demarco Chapter 1: Public Health Nursing

A nurse is striving to practice patient-centered care at a hospital. Which action best exemplifies providing patient-centered care?

A) Having a client complete a self-reported functional status indicator and then reviewing it with the client

B) Explaining to a client the benefits of computer-assisted robotic surgical techniques, which the hospital recently implemented

C) Recording a client's signs and symptoms in an electronic health record

D) Performing continuous glucose monitoring of a client while the client is in the hospital

ANSWER: A

Feedback: Patient-centered care considers cultural traditions, personal preferences, values, families, and lifestyles. Clients become active participants in their own care, and monitoring health becomes the client's responsibility. To help clients and their healthcare providers make better decisions, the Agency for Healthcare Research and Quality (AHRQ) has developed a series of tools that empower clients and assist providers in achieving desired outcomes, including client-reported functional status indicators. Computer-assisted robotic surgical techniques, electronic health records, and continuous glucose monitoring in the hospital are all technological advances in healthcare, but they do not help the client become a more active participant in his or her care, and thus are not good examples of patientcentered care.

A nurse is caring for an older client who is struggling to manage her type 2 diabetes mellitus. The nurse should recognize which social determinants of this client's health? (Select all that apply.)

A) Household income of $23,000 per year

B) Reading level of a third grader

C) Medication ineffective due to error in prescription

D) Originally from Sudan

E) No family in the area

ANSWER: A, B, D, E

Feedback: The social conditions in which people live, their income, social status, education, literacy, home and work environment, support networks, gender, culture, and availability of health services are the social determinants of health. These conditions have an impact on the extent to which a person or community possesses the physical, social, and personal resources necessary to attain and maintain health. A medical error on the part of the client's primary care provider or nurse would not constitute a social determinant of the client's health.

A nurse successfully persuades an obese client to perform a weekly weigh-in at home using a digital scale and record the weight in a log. This strategy is an example of:

A) Telehealth

B) Health information technology

C) Personal responsibility for health

D) Evidence-based nursing

ANSWER: C

Feedback: Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. In this case, the client makes a positive change in lifestyle by monitoring body weight weekly. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, client and professional health-related education, public health, and health administration. Health information technology (HIT) is defined as the comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner. Evidence-based nursing is the integration of the best evidence available with clinical expertise and the values of the client to increase the quality of care.

A nurse performs a variety of tasks as part of the nurse's position at a hospital. Which task best exemplifies public health?

A) Reading current nursing journals and integrating the latest research into daily practice

B) Instructing a client on how to best care for a suture site at home

C) Participating in a videoconference call with a client who lives in a remote area

D) Facilitating a community-wide smoking cessation program one month out of the year

ANSWER: D

Feedback: Public health is what society does collectively to ensure the conditions exist in which people can be healthy. A community-wide smoking cessation program is a great example of a public health intervention, in that it involves the collective effort of society to improve the health of its members. Reading and applying the latest nursing research is an example of evidence-based nursing. Instructing a client on how to best care for a suture site at home is an example of personal responsibility for health, but it is not focused on the health of the greater community. Participating in a videoconference call with a client who lives in a remote area is an example of patient-centered care and of an effective implementation of technology, but it is not particularly related to public health.

Public health nursing is distinguished from other specialties by adherence to eight principles. Which is one of the eight domains of public health nursing practice?

A) Analytic assessment skills

B) Investigation of disease

C) Referral and follow-up

D) Case management

ANSWER: A

Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills. Investigation of disease, referral and follow-up, and case management are all public health nursing interventions but are not domains of public health nursing practice.

Public health nursing is distinguished from other specialties by adherence to eight principles. Which is one of the eight domains of public health nursing practice?

A) Policy development and individual planning skills

B) Individual dimensions of practice skills

C) Financial planning and management skills

D) Leadership and individual critical thinking skills

ANSWER: C

Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills.

Public health nursing is distinguished from other specialties by adherence to eight principles. Which are domains of public health nursing practice? (Select all that apply.)

A) Intuitive assessment skills

B) Community organization skills

C) Communication skills

D) Cultural competency skills

E) Product marketing skills

ANSWER: C, D

Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills.

Which was a duty performed by district nurses in Liverpool, England, in 1865?

A) Use epidemiologic knowledge and methods

B) Encourage community organization

C) Report facts to and ask questions of physicians

D) Assist physicians with surgery in the newly constructed hospitals

ANSWER: C

Feedback: Duties of district nurses in Liverpool, England, in 1865 included the following: Investigate new referrals as soon as possible; report to the superintendent situations in which additional food or relief would improve recovery; report neglect of clients by family or friends to the superintendent; assist physicians with surgery in the home; maintain a clean, uncluttered home environment and tend fires for heat; teach the client and family about cleanliness, ventilation, giving of food and medications, and obedience to the physician's orders; set an example for "neatness, order, sobriety, and obedience"; hold family matters in confidence; avoid interference with the religious opinions and beliefs of clients and others; report facts to and ask questions of physicians; and refer the acutely ill to hospitals and the chronically ill, poor without family to infirmaries. Using epidemiologic knowledge and methods and encouraging community organization are principles of public health today, not duties of district nurses in England in 1865. Nurses at that time assisted physicians with surgery in the home, not in newly constructed hospitals.

Which is a Healthy People 2020 goal?

A) Decrease the incidence of preventable disease, disability, injury, and premature death

B) Reduce health inequity, decrease disparities, and improve the health of certain groups

C) Create social and physical environments that promote good health for all

D) Promote healthy development and healthy behaviors for the geriatric stage of life

ANSWER: C

Feedback: The Healthy People 2020 goals are as follows: attain high-quality, longer lives free of preventable disease, disability, injury, and premature death (not just to decrease the incidence of these); achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote healthy development and healthy behaviors across every stage of life, not just older adults.

A nurse is coordinating a plan to bring vaccinations in a cost-effective way to a rural community that currently lacks access to them. This is an example of which public health intervention?

A) Surveillance

B) Outreach

C) Screening

D) Case management

ANSWER: D

Feedback: In the intervention of case management, the nurse coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way. In the intervention of surveillance, the nurse monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions. In the intervention of outreach, the nurse locates populations at risk, provides information, identifies possible actions, and identifies access to services. In the intervention of screening, the nurse identifies individuals with unrecognized risk factors or asymptomatic conditions.

The nurse is locating populations in her region who are exposed to lead-based paint and providing them with information regarding the dangers of lead poisoning. This is an example of which public health intervention?

A) Surveillance

B) Outreach

C) Screening

D) Case management

ANSWER: B

Feedback: In the intervention of outreach, the nurse locates populations at risk, provides information, identifies possible actions, and identifies access to services, which is what the nurse is doing in this situation. In the intervention of surveillance, the nurse monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions. In the intervention of screening, the nurse identifies individuals with unrecognized risk factors or asymptomatic conditions. In the intervention of case management, the nurse coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way.

Select the great public health achievements in the United States in the 20th century. (Select all that apply.)

A) Elimination of common infectious diseases

B) Recognition of tobacco as a health hazard

C) Fluoridation of drinking water

D) Healthier mothers and babies

E) Decline in the percentage of obese and overweight people

ANSWER: B, C, D

Feedback: Great public health achievements in the United States in the 20th century include the following: control (not elimination) of common infectious diseases; recognition of tobacco as a health hazard; fluoridation of drinking water; and healthier mothers and babies. The percentage of overweight and obese people increased over the course of the 20th century and continues to increase today.

Demographic characteristics indicate that people in developed countries are living longer, healthier lives, yet tremendous health and social disparities exist. Which describes social determinants of health?

A) What society does collectively to ensure the conditions exist in which people can be healthy

B) Social conditions in which people live and work

C) Context of preventing disease and disability and promoting and protecting the health of the entire community

D) Comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers

ANSWER: B

Feedback: Social determinants of health are the social conditions in which people live and work. Health information technology is the comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers. Public health is what society does collectively to ensure the conditions exist in which people can be healthy. Public health nursing is a population-based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire community.

Why is there an increasing use of home monitoring devices? (Select all that apply.)

A) Rising number of people with acute conditions

B) Increased need to deliver healthcare to medically underserved populations

C) Advances in technology to assess clients' conditions in their home

D) Performing assessments in real time using Internet video systems

E) Decline in the number of older adults

ANSWER: B, C, D

Feedback: Home monitoring devices are becoming necessities, due in part to the aging population, the rising number of people with chronic (not acute) conditions, and the need to increase healthcare delivery to medically underserved populations. Advances in technology, specifically medical devices, sensors, and high-speed telecommunication networks, have made it possible to assess clients' conditions remotely in their homes, either by storing information for later access or by performing assessments in real time using Internet video systems. The number of older adults in the United States is increasing, not declining

Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. Which exemplify personal responsibility? (Select all that apply.)

A) Reviewing one's own medical records

B) Monitoring the positive and negative effects of prescription and over-the-counter medications

C) Avoiding tobacco and recreational drug use

D) Showing up for scheduled tests and procedures

E) Eating the types of foods one most enjoys

ANSWER: A, B, C, D

Feedback: Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. It includes responsibility for reviewing one's own medical records and monitoring both the positive and negative effects of prescription and over-the-counter medications. It means showing up for scheduled tests and procedures and avoiding tobacco and recreational drug use. Eating the types of foods one most enjoys is not necessarily responsible, if one most enjoys foods that do not meet dietary recommendations.

Why has there been an increase in the number of acute and chronically ill people residing in the community who need professional nursing care?

A) Shorter length of stay in long-term care facilities

B) Increase in ambulatory surgery

C) Decrease in the use of outpatient clinics

D) Increase in length of stay in emergency departments

ANSWER: B

Feedback: The shorter length of stay in acute care (not long-term care) facilities, as well as the increase in ambulatory surgery and outpatient clinics, has resulted in more acute and chronically ill people residing in the community who need professional nursing care

Which organization publishes and articulates the essentials of public health nursing, including the activities and accountabilities that are characteristics of practice at all levels and settings?

A) Association of Community Health Nurse Educators (ACHNE)

B) American Nurses Association (ANA)

C) American Public Health Association (APHA)

D) Association of State and Territorial Directors of Nursing (ASTDN)

ANSWER: B

Feedback: The American Nurses Association (ANA) sets the scope and standards for all professional practice. The publication Public Health Nursing: Scope and Standards of Practice articulates the essentials of public health nursing, including the activities and accountabilities that are characteristic of practice at all levels and settings. The Quad Council of Public Health Nursing Organizations is an alliance of four national nursing organizations that addresses public health nursing issues in the United States, composed of the following: Association of Community Health Nurse Educators (ACHNE), ANA's Congress on Nursing Practice and Economics (CNPE), American Public Health Association (APHA)-Public Health Nursing Section, and Association of State and Territorial Directors of Nursing (ASTDN).

A high school graduate has decided to pursue a career in public health nursing. Which represents the minimum educational credential that this student will need to obtain entry into public health nursing practice?

A) Associate's

B) Baccalaureate

C) Master's

D) Doctorate

ANSWER: B

Feedback: The baccalaureate degree in nursing is the educational credential required for entry into public health nursing practice. Master's level education, with specific expertise in population-focused care, is required for advanced practice or specialist practice. Registered nurses and licensed practical nurses with a diploma or associate's degree may appropriately practice in community settings where care is directed toward the health or illness of individual clients or families rather than populations. A doctorate degree in nursing may be required for academic and research positions associated with public health nursing.

Who prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions?

A) Clara Barton

B) Dorothea Dix

C) Lemuel Shattuck

D) Lillian Wald

ANSWER: C

Feedback: Lemuel Shattuck prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions. Clara Barton achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with the help of her team of nurses. Dorothea Dix was also an American political activist in the 19th century who became aware of the dreadful conditions in prisons and mental hospitals, and she vigorously lobbied state and federal officials to remedy the situation. Lillian Wald was the founder of public health nursing.

Which core functions of the government address the health of its citizens? (Select all that apply.)

A) Providing healthcare directly to its citizens

B) Assessing healthcare problems

C) Developing healthcare policy that provides access to services

D) Building state-of-the-art hospitals

E) Ensuring delivery of healthcare services and achievement of desired outcomes

ANSWER: B, C, E

Feedback: A government has three core functions in addressing the health of its citizens: (1) it assesses healthcare problems, (2) intervenes by developing relevant healthcare policy that provides access to services, and (3) ensures that services are delivered and outcomes achieved. Although some government agencies, such as the U.S. Department of Veterans Affairs, do provide healthcare directly to citizens, this is not a core function of the government. Building state-of-the-art hospitals is not a core function of government, either.