N327 Quiz 1 & Midterm Exam Practice Questions

A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on which functions?

A. Monitoring pregnant teenagers for symptoms of complications of pregnancy
B. Offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members
C. Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders
D. Preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses

C. Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders

A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. Which of the following is most likely to be the rationale for the lack of support?

A. Colleagues' push for nurses to focus on population initiatives.
B. Costs associated with staff training and revision of documents.
C. Lack of support from the agency's funding sources.
D. Opinions that nursing should focus on direct client care and services.

D. Opinions that nursing should focus on direct client care and services.

The role and goals of the community health nursing practice can best be described as:

A. community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes.
B. education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs.
C. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole.
D. activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.

C. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole.

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. Which core public health function does this represent?

A. Assessment
B. Assurance
C. Policy development
D. Research

A. Assessment

The state public health 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 eldercare programs. Which public health core function does the nurse apply in this situation?

A. Assurance
B. Policy development
C. Primary prevention
D. Public transportation

A. Assurance

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing what type of care?

A. Community-oriented
B. Community-based
C. Secondary care
D. Tertiary care

A. Community-oriented

A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals. This can best be described as an example of which type of care?

A. Clinical community health practice
B. Community-based practice
C. Population-focused practice
D. Public health nursing

A. Clinical community health practice

Nurses consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. Which is an example of such opportunity?

A. Operator of a nurse practitioner-run urgent care center in a major retail location
B. Director of clinical services providing a wide range of services to populations seen by the system
C. Clinical director of a home health agency
D. School nurse position in the local high school

B. Director of clinical services providing a wide range of services to populations seen by the system

Public health nursing specialists are interested in which of the following topic(s)? (Select all that apply.)

A. Educational materials for individuals with HIV/AIDS
B. Evaluation of an outreach program for at-risk pregnant teenagers
C. Community subpopulations with high rates of type 2 diabetes
D. New technologies to monitor diabetes
E. Prevalence of hypertension among various age, race, and gender groups

B. Evaluation of an outreach program for at-risk pregnant teenagers
C. Community subpopulations with high rates of type 2 diabetes
E. Prevalence of hypertension among various age, race, and gender groups

To develop a baseline for a presentation at the local women's club about the status of women's health in the community, a community-oriented nurse researches national vital statistics to establish the leading cause of women's deaths in the United States. In the United States, the leading cause of death for women is:

A. cancer.
B. heart disease.
C. infectious disease.
D. stroke.

B. heart disease.

The nurse counseling women regarding hormone replacement therapy (HRT) would include which information?

A. HRT is beneficial for vasomotor symptoms for a brief time.
B. HRT should be considered for prevention of osteoporosis in all women.
C. Menopause is a result of hormone deficiency and HRT is appropriate for all women.
D. Research concludes that HRT does prevent heart disease in menopausal women.

B. HRT should be considered for prevention of osteoporosis in all women.

At the request of a local senior women's group, a nurse is developing an osteoporosis primary prevention program. Which of the following is an appropriate strategy the nurse would incorporate in the program?

A. Design a nurse-directed program instead of a peer-directed program.
B. Encourage exercise and consideration of HRT.
C. Promote diets rich in calcium and vitamin D and daily weight-bearing exercise.
D. Promote swimming and supplementation with calcium and vitamin D.

C. Promote diets rich in calcium and vitamin D and daily weight-bearing exercise.

In comparison with women, men:

A. incur more work-related injuries.
B. experience lower survival rates in the first year after myocardial infarction.
C. metabolize alcohol more efficiently.
D. more actively initiate preventive health care interventions.

A. incur more work-related injuries.

Which man would have the highest risk for prostate cancer?

A. Has erectile dysfunction
B. Has multiple sex partners
C. Is African American
D. Refuses to be screened

C. Is African American

A new primary health clinic is established in a predominantly African American neighborhood to address the top causes of mortality in the local adult population. The nurse at the clinic uses a community-focused nursing process to plan interventions aimed at reducing the incidence of:

A. cardiovascular accident, lung cancer, and alcoholism
B. depression, alcohol abuse, and obesity
C. heart disease, stroke, and homicide
D. mental illness, drug and alcohol abuse, and heart disease

C. heart disease, stroke, and homicide

A nurse designing a program to improve the health of frail elderly. What does the nurse need to address in this program?

A. Culture, religion, and race
B. Media and marketing initiatives
C. Racial/ethnic and sociological disparities
D. Vital statistics on mortality causes

C. Racial/ethnic and sociological disparities

Diabetes mortality rates continue to rise for all ethnic and socioeconomic groups, but evidence shows that which of the following are true? (Select all that apply.)

A. Addressing the diabetic epidemic involves more than a focus on individual factors
B. Community-based education programs have done little to address the problem
C. Complications and mortality rates are highest among low-income and minority groups
D. Selection of healthy food options is both an availability issue and an education issue
E. Standard of living does not affect decision making

A. Addressing the diabetic epidemic involves more than a focus on individual factors
C. Complications and mortality rates are highest among low-income and minority groups
D. Selection of healthy food options is both an availability issue and an education issue

A community-oriented nurse is developing goals for a community health center's senior center. The goals should focus on which of the following? (Select all that apply.)

A. Helping elders accept the inevitability of aging
B. Implementing secondary prevention measures
C. Maximizing functional status
D. Meeting social needs
E. Providing appropriate recreation

B. Implementing secondary prevention measures
C. Maximizing functional status
D. Meeting social needs
E. Providing appropriate recreation

A nurse is planning a women's screening program to detect the presence of the leading causes of disease burden for women in the United States. What items would the nurse include in the program? (Select all that apply.)

A. Blood pressure
B. Depression
C. Usual diet
D. Sexually transmitted diseases
E. Smoking

A. Blood pressure
C. Usual diet
E. Smoking

What was one of Mary Breckenridge's innovative contributions to health care in the United States?

A. Establishing the Federal Emergency Relief Administration
B. Introducing the first nurse-midwifery training
C. Introducing the nursing process
D. Establishing occupational health nursing

B. Introducing the first nurse-midwifery training

The most important contribution made by Florence Nightingale to community-oriented nursing was which of the following?

A. Developing the settlement house concept to improve urban health standards
B. Expanding the role of nursing to include health-promotion practices
C. Founding the first district nursing association in England
D. Introducing professional schools of nursing in the United States

B. Expanding the role of nursing to include health-promotion practices

The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy of Title VI of the Social Security Act (1935) related to public health nursing was funding which of the following?

A. The Frontier Nursing Service
B. Employment and education of nurses
C. Research and investigation of disease
D. The district nursing model

B. Employment and education of nurses

The primary impetus for the school nurse program established by Lilian Wald was to work with children in the schools and make home visits for the purpose of:

A. enforcing the department of health's rules and regulations.
B. excluding infectious children from the school environment.
C. providing and obtaining medical treatment for absent students.
D. providing shoes and clothing for students.

C. providing and obtaining medical treatment for absent students.

Categorical Congressional funding has had which effect on health care?

A. Positive by adoption of 2-year associate degree nursing programs
B. Negative leading to exclusion of home-based care from health insurance coverage
C. Negative as the national preference service model neglects emerging problems
D. Positive due to the sharp rise in hospital-based care and technological resources

C. Negative as the national preference service model neglects emerging problems

During the Depression, which of the following created a negative effect on public health nursing?

A. Decrease in focus on the community as the unit of service.
B. Increase in the scope of fundamental services.
C. Increase in field experience requirements for public health.
D. Decrease in the need for training and supervision.

A. Decrease in focus on the community as the unit of service.

The Association of Community Health Nurse Educators has called for increased graduate programs to educate Public Health Nursing leaders, educators, and researchers in such areas as:

A. immigrant and migrant health.
B. natural and human-made disasters.
C. automobile safety for children.
D. student health.

B. natural and human-made disasters.

Which of the following are recommendations of the 1850 Shattuck Report that represented major innovations in public health? (Select all that apply.)

A. Establishment of state health departments and local health boards in every town
B. Promotion of environmental sanitation and collection of vital statistics
C. Steps to decrease preventable disease and control smoking and alcohol use
D. Targeting of efforts solely on environmental hazards
E. Provision of supplemental food to low-income persons

A. Establishment of state health departments and local health boards in every town
B. Promotion of environmental sanitation and collection of vital statistics
C. Steps to decrease preventable disease and control smoking and alcohol use

Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of her times? (Select all that apply.)

A. Community health's focus on teaching and prevention
B. Establishment of settlement houses
C. Establishment of the town and country nursing services in large cities
D. Lack of public interest in limiting disease
E. Middle and upper class fear of diseases

A. Community health's focus on teaching and prevention
B. Establishment of settlement houses
E. Middle and upper class fear of diseases

Which are major accomplishments of the National Organization for Public Health Nursing (NOPHN)? (Select all that apply.)

A. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home
B. Established public health nursing programs for military outposts in World War I
C. Provided matching funds to establish maternal and child health divisions in state health departments
D. Responded to the 1918 worldwide influenza pandemic in the United States
E. Supported nurse employment through increased grants-in-aid for state programs of home medical care

A. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home
B. Established public health nursing programs for military outposts in World War I
D. Responded to the 1918 worldwide influenza pandemic in the United States

The three components of the Intervention Wheel are:

A. communities, systems, and individuals/families.
B. interventions, color wedges, and levels of practice.
C. population base, levels of practice, and public health interventions.
D. populations at risk, populations of interest, and levels of practice.

C. population base, levels of practice, and public health interventions.

Public health nursing practice is guided by the community's priorities as identified by community:

A. assessment
B. diagnosis
C. interventions
D. planning

A. assessment

Collaboration is an intervention that would be located where in the Intervention Wheel?

A. Red wedge at the individual/family level of practice
B. Blue wedge at the community level of practice
C. Orange wedge at the community level of practice
D. Green wedge at the systems level of practice

C. Orange wedge at the community level of practice

The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as:

A. advocacy
B. coalition building
C. consultation
D. social marketing

D. social marketing

Promoting the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of:

A. community-level practice
B. family-level practice
C. individual-level practice
D. systems-level practice

D. systems-level practice

When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses (PHNs) conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of:

A. community-level practice
B. family-level practice
C. individual-level practice
D. systems-level practice

A. community-level practice

A nursing diagnosis of increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the \_______ level of practice and the \_______ level of prevention.

A. individual/family; secondary
B. community; primary
C. community; secondary
D. individual/family; primary

D. individual/family; primary

After consulting with the health department director, a PHN collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the \_______ component of the nursing process to a \_______ level of practice.

A. evaluation; systems
B. assessment; community
C. implementation; systems
D. diagnosis; community

C. implementation; systems

A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to \_______ the program and design program improvements.

A. evaluate the effectiveness of
B. assess the expansion needs of
C. identify problems with
D. implement the expansion of

A. evaluate the effectiveness of

Factors related to the determinants of health identified in Healthy People 2020 include which of the following? (Select all that apply.)

A. Education and literacy
B. Genetic endowment
C. Gender
D. Culture
E. Social status

All answer choices are correct.

Primary health care (PHC) differs from primary care in which of the following ways?

A. PHC encourages community participation
B. PHC focuses on prevention and cure
C. PHC is defined more narrowly
D. PHC is the primary method of health care delivery in the United States

A. PHC encourages community participation

A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include which of the following?

A. Administration of Medicare reimbursement rates and eligibility determination
B. Programs involving the local community, including sanitation and communicable disease contact tracing
C. Disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes
D. Monitoring drugs and over-the-counter products available for sale and use by consumers.

C. Disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes

What is the major barrier to achieving the "Health for All in the 21st Century in the United States?

A. Global indicators are not applicable to the United States.
B. Healthy People 2020 is not consistent with the Declaration of Alma-Ata.
C. Primary Health Care is not the primary delivery method for health care in the United States.
D. The U.S public health system is not structured to provide PHC.

C. Primary Health Care is not the primary delivery method for health care in the United States.

The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is which of the following?

A. Department of Homeland Security
B. U.S. Department of Health and Human Services
C. Local Health Department
D. State Department of Health

B. U.S. Department of Health and Human Services

What is the major factor driving current discussions about a Medicare shortfall in the middle of the twenty-first century?

A. Diversity of the U.S. health care workforce
B. Longevity of the U.S. population
C. Percentage of elderly in the U.S. population
D. Percentage of foreign-born in the U.S. population

C. Percentage of elderly in the U.S. population

The local nurse-managed community health center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. What system does this best describe?

a. Managed care
b. Primary care
c. Primary health care
d. Private health care

c. Primary health care

A factor that strongly influences the success of a PHC system is:

A. participation of the community members in the design, implementation, and evaluation of the initiative
B. assurance of access to care for every woman and child from pregnancy through childhood
C. each entity's sense of urgency regarding the evaluation of indicators
D. cure orientation of the private sector of health care delivery in the United States

A. participation of the community members in the design, implementation, and evaluation of the initiative

Which of the following groupings of health care trends will have the greatest influence on the health care transformation process? (Select all that apply.)

A. Aging of the population and medical technology advances
B. Funding levels, political structure, and professional licensure requirements
C. Longevity, population diversity, and funding sources
D. Managed care, workforce shortages, and level of education of the population

A. Aging of the population and medical technology advances
C. Longevity, population diversity, and funding sources

Benefits of an electronic health record in the public health system include: (Select all that apply.)

A. 24-hour availability of health records
B. ease of referral coordination
C. reduction in medication errors
D. increased privacy
E. consistently reliable internet resources

A. 24-hour availability of health records
B. ease of referral coordination
C. reduction in medication errors

The most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand include which of the following? (Select all that apply.)

A. Transforms the health care system from a sick care system to health care system
B. Uses piecemeal approach to strengthen the safety net
C. Replaces the rational equitable health care system
D. Provides insurance reform
E. Increases access to affordable health care insurance

A. Transforms the health care system from a sick care system to health care system
D. Provides insurance reform
E. Increases access to affordable health care insurance

Which action by the community-oriented nurse best illustrates a partnership for health?

A. Assisting a school nurse in conducting vision screening of elementary school children
B. Developing a volunteer program for teaching parenting skills
C. Helping a group of citizens collect relevant health data and develop interventions related to potential environmental hazards
D. Informing a neighborhood council that smoking is its major community health problem

C. Helping a group of citizens collect relevant health data and develop interventions related to potential environmental hazards

A rural county public health nurse is in the first phase of a community assessment to determine the health status characteristics of the local county. This initial data gathering should most likely begin with which agency?

A. County public health department
B. National Centers for Disease Control and Prevention
C. State vital statistics bureau
D. U.S. Census Bureau

C. State vital statistics bureau

A nurse new to community-oriented nursing expresses concern about traveling to a specific area of town. What response by the nursing manager is best?

A. "Don't worry, I've gone there many times myself."
B. "It is safe during the daytime but expect people loitering around."
C. "Someone needs to go to that community, so don't stereotype them."
D. "We can arrange another nurse to go with you."

B. "It is safe during the daytime but expect people loitering around."

A public health nurse leader is working with community leaders and interested citizens to improve access to services for the underserved by planning an expansion of the local community health clinic. This is an example of which type of community partnership model?

A. Coalition
B. Democratic
C. Passive
D. Community member-professional

D. Community member-professional

The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who makes introductions between the nurse and the neighborhood residents who will partner together. The role of the pastor in this example is:

A. gatekeeper
B. community health worker (CHW)
C. professional service provider
D. stakeholder

A. gatekeeper

The most important aspect of the nursing community assessment phase can best be described as:

A. analyzing and synthesizing data
B. collecting and gathering data
C. formulating a community nursing diagnosis
D. identifying problem correlates

C. formulating a community nursing diagnosis

A rural community health nurse has made sure that CHWs are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be:

A. influential with their insider status to engage community members
B. medical professionals within the migrant community
C. natural healers within their community
D. translators to help overcome language barriers

A. influential with their insider status to engage community members

The public health nurse is planning community programs. Which program would the nurse plan to incorporate utilitarianism?

A. Ensuring vaccinations in poorer neighborhoods
B. Providing vaccinations to low-income senior centers
C. Using stakeholders to determine priority areas for vaccinations
D. Widespread influenza vaccination events

D. Widespread influenza vaccination events

If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about:

A. boundaries, parts, and dynamic processes
B. community health status and structure
C community problems and problem correlates
D. role of the nurse and lay advisers

A. boundaries, parts, and dynamic processes

Which of the following are important concepts related community-as-client nursing? (Select all that apply.)

A. Change for the benefit of the community-client must often occur at several levels
B. Changes in the health of individuals will affect the health of their communities
C. The idea of providing health-related care within the community is not new
D. The impact of the environment on health has long been established
E. Direct hands-on nursing care delivered to individuals or families in community settings is important

A. Change for the benefit of the community-client must often occur at several levels
B. Changes in the health of individuals will affect the health of their communities
C. The idea of providing health-related care within the community is not new
D. The impact of the environment on health has long been established

A nurse asks a couple who are new parents for their baby's full name. The parents reply that in their culture they are only supposed to give the baby its first name. What response by the nurse is most appropriate?

A. Tell the couple that they are the child's parents and it is up to them to name their baby
B. Explain that the Bureau of Vital Statistics has a deadline for completing the birth certificate
C. Give the couple the paperwork and ask when the baby will have a name
D. Express interest and ask the couple to share how their new baby will receive its name

D. Express interest and ask the couple to share how their new baby will receive its name

A new group of migrant farmworkers has arrived in a community. What action by the public health nurse is most important prior to scheduling clinic services?

A. Consult the public health staff regarding their schedule for large open time blocks
B. Learn about the farmworkers' concept of time and their work schedule
C. Review written materials about the farmworkers' culture of origin
D. Visit the farmworker camp and tell the camp leaders when clinic services will be available

B. Learn about the farmworkers' concept of time and their work schedule

A nurse is conducting a diabetes self-management group-education session for recent immigrants. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. What action by the nurse is best?

A. Clarify that no one has to remove his or her shoes and continue the education
B. Explain that everyone must learn to do foot inspection to manage their diabetes
C. Slowly repeat the instructions for all participants to remove their shoes
D. Stop the group session, pull the two gentlemen aside, and apologize to them

A. Clarify that no one has to remove his or her shoes and continue the education

A nurse who is ethnocentric in interacting with a client of a different culture. Which statement is most likely true about this nurse?

A. Most likely has little experience and is uncomfortable with people from other cultures
B. Is appreciative of and inquisitive about the client's cultural beliefs
C. Accommodates the client's cultural beliefs when planning care
D. Imposes the nurse's value system on the client for best care outcomes

A. Most likely has little experience and is uncomfortable with people from other cultures

Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as:

A. culture shock
B. prejudice
C. ignorance
D. racism

A. culture shock

A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. Which assessment should the nurse conduct first?

A. General cultural assessment
B. Head-to-toe assessment
C. In-depth cultural assessment
D. Nonverbal communication assessment

A. General cultural assessment

A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse is integrating client care with knowledge of which cultural organizing factor?

A. Biological variations
B. Communication
C. Environmental control
D. Space

C. Environmental control

A community-based hospice nurse has an Asian client with terminal-stage cancer. The client complains of continuous pain and receives no relief from the prescribed opioid medication. The nurse contacts the client's provider to discuss replacing this medication with another pain-reducing drug. What is this action an example of?

A. Cultural accommodation
B. Cultural assessment
C. Cultural brokering
D. Cultural repatterning

C. Cultural brokering

The nurse is educating an immigrant client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of which of the following?

A. Cultural accommodation
B. Cultural brokering
C. Cultural preservation
D. Cultural repatterning

A. Cultural accommodation

The nursing student learning about cultural variations would need to study which of the following topics? (Select all that apply.)

A. Biological variations
B. Personal space
C. Time perception
D. Social organizations
E. Communication patterns

All answer choices are correct.

Health policy can best be defined as a set course of action to do which of the following?

A. Administer public health programs for disaster preparedness, response, and recovery.
B. Obtain a desired health outcome for an individual, family, group, community, or society.
C. Support publicly funded health care programs at the local, state, and national levels.
D. Support health care development and research to improve the health status of citizens.

B. Obtain a desired health outcome for an individual, family, group, community, or society.

The relationship between nursing practice, health policy, and politics can best be described as nursing:

A. advocacy
B. policy process
C. process
D. profession

A. advocacy

The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are:

A. federal and state
B. federal, state, and local
C. all, but primarily state and local
D. all, but primarily federal and state

B. federal, state, and local

What entity governs nursing practice?

A. Boards of nursing established by the U.S. Department of Health and Human Services
B. Nurse practice acts promulgated by federal and state legislative boards
C. Nurse practice acts created by state legislatures and operationalized by state boards of nursing
D. Nurse practice acts written by the states in conformity with broad federal guidelines

C. Nurse practice acts created by state legislatures and operationalized by state boards of nursing

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, where would the nurses begin their search?

A. Centers for Disease Control and Prevention
B. Centers for Medicaid and Medicare Services
C. Health Resources and Services Administration
D. National Institute of Nursing Research

A. Centers for Disease Control and Prevention

The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. What is important for nurses to understand about WHO policy statements? Such statements:

A. apply only to underdeveloped countries
B. are guides for in-country initiatives and priorities
C. carry the weight of international law
D. provide mandates for in-country legislatures

B. are guides for in-country initiatives and priorities

A public health nurse (PHN) has identified a need to make amendments to an existing health-related law. The nurse knows the amendment of any existing laws would ultimately be decided by which of the following?

A. Executive branch of government
B. Legislative branch of government
C. Local representative
D. Senate hearings

B. Legislative branch of government

A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. What is the best source for this information?

A. American Public Health Association's guidelines
B. Website of the Centers for Disease Control and Prevention
C. Healthy People initiatives
D. Pan American Health Organization's mission statement

C. Healthy People initiatives

A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following?

A. Citizen action committee
B. Nursing diagnosis
C. Nursing process
D. Socratic method

C. Nursing process

State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.)

A. Documentation of client status and progress
B. Documentation of services
C. Living wills and advance directives
D. Resident's rights in long-term care facilities
E. Right to death with dignity

All answer choices are correct.

A public health nurse has been recruited to lead a community environmental lead exposure reduction program. What action by this nurse is best?

A. Advocate for funding at the state and federal levels
B. Create a multidisciplinary team to work on different aspects of the problem
C. Determine how other cities and counties have managed this problem
D. Research the number of houses likely to contain lead-based paint

D. Research the number of houses likely to contain lead-based paint

An occupational health nurse is conducting employee toxic exposure histories at a dog food manufacturing plant. Using the I PREPARE model, what question does the nurse ask?

A. Do you eat your lunch inside or outside the building?
B. Does your job include soldering any metals?
C. Have you ever served in the military?
D. What is the intensity of your exposure to chemicals?

B. Does your job include soldering any metals?

A college health nurse is working to improve environmental air quality on campus. Using the precautionary principal, what action does the nurse take?

A. Develop a bike-rental program for students, staff, and faculty
B. Install "smart thermostats" and motion-generated lights in buildings
C. Make the entire campus a smoke-free zone
D. Raise the parking fees to discourage people from driving to campus

B. Install "smart thermostats" and motion-generated lights in buildings

Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply which ethical principle?

A. Societal justice
B. Nonmaleficence
C. Beneficence
D. Environmental justice

D. Environmental justice

A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between:

A. community strengths and weaknesses
B. environment and human health/disease
C. toxicology studies and the environment
D. federal and state environmental regulations

B. environment and human health/disease

A family with a small child lives in a home on a Brownfield site. What action does the public health nurse take when conducting a home visit?

A. Assess the child for meeting developmental milestones
B. Have the parent complete a 3-day food diary
C. Request the child's immunization records
D. Watch the child during therapeutic play

A. Assess the child for meeting developmental milestones

Monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of:

A. compliance and enforcement
B. environmental epidemiology
C. secondary prevention
D. toxicology

B. environmental epidemiology

When applying the nursing process to environmental health, which action would the nurse take?

A. Conduct an assessment focused on a client's presenting problem.
B. Coordinate interventions with the primary care provider of record.
C. Examine criteria that are limited to the client's immediate responses.
D. Include outcome measures to mitigate and eliminate the contributing factors.

D. Include outcome measures to mitigate and eliminate the contributing factors.

The role of the nurse who wants to become more active in environmental health could include which of the following? (Select all that apply.)

A. Assessing farmworkers for pesticide exposure and providing pesticide risk education
B. Conducting epidemiologic investigations as a public health nurse (PHN)
C. Developing corporate policy to protect workers from unsafe levels of toxic agents
D. Organizing the local community to encourage landlords to remove lead-based paint
E. Working as a skilled risk communicator for a local chemical manufacturer

All answer choices are correct.

A new nurse asks the mentor what an MSDS is for. What responses by the mentor are most accurate? (Select all that apply.)

A. Contains information on chemical products.
B. Describes any special precautions using chemicals requires.
C. Details the health risks associated with the products.
D. Explains the manufacturing precautions taken.
E. Must be written by the product manufacturer.

A. Contains information on chemical products.
B. Describes any special precautions using chemicals requires.
C. Details the health risks associated with the products.
E. Must be written by the product manufacturer.

In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as:

A. what public-private partnerships do to treat vulnerable populations
B. what the government does to ensure that vital programs are in place
C. what the U.S. Public Health Service does to prevent disease, promote health, and deliver services
D. what society does collectively to ensure the conditions in which people can be healthy

D. what society does collectively to ensure the conditions in which people can be healthy

A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, non-metropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding?

A. Apple grower who lives in a 100-square mile county with a population of 19,000
B. Client who lives next to a ranch in a town of 1200 people
C. Soybean grower and spouse who live in a 400-square-mile county with a population of 39,200
D. 70-year-old client residing in an assisted living facility in a rural area

D. 70-year-old client residing in an assisted living facility in a rural area

A community health nurse is prioritizing health promotion activities with the local rural community. An understanding fo the health status and health risks of the rural community would lead the nurse to give priority to which activity?

A. Aerobic exercise classes
B. English as a second language program
C. Mentoring program to increase adult literacy
D. Motor vehicle and farm accident prevention

D. Motor vehicle and farm accident prevention

Rationale: Health promotion activities should be prioritized according to the most common causes of morbidity and mortality for the population served. Rural residents are at increased risk of injury and death secondary to motor vehicle crashes and farm-related occupational injuries.

What causes nurses practicing in rural communities to often observe that protecting client confidentiality is a unique challenge?

A. Close-knit atmosphere among residents
B. Difficulty keeping one's business private
C. "Everyone knows everything already"
D. Social informality and respect

D. Social informality and respect

A rural health nurse who is planning programs to address the population's needs should recognize that, in general, rural populations:

A. Engage in physical activity during leisure time
B. Engage in preventative health behaviors
C. Perceive their overall health as less favorable
D. Use seat belts

C. Perceive their overall health as less favorable

A nurse will be starting a new job serving a rural, Native American reservation. What supplies or equipment does the nurse anticipate having the highest need for?

A. Diabetic testing supplies
B. Oximeter and sensors
C. Suicide prevention pamphlets
D. Water purifiers

A. Diabetic testing supplies

A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach?

A. Assessment
B. Case management
C. Geriatrics
D. Tertiary prevention

B. Case management

Rationale: Case management is a client-professional partnership that can be used to arrange a continuum of care for rural clients, with the case manager tailoring and blending formal and informal resources. Collaborative efforts between a client and the case manager allow clients to participate in their plan of care in an acceptable and appropriate way, especially when local resources are few and far between.

What does the nurse understand when considering whether a geographic area is rural or urban?

a. Rural and urban areas occur on a continuum.
b. Rural regions have fewer than six persons per square mile.
c. Rural residents feel isolated.
d. Rural areas are recreational communities.

a. Rural and urban areas occur on a continuum.

Rationale: Rural and urban residencies are not opposing lifestyles. Rather, they occur on a rural-urban continuum ranging from living on a remote farm, to living in a village or small town, to residing in a larger town or city, to living in a large metropolitan area with a core inner city.

Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression? (Select all that apply.)

a. Elevated levels of poverty
b. Geographic isolation
c. Insufficient mental health services
d. Lack of awareness
e. Tolerance for destructive coping mechanisms

a. Elevated levels of poverty
b. Geographic isolation
c. Insufficient mental health services

Rationale: There appears to be persistent, endemic depression among rural residents. Factors that relate to this level of depression are the high rate of poverty, geographic isolation, and insufficient mental health services.

What does a community-oriented nurse newly assigned to a rural community learn about the characteristics of rural and small town life?

a. Fractured family and social systems
b. Informal social and professional relationships
c. Openness to people new to the community
d. Role of churches as socialization centers
e. Work of many residents in high-risk occupations

b. Informal social and professional relationships
d. Role of churches as socialization centers
e. Work of many residents in high-risk occupations

Rationale: The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").

A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. Which strategy would the nurse consider most effective when working with these clients?

a. Form a community partnership to establish a clinic for homeless persons.
b. Create a trusting environment and establish a therapeutic relationship.
c. Collaborate with the local united way to obtain funding for primary care services.
d. Dialogue with local clergy to address the unmet primary care need for homeless persons.

b. Create a trusting environment and establish a therapeutic relationship.

Rationale: In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.