Community/Public Health Nursing-Final and HESI Prep: Practice Questions

A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing:

a. community-based nursing.

b. community-oriented nursing.

c. institutional nursing.

d. public health nursing.

a. 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.

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:

a. community-oriented nursing.

b. community-based nursing.

c. public health nursing.

d. tertiary health nursing.

b. community-based nursing.

In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span.

A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of:

a. community-based nursing.

b. community-oriented nursing.

c. institutional nursing.

d. public health nursing.

a. 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.

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?

Select all that apply.

a. Assisting communities to implement and evaluate plans and projects.

b. Building constituencies to work with the community.

c. Collecting, analyzing, and disseminating information.

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

e. Questioning the availability of health services to the community

c. Collecting, analyzing, and disseminating information.

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

e. 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:

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

b. program characteristics are assessed for their effectiveness in making the school population healthier.

c. referral is provided for a child identified with delayed psychomotor development.

d. treatment is initiated for a child with an identified learning disability.

a. 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.

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:

a. drug treatments for diabetes.

b. populations with the highest rate of diabetes.

c. educational materials for individuals with diabetes.

d. new technology for diabetic care.

b. 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.

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:

a. assurance.

b. policy development.

c. primary prevention.

d. public transportation.

a. 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.

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:

a. community-oriented care.

b. community-based care.

c. secondary care.

d. tertiary care.

a. community-oriented care.

Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients.

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. a holistic treatment plan.

b. a specific clinical diagnosis.

c. individual dietary interventions for cardiovascular disorders.

d. the prevalence rate of cardiovascular disorders among various groups.

d. the prevalence rate of cardiovascular disorders among various groups.

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:

a. assessment.

b. assurance.

c. policy development.

d. research.

a. 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.

The federal agency most responsible for improving the health status of the American people is the:

a. Office of Health Preparedness.

b. Office of Global Affairs.

c. Food and Drug Administration.

d. US Department of Health and Human Services.

d. US Department of Health and Human Services.

The US Department of Health and Human Services (USDHHS) is the federal agency most heavily involved with the health and welfare concerns of US citizens. The department includes the Office of the Secretary, 11 agencies, and a program support center. It is charged with regulating health care and overseeing the health status of America.

Implementing a community-level program, such as walking for exercise, to assist citizens in improving health behaviors is an example of which level of prevention?

a. Primary prevention

b. Secondary prevention

c. Tertiary prevention

d. Disease promotion

a. Primary prevention

Implementation of a community-level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle is an example of primary prevention at the public health level.

A nurse is working with her church to develop a new outreach program aimed at providing support services for recovering substance abusers in the local community. What agency might the nurse contact to secure federal funding for the program?

a. Center for Faith-Based and b. Neighborhood Partnerships

b. Office of Global Affairs

c. Office of Public Health Preparedness

d. The National Health Services Corp

a. Center for Faith-Based and b. Neighborhood Partnerships

The US Department of Health and Human Services (USDHHS; or simply HHS) is the agency most heavily involved with the health and welfare concerns of US citizens. Newer areas in the HHS are the Office of Public Health Preparedness, the Center for Faith-Based and Neighborhood Partnerships, and the Office of Global Affairs.

A nurse who is interested in disaster training through the Community Emergency Response Team (CERT) program would look to which government jurisdiction or agency to seek the certification?

a. Local system

b. State system

c. Department of Homeland Security

d. US Department of Health and Human Services

d. US Department of Health and Human Services

The mission of the DHS is to prevent and deter terrorist attacks and protect against and respond to threats and hazards to the nation. The goals for the department include awareness, prevention, protection, response, and recovery.

A nurse works in a free clinic for uninsured low-wage employees in the community. The free clinic setting operates in a primary health care (PHC) strategy. The nurse would most likely focus on:

a. incidence of the disease.

b. physician orders for the individual.

c. pathophysiology of the disease.

d. self-care/management.

d. self-care/management.

With an emphasis on broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team, PHC promotes the integration of all health care systems within a community to come together to improve the health of the community. It includes a comprehensive range of services including public health; prevention; and diagnostic, therapeutic, and rehabilitative services.

Parents can expect their children to be immunized for communicable diseases before entering kindergarten in the local school system because:

a. primary-care clinics focus on prevention.

b. primary-care clinics maintain adequate supplies of immunization.

c. the public health system has mandates for immunization.

d. the public health system provides good access to immunization clinics.

c. the public health system has mandates for immunization.

Although the goal of the public health system is to ensure that the health of the community is protected, promoted, and ensured, overlap exists between this system and the primary-care system. The overlap comes from the primary-care system, which provides health promotion and disease prevention, and through the public health system, which provides personal primary-care services for those who cannot afford to receive care elsewhere.

What are some examples of programs which may be provided at the local health department level?

Select all that apply.

a. Immunization clinics

b. Health education

c. Family planning services

d. Licensing of health care professionals

e. Quality and safety data

a. Immunization clinics

b. Health education

c. Family planning services

Primary care refers to personal health care for the most common needs of members of a community. Which of the following statements also differentiates primary care from primary health care?

Select all that apply.

a. Primary care consists of a multidisciplinary team.

b. Primary care is provided within the context of family and community.

c. Primary care encourages self-care and self-management.

d. Primary care provides first-contact, continuous, comprehensive, and coordinated care.

f. Primary care provides preventive, curative, and rehabilitative services.

b. Primary care is provided within the context of family and community.

d. Primary care provides first-contact, continuous, comprehensive, and coordinated care.

Primary care refers to personal health care that provides first-contact and continuous, comprehensive, and coordinated care. The providing of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of family and community. Primary health care is defined more broadly than is primary care.

What are some of the effects of technology in the area of home health care?

Select all that apply.

a. High technology equipment increases expense.

b. Technology decreases legal liability.

c. Technology has the potential for increased privacy.

d. Technology quickly becomes outdated when newer developments occur.

e. There is inconsistent quality of resources available on the Internet.

a. High technology equipment increases expense.

d. Technology quickly becomes outdated when newer developments occur.

e. There is inconsistent quality of resources available on the Internet.

Cost is the most significant negative aspect of advanced health care technology. The more high-technology equipment and computer programs become available, the more they are used.

What are some of the benefits of an electronic medical record in the public health setting?

Select all that apply.

a. Timely billing and financial reimbursement for services provided

b. Improved public reporting of medication errors

c. Coordination of referrals and facilitation of chronic disease management

d. Improvement of quality measurement and monitoring

e. Incorporation of protocol reminders for prevention, screening, and management of chronic disease

c. Coordination of referrals and facilitation of chronic disease management

d. Improvement of quality measurement and monitoring

e. Incorporation of protocol reminders for prevention, screening, and management of chronic disease

A nurse exclaims proudly to other nurses at the agency, "The care I provide is the same for everyone. I treat everyone the same." In fact, this nurse is demonstrating what inhibitor to developing cultural competence?

a. Cultural blindness

b. Cultural competence

c. Cultural conflict

d. Culture shock

a. Cultural blindness

Cultural blindness is the tendency to ignore all differences among cultures and to act as though the differences do not exist and to treat all people the same when, in truth, each person is different.

A nurse demonstrates cultural competence by using statements such as:

a. "I know how you feel."

b. "Tell me about your health care beliefs."

c. "Let me show you the way you should do this."

d. "You can do things in a more modern way now."

b. "Tell me about your health care beliefs."

Culturally competent nurses learn about the cultures of the clients whom they serve and they respect people from other cultures and value diversity; this helps them provide more responsive care.

In caring for a young adult from West Africa, the community nurse is introduced to another individual who is referred to as "auntie." A culturally competent nurse who is aware of the basic organizing factor of culture related to social organization would:

a. assess the competence of the "auntie" to care for the young adult.

b. assume that the "auntie" is related to one of the young adult's parents.

d. declare that the young adult is capable of making personal health decisions.

e. find out who is considered to be a member of the family.

e. find out who is considered to be a member of the family.

Social organization is one of the basic organizing factors related to cultures. It refers to the way in which a cultural group structures itself around family to carry out roles and functions. The nurse should find out who is considered to be in the family, who the key decision makers are, and if the needs of the family supersede those of the individuals in the family.

A nurse who speaks only English has just gotten a new client for an intake interview. The client is a refugee who has very limited English proficiency (LEP). The nurse should:

a. get an interpreter.

b. see whether another nurse, more comfortable with refugees, will work with the client.

c. see what helpful information is on the Internet.

d. try to communicate with hand gestures.

a. get an interpreter.

In selecting an interpreter, nurses should consider the clients' cultural needs and respect their right to privacy.

A Public Health Service nurse working for the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands that within the culture, disease is often perceived as disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. The nurse is integrating her knowledge of the cultural organizing factor of:

a. biological variations.

b. communication.

c. environmental control.

d. space.

c. environmental control.

Environmental control refers to the relationships between humans and nature. Cultures that view a human harmony with nature may perceive illness as a disharmony with other forces and believe that medicine can only relieve the symptoms rather than cure the disease.

A nurse in community health is visiting with an older adult Asian woman for the first time. The nurse has not encountered many clients from this culture. An effective way to ensure client-centered care is performed is to:

a. explain to the client how the nurse intends to fix the problem.

b. focus on the differences between the two cultures.

c. tell the client how Western medicine will fix her problem.

d. listen to the client's perceptions of the problems.

d. listen to the client's perceptions of the problems.

Skills such as listening, explaining, acknowledging, recommending, understanding, and negotiating help the nurse be nonjudgmental. It is vital that nurses listen to clients' perceptions of their problems and, in turn, that nurses explain to clients the nurses' perceptions of the problems.

It is important that nurses understand the nontraditional healing practices of their clients because:

a. folk practices are usually ineffective.

b. nurses can refer clients to the appropriate local folk healers.

c. safe, effective nontraditional healing methods can be blended with Western medicine.

d. the nurse must understand them to help the client give them up.

c. safe, effective nontraditional healing methods can be blended with Western medicine.

Nurses need to understand the nontraditional healing practices that their clients use. Many of these treatments have proven effective and can be blended with traditional Western medicine.

Nurses in community health who understand the basis of their own behaviors and how those behaviors help or hinder the delivery of competent care to persons from cultures other than their own are demonstrating the cultural competence development process construct of:

a. cultural awareness.

b. cultural desire.

c. cultural encounter.

d. cultural skill.

a. cultural awareness.

The five constructs that explain the process of developing cultural competence are cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural awareness is self-examination and in-depth exploration of one's own beliefs and values as they influence behavior.

A nurse overhears the doctor saying, "Do not give him milk; he is from Africa." The nurse reflects on the comment and determines that the:

Select all that apply.

a. doctor is culturally competent.

b. doctor is prejudiced.

c. doctor should have called an interpreter.

d. doctor's ability to assess nutritional practices based on culture may be limited.

e. doctor is planning care based on racial enzymatic differences.

a. doctor is culturally competent.

e. doctor is planning care based on racial enzymatic differences.

Biological variations distinguish one racial group from another. They occur in areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Lactose in tolerance is much more common in African Blacks and African Americans than in the general population.

A community-based hospice nurse has an Asian male client with terminal stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care practitioner (PCP). The nurse contacts the client's PCP to discuss replacing the prescription of codeine with another pain-reducing non-codeine-based drug. The nurse is demonstrating knowledge of the cultural organizing factor of:

a. biological variance.

b. communication.

c. space.

d. time perception.

a. biological variance.

Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. Research findings suggest that sensitivity to codeine varies with ethnic background, and that Asian men experience significantly weaker effects from the drug than do European men.

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:

a. community.

b. community as client.

c. individual as client.

d. partnership.

b. 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).

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:

a. evaluation phase.

b. implementation phase.

c. needs assessment.

d. problem analysis.

a. evaluation phase.

Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified.

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:

a. analyze the community problem.

b. establish priorities.

c. establish goals and objectives.

d. identify intervention activities.

a. 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

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:

a. composite database.

b. participant observation.

c. secondary analysis.

d. windshield survey.

d. 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.

Which of the following best support the concept of community-oriented nursing practice?

Select all that apply.

a. Direct nursing care of individuals with tuberculosis (TB)

b. Hospice home care for a terminally ill individual and family

c. Nursing interventions to stop elder abuse

d. Nutrition education programs for teenagers and their families

e. Wound care for a homebound individual

a. Direct nursing care of individuals with tuberculosis (TB)

c. Nursing interventions to stop elder abuse

d. Nutrition education programs for teenagers and their families

In community-oriented practice, the nurse and community seek healthful change together. Their common goal involves an ongoing series of health-promoting changes rather than a fixed state.

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:

a. community

b. community client

c. community health

d. community partnerships

d. community partnerships

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. 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:

a. data gathering.

b. data generation.

c. data interpretation.

d. problem identification.

b. 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.

Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a:

a. community.

b. group.

c. setting of practice.

d. target population.

a. community.

In most definitions the concept of community includes people, place/time, and function.

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:

a. partnership.

b. process.

c. status.

d. structure.

d. structure.

Community health has three dimensions: status, structure, and process. Community health in terms of status, or outcome, is the most well-known and accepted approach; it involves biological, emotional, and social parts.

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:

a. change agent.

b. change partner.

c. group leader.

d. data collector.

b. 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.

Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be:

a. two new cases divided by 16 at risk.

b. two new cases divided by 20.

c. six cases divided by 20.

d. four cases divided by 16.

a. two new cases divided by 16 at risk.

An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time.

People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it.

A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect:

a. current and past breast cancer events in this population of women.

b. newly diagnosed cases of breast cancer in this population of women.

c. past breast cancer events in this population of women.

d. the population of women that had no evidence of breast cancer.

a. current and past breast cancer events in this population of women.

The prevalence proportion is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population).

Clinical medicine and epidemiology differ from each other in the major aspect of:

a. practice focus.

b. health monitoring.

c. determinants of health and disease.

d. evaluation of interventions.

a. practice focus.

Epidemiology focuses on populations, whereas clinical medicine focuses on the diagnosis and treatment of disease in individuals. Epidemiology studies populations to determine the causes of health and disease in communities and to investigate and evaluate interventions that will prevent disease and maintain health.

Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends?

a. A nurse in community health conducts an education class for clients newly diagnosed with diabetes.

b. A nurse in community health investigates a breakout of whooping cough in a local middle school.

c. A nurse in community health organizes a health fair at the community health center.

d. A nurse in community health participates on a county school board that addresses student health issues.

b. A nurse in community health investigates a breakout of whooping cough in a local middle school.

Nurses are a key part of the interdisciplinary team in community settings and often use epidemiology to look at health and at disease causation and how to both prevent and treat illness. Nurses use epidemiology in the community to examine factors that affect the individual, family, and population group because it is more difficult to control these factors in the community than in the hospital.

A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies such as removing carpets and avoiding pets is intervening at the level of:

a. assessment.

b. primary prevention.

c. secondary prevention.

d. tertiary prevention.

c. secondary prevention.

This is an example of secondary prevention. Health screenings are at the core of secondary prevention.

One of the basic concepts in epidemiology is the concept of risk. Risk refers to the:

a. prevalence of an event occurring.

b. probability that an event will occur within a specified time period.

c. population most likely to develop a disease.

d. rate of development of new cases.

b. probability that an event will occur within a specified time period.

Risk refers to the probability that an event will occur within a specified time period. A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring.

Which of the following tools are used in analytic epidemiology?

Select all that apply.

a. Cohort study

b. Case-control study

c. Cross-sectional study

d. Clinical trials

e. Community trials

a. Cohort study

b. Case-control study

c. Cross-sectional study

Analytic epidemiology deals with the factors that influence the observed patterns of health and disease and increase or decrease the risk of adverse outcomes. Analytic study designs include cohort studies, case-control studies, and cross-sectional studies.

A nurse is concerned about the accuracy of the PPD test in identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of:

a. reliability.

b. sensitivity.

c. specificity.

d. variation.

b. sensitivity.

Validity of a screening test is measured by sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those with the condition or trait. High sensitivity is needed when early treatment is important and when identification of every case is important. Specificity indicates how accurately the test identifies those without the condition or trait. Reliability is the consistency of repeating a measure and is affected by variation in results.

A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between:

a. host and agent.

b. host, agent, and environment.

c. risk and causality.

d. morbidity and disease.

b. host, agent, and environment.

Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle.

Analytic epidemiology differs from descriptive epidemiology because it searches for:

a. "when" of disease patterns.

b. "where" of disease patterns.

c. "why" of disease patterns.

d. "who" of disease patterns.

c. "why" of disease patterns.

Descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns. Analytic epidemiology, on the other hand, searches for the determinants of the patterns observed—the how and why of disease patterns.

The federal act that grants authority to the Environmental Protection Agency (EPA) which controls the generation, transportation, treatment, storage, and disposal of hazardous waste and ultimately called for the phaseout of land disposal of hazardous waste under a later amendment was the:

a. Emergency Planning and Community Right-to-Know Act (EPCRA).

b. National Environmental Policy Act (NEPA).

c. Pollution Prevention Act (PPA).

d. Resource Conservation and Recovery Act (RCRA).

d. Resource Conservation and Recovery Act (RCRA).

The Resource Conservation and Recovery Act (RCRA) gave the EPA the authority to control the generation, transportation, treatment, storage, and disposal of hazardous waste. The 1984 federal Hazardous and Solid Waste Amendment to this act required phasing out land disposal of hazardous waste.

Nurses should review which of the following reports to determine what pollutants have been found in the drinking water of a community?

a. Point source report

b. Consumer confidence report

c. Material Safety Data Sheet

d. Environmental standards report

b. Consumer confidence report

When a community is provided drinking water by a water supplier (as opposed to individual wells), the water provider is responsible for testing the water according to EPA standards. The results of the testing must be reported to those who purchase the water, in the form of a consumer confidence report (CCR). Nurses should review consumer confidence reports, sometimes referred to as right-to-know reports, to learn what pollutants have been found in the drinking water. Pollution sources are characterized as point sources.

Which of the following statements best explains the need for geologists, meteorologists, and chemists on the multidisciplinary team in environmental health?

a. Earth sciences explain how pollutants travel in air, water, and soil.

b. Earth sciences help us understand the strength of the association between exposures and health effects in human populations.

c. Earth scientists study the negative effects of chemical exposure.

d. Earth scientists work with the community to coordinate services to meet the community's needs.

a. Earth sciences explain how pollutants travel in air, water, and soil.

The Food Quality Protection Act of 1996 increased the protection of infants and children from pesticide exposure from multiple sources by establishing a new health-based standard of reasonable certainty of "no harm" that:

a. considers the cumulative impacts of all pesticides that may share a common mechanism of action.

b. establishes a 15-year renewal process for all pesticides.

c. prohibits taking into account economic considerations when children are at risk.

d. uses an additional tenfold margin of safety when there are adequate data indicating developmental risks.

c. prohibits taking into account economic considerations when children are at risk.

The Food Quality Protection Act of 1996 added new provisions related to protection of infants and children from pesticide exposure from multiple sources. The law established a health-based standard of reasonable certainty of "no harm" that prohibits taking into account economic considerations when children are at risk.

When a community health nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning land parcels for industrial use, the nurse is:

a. advocating for ethical choices.

b. communicating risk.

c. controlling environmental damage.

d. volunteering for service on state boards.

a. advocating for ethical choices.

Understanding ethics is essential for nurses making their own choices, in describing issues and options within groups, and in advocating for ethical choices.

The community health nurse asks a client, "Have you ever been exposed to any radiation or chemical liquids, dust, mists, or fumes?" The nurse is conducting an:

a. environmental advocacy activity.

b. environmental compliance activity.

c. environmental health assessment.

d. environmental risk communication.

c. environmental health assessment.

The key questions in an environmental health assessment should cover present and past conditions in work, home, and community environments. In an assessment of environmental exposures, the environment can be divided into functional locations such as home, school, workplace, and community.

When applying the nursing process to environmental health, the community health nurse would:

a. conduct a focused assessment on the presenting problem.

b. coordinate interventions with the physician only.

c. examine criteria that include only the client's immediate response.

d. include outcome measures that mitigate and eliminate the environmental factors.

d. include outcome measures that mitigate and eliminate the environmental factors.

If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process.

The monitoring and public reporting of air quality in a local community to alert individuals with asthma or other respiratory conditions would illustrate:

a. compliance and enforcement.

b. environmental epidemiology.

c. secondary prevention.

d. toxicology.

b. environmental epidemiology.

By examining specific populations or communities exposed to different ambient environments, environmental epidemiology seeks to clarify the relationship between physical, chemical, and biological factors and human health. Secondary prevention and compliance and enforcement are not associated with monitoring and public reporting.

The Clean Air Act of 1970 was amended in 1990 to meet unaddressed or insufficiently addressed problems that included which of the following?

Select all that apply.

a. Addressing acid rain

b. Addressing excessive noise and heat or cold extremes

c. Addressing ground-level ozone

d. Addressing stratospheric ozone depletion

e. Tracking 75,000 industrial chemicals

a. Addressing acid rain

c. Addressing ground-level ozone

d. Addressing stratospheric ozone depletion

When applying the nursing process to environmental health, the community health nurse would examine criteria that include the immediate and long-term responses of the client to the planned interventions. Another important factor to consider in the evaluation process would be:

a. recidivism of the problem for the client.

b. consideration of community policy and laws.

c. relationship between the disease and the environmental factors.

d. coordination of actions to meet the client's needs.

a. recidivism of the problem for the client.

If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process.

A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's:

a. efficiency.

b. impact.

c. relevance.

d. sustainability.

d. sustainability.

A program can be continued if there are resources for it. Programs funded as a demonstration project or through outside sources require ongoing funding to survive after the initial funding or time frame for the demonstration project has ended. If the reason for the evaluation is to examine the efficiency of a program, it may occur on an ongoing basis as a formative evaluation.

A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena?

a. Assessment Protocol for Excellence in Public Health (APEXPH)

b. Health Evaluation Data Information System (HEDIS)

c. Mobilizing for Action Through Planning and Partnership (MAPP)

d. Planning Approach to Community Health (PATCH)

c. Mobilizing for Action Through Planning and Partnership (MAPP)

MAPP is the newer approach to program planning in the public health arena. It is a strategic planning model that helps the community health workers be facilitators, as communities establish priorities in their public health issues and identify resources to address the issues. APEXPH addresses the three core competencies of public health: assessment, assurance, and policy development. PATCH is a health education model and HEDIS is not associated with program planning.

A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be:

a. community forums.

b. focus groups.

c. key informants.

d. surveys.

a. community forums.

Community forums have the advantage of being low in cost and capturing the perspectives of a large number of persons. Focus groups and key informant methods limit the number of persons expressing their perspectives. Surveys are expensive and technically demanding.

A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is:

a. Centers for Disease Control and Prevention (CDC) reports.

b. epidemiologic data.

c. recent census data.

d. voter registration records.

b. epidemiologic data.

A major source of evaluation is epidemiologic data. Mortality and morbidity data measuring health and illness indicators are probably cited more frequently than any other single index for program evaluation.

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's:

a. efficiency.

b. progress.

c. relevance.

d. sustainability.

a. efficiency.

A program evaluation may be able to determine whether a program provides better benefits at a lower cost than does a similar program or whether the benefits to the clients or number of clients served justifies the costs of the program. This is a measure of the efficiency of a program. A reduction in teen pregnancies can represent significant cost savings to the overall health of the community.

A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about child care. The next step in the program management process would be to:

a. conduct a survey to determine how many children the fathers have.

b. determine whether the fathers have benefited from this type of program before.

c. meet with community members to form a planning body.

d. provide the fathers with community resources.

c. meet with community members

The program management process is like the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. One is applied to a program, whereas the other is applied to clients. Following the assessment, planning for the program should occur.

The nurse engaging in formative program evaluation would most likely:

a. conduct medical record audits for quality assurance.

b. make a home visit before a client is discharged from the program.

c. participate in new client evaluation.

d. write policy for risk management.

a. conduct medical record audits for quality assurance.

Quality assurance audits are prime examples of formative program evaluation in health care delivery. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program.

The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to:

a. assess the needs of potential outreach clients.

b. recognize the special needs of vulnerable people in the area.

c. identify how the problems of similar programs will not be repeated.

d. identify the resources and activities that will help them meet their program objectives.

d. identify the resources and activities that will help them meet their program objectives.

Systematic planning for meeting client needs assists in identifying the resources and activities that are needed to meet the objectives of client services. Today this type of planning is referred to as strategic planning and it involves the successful matching of client needs with specific provider strengths and competencies and agency resources.

A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is:

a. a formative evaluation.

b. an informal evaluation.

c. an ongoing evaluation.

d. a summative evaluation.

d. a summative evaluation.

Summative evaluations assess program outcomes or are a follow-up of the results of the program activities and look at the end result.

The major sources of information for program evaluation are:

Select all that apply.

a. community indexes.

b. media reports.

c. program clients.

d. program providers.

e. program records.

a. community indexes.

c. program clients.

e. program records.

Major sources of information for program evaluation are program clients, program records, and community indexes. The program participants, or clients of the service, have a unique and valuable role in program evaluation.

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:

a. assess the literacy level of the group.

b. see how many plan to attend.

c. see whether the group is ready to learn.

d. secure a good space for a group meeting.

a. 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.

Which educational method has been shown to be most effective in fostering treatment adherence?

a. Internet-based education

b. In-person counseling

c. Telephone counseling

d. Self-directed learning

a. 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

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?

a. Cognitive domain

b. Events of instruction

c. Principles of effective instruction

d. Psychomotor domain

d. 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.

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:

a. an andragogical approach.

b. a behavioral approach.

c. an operational approach.

d. a pedagogical approach.

a. 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.

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?

a. Repetition

b. Integration

c. Participation

d. Sequencing

a. 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.

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:

a. provide an online test module.

b. ask whether there are any questions.

c. ask for a return demonstration.

d. give a short paper-and-pencil quiz.

c. ask for a return demonstration.

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.

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:

a. affective domain.

b. cognitive domain.

c. events of instruction.

d. principles of effective education.

b. 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).

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?

Select all that apply.

a. Use of films

b. Small group interaction

c. Use of games

d. Session timing

e. Session space

a. Use of films

b. Small group interaction

c. Use of games

d. Session timing

e. Session space

Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics.

Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support.

Which of the following barriers are specific to the educator?

Select all that apply.

a. Fear of public speaking

b. Low literacy

c. Limited experience with the topic

d. Lack of motivation

e. Lack of experience with gaining participation

a. Fear of public speaking

c. Limited experience with the topic

e. Lack of experience with gaining participation

Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in 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.

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?

a. Cultural sensitivity

b. Efficiency in client service

c. Learning of new skills

d. Distraction-free surroundings

b. 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.

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters?

a. Anxiety

b. Effects of stress on individuals

c. Sense of urgency

d. Scapegoating and blaming

b. Effects of stress on individuals

The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings.

Nurses often participate in field assessment teams during a disaster response. These assessments are crucial to best help:

a. encourage good intentions of those giving aid.

b. match available resources to the population's emergency needs.

c. separate casualties and allocate treatment.

d. provide compassion and dignity.

b. match available resources to the population's emergency needs.

Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features.

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of:

a. anger.

b. delayed stress reaction.

c. inability to concentrate.

d. insomnia.

b. delayed stress reaction.

Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations.

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts:

a. environmental hazards are minimal.

b. individuals must ultimately recover on their own.

c. the government provides economic support.

d. religious organizations must bear the burden of the community.

b. individuals must ultimately recover on their own.

Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster.

The major factor that has increased the danger of natural disasters is:

a. El Niño.

b. geography.

c. trade winds.

d. urbanization.

d. urbanization.

The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones.

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be:

a. ARC disaster training.

b. community preparedness.

c. personal preparedness.

d. professional preparedness.

d. professional preparedness.

The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of:

a. immunizations.

b. active tuberculosis (TB) cases.

c. WIC enrollees.

d. vulnerable populations.

d. vulnerable populations.

When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects?

Select all that apply.

a. Bed-wetting episodes

b. Desire to return to school

c. Fantasies of denial

d. Increased playfulness with peers

e. Thumb sucking

a. Bed-wetting episodes

c. Fantasies of denial

e. Thumb sucking

The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to parents or have nightmares and fantasies that the disaster never occurred. School-related problems may also develop, and the child may not be able to concentrate or may even refuse to attend school.

Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response?

Select all that apply.

a. Disillusionment and reconstruction is most associated with response efforts.

b. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster.

c. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared.

d. Disillusionment is the longest phase in the stress reaction process.

e. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

b. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster.

c. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared.

e. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

The first two phases, the Heroic and Honeymoon phases, are most often associated with response efforts. The latter two phases, Disillusionment and Reconstruction, are most often linked with recovery.

In the event of a disaster, shelters are generally the responsibility of which of the following entities?

a. Centers for Disease Control and Prevention (CDC)

b. Federal Emergency Management Agency (FEMA)

c. Public Health Service (PHS)

d. Red Cross chapter

d. Red Cross chapter

Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members.

What are the core competencies of the nurse participating in surveillance and investigation activities?

Select all that apply.

a. Basic patient assessment skills

b. Effective communication skills

c. Ability to collaborate with community partners

d. Advanced-practice nurse with secondary science degree

e. Leadership and systems thinking

b. Effective communication skills

c. Ability to collaborate with community partners

e. Leadership and systems thinking

According to the Minnesota Model of Public Health interventions, what is the first step of surveillance for the public health nurse?

a. Organize the data.

b. Analyze the data.

c. Interpret and disseminate the data.

d. Determine if surveillance is appropriate.

d. Determine if surveillance is appropriate.

The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice (Centers for Public Health Nursing 2001, pp. 15, 16) suggests that surveillance is one of the interventions related to nursing practice in public health. The model provides seven basic steps of surveillance for nurses to follow

The hospital infection control practitioner reports new cases of tuberculosis to the public health department. Of what type of surveillance system is this an example?

a. Passive

b. Active

c. Sentinel

d. Special

a. Passive

Surveillance systems in use today are defined as passive, active, sentinel, and special. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems.

Which of the following systems of surveillance is used to monitor trends in commonly occurring diseases?

a. Active

b. Passive

c. Sentinel

d. Syndronic

c. Sentinel

In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored.

What is the purpose of using an algorithm in the surveillance process?

a. Tells the nurse who to call in the event of an outbreak.

b. Provides the nurse with a step by step plan to identify events needing investigation.

c. Provides the nurse with a system for telephone triage in an outbreak.

d. It is a visual reminder of the epidemiologic triangle.

b. Provides the nurse with a step by step plan to identify events needing investigation.

A quality surveillance system requires collaboration among a number of agencies and individuals: federal agencies, state and local public health agencies, hospitals, health care providers, medical examiners, veterinarians, agriculture, pharmaceutical agencies, emergency management, and law enforcement agencies, as well as 911 systems, ambulance services, urgent care and emergency departments, poison control centers, nurse hotlines, school, and industry.

A disease outbreak of severe acute respiratory syndrome has occurred and has spread over several countries outside the United States. This level of occurrence is said to be:

a. hyperendemic.

b. sporadic.

c. epidemic.

d. pandemic.

d. pandemic.

Pandemic refers to the epidemic spread of the problem over several countries or continents (such as severe acute respiratory syndrome [SARS] outbreak). If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. Sporadic problems are those with an irregular pattern with occasional cases found at irregular intervals. Epidemic means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period

What are the purposes of disease surveillance in public health?

Select all that apply.

a. Tries to identify terrorist attacks before they occur.

b. Provides a means for nurses to monitor disease trends.

c. Generates knowledge about disease or outbreak patterns.

d. Allows the nurse to advocate for policy changes.

e. Reduces morbidity and mortality and improves health through disease trend monitoring.

b. Provides a means for nurses to monitor disease trends.

c. Generates knowledge about disease or outbreak patterns.

e. Reduces morbidity and mortality and improves health through disease trend monitoring.

Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations). Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and to improve health.

The public health nurse is most likely to use what types of surveillance systems?

Select all that apply.

a. Active

b. Passive

c. Sentinel

d. Syndronic

a. Active

b. Passive

Although all of the systems are important, the public health nurse is most likely to use the active or passive systems. A passive system may use the state reportable disease system to complete a community assessment or MAPPS. The active system is used when several schoolchildren become ill after eating lunch in the school cafeteria or at the local hot dog stand, to investigate the possibility of food poisoning, or to follow up the contacts of a newly diagnosed client with tuberculosis or a sexually transmitted infection (STI) at the local homeless shelter.

The deliberate release of viruses, bacteria, or other germs with the intent of causing illness or death is:

a. event outbreak.

b. chemical terrorism.

c. biological terrorism.

d. surveillance.

c. biological terrorism.

An elementary classroom of 28 students has had 13 children who have developed chicken pox over the last 3 weeks. What is the pattern of occurrence?

a. Common source outbreak

b. Point source outbreak

c. Continuous source

d. Mixed outbreak

c. Continuous source

Intermittent or continuous source cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. In a point source outbreak all persons exposed become ill at the same time, during one incubation period. A mixed outbreak (which was described while investigating a foodborne gastroenteritis caused by a Shigella sonnei virus) is a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza.