this intervention.

The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the:
Evaluation phase
Implementation phase
Needs assessment
Problem analysis

Evaluation phase

Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the accomplishment of objectives and the effects of the intervention activities have to be assessed. The nurse will evaluate whether the objectives were met and whether the intervention activities were effective

The nurse in community health identifies an elder abuse problem related to caregiver stress among families. The nurse further identifies a lack of caregiver support services in the local community. The next step in the community-oriented nursing process would be to:
Analyze the community problem
Establish priorities
Establish goals and objectives
Identity intervention activities

Analyze the community problem

After the identification of the community problem(s), the planning phase of the community-oriented nursing process should begin with an analysis of the problem. During the analysis, the nurse seeks to clarify the nature of the problem, its origins and effects, points at which intervention might be undertaken and interested parties/change agents. Analysis often requires identifying direct and indirect contributing factors, outcomes of the problem, and relationships between problems. Once high-priority problems are identified, relevant goals and objectives are developed, followed by the identification of intervention activities.

Two nurses in community health schedule a day to ride through a low-income community to better understand the community and what factors affect the health of that community. This direct data collection method is often referred to as:
Composite database
Participation observation
Secondary analysis
Windshield survey

Windshield survey

Five useful methods of data collection are informant interviews, participation observation, windshield survey, secondary analysis of existing data, and surveys. Windshield surveys are the motorized equivalent of simple observation. While driving a car or riding public transportation, the nurse can observe many dimensions of a community's life and environment through the windshield. A basic method is participant observation, the deliberate sharing, if conditions permit, in the life of a community. In secondary analysis, the nurse uses previously gathered data, such as minutes from community meetings

Which of the following best support the concept of community-oriented nursing practice? SATA
Direct nursing care of individuals with tuberculosis (TB)
Hospice home care for a terminally ill individual and family
Nursing interventions to stop elder abuse
Nutrition education programs for teenagers and their families
Wound care for a homebound individual

Direct nursing care of individuals with tuberculosis (TB)
Nursing interventions to stop elder abuse
Nutrition education programs for teenagers and their families

A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is:
Community
Community client
Community health
Community partnership

Community partnership

Community partnership is necessary because when there is community partnership lay community members have a vested interest in the success of efforts to improve the health of their community. Most changes must aim at improving community health through active partnerships between community residents and health workers from a variety of disciplines. Partnership, as defined here, is a concept that is as essential for nurses to know and use as are the concepts of community, community as client, and community health

While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as:
Data gathering
Data generation
Data interpretation
Problem identification

Data generation

Data generation in a community health assessment is the process of developing data that do not already exist through interaction with community members, individuals, families, and groups. This type of data includes community knowledge and beliefs, values, goals, perceived needs, norms, problem-solving processes, power, leadership, and influence structures. This activity parallels the assessment phase of the nursing process. Data gathering is the process of obtaining existing, readily available data. Data interpretation is conducted in the analysis phase. All of the steps will assist the nurse in problem identification

Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a:
Community
Group
Setting of practice
Target population

Community

In most definitions the concept of community includes people, place/time, and function. Nurses in community health practice regularly need to examine how the personal, geographic, and functional dimensions of community shape theirnursing practice with individuals, families, and groups. They can use both a conceptual definition and a set of
indicators for the concept of community in their practice. The community is first the setting for practice for the nurse practicing health-promotion and disease-prevention interventions with individuals, families, and groups. Second, the community is the target of practice for the public health nurse whose practice is focused on the broader community rather than on individuals.

The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of:
Partnership
Process
Status
Structure

Structure
Community health has three dimensions: status, structure, and process. Measures of community health services and resources include service use patterns, treatment data, and provider-to-client ratios. Community health in terms of status, or outcome, is the most well-known and accepted approach; it involves biological, emotional, and social parts. The view of community health as the process of effective community functioning or problem solving is well established. In population-centered practice, the nurse and community seek healthful change together.

A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of:
Change agent
Change partner
Group leader
Data collector

Change partner

Content-focused roles often are considered change agent roles, whereas process roles are change partner roles. Change partner roles include enabler-catalyst, teacher of problem-solving skills, and activist advocate. Different roles may be required if the community lacks problem-solving skills or has a history of unsuccessful change efforts. The nurse may have to focus on developing problem-solving capabilities or on making one successful change so that the community becomes empowered to take on the job of promoting change on its own behalf.

The home health nurse completes an initial assessment on a recently admitted home health client. The nurse should now analyze the assessment data and complete what step in the nursing process that is consistent with the standards of home health practice?
Diagnosis
Implementation
Outcome identification
Planning

Diagnosis
The nursing process is the theoretical framework used by the ANA, which notes that the nursing process is the essential methodology by which client goals are identified and achieved. Their scope and standards publications, including those for Home Health Nursing and Hospice and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance (ANA, 2014; HPNA/ANA, 2014). Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource use.

Nonprofit home health agencies can be reimbursed for home health services through Medicare, Medicaid, and private insurance companies. A major difference between an official agency and a voluntary or private agency is that official agencies receive additional:
Client payment
Charity support
Public funding
Third party payments

Public funding

Official agencies, operated by the state, county, city, or other local government units such as health departments, are funded primarily by tax revenue (public funding). They are a type of nonprofit home health agency. The home care services provided are reimbursed through Medicare, Medicaid, and private insurance companies.

The model of care delivered in the home setting which focuses on symptom management at the end of life is known as:
Hospice care
Palliative care
Personal care
Transitional care

Palliative care

Palliative care is symptom management with a focus on care coordination and comprehensive support often in specialized inpatient hospice units. Both home-based and inpatient hospice care models share a focus on comfort, pain relief, and mitigation of other distressing symptoms. Hospice care is the care of the dying client and his or her significant others. The Program of All-Inclusive Care for the Elderly (PACE) is a managed care model of integrated health and personal care services. Transitional care programs in the home are designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another.

Each client in the Medicare home care program must be under the care of a doctor (medicine, podiatry, or osteopathy). The home health nurse must involve the doctor in developing a plan of care. The role of the doctor in the home health interdisciplinary team is to do which of the following?
Achieve the optimal level of functioning by teaching.
Certify/recertify the medical necessity and plan of care.
Deal with the social, emotional, and environmental factors that affect well-being
Provide maintenance, preventive, and restorative treatment for clients.

Certify/recertify the medical necessity and plan of care.
Each client in Medicare-funded home care programs must be under the current care of a doctor of medicine, podiatry, or osteopathy to certify that the client has a medical problem. The physician must certify a plan of treatment before care is provided to the client.

Nurses come to home health from a variety of educational and practice settings. Based on educational level, nurses are prepared to practice at various levels. To ensure the public of competence and quality in a highly competitive health care environment, it may become necessary for nurses to seek which of the following?Accreditation
Advanced degrees
Certification
Specialization

Certification
In a highly competitive health care environment, certification is expected to become more necessary to ensure the public of competence and quality. Home health nurses can seek professional certification as a generalist, clinical nurse specialist, nursing care manager, nurse in community health, or clinical specialist in community health through the American Nurses Credentialing Center.

Home health care can be defined as a broad spectrum of health and social services offered in the home environment to recovering, disabled, or chronically ill persons. Participation in providing the needed maintenance care for the home care client is essential by which of the following?
Chaplain
Family caregivers
Home health aids
Physicans

Family caregivers

Working with the family in providing care to an individual client is essential. Family is defined by the individual and includes any caregiver or significant person who assists the client in need of care at home. The caregiver is essential in providing the needed maintenance care between the skilled visits of the professional provider.

Since 2000, home health agencies have been paid by the federal government based on which type of reimbursement?
Diagnosis-related groups
Distributive care
Episodic care
Prospective payment system

Prospective payment system

Because of the increased number of home health agencies and increasing costs, the federal government instituted a prospective payment system on October 1, 2000. This system prevents the abuse or fraudulent use of Medicare funding. Nurses in many settings are not directly exposed to the financial aspects of health care. In home health, nurses must be "cost-conscious" so that they can explain to clients what Medicare will or will not cover. It is often difficult for older clients to understand why Medicare will not pay for the nurse to make home visits to take their blood pressure if their condition remains stable. Medicare pays for services only if the client's condition is unstable, the client is homebound, and the client requires skilled, intermittent, and part-time care.

A current challenge for home health care is the issue of family responsibility for the role of caregiver. Which of the following statements reflect underlying factors that contribute to this home health care challenge? SATA
Able family members with multiple obligations
Debilitation of family members
Number of women working outside the home
Reimbursement to family
Social support systems for caregivers

Able family members with multiple obligations
Number of women working outside the home
Social support systems for caregivers

Home health agency types, whether official, private and voluntary, combination, hospital based, or proprietary, are similar in terms of which of the following?
Conditions of participation (COP) for Medicare and Medicaid
Federal income tax exemption status or accreditation status
Governance models and administrative structures
Homemaker services or service contracting practices

Conditions of participation (COP) for Medicare and Medicaid

Home health agencies are different in administrative and organizational structures such as funding and governance, but they are similar in terms of the standards they must meet for licensure, certification, and accreditation. Nursing care in home health is covered by Medicare and other third-party payers as long as the care being delivered is skilled care

A home health nurse is working with a client who requires a catheter insertion and wound care. The nurse is also helping the client and family to develop positive coping skills and identify resources that will help the client to attain a state of optimal functioning. It is important for the nurse to specifically document nursing services provided because of which of the following?
The agency is required to practice within the guidelines set up by regulatory agencies.
Each criterion has minimum standards to which the program must adhere.
c. Nurses are required to provide supervision of services.
d. Reimbursement is dependent on the provision of skilled care.

d. Reimbursement is dependent on the provision of skilled care.

Nursing care in home health is covered by Medicare and other third-party payers as long as the care being delivered is "skilled care" as defined by the home care agency regulations. Examples of skilled nursing services include: evaluating a client's health status and condition, administering treatments, rehabilitative exercises, and medications; inserting catheters; providing wound care, teaching the client and family to implement the therapeutic plan such as treatments, diets and medications, reporting changes to the physician, and arranging for medical follow-up as indicated.

One reason that nursing may be slow in developing evidence-based practice (EBP) in the community setting may be the lack of understanding about the links between EBP and:
Evidence gathering
Research designs
Research funding
Research use

Research use
EBP represents a cultural change in practice. It provides an environment to improve both nursing practice and client outcomes. Several factors have been identified in the literature that support implementation of EBP or that will need to be overcome for nursing and other disciplines to successfully implement EBP. These factors include knowledge of research and current evidence and the ability to interpret evidence, among other factors. Gathering of evidence, research design, and funding are not associated with the slower development of EBP for nursing.

Which of the following factors has influenced the implementation of evidence-based practice in health care? SATA
Increased expectations of consumers
Advances in technology
Nursing shortages
Increases in lawsuits
Implementation of electronic health records

Increased expectations of consumers
Advances in technology
Increases in lawsuits

Finding resources to implement evidence-based practice (EBP) in community health will continue to be a challenge because of the emphasis on quality care, equal distribution of health care resources, and cost control. Which of the following would demonstrate a creative strategy to implementing EBP?
Adopting quality indicators for evaluating websites claiming to contain EBP
Avoiding the issue of community politics
Creating the role of a knowledge manager
Making decisions on behalf of the community

Adopting quality indicators for evaluating websites claiming to contain EBP

Although the Internet is one source of evidence data, there may be a lack of quality indicators to evaluate the myriad of websites claiming to contain evidence-based information. It is essential to evaluate the quality of the information on the website, whether it comes from a reputable agency or scholar, and whether the source of the website has a financial interest in the acceptance of the evidence presented.

Evidence-based public health utilizes which of the following guidelines? SATA
Decision making for the community served
Application of program planning frameworks
Judicious use of the Internet for use of evidence
Conducting evaluations
Disseminating what has been learned

Application of program planning frameworks
Conducting evaluations
Disseminating what has been learned

When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is:
Acceptable to the community
Contains cost and reduce legal liability
Applied as a universal remedy
Limited to research funding

Acceptable to the community

Public health nurses consider EBP as a process to improve practice and outcomes and use the evidence to influence policies that will improve the health of communities.Nursing has a legitimate role to play in interdisciplinary community health practice, and nurses are obligated to ensure that evidence applied to practice is acceptable to the community.

The gold standard of evidence gathering in evidence-based practice is:
Clinical knowledge and judgment
Expert opinions
Randomized clinical trials
Theories of practice

Randomized clinical trials
A hierarchy of evidence, ranked in order of decreasing importance and use, has been accepted by many health professionals. The double-blind randomized controlled trial (RCT) generally ranks as the highest level of evidence. Some nurses would argue that this hierarchy ignores evidence gained from clinical experience. However, the definition of evidence-based nursing presented above indicates that clinical expertise as evidence, when used with other types of evidence, is used to make clinical decisions.

Which of the following domains are used in evaluating the strength of evidence? SATA
Quality
Quantity
Cost effectiveness
Consistency
Usefulness

Quality
Quantity
Consistency

The nurse who works in the community setting must ensure that the application of the best available evidence to improve practice is also:
Accessible and diverse
Competence and complaint
Culturally and financially appropriate
Reasonable and deliverable in a timely fashion

Culturally and financially appropriate

Applied to nursing, evidence-based practice includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders. Culturally and financially appropriate best practices need to be identified when working with communities instead of individuals. The use of evidence to determine the appropriate use of interventions that are culturally sensitive and cost effective is a must.

There are many barriers that affect the actual implementation of evidence-based practice (EBP) in a nursing environment. Which statements reflect the most significant concerns of nurses in the community-focused setting? SATA
EBP requires compliance by the client.
EBP requires little support.
EBP demands change.
EBP questions long-standing nursing practice.
Lack of resources

EBP requires compliance by the client.
EBP questions long-standing nursing practice.
Lack of resources

When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is:
a. acceptable to the community.
Contains cost and reduces legal liability
Applied as a universal remedy
Limited to research funding

a. acceptable to the community.

Public health nurses consider EBP as a process to improve practice and outcomes and use the evidence to influence policies that will improve the health of communities.Nursing has a legitimate role to play in interdisciplinary community health practice, and nurses are obligated to ensure that evidence applied to practice is acceptable to the community.

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to:
Assess The literacy level of the group
See how many plan to attend
See weather the group is ready to learn
Secure a good space for a group meeting

Assess The literacy level of the group

Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels.One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States.

Which educational method has been shown to be most effective in fostering treatment adherence?
Internet-based education
In-person counseling
Telephone counseling
Self-directed learning

Internet-based education

Educating people through the Internet has been shown to be more effective in fostering treatment adherence than in-person counseling, telephone counseling, or self-directed learning. It is important to be aware that people increasingly are using the Internet as a source of health information. Clients may ask nurses to provide them with information about ways to evaluate the quality and reliability of this information.

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined?
Cognitive domain
Events of instruction
principles of effective instruction
Psychomotor domain

Psychomotor domain

The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use:
An andragogical approach
A behavioral approach
A operational approach
A pedagogical approach

An andragogical approach

Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation.

A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle?
Repetition
Integration
Participation
Sequencing

Repetition

Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group.

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to:
Provide an online test module
Ask whether there are any concerns
Ask for a return demonstration
Give a short paper and pencil quiz

Ask for a return demonstration

Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given.

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of:
Affective domain
Cognitive domain
Events of instruction
Principles of effective education

Cognitive domain

The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition
in order of difficulty. The affective domain includes changes in attitudes and the development of values.
This situation does not demonstrate events of instruction or educational principles.

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? SATA
Use of films
Small group interaction
Use of game
session timing
Session space

Use of films
Small group interaction
Use of game
session timing
Session space

Which of the following barriers are specific to the educator? SATA
Fear of public speaking
Low literacy
limited experience with the topic
Lack of motivation
Lack of experience with gaining participation

Fear of public speaking
limited experience with the topic
Lack of experience with gaining participation

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved?
Cultural sensitivity
Efficiency in client service
Learning of new skills
distraction free surroundings

Efficiency in client service

In the education process, one of the important skills for educators to develop in selecting appropriate educational methods is realizing the benefits of group teaching, such as cohesiveness among members, increased number of clients seen, clients learning from one another, and cost effectiveness. Cohesive groups tend to be more productive and able to accomplish their goals; cohesion can be increased as members better understand the experiences of others and identify common ideas and reactions to various issues. Nurses facilitate this process by pointing out similarities, contrasting supportive differences, or helping members redefine differences in ways that make those dissimilarities compatible

The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families:
fosters equal family and provider commitment to success.
facilitates outcomes-oriented family nursing research.
decreases the need for nurse contact and intervention.
removes barriers to needed services to achieve success.

fosters equal family and provider commitment to success.

Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between the parents, or the indirect interaction between the parents and the child). The systems approach to family always implies that when something happens to one family member, the other members of the family system are affected.

The nurse in community health uses information about family structure, household composition, marriage, divorce, birth, death, adoption, and other family life events to forecast and predict stresses and developmental changes experienced by families and identify possible solutions to family challenges. This best describes the study of:
Family demographics
Family functions
Family health
Family resilience

Family demographics

Family demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing. Nurses must be knowledgeable about family structures, functions, processes, and roles. In addition, nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures.

The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition?
Families are defined by genetic ties.
Family names are needed to confer status
Members of a family are self-defined.
Traditional family functions have been redefine

Members of a family are self-defined.

The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time?
Life cycle theory
Family developmental theory
Family systems theory
bioecological system theory

bioecological system theory
The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. Nurses use family systems theory to understand how a family is an organized whole as well as composed of individuals.

What terms are used to describe healthy families?
Families with strength
Dysfunctional
Functional families
Resilient families
Resistant families

Families with strength
Functional families
Resilient families

The family systems theory encourages nurses to view both the individual clients as participating members of a whole family. What is the major weakness of the systems framework?
Views families from both a subsystem and a suprasystem approach.
Defines the direction of interactions.
Views the family as an agent of change.
Focuses on the interaction of the family with other systems.

Focuses on the interaction of the family with other systems.

he major strength of the systems framework is that it views families from both a subsystem and a suprasystem approach. That is, it views the interactions within and between family subsystems as well as the interaction between families and the larger supersystems, such as the community and the world. The major weakness of the systems framework is that the focus is on the interaction of the family with other systems rather than on the individual, which is sometimes more important.

In applying the developmental theory, a family nurse determines the developmental stage of the family based on:
Age of the eldest child
Family strengths
Individual growth patterns
Overall tasks of the family

Age of the eldest child

Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development.

Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? SATA


A. Assessment of the individual's health does not determine the overall family system's health.
B. Family functioning affects the health of individuals.
C. Family system assessment specifically addresses the individual's health.
D. The individual's health affects family functioning.
C. Simultaneous assessment of individual family members and the family system as a whole is
important to family health.

Family functioning affects the health of individuals.

The individual's health affects family functioning.

Simultaneous assessment of individual family members and the family system as a whole is
important to family health.

A family nurse is working with a married couple that has decided to remain child-free. The nurse recognizes this decision as a:
Biological necessity
Contemporary family function
Religious belief decision
Threat to family survival

Contemporary family function

In contemporary times, the traditional functions of families have been modified and new functions added. One of the traditional family functions was to procreate to ensure the survival of the species. Many married couples are electing to be child-free rather than to reproduce.
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A nurse doing a family assessment asks the client, "Have any of your blood relatives had mental illness?" The nurse is asking this question to:
determine whether the family is stable.
assess for biological risk factors.
decide whether this family member needs medication
demonstrate open-mindedness about mental illness

assess for biological risk factors.

Healthy People 2020 (US Department of Health and Human Services, 2010) identified the following major categories as being: inherited biological risk, including age-related risks, social and physical environmental risks and behavioral risks as well as health care risks. Although single risk factors can influence outcomes, the combined effect of several risks has greater influence.

A parent with two school-age children has just finished a family health assessment questionnaire. The parent asks the nurse why one of the questions asks whether there is a neighborhood playground. The nurse's best response would be:
"Don't worry about it. We are going to talk about all this anyway."
"It's important to good health to have adequate recreation resources."
"We want to be able to report any dangerous playground equipment to the city.
"We want to know what kind of neighborhood you're in so we can assess income."

"It's important to good health to have adequate recreation resources."

The importance of social risks to family health is gaining increased recognition. A family's health risk increases if they are living in high-crime neighborhoods, communities without adequate recreation or health resources, in communities with major noise pollution or chemical pollution, or in other high-stress environments.

A nurse in community health is conducting an assessment on a family of four. During the course of the assessment, the nurse collects information about previous generations of the family and siblings. The results are used to create a diagram for the family that displays the family unit across generations. Further discussions occur regarding the patterns of health and illness that relate to biological health risks. The diagram is called
An ecomap
A family plan
A genogram
A risk plot

A genogram

A genogram is a drawing that shows the family unit of immediate interest and includes several generations, using a series of circles, squares, and connecting lines. Basic information about the family, relationships in the family, and patterns of health and illness can be obtained by completing the genogram with the family.

The problem of the working poor and uninsured places a major burden on the current health care system that affects those families and the community in general. Nurses in community health see this as a major SATA
Behavioral issues
Policy issue
Health risk issue
Social issue
Nursing issue

Policy issue
Health risk issue
Social issue

A nurse in community health is conducting a parenting class for prospective parents that will focus on the development of new skills, identification of needed resources, planning, and other preparations for the arrival of a newborn. This intervention is addressing a potential risk associated with:
Biology
Behavior
Environment
transitions

transitions

Transitions, or the movement from one stage or condition to another, are times of potential risk for families. Age-related or life event risks often occur during transitions from one developmental stage to another. They require families to learn new skills; change behaviors, schedules, or patterns of communication; identify needed resources; and make plans.

One member of an older couple has just retired. This is considered a:

A. developmental stage that will help the family with stress reduction.
B. nonnormative event that will have psychological impact on the family.
C. normative event and can increase the family's risk for illness.
D. normative event and will have little effect on the family' well-being.

C. normative event and can increase the family's risk for illness.

Life events can increase the risk for illness. Normative events are those that are generally expected to occur at a particular stage of development or the life span. If the event is normative, families may be able to identify needed resources, make plans to cope with the change, learn new skills, and prepare for the event and its consequences. This kind of anticipatory preparation can increase the family's coping ability and decrease stress and negative outcomes. However, when the event is nonnormative, or unexpected, families have little or no time to prepare and the outcome can be increased stress, crisis, or even dysfunction.

During a family nursing assessment, a parent questions whether God is punishing the family, because one of the children has just been diagnosed with leukemia. The most facilitative response by the nurse would be:
"God is loving and doesn't punish people."
"Tell me more about your family's spiritual beliefs."
"That is not part of my religious belief system, so I don't know."
"Why do you think your family needed to be punished?"

"Tell me more about your family's spiritual beliefs."

The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change.

A nurse in community health decides to form a contract with a family. The contract states that the family will designate one night as a family night. The nurse is most likely using the contract to:
make sure the family does what is expected.
encourage the family to put plans in writing.
let the family know that this is a legal agreement.
shift the responsibility so that it becomes a shared effort.

shift the responsibility so that it becomes a shared effort.

Contracting involves a shift in responsibility and control toward a shared effort by the client and professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, its ability to make healthful choices is increased. Contracting is a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional.

Nursing interventions and approaches for helping individuals and families to assume an active role in their care should focus on empowerment rather than on enabling. The underlying principle to empowerment is:
Client dominance
Decreased competence
Professional dominance
professional client partnership

professional client partnership

Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. For families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action.

Many families have financial resources that allow them to maintain themselves but limit the quality of their purchasing power. Food high in fat and calories may be affordable, whereas fresh fruits and vegetables may not be affordable. A federal program that attempts to promote healthier diets for vulnerable populations is:
Medicaid
Medicare
Supplemental security income (SSI)
Women, infant and children (WIC)

Women, infant and children (WIC)

Nutritious diets are important in preventing illness and promoting health. A US Department of Agriculture (USDA) study examined the effects of its Women, Infants, and Children (WIC) nutrition program. The study found that children who participated in WIC were more linked to the health care system than children who were not. Children in WIC were more likely to receive both preventive and curative care more often than children not participating in WIC.

The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges:
adapting and coping responses.
intellectual capacity.
socioeconomic status.
spiritual awareness.

adapting and coping responses.

Eighty-five percent of all elderly people live in homes alone, with spouses or other family or friends. For many families, the caregiving experience is a positive, rewarding, and fulfilling one. Nursing intervention can facilitate good health for older persons and their caregivers and contribute to meaningful family relationships during this period.

The most common causes of preventable disease, disability, and death among children are:
injuries and accidents.
maintaining a healthful diet.
physical activity.
cardiovascular health.

injuries and accidents.

Injuries and accidents are the most common causes of preventable disease, disability, and death among children. Unintentional injuries are any injuries sustained by accident such as falls, fires, drowning, suffocation, poisoning, sports, recreation, or motor vehicle accidents. Because of their size, growth and development, inexperience, and natural curiosity, children and teens are especially at risk for injury.

The community health nurse is aware that lesbian, gay, bisexual, and transgender (LGBT) adults are more likely to experience which of the following conditions?
Cardiovascular disease
Poor mental health
Obesity
Poverty

Poor mental health

Lesbian, gay, bisexual, and transgender (LGBT) adults represent a sometimes hidden special population, in part because of the social stigma associated with homosexuality coupled with the fear of discrimination. Several studies have documented health disparities by sexual orientation in population-based data and have revealed differences in health between LGBT adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, higher risk of disability, and excessive drinking.

A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for:
Asthma
Attention deficit disordered (ADDO
Childhood obesity
Poisoning

Childhood obesity

Obesity among the youth of the nation has reached epidemic proportions. Many factors contribute to the likelihood that a child will become overweight or obese. Factors include genetics, family eating, and
physical activity patterns and time spent inactive while viewing television, playing computer games, or
using other electronic devices. The environment in which children live influences obesity.

The Patient Self-Determination Act of 1990 requires that providers receiving Medicare and Medicaid funds give
clients written information regarding:
legal options for treatment choices in the event the person becomes incapacitated.
Patient rights
The cost of services
Patient privacy

legal options for treatment choices in the event the person becomes incapacitated.

The Patient Self-Determination Act of 1990 (PL 103-43) requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. A routine discussion of advance medical directives can help ease the difficult discussions faced by health care professionals, family, and clients. The nurse can assist an individual to complete a values history instrument. These instruments ask questions about specific wishes regarding different medical situations.

Which of the following statements are true regarding the health-related vulnerabilities of men?
More males die at birth
Fewer health services are emphasized for men.
Men are less likely to be honest about their symptoms.
More males die from suicide.
Men do not participate in health care at the same level as women.

Fewer health services are emphasized for men.

Men are less likely to be honest about their symptoms.

Men do not participate in health care at the same level as women.

A particular chronic health problem that is a serious public health challenge and results in health complications that double medical costs is:
Stroke
Hypertension
Diabetes
Cardiovascular disease

Diabetes

Diabetes is a serious public health challenge for the United States. According to the National Diabetes Statistics Report 2014, one out of every 11 people of the United States population have diabetes (CDC, 2014). People with diabetes are at a higher risk for serious health complication, such as: blindness, kidney failure, heart disease, stroke, and loss of toes, feet, or legs. Due to these health complications, medical costs are twice a high for people with diabetes as those without diabetes. At least 18 of the goals of Healthy People 2020 are related to diabetes.

Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as:
Neglect
Incompetence
Exploitation
self-determination

Exploitation

Neglect refers to a lack of services that are necessary for the physical and mental health of an individual by the individual or a caregiver. Older persons can make independent choices with which others may disagree. Their right to self-determination can be taken from them if they are declared incompetent. Exploitation is the illegal or improper use of a person or their resources for another's profit or advantage. During the assessment process, nurses need to be aware of conflicts between injuries and explanation of cause, dependency issues between client and caregiver, and substance abuse by the caregiver.

The school nurse is interested in providing an anti-smoking program in a local middle school and is aware that programs are more effective for this age group when they focus on short-term versus long-term effects of smoking. Besides including health risks and cosmetic effects, the nurse should also consider:
behavior modification techniques.
effects on the environment.
laws regarding tobacco sales to minors.
social skills instruction to resist pressure to smoke.

social skills instruction to resist pressure to smoke.

Anti-smoking programs directed toward children and teenagers are more successful if the focus is on short-term effects rather than long-term effects. Developmentally, children and teenagers cannot visualize the future to imagine the consequences of smoking. Teaching should include how advertising puts pressure on people to smoke.

An underlying current throughout the special population groups with health disparities is:
Poverty
Aging
Minority groups
Children

Poverty

Health disparities present political implications and influence government actions. Certain groups have been recognized as experiencing health disparities and have become a priority for policy efforts. Poverty is a strong and underlying current throughout all of the special groups.