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Community Nursing Test Banks
Which of the following best describes the primary reason that Americans are concerned about health care? a. Politicians are discussing how to improve health care. b. The media has provided mixed messages about the health care system. c. Our national health care costs keep increasing. d. (^) The new health care system offers free services to Americans. ANS: C The primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. The costs of caring for the sick accounted for the majority of escalating health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 17.6% in 2009. Politicians and the media both influence Americans’ perceptions about health care; however, they are not the primary reason why Americans are concerned. The new health care system will change the health care access and availablity, but will not necessarily be offering any free services to Americans. DIF: Cognitive Level: Understand (Comprehension) REF: p. 2
- A nurse has begun to lobby with politicians for changes to the health care system. Why is this involvement important? a. Nurses, as central characters in several popular TV series, are currently very visible in American media. b. Nurses are primarily responsible for managing the various units in our health care system. c. (^) Nurses are the largest group of health care providers. d. Nurses are the only group that is employed both inside and outside of hospitals. ANS: C As the largest group of health care providers, nurses are informed about the current health care system and all the problems that result from people not seeking care until they are desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to our current health care delivery system, can also be instrumental in working politically to create a health care
delivery system that will meet health needs. While nurses are in several current TV series and are employed both inside and outside of hospitals, physicians and other health care providers are as well. Nurses are often managers, but managers often have other backgrounds, such as business administration. DIF: Cognitive Level: Understand (Comprehension) REF: p. 2
- What conclusion can be drawn from examining where nurses are employed? a. There is a trend toward consolidation of health care into large central medical centers. b. There is an increased emphasis on community-based health care. c. There is an obvious need to decrease health care costs by cutting positions. d. Managed care organizations (MCOs) are employing nurses to improve customer relations. ANS: B MCOs are employing nurses in many capacities. Although hospitals are closing and acute care is increasingly found in central medical centers, the same trend may be seen in an increase in neighborhood-based practice centers. While positions are cut in most industries, health care is recognized as an area where growth in employment is expected. However, nurses are increasingly employed in community settings as opposed to hospitals. This change reflects the move toward community-based care rather than hospital-based tertiary care. To help decrease the continued rise in health care costs, the increased emphasis is on disease prevention rather than high-cost treatment. DIF: Cognitive Level: Understand (Comprehension) REF: p. 2
- Which ethical belief would be most helpful in the current health care crisis? a. Emphasis should be on individual and corporation freedom in the marketplace. b. (^) Emphasis should be on individual autonomy and freedom of choice. c. (^) Emphasis should be on social justice and collective responsibility. d. Emphasis should be on the effectiveness of technology in resolving problems. ANS: C Public health recognizes the necessity of collective action in keeping the environment safe and in egalitarian tradition and vision. An overinvestment in technology and seeking of cures within the market justice system has stifled the evolution of a health system to protect and preserve the health of the population. Although individual
The ANA Code of Ethics promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. The code does not directly address workplace issues, such as work schedules or need for overtime. DIF: Cognitive Level: Analyze (Analysis) REF: p. 2
- What is the community health nursing definition of health? a. (^) Health is a person’s goal-directed purposeful process toward well-being or wholeness. b. Health is an individual’s physical, mental, and social well-being, not merely the absence of disease or infirmity. c. Health is the mutual adaptation between a person and his or her environment in meeting daily existence. d. Health is families and aggregates choosing actions to ensure safety and well-being. ANS: D The text stresses that health is not just the result of an individual’s choices, but choices and actions of individuals, families, groups, and communities that lead to better health. DIF: Cognitive Level: Apply (Application) REF: p. 3
- How does community health nursing define community? a. A group of persons living within specific geographic boundaries b. A group of persons who share a common identity and environment c. A group of persons who work together to meet common goals d. Persons who form a group to resolve a common concern ANS: B Community health nurses work with both geopolitical groups (within specific geographic boundaries) and phenomenological groups (who have a common identity based on culture, history, or goals). A particular phenomenological group may or may not have been a planned group—that is, a group that came together to resolve a recognized common problem or to meet a common goal. However, of all the choices, a group of persons who share a common identity (phenomenological group) and environment (which implies a specific geographic setting) is the broadest and most complete definition. DIF: Cognitive Level: Apply (Application) REF: p. 3
- Which variable has a major influence on a community’s health? a. Behavior choices made by persons in the community b. Number of health care providers and hospitals in the community c. Quality of the public safety officers (police officers, firefighters, etc.) d. (^) The number and credentials of public health officials in the community ANS: A Individual behavior choices and environmental factors are responsible for about 70% of health outcomes. Individual choices are affected through interaction with other individuals, and their mutual social and physical environments. Health care providers are responsible for only 10% of the outcome. The quality of public safety officers and number of public health officials have not been identified as major contributors to the determinants of health. DIF: Cognitive Level: Apply (Application) REF: p. 4
- What change could most effectively lead to a longer life span in Americans? a. Parenting and sexual behavior classes in all public school systems b. Legislation restricting alcohol and drug use c. Notably reducing speed limits on all state and federal highways, and changing the age limit for driving to 21 years of age d. The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm ANS: D Smoking is responsible for about 20% of all deaths in the United States. Although smoking is an individual’s choice, all people are affected by social norms. Parenting and sexual behavior classes and legislative changes may influence health, but may not necessarily lead to a longer lifespan. Community health nurses should recognize that health is influenced by a web of factors, some that can be changed and some that cannot. Influencing social norms may better promote change among Americans. DIF: Cognitive Level: Apply (Application) REF: p. 4
- What is the health issue causing the most concern in the United States today? a. Diabetes epidemic
nurses often do have to justify budgets, data are needed to compare the local community with itself over time and with other communities so that problems may be recognized and action taken to confront health issues. The first step is always to recognize problems as they develop. DIF: Cognitive Level: Apply (Application) REF: p. 5
- How do public health efforts differ from medical efforts in improving the health of our citizens? a. (^) Medical care providers autonomously choose appropriate interventions, whereas public health care providers must engage in whatever actions legislation requires. b. Medical care providers are self-employed or agency employed, whereas public health care providers are employed by and paid through the government. c. Medical care providers focus only on individuals, whereas public health care providers focus only on aggregates. d. (^) Medical care providers focus on disease diagnosis and management, whereas public health care providers focus on health promotion and disease prevention. ANS: D Medical care providers are restricted by insurance and government regulations. Providers may also be employed in government facilities, such as Veterans Administration facilities. However, medical care providers primarily focus on diagnosis and treatment of disease, whereas public health care providers try to promote health and prevent disease. Although medical care providers primarily focus on individuals and public health care providers primarily focus on aggregates, their practice is not limited to only individuals or only aggregates. DIF: Cognitive Level: Apply (Application) REF: p. 7
- Which primary prevention would the school nurse choose to address the school’s number of unwed pregnancies? a. Create a class on parenting for both the moms-to-be and the dads-to-be b. Convince the school board to allow sex education classes to include birth control measures c. Employ the moms-to-be as 1-hour-a-day employees in the school day care center for children born to school students
d. Establish a class where all the unwed moms-to-be can learn infant care ANS: B Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies. DIF: Cognitive Level: Apply (Application) REF: p. 7
- What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations? a. (^) Health education b. Secondary prevention c. Specific protection d. (^) Tertiary prevention ANS: C Immunizations are a specific protection effort as part of primary prevention. DIF: Cognitive Level: Understand (Comprehension) REF: p. 7
- Which action would probably result in the largest change in health care outcomes for Americans? a. Establish large numbers of scholarships for education of nurses, physicians, and other health care providers b. Fund a one-time extremely large stimulus to allow all health care providers and agencies to create and integrate computer network systems for client health care records c. Increase funding for hospitals and medical centers to expand their neighborhood clinics d. Redirect a large portion of federal funding from acute care to health promotion activities ANS: D Of the choices given, health promotion activities would make the largest difference. Increased expenditures on acute care will not notably change the health of the population, whereas funding that addresses health promotion such as education and safe environments would improve the health of the aggregate. DIF: Cognitive Level: Apply (Application) REF: p. 8
- A nurse who works on the surgical unit at the local hospital was asked by the home health unit to make a home visit to a patient who had been discharged the previous day and to give follow-up care (for overload pay). What kind of nursing would this nurse be doing? a. Acute care hospital nursing b. (^) Community-based nursing c. (^) Community health nursing d. (^) Public health nursing ANS: B The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere in the community. As the nurse is not focusing on the health of the community but on an individual, it is not community or public health nursing. It is not acute care hospital nursing because the nurse is seeing the patient in his or her home. DIF: Cognitive Level: Apply (Application) REF: p. 11
- Which task is most crucial for the community health nurse to do well? a. (^) Review the most recent morbidity and mortality data b. Create a new clinic to better meet local health needs c. Evaluate the results of the recent screening program d. Give testimony regarding proposed state health legislation ANS: D Public health’s core functions are assurance, assessment, and policy development. Giving testimony regarding legislation directly reflects policy development, which would have a wider impact than the other options, which are more local and narrow in focus. DIF: Cognitive Level: Analyze (Analysis) REF: p. 11
- A new public health nurse carefully assessed all the local mortality and morbidity data in preparation for making appropriate planning suggestions at a meeting next week. What other action is crucial before the nurse can feel prepared? a. (^) Ask other nursing staff their perceptions of the community’s needs b. Assess the nurse’s own assets, strengths, and ability to contribute c. Meet members of the community to determine their culture and values
d. Review discussions and decisions from previous meetings ANS: C Community health nurses must work with the community. It is essential to assess an aggregate’s needs and resources and identify its values. The best way to do this is by meeting with the members of the community to determine their culture and values. Assessing one’s own assets, asking other nursing staff, and reviewing previous discussions will not allow the nurse to assess the needs of the community. DIF: Cognitive Level: Apply (Application) REF: p. 13
- Why are high-risk and vulnerable subpopulations identified by public health nurses before deciding on appropriate interventions? a. It is easiest to make improvements among these groups. b. (^) Populations are not homogeneous, and resources are limited. c. (^) Such groups are most vocal about their needs and wants. d. These groups are often recipients of special funding. ANS: B Populations are not all the same. The needs of subpopulations must be assessed. The high-risk and vulnerable subpopulations must be identified early. Those individuals who do not receive service early become very expensive high-cost users later. DIF: Cognitive Level: Understand (Comprehension) REF: p. 16
- A nurse works hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called? a. Building coalitions b. Collaboration c. Communication d. Community cooperation ANS: A By definition, the nurse’s actions are coalition building. Although collaboration has a very similar meaning, Table 1-4 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, but not yet working with them toward a goal. DIF: Cognitive Level: Understand (Comprehension) REF: p. 15
- After completing a master’s degree, a nurse took a course in marketing. Should the agency reimburse the nurse’s tuition costs?
immigration e. Legislative issues f. Physical and social environmental factors ANS: B, C, F Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues. Financial issues, issues related to legal and illegal immigration, and legislative issues are not found in Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) REF: p. 5
- What historically have been public health nurses’ two most important priorities? (Select all that apply.) a. Establishing school nursing to improve care of children b. (^) Engaging in political activity to improve living conditions c. Giving superb clinical bedside care in the home d. Increasing funding to public health efforts e. Teaching family members how to care for their family f. Working with the community to confront health issues and poverty ANS: B, F Neither administering bedside clinical nursing nor teaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty. DIF: Cognitive Level: Understand (Comprehension) REF: p. 6 - As in Healthy People 2010, what are the two primary goals of Healthy People 2020? (Select all that apply.) a. Eliminate health disparities b. (^) Expand health promotion activities in every community c. Improve funding, including diverting funds from other priorities to health care d. Improve health outcomes measures to be more consistent with other developed nations’ outcomes
e. Increase quality and years of healthy life f. Reduce mortality and morbidity figures nationwide ANS: A, E As published, the two goals are to increase quality and years of healthy life and eliminate health disparities. Expanding health promotion activities in every community, improving funding and improving health outcomes, and reducing mortality and morbidity are not the primary goals of Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) REF: p. 9 Which of the following 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. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 20-
- Which of the following 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.
Chemical intervention and herbal remedies were not used to self-protect from the Black Death. DIF: Cognitive Level: Understand (Comprehension) REF: p. 21
- Which of the following diseases 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 22
- 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 environmental 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 geographic factors related to regional health and disease. They were able to demonstrate environmental factors related to regional disease. They did not address the safety of wells, housing areas, or the isolation of disease. DIF: Cognitive Level: Apply (Application) REF: p. 22
- 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 22
- Which of the following 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 23
- Which of the following 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
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 to avoid possible infections. 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. DIF: Cognitive Level: Apply (Application) REF: p. 24
- Which of the following scientific beliefs or ideas 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 26
- 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 26
- Which of the following interventions 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 in 1897. DIF: Cognitive Level: Understand (Comprehension) REF: p. 27
- Which of the following 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.
