Chapter 02: Historical Factors: Community Health Nursing in Context Nies: Community/Public Health Nursing, 8th Edition

1. Which best describes the time period when communities began to agree on collective action to stay healthy?

a. When industrialization occurred

b. When large urban centers began to develop and the population expanded

c. When people gathered together to settle in villages

d. When people were nomads engaged in hunting and gathering

ANS: D

Primitive prehistorical societies had health practices to ensure their survival. Isolation and fumigation were used for thousands of years. This time period is best described by when people were nomads engaged in hunting and gathering. Industrialization, development of large urban centers, and settlement into villages do not describe this time period.

2. Which best describes the first measures used by large communities to ensure community health?

a. Building safe sewage disposal systems

b. Healthy food choices and exercise

c. Praying to the gods for preservation

d. Use of medicine and other herbal remedies.

ANS: A

In classical times, large cities grew, and elaborate drainage systems were constructed. In Leviticus, the Hebrews formulated the first hygiene code. This hygiene code protected water and food by creating laws that governed personal and community hygiene, such as contagion, disinfection, and sanitation. This is best described through the building of safe sewage disposal systems. Healthy food choices and exercise, praying to the gods for preservation, and the use of medicine and other herbal measures were not among the first measures used by large communities to ensure health.

3. A nurse has determined that there is always a consistent level of people in the population who experience pneumonia. Which best describes the prevalence of this disease?

a. Prevalent

b. Endemic

c. Epidemic

d. Pandemic

ANS: B

By definition, when diseases are always present in a population they are called endemic. Diseases which were occasionally present and often fairly widespread are called epidemic. Pandemic is used to describe the existence of a disease in a large proportion of the population. Prevalent means widespread, and would not be the best term to describe this disease.

4. Which best describes an innovation introduced by the Romans?

a. Citizenship duties

b. Immunizations

c. Hospitals and nursing homes d. Daily exercise

ANS: C

The Romans introduced many health innovations such as fresh water, public physicians, hospitals, surgeries, infirmaries, and nursing homes. Unfortunately, these services were only for the wealthy. Citizenship duties, immunizations, and daily exercise were not innovations introduced by the Romans.

5. Which best describes a modern public health practice that was originally developed as a means of self-protection from the Black Death (bubonic plague)?

a. Care in a hospital

b. Chemical intervention

c. Isolation and quarantine

d. Herbal remedies

ANS: C

Modern public health practices, such as isolation, disinfection, and ship quarantines, emerged in response to the bubonic plague. Care in a hospital was originally developed by the Romans. Chemical intervention and herbal remedies were not used to self-protect from the Black Death.

6. Which disease provided immunity to smallpox?

a. Cowpox

b. Measles

c. Mumps

d. Scarlet fever

ANS: A

Those that had an infection of cowpox were thereafter immune from smallpox, which was endemic and killed about 10% of the population. Measles, mumps, and scarlet fever did not provide immunity to smallpox.

7. A scholar during the Sanitary Revolution created medical topographies. What was the advantage of these surveys?

a. Citizens knew which wells were safe to use for drinking water.

b. People knew what housing areas to avoid.

c. Results demonstrated geographical factors related to regional disease.

d. The king could isolate areas of disease from safe areas.

ANS: C

Survey methods were being used to study health problems. The medical topographies illustrated geographical factors related to regional health and disease. They did not address the safety of wells, housing areas, or the isolation of disease.

8. How did Edwin Chadwick's ideas help decrease disease in the nineteenth century?

a. The minimum wage was increased leading to improved quality of life.

b. Parish workhouses where poverty-level children labored for their room and board were closed.

c. Social reform legislation resulted in changes such as sidewalks.

d. The new emphasis on individual responsibility encouraged people to act to protect their own health.

ANS: C

Edwin Chadwick's Report on the Sanitary Conditions of the Labouring Population of Great Britain led to legislation for social reform, including child welfare, factory management, clean water, sewers, fireplugs, and sidewalks. This report did not address increasing the minimum wage, closing parish workhouses, or increasing individual responsibility.

9. Which best describes how John Snow was able to decrease deaths from cholera?

a. Removed a source of contaminated water

b. Created the world's first antibiotic

c. Encouraged the new process of vaccination

d. Helped pass laws that required home quarantine.

ANS: A

John Snow demonstrated that cholera was transmissible through contaminated water. He removed the pump handle from the contaminated water so an alternate source of water had to be used. Alexander Fleming created the first antibiotic. Legislators were responsible for encouraging the new process of vaccination and passing laws related to home quarantine.

10. Which best describes the achievement that Lemuel Shattuck is well known for in the United States?

a. Publishing the census of Boston, which demonstrated the effect of sanitary reforms

b. Demonstrating the usefulness of vital statistics by analyzing environmental data c. Developing ideas about public health care reform, which were eventually adopted d. Establishing a state board of health to deal with the problems he had noted

ANS: C Lemuel Shattuck organized the American Statistical Society and issued a census, which demonstrated high mortality rates. His report of the Massachusetts Sanitary Commission recommended modern public health reforms. However, nothing was actually done about the recommendations for almost two decades. Eventually, the merit of his ideas was recognized.

11. Which nursing intervention would have most likely been used by Florence Nightingale when treating wounded soldiers? a. Establishing private visits with spouses b. Improving food, clothing, and cleanliness c. Administering intravenous medications d. Completing a community assessment of the army hospital

ANS: B Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens and a laundry and provided food, clothing, dressings, and laboratory equipment. Her focus on environmental improvements did not address private spousal visits, administration of IV (intravenous) medications, or completion of a community assessment.

12. Which best describes how Nightingale responded to challenges about her suggestions for reform of health care? a. She influenced male friends as political leaders to publicize her ideas. b. She conveyed her statistical data in more detail and depth, and shared it with political leaders. c. She encouraged those who challenged her to come up with more acceptable approaches to lowering the death rate. d. She understood their concerns and tried to word her suggestions in a more

ANS: B

13. When comparing a surgeon today with a surgeon of Nightingale's time, which best describes the primary difference in how they would operate on a patient? a. Current physicians have better surgical equipment (tools). b. Current physicians have nursing support staff in the operating room. c. Current physicians would carefully scrub between cases. d. Current physicians would prescribe antibiotics in the operating room.

ANS: C Physicians in Nightingale's time believed in spontaneous generation, which stated that disease organisms grew from nothing, and were unaware of how diseases spread. Consequently, they did not use sanitary operating procedures, including scrubbing between cases. The different surgical equipment, nursing support, and use of antibiotics do not describe the primary difference.

14. Which scientific belief or idea eventually changed medical practice and decreased morbidity and mortality? a. Bad fluids cause disease, which can be cured by their removal. b. Specific contagious organisms cause disease. c. Spontaneous generation theory—disease grows naturally. d. The miasmic theory—environmental conditions cause disease.

ANS: B The emergence of the germ theory of disease focused diagnosis and treatment on the individual organism and the individual disease. The theories related to bad fluids causing disease, spontaneous generation, and miasmic theory were all proven to be incorrect.

15. Why did local and state governments start to become more involved in controlling disease? a. Hospitals were becoming overcrowded. b. Businesses were unable to make a profit when employees were ill. c. Physicians demanded government support in their individual efforts. d. Citizens were becoming upset with local conditions.

ANS: D Community outcry for social reform forced state and local governments to take notice of deplorable conditions and take more responsibility for controlling the spread of bacteria and other microorganisms. Hospital overcrowding, unprofitability of businesses, and physician demand for government support did not influence the increased involvement of local and state governments.

16. Which intervention was the first step in controlling the incidence of tuberculosis (TB)? a. Institutions were required to report TB cases.

b. Federal funding was devoted to seeking TB causes and cures. c. Physicians began surveillance of TB cases. d. States built large public hospitals to treat patients with TB.

ANS: A Physicians fought being required to maintain surveillance of TB and TB health education. States had to build large state hospitals for treatment but that did not notably control the incidence. The New York City Health Department required institutions to report cases of TB in 1894 and required physicians to do the same by 1897.

17. Which best describes the overall result of Abraham Flexner's report? a. All medical schools reorganized into the German model. b. Citizens were encouraged to become more involved in medical education. c. Folk healers again became more widely used than physicians. d. Funding was withdrawn from weak medical schools.

ANS: D Funding was withdrawn such that scientifically inadequate medical schools closed, not reorganized into the German model. The Flexner report outlined shortcomings of weak schools that were not built on the German model of a scientific base. Physicians now emerged who had been taught the germ theory of disease. The report did not address citizen involvement in medical education or the increased use of folk healers.

18. Which group was primarily responsible for the establishment of the first school of public health? a. The American Medical Association b. The Association of State Departments of Public Health c. The federal government d. The Rockefeller Foundation

ANS: D Philanthropic foundations influenced many health care efforts. The Rockefeller Sanitary Commission strived for the eradication of hookworm. This model of prevention was so successful that the Rockefeller Foundation established the first school of public health in 1916.

19. A family living in England in 1860 was part of the community where district nursing was implemented. Who would most likely have seen this family? a. A social worker and a nurse b. A health teacher and a nurse c. A nurse d. A physician and a nurse

ANS: A

20. Which intervention was most helpful in assisting people become educated on healthful living in nineteenth-century England? a. Brochures were distributed without charge in public places. b. Health visitors joined nurses in providing care in the homes. c. Nurses spent the majority of their time teaching families. d. Schools set up health programs for neighborhood adults.

ANS: B Health pamphlets alone had little effect, so health-visiting services enlisted home visitors to distribute health information to the poor. Eventually, although Nightingale thought district nurses should be the health teachers, district nurses provided care for the sick while the health visitor provided health information in the home.

21. Which best describes the district nursing service created in the United States by Lillian Wald and Mary Brewster? a. House on Henry Street b. Visiting Nurses Association c. New York City District Nursing Service d. Wald and Brewster Nursing Service

ANS: A They established a district nursing service on the Lower East Side of New York City called the House on Henry Street for all the unemployed and homeless immigrants who needed health care. It later evolved into the Visiting Nurse Association of New York City and helped establish public health nursing in the United States.

22. Which statement best summarizes Wald and Brewster's approach to home nursing? a. "All services all the time" b. "Helping people to help themselves" c. "One person, one family, at a time" d. "Your home or ours"

ANS: B The nursing service adopted the philosophy of meeting health needs of aggregates including social, economic, and environmental determinants of health. This aggregate approach empowered people of the community. A later director summarized their role as "one of helping people to help themselves." Because they were empowering others, the other statements do not fit this philosophy.

23. Which did Lillian Wald help establish? a. Child employment centers with shortened work days b. Daycare centers for preschool-aged children

c. Nurseries for infants of working mothers d. School health nursing for school-aged children

ANS: D Wald convinced the New York City Health Commissioner to put a public health nurse into a school. The experiment was so successful that schools adopted nursing on a widespread basis, thereby creating the field of school health nursing. Child employment centers, daycare centers, and nurseries for working mothers were not created by Wald.

24. Which statement best summarizes the view of nurses as seen in novels over the past 100 years? a. Nurses are and have always been seen as very strong intelligent women. b. For the past 50 years, nurses were primarily viewed as promiscuous women. c. Nurses are controlling, almost sadistic women who enjoy their power over patients. d. Nurses are obedient handmaidens to physicians, following whatever orders are given.

ANS: B

In the early 1900s novels began to depict strong, independent, female nurses. This continued until the 1960s and 1970s when they were presented very negatively as promiscuous "bed hopping honeys." Popular literature showed the most negative image of nurses, and classics and children's literature showed a more positive image.

25. Which best describes the primary focus of health care efforts in the United States? a. Acute illnesses and trauma b. Chronic diseases c. Diarrhea and starvation d. Infectious diseases

ANS: B Whereas diarrhea, starvation, and infectious diseases are major causes of death in developing countries, in developed countries such as the United States, chronic diseases are the primary cause of mortality.

26. Which statement best describes why there is an increased need for advanced practice nurses in primary care? a. Clinics are being built in many middle-class neighborhoods. b. Hospitals are increasing their number of beds. c. More nurses are choosing to obtain master's degrees. d. Most physicians are specialists.

ANS: D

In 2010, about two thirds of the active physicians in the United States were specialists. Because so many physicians are specialists and there is increasing demand for primary care providers, there are increased opportunities for advanced practice nurses in primary care. Hospitals are decreasing the number of beds, not increasing them.

27. Which statement best explains the continued incidence of infectious disease in the United States today? a. Illness theory explains that there are many causes of illness resulting from environmental conditions. b. No single theory adequately explains why a particular person gets a particular illness at a particular time. c. The germ theory explains that a specific infection is caused solely by the invasion of particular bacteria. d. The theory of susceptibility states that an individual only gets ill when there is extensive stress in his or her life.

ANS: B

Each theory explains some disease under some conditions, but no single theory accounts for all disease. Infectious agents cause disease when a person is susceptible as a result of stress and/or environmental conditions. The definition of germ theory is correct; however, this does not best explain the continued incidence of infectious disease in the United States. Illness theory is not a major theory that is used to discuss incidence of infectious disease.

28. Which best describes the primary concern both historically and today for many people when they become ill? a. Can they get an appointment to see their physician in a timely fashion? b. Can they get admitted to their local hospital without delay? c. How can they afford to take time off from work and lose pay to be ill? d. Will the expenses be covered by their health insurance?

ANS: C The greatest health concerns at the beginning of the twentieth century were lost wages associated with sickness. This continues today as many employment positions do not have sick leave; if employees are not at work, they do not get paid. All illnesses do not require a visit to a physician or admission to a hospital. Historically, the public has not paid much attention to health care charges as health care insurance from third party reimbursement has been the payer for many health care services.

29. Which statement best describes the increase in life expectancy among Americans during the twentieth century?

a. Life expectancy increased by 30 years; the majority can be attributed to advances in medical technology. b. Life expectancy increased by 30 years; the majority can be attributed to public health efforts. c. Life expectancy increased by 30 years; the majority can be attributed to improved physician education. d. Life expectancy increased by 30 years; the majority can be attributed to increased access to care.

ANS: B

During the twentieth century, the health and life expectancy of persons living in the United States improved dramatically. It is important for nurses to realize that of the 30 years of life expectancy gained during the century, 25 years were attributable to public health efforts. The advances in medical technology, improved physician education, and increased access to care have not had the impact on increasing life expectancy that the public health efforts have had

30. Which is a major challenge for health care provider education today? a. Ensuring that research findings related to families and groups are included in the curriculum b. Expanding the curriculum to allow additional experiences in community health settings outside the hospital c. Increasing course emphasis on environmental influences on health d. Refocusing the curriculum from care of the individual to needs of aggregates

ANS: D There is an obvious need for a primary care curriculum that prepares students to meet the needs of aggregates through population-based strategies that include understanding of statistical data and epidemiology. Primary health care and health promotion rather than acute care treatment would be emphasized. Such a curriculum would move the focus from the individual to a broader population approach.

In which historical age would people have had an increased risk for contracting salmonella, anthrax, Q fever, or tuberculosis from the proximity of domesticated animals and herds?

Hunting and gathering stage

Settled village stage

Preindustrial cities stage

Industrial cities stage

Settled village stage

During the Renaissance period, much was learned about health and disease. The Elizabethan Poor Law was enacted during this time to

govern personal and community hygiene such as contagion, disinfection, and sanitation.

make local church parishes responsible for caring for the poor in the community.

enforce hygienic codes from Leviticus and establish leper houses.

legislate social reform, addressing issues such as child welfare and factory management.

make local church parishes responsible for caring for the poor in the community.

Edwin Chadwick’s Report on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britain greatly contributed to the development of the

National Organization for Public Health Nursing.

American Medical Association.

General Board of Health for England. 

National Institute.

General Board of Health for England.

What discovery by Edward Jenner resulted in one of the greatest medical advances of the 18th century?

The benefits of isolation in the control of communicable disease such as bubonic plague

The discovery that cholera was transmissible through contaminated water

The identification of modern epidemiologic principles, such as agent-host-environment

The development of the smallpox vaccination that resulted in immunity after inoculation with the cowpox virus

The development of the smallpox vaccination that resulted in immunity after inoculation with the cowpox virus

Lemuel Shattuck, a Boston bookseller with an interest in public health, published the 1850 book Report of the Massachusetts Sanitary Commission. Which was not a recommendation of the report?

Keeping a record of vital statistics

Developing well-infant and well-child care programs

Introducing modern family planning methods in the United States 

Beginning a system of vaccination and health education

Introducing modern family planning methods in the United States

The first visiting nurse in the United States was

Lillian Wald.

Mary Brewster.

Florence Nightingale.

Francis Root.

Francis Root.

Modern community health nursing requires the nurse to __________, which empowers people to understand and address their health issues and disease.

practice from a population focus

adopt a medical model of care

return to earlier models of prevention

focus on the individual and family

practice from a population focus

Which was not a public health service provided by the Romans?

A supervisor of the public baths

Street cleaners

Supervision of the sale of food

Housing for the indigent population

Housing for the indigent population