TEST BANK for Public Community Health and Nursing Practice 2nd Edition. Caring for Populations. ISBN

Chapter 1: Public Health and Nursing Practice Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Public health nurses (PHNs) know they must approach a public health issue with an understanding of the related underlying risk factors to develop effective nursing interventions. They evaluate these risk factors from two perspectives: 1. Disease; individual 2. Intervention; government 3. Epidemic; population 4. Individual; population 2. A nursing student is studying public health. She learns that, according to C.E.A. Winslow’s definition, some of the goals of public health include disease prevention, promoting health, control of communicable infections, and .

1. Risk assessment for disease 2. Promotion of primary care 3. Organization of medical and nursing services for the early diagnosis and preventive treatment of disease 4. Governmental safety regulations 3. If the international medical community was working to contain several worldwide pandemics, they would look to the World Health Organization (WHO), which is: 1. The public health arm of the United Nations.

2. Working to improve health and well-being for the global population.

3. Working with nurses to promote public health interventions.

4. All of the above.

4. The Institute of Medicine (IOM), now known as the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine, stated in their report, The Future of the Public’s Health, that there are three core functions that society carries out to collectively support the optimum conditions for public health. Which one of the following is not one of these functions?

1. Prevention 2. Assessment 3. Policy development 4. Assurance 5. With aging, there is an increased prevalence of both noncommunicable (chronic) and communicable disease (NCD). The most pressing issue from a public health perspective based on this increase is: 1. An increased demand for long-term care 2. An increased need for further research 3. Further exploration of the developmental stages related to aging 4. Decreased cost of medications.

6. A PHN would like to use the Dahlgren-Whitehead model to help herself and other local practitioners understand health in populations. She understands that the Dahlgren-Whitehead ecological model assumes that: 1. There are multiple determinants of health, and thus multiple strategies are needed.

2. A population and environmental approach is essential.

3. Linkages and relationships are crucial.

4. All of the above.

7. The PHN completed a community assessment and found that the obesity rate in one of the neighborhoods was higher than the other neighborhoods in the county. She suspects that this is partially due to limited access to full-service grocery stores and a lack of dedicated safe venues for exercise. Assuming her conclusion is correct, what category or categories of determinants of health would these issues within the community fall into?

1. Upstream determinants of health 2. Downstream determinants of health 3. Behavioral determinants of health 4. Genetic determinants of health 8. Two PHNs working in a large urban community notice that community members are rarely engaged in the process of planning interventions aimed at addressing a particular increase in a specific disease in the community. For their next project, they include community collaboration as an essential component of the development, implementation, and evaluation of the program. When questioned by others, they report that there is evidence that community collaboration increases effectiveness and productivity, empowers the participants, strengthens social engagement, and .

1. Decreases disease rates 2. Ensures accountability 3. Increases the availability of treatment for the targeted disease 4. Improves screening rates 9. Which one of the following scenarios is not an example of community collaboration?

1. Local service groups working to organize disaster relief for tornado victims 2. A city council passing an ordinance to stop smoking in restaurants 3. An advocacy group working with the local churches to improve health care for the indigent with mental health disorders 4. A school working with the local health department to start a school clinic 10. Which layer of government is primarily responsible for issuing quarantines during a communicable disease outbreak?

1. Federal 2. State 3. Local 4. All of the above 11. As a PHN in a small local public health department, you understand that based on federal mandates your public health department routinely performs all but which of the following?

1. Surveillance of disease at the local level 2. Investigation of disease outbreaks 3. Licensing of local hospitals 4. Quarantine 12. The PHN recognizes that environmental science, epidemiology, biostatistics, biomedical sciences, and form the foundational subjects of public health.

1. Economics 2. The humanities 3. Social and behavioral sciences 4. Anthropology 13. As defined by the World Health Organization (WHO), an example of a health promotion intervention is whereas a risk reduction/health protection intervention is .

1.

2.

3.

4.

Conducting a health fair; funding a school exercise program Giving a free exercise class; conducting a flu vaccine outreach program Providing flu medication free to older adults; a diet class for teenagers Offering a tour of a hospital; a relaxation technique class

14. From a health promotion perspective, how could an occupational health nurse advise a company to encourage its employees to work towards good health?

1. Lower insurance premiums for employees who demonstrate good health habits 2. Have employee exercise classes or discounted health club memberships 3. Have incentives for healthy eating 4. All of the above 15. Diversity refers to all of but which of these concepts?

1. Race 2. Culture 3. Ethnicity 4. Environment Multiple Response Identify one or more choices that best complete the statement or answer the question.

16. Many of the emerging threats for public health are tied to increasing globalization. Which of the following reflect these globalization threats? (Select all that apply.)

1. Greater disparities between rich and poor 2. Greater need for newer technology 3. Greater distribution of tobacco and alcohol 4. Emergence or re-emergence of communicable diseases 5. Increased need for improved transportation 17. Several nurses who work in the emergency department of an urban hospital notice during the evening shift that a number of children in a certain ethnic population have all come in presenting with similar symptoms.

The first step the nurses take to address the issue is which of the following? (Select all that apply.)

1. Increase antibiotic therapy availability 2. Identify characteristics of the disease 3. Group patients by diagnosis 4. Notify the public health department 5. Assess the environment of the patients 18. The six standards of practice for public health nursing include which of the following? (Select all that apply.)

1. Assessment 2. Population diagnosis and priorities 3. Outcomes identification 4. Planning 5. Mitigation 19. Which of the following activities of PHNs reflect the PHN Core Competencies? (Select all that apply.)

1. Develop policy for handling a local quarantine.

2. Understand dietary restrictions when planning a program for new immigrants.

3. Create a financial plan for implementing a community level health intervention.

4. Develop a treatment plan for persons with a specific communicable disease.

5. Analyze data to determine rates of disease in the community.

Chapter 1: Public Health and Nursing Practice Answer Section MULTIPLE CHOICE 1. ANS: 4 Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs).

Page: Heading: Introduction to Public Health Integrated Processes: Nursing Process Client Need: Physiological Integrity Cognitive Level: Comprehension Concept: Critical Thinking, Promoting Health Difficulty: Easy Feedback 1 The approach cannot be disease based because diseases can affect populations in multiple locations, but the risk factors can be different.

2 Interventions occur after the public health event, and governments can only follow the evidence of public health studies.

3 An epidemic is an occurrence of a disease and has the same limitations as a disease-based approach.

4 PHNs assess risk for disease and other public health issues at both the individual level, so that they can intervene on a one-to-one situational basis, as well as at the population level to identify risk factors beyond the individual level and implement population-level interventions.

PTS: 1 REF: 2 CON: Promoting Health | Critical Thinking 2. ANS: 3 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health.

Page: Heading: Public Health Science and Practice Integrated Processes: Nursing Process Client Needs: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Infection; Nursing Roles; Promoting Health Difficulty: Easy Feedback 1 Risk assessment is considered a part of disease prevention.

2 Promotion of primary care occurred through the Alma Ata World Health Organization conference not Winslow’s definition.

3 Health-care providers are an essential component of public health.

4 The goal of public health is to guide governmental policy but not to create regulations.

PTS: 1 REF: 3 CON: Infection | Nursing Roles | Promoting Health 3. ANS: 4 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health.

Page:

Heading: Introduction to Public Health Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Difficulty: Easy Concept: Promoting Health; Health-Care System; Management; Safety Difficulty: Easy Feedback 1 The World Health Organization (WHO) is the “directing and coordinating authority for health within the United Nations system”.

2 The WHO has the capability to monitor global epidemiological situations.

3 The WHO brings resources and knowledge to nurses who are working directly with patients for them to make informed decisions.

4 The WHO is the public health arm of the United Nations and works toward both of the previously mentioned goals.

PTS: 1 REF: 15-17 CON: Promoting Health | Health-Care System | Management | Safety 4. ANS: 1 Objective: 4. Explore the connection between environment, resource availability, and health.

Page: Heading: Public Health Science and Practice Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 Prevention is not considered a core function of public health, as assessment, policy development, and assurance have prevention as an implied goal of each function.

2 Assessment focuses on analysis and collection of data, as well as the monitoring of health problems and needs.

3 Policy development uses the acquired knowledge from assessments to create useful public health policies.

4 Assurance creates trust in health-care agencies to provide necessary services that are in line with public health goals.

PTS: 1 REF: 3 CON: Assessment | Promoting Health 5. ANS: 1 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health.

Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis Concept: Immunity; Infection; Promoting Health Difficulty: Easy Feedback

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2 3 4

As the percent of the population over the age of 65 increases, so does the prevalence of chronic disease and the need for long-term care. From a population public health perspective, decreased availability of care will result in increased morbidity and mortality, and decreased quality of life.

An increased need for further research is important but is not the most pressing issue.

Further exploration of developmental stages related to aging might help in understanding response to disease but is not the most pressing issue.

Decreased cost of medications will assist in access to treatment but is only one aspect of long-term care needs.

PTS: 1 REF: 4 CON: Immunity | Infection | Promoting Health 6. ANS: 4 Objective: 4. Explore the connection between environment, resource availability, and health.

Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Evidence-Based Practice; Promoting Health Difficulty: Moderate Feedback 1 Location and social systems are two of many determinants in the ecology of a public health problem.

2 This model asserts that the environment of the affected population is a key component in assessing risk factors.

3 Social systems, families, and communities play a role in the health or lack of health for an individual or a population.

4 The Dahlgren-Whitehead model is key to understanding the layers of influence and relationships regarding population health and how important environment is to said health. Thus, all of the answer choices together are correct.

PTS: 1 REF: 5 CON: Evidence-Based Practice | Promoting Health 7. ANS: 1 Objective: 3. Investigate determinants of health within the context of culture.

Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis Concept: Promoting Health; Economics Difficulty: Moderate Feedback 1 Upstream refers to determinants of health that include the physical as well as conditions in the social environment creating poor health, 2 Downstream refers to the biological and behavioral bases for disease.

3 Genetic determinants of health occur at the individual biological level.

4 Behavioral determinants of health occur at the individual level.

PTS: 1

REF: 6

CON: Promoting Health | Economics

8. ANS: 2 Objective: 4. Explore the connection between environment, resource availability, and health.

Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing Roles; Communication; Collaboration Difficulty: Easy Feedback 1 Although decreased disease rate is a definite sign that the health population is improving, community collaboration is a vehicle that brings participants together to address health issues such as rates of disease. Community collaboration efforts are a good way to achieve this.

2 Accountability among members of a community is improved when communities are actively engaged in health programs.

3 Availability of treatment may not be an identified risk factor for the increase in the rate.

4 Improving screening rates may not be an identified risk factor for the increase in the disease rate.

PTS: 1 REF: 6 CON: Nursing Roles | Communication | Collaboration 9. ANS: 2 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health.

Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Communication and Documentation Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration Difficulty: Easy Feedback 1 This collaboration benefits the community’s public health after a natural disaster.

2 Community collaboration can include advocating for change in regulations but does not involve direct legislative activity that is the responsibility of governmental bodies.

3 A volunteer group can offer valuable services to enhance the lives of people suffering from mental illness.

4 This community-based institution is an example of a social system that can work with a health department to use each other’s strengths to produce a meaningful project.

PTS: 1 REF: 6 CON: Promoting Health | Collaboration 10. ANS: 3 Objective: 6. Identify the formal organization of public health services from a global to local level.

Page: Heading: Introduction to Public Health > Public Health Organization and Management Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis Concept: Health-Care System, Regulation, Infection Difficulty: Easy

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Feedback The Constitution did not provide for a national public health agency but rather assigned that duty to the states. Although the Centers for Disease Control and Prevention (CDC) provides ongoing research, sets guidelines, and offers support, quarantines are usually the responsibility of local health departments.

State constitutions empower the states to establish state boards of health. Their duty is to protect the citizens, but quarantines are mostly managed at the local level.

Quarantines are managed at the local level with assistance from the state if needed.

All levels of government are not needed or agile enough to handle local health crises.

PTS: 1 REF: 17 CON: Health-Care System | Regulations | Infection 11. ANS: 3 Objective: 6. Identify the formal organization of public health services from a global to local level.

Page: Heading: Introduction to Public Health > Public Health Organization and Management Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Health-Care System, Regulations Difficulty: Easy Feedback 1 Local public health departments protect the health of the citizens that live in their county, municipality, or township. In conjunction with the state public health department and the Centers for Disease Control and Prevention, they conduct routine surveillance to help identify an increase in disease.

2 Once there is a disease outbreak, local health departments participate in the outbreak investigation in coordination with the state public health department and the Centers for Disease Control and Prevention.

3 Hospitals are licensed by state and federal agencies, not local health departments.

4 Local public health department in coordination with the state public health department and the Centers for Disease Control and Prevention implement and monitor quarantine efforts in the event of communicable disease outbreak that warrants isolation of those with the disease.

PTS: 1 REF: 19 CON: Regulations | Health-Care System 12. ANS: 3 Objective: 1. Identify how public health plays a central role in the practice of nursing across settings and specialties.

Page: Heading: Public Health as a Component of Nursing Practice Across Settings and Specialties > Health From a Population Perspective Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Evidence-Based Practice; Promoting Health Difficulty: Moderate Feedback 1 Although economics could be a useful tool to assess the impact of a health program, it is not considered one of the foundational subjects of public health.

2 3 4

The humanities are not considered one of the foundational subjects of public health.

Many branches of social and behavioral sciences are useful for analysis of public health issues.

The study of man and his development is not considered one of the foundational subjects of public health.

PTS: 1 REF: 2 CON: Evidence-Based Practice | Promoting Health 13. ANS: 2 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health.

Page: Heading: Health Promotion, Risk Reduction, and Health Protection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Easy Feedback 1 Both of these options are health promotions because they create opportunities to improve health through individual behavior change.

2 A health promotion intervention, such as an exercise class, creates an opportunity to improve health through individual behavioral change, whereas a risk reduction program, such as administering vaccinations, involves actions taken to reduce a person’s risk for disease.

3 Free medication for the flu is a treatment program that occurs when disease is present and not related to either health promotion or protection, and a diet class is a health promotion program aimed at individual behavior change.

4 The hospital tour is educational but not related to health promotion or protection, and the relaxation techniques class is health promotion exercise aimed at individual behavior change.

PTS: 1 REF: 7 CON: Promoting Health 14. ANS: 4 Objective: 4. Explore the connection between environment, resource availability, and health.

Page: Heading: Health Promotion, Risk Reduction, and Health Protection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Financial benefits or savings would promote behavioral change.

2 Health club memberships would facilitate the employees’ ability for change.

3 Encouraging a good diet through incentives would promote healthy behavior.

4 All of the options previously listed promote good health and reduce the risk for illness.

PTS: 1 15. ANS: 4

REF: 15

CON: Promoting Health | Nursing Roles

Objective: 3. Investigate determinants of health within the context of culture.

Page: Heading: Health Promotion, Risk Reduction, and Health Protection > The Context of Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Diversity; Promoting Health Difficulty: Moderate Feedback 1 Race continues to be used to identify groups and as a marker for diversity.

2 Culture refers to beliefs, values, and norms shared across a group of people and reflects diverse world views.

3 Ethnicity reflects diversity in that specific groups differ based on geographic origin, language and dialect, religious faith, folklore, and food preferences.

4 Environment is an important factor in understanding the context of health but is separate from the concept of diversity.

PTS: 1

REF: 7

CON: Diversity | Promoting Health

MULTIPLE RESPONSE 16. ANS: 1, 3, 4 Objective: 1. Identify how public health plays a central role in the practice of nursing across settings and specialties.

Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Addiction; Promoting Health; Economics; Infection Difficulty: Easy

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Feedback Globalization has resulted in widening of disparity between low-income and high-income countries especially in relation to food security and environmental degradation.

In public health, better strategies for managing health care and current resources are needed more than newer technology.

The widespread availability of tobacco and alcohol increases the abuse of these substances and the problems that accompany it.

Some of the diseases that have emerged or re-emerged as a result of globalization are HIV, AIDS, severe acute respiratory syndrome, hepatitis, malaria, diphtheria, cholera, Ebola, and Zika virus. There is a need for planning for these possible pandemics using limited resources.

Although improved transportation has resulted in increased globalization, further improvements are not a public health threat.

PTS: 1 REF: 4 CON: Addiction | Promoting Health | Economics | Infection 17. ANS: 2, 3, 4, 5 Objective: 4. Explore the connection between environment, resource availability, and health.

Page:

Heading: Health Promotion, Risk Reduction, and Health Protection > Population-Focused Care Across Settings and Nursing Specialties Integrated Processes: Nursing Process Client Need: Physiological Integrity Cognitive Level: Synthesis Concept: Assessment; Critical Thinking Difficulty: Easy

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Feedback Antibiotics may not be a necessary route of treatment for the diagnosis.

The first step is to note and compare symptoms, onset, and other information to ascertain whether this is the same illness and if it is potentially due to a common cause.

Grouping the patients according to diagnosis will allow the health-care team to give better care and help create a care map but would not be the first step.

Once the data on symptoms, onset, and other key information has been gathered, the next step is to inform the public health department if warranted.

Evaluating the environment of the patients may create an understanding of why the illness occurred and prevent a re-occurrence of the illness and would occur as part of the public health department’s outbreak investigation, if one is warranted.

PTS: 1 REF: 9 | 10 CON: Infection | Assessment 18. ANS: 1, 2, 3, 4 Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs).

Page: Heading: Public Health Nursing as a Specialty > Public Health Nursing Scope and Standards of Practice Integrated Processes: N/A Client Need: N/A Cognitive Level: Knowledge Concept: Regulations; Nursing Roles Difficulty: Easy

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Feedback The PHN collects comprehensive data pertinent to the health status of populations.

The PHN analyzes the assessment data to determine the diagnoses or issues.

The PHN identifies expected outcomes for a plan specific to the population or situation.

The PHN develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Mitigation is a part of emergency preparedness and disaster management

PTS: 1 REF: 13 CON: Regulations | Nursing Roles 19. ANS: 1, 2, 3, 5 Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs).

Page: Heading: Public Health Nursing as a Specialty > Public Health Nursing Scope and Standards of Practice Integrated Processes: N/A Client Need: N/A Cognitive Level: Application [Applying] Concept: Infection; Nutrition; Diversity; Nursing Roles Difficulty: Easy

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Feedback Policy development/program planning is an essential skill for a PHN. To reach a population that might not receive adequate health care, cultural competency and communication skills are needed to overcome any barriers.

Financial and management skills are needed to maintain the sustainability of programs.

Development of individual treatment plans is part of the basic skills of all nurses and does not reflect a specific PHN competency.

One of the new challenges PHNs face is preparing the public for sudden, catastrophic health events, such as bioterrorism.

PTS: 1

REF: 15

CON: Infection | Nutrition | Diversity | Nursing Roles

Chapter 2: Optimizing Population Health Multiple Choice Identify the choice that best completes the statement or answers the question.

1. In 2011, the National Prevention Strategy released a plan to increase the number of Americans who are healthy at every stage of life. Which of the following is not one of the strategic directions included in the strategy?

1. Eliminating health disparities 2. Building healthy and safe community efforts 3. Increasing access to care 4. Empowering people to make healthy choices 2. PHNs in a county with an increase in measles during the 2018-2019 outbreak used the natural history of disease framework to develop a primary prevention program aimed at preventing measles. Their first step was to: 1. Conduct an outreach to all parents to have their children vaccinated.

2. Educate health-care providers on the signs and symptoms of disease.

3. Start a screening program to identify persons who may have measles.

4. Provide an educational program for parents whose children have measles on the importance of keeping them home from school and away from public places.

3. Based on recent studies on risk for disease, the nurse working in a primary care clinic in a poorer urban community decides to develop an educational program on the importance of including whole grains, fruits and vegetables in her patient’s diets. To help guide the development of her program she first reviews the availability of fresh fruits and vegetables in the community. Her decision to gather information on these factors best reflects the ?

1. Ecological determinants of health 2. Social determinants of health 3. Individual behavioral determinants of health 4. Genetic determinants of health 4. The school nurse in a school district in southwestern Texas is working with the school cafeteria to revise their healthy choices menus for the school year. They have used as their guide the 2012 national law that calls for school lunch programs to have larger portions of fruits and vegetables, less sodium, and no trans fats. To help increase the success of the program, the nurse conducted a survey of parents to learn more about the cultural aspects of food choices related to fruits and vegetables. Providing a culturally appropriate menu that meets federal guidelines for the school children represents: 1. An upstream approach 2. A tertiary prevention approach 3. A socioecological approach 4. A and C 5. A PHN notices the rising incidence of H1N1 (swine flu) in a geographic area. The nurse considers possible interventions, knowing that the preclinical phase of H1N1 lasts: 1. 1 to 2 days 2. 2 to 4 days 3. 3 to 4 days 4. 5 to 7 days

6. In the traditional public health prevention framework, the level of prevention that includes early detection and initiation of treatment for disease, or screening, is referred to as the: 1. Clinical level 2. Primary level 3. Tertiary level 4. Secondary level 7. Attributable risk is the proportion of cases or injuries that would be eliminated if a risk factor did not occur, but preventable fraction is: 1. The number of cases that actually occur in a given population at a specific point in time.

2. What could be achieved with a program implemented in a community setting within the at-risk population when community members actually participate in the program.

3. The number of cases that require intervention in a community setting within the at-risk population.

4. An estimation of the number of cases with the high-risk factor(s) among the at-risk population when community members actually participate in the program.

8. Population attributable risk (PAR) is based on the assumption that the risk factor is removed from the entire population being targeted. It also can be used to calculate the cost benefit and the of a prevention program.

1. Cost effectiveness 2. Necessity 3. Population ecology 4. Percent of repeat participants 9. The PHNs within the public health department experiencing a measles outbreak decide to do Public Service Announcements (PSAs) on TV aimed at improving vaccination rates among the population, and letting parents know they can come to the PHD clinic to have their children vaccinated. The county their department serves has a large population of Mexican American families, so they work together with the Mexican American community to make sure the PSAs are culturally relevant. Which learning theory best matches their approach?

1. Constructivism 2. Cognitivist 3. Bandura’s theory of social learning 4. Behaviorism 10. A patient diagnosed with diabetes buys books, reads articles, talks with knowledgeable people, informs himself about what he can do to improve his health, and takes action. The nurse recognizes that this method of adult learning is best described as: 1. Pedagogy 2. Andragogy 3. Constructivism 4. Humanism 11. A nurse working in a busy primary care clinic wonders why Mr. Smith, a 65-year old insulin dependent man recently diagnosed with type 2 diabetes, keeps coming back with elevated A1Cs. The nurse knows that he has given Mr. Smith the literature on how to manage type 2 diabetes and, as time allowed, reviewed it with him.

He doesn’t understand why Mr. Smith is still struggling with managing his disease. What should he check first before providing Mr. Smith with more information?

1. His level of health literacy 2. Whether or not he can afford his medication 3. His eating habits

4. His routine for checking his A1C 12. Two nurses working in a head, nose, and throat oncology unit noticed that many of their patients not only smoked but used alcohol. They had been to a recent conference and learned about evidence-based screening tools for alcohol use that were different from the tool they were currently using. They approached the director of the unit and suggested that they use the newer screening tools. Screening for alcohol use is primarily done: 1. Only with persons whose clinical presentation appears to indicate heavy alcohol use.

2. Only to detect those who are currently using alcohol to avoid an interaction with treatment modalities.

3. Only to detect those who may have an alcohol use disorder 4. To detect those at risk for disease or injury who do not yet meet the criteria for having an alcohol use disorder as well as those who may have an alcohol use disorder.

13. A clinical group of nursing students was assigned, during their public health rotation, to the local public health department (LPHD). The LPHD was just beginning to start a “Breast is Best” campaign in the community. The students were asked to come up with ideas for the campaign. The LPHD had found that the lowest breastfeeding rates were in one of the ethnic communities. The students agreed to conduct a preliminary outreach program with pregnant women coming to the LPHD’s prenatal clinic that had the highest number of women in that ethnic group. This is an example of what level of intervention using the Substance Abuse and Mental Health Services Administration (SAMSHA) framework?

1. Universal 2. Indicated 3. Primary 4. Selected Completion Complete each statement.

14. If the total number of cases of a disease is 100, and the total number of persons in a population is 1,000, what would the prevalence be? Record answer as a decimal.

15. In a hypertensive study, nurses took the blood pressure readings of 250 participants. To determine the accuracy of their readings, they wanted to test the sensitivity of their instruments. If the number of true positives is 40, and the total number of participants with disease (true positives plus false negatives) is 55, the sensitivity of the instrument is . Record answer with one decimal place.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

16. A nurse working in the emergency department (ED) has noticed over the past year the increasing number of young patients being treated for conditions that could be handled in primary care. She overhears a colleague wondering why their parents don’t just go to the clinic. To help better understand the issue, the nurse tells her colleague that perhaps they should be looking at other determinants of health besides the parents’ behavior.

She explains that the four broad levels of determinants of health included in the social ecological model would be a good start to help determine what factors might be driving the increased use of the ED for non-emergent pediatric care. Which of the following determinants of health are included in the model? (Select all that apply.)

1. Communication 2. Relationship 3. Policy

4. Genetics 5. Societal 17. When screening for, monitoring, and diagnosing disease, a health-care provider always evaluates a measurement tool for which of the following attributes? (Select all that apply.)

1. Reliability 2. Validity 3. Functionality 4. Sensitivity 5. Specificity 18. To assess the prevalence of a disease in a population, a public health nurse (PHN) can use the prevalence pot to help better understand the occurrence of disease in her or his community. The prevalence pot: (Select all that apply.)

1. Depicts the total number of current cases in the population.

2. Takes into account duration and incidence of the disease.

3. Includes assessing the total number of cases of a disease taking into account all of the stages of the disease.

4. Is a method of calculating the potential number of new cases in a population.

5. Determines the amount of primary medications used to treat diseases in a certain population.

19. Based on the Social-Ecological model of health, which of the following are components of health? (Select all that apply.)

1. Physical environments 2. Social environments 3. Social relations 4. Political systems 5. Health-care systems

Chapter 2: Optimizing Population Health Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Needs: Health Promotion and Maintenance Concept: Promoting Health, Legal Cognitive Level: Knowledge Difficulty: Easy

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Feedback Eliminating health disparities is one of the four fundamental strategies.

Building healthy and safe community efforts is one of the four fundamental strategies.

Although the National Prevention Strategy was authorized by the Affordable Care Act, the focus is to promote health and not increase access to care.

Empowering people to make healthy choices is one of the four fundamental strategies.

PTS: 1 REF: 25 CON: Promoting Health | Legal 2. ANS: 1 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Prevention Frameworks > Natural History of Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Promoting Health | Health-Care System Cognitive Level: Analysis Difficulty: Moderate Feedback 1 Using the natural history of disease, the best approach for the primary prevention of measles is to vaccinate the population and would be the first step.

2 Educating health-care providers to recognize the disease might help identify patients earlier and would occur during the clinical phase of the natural history of disease. It might also help reduce other’s exposure to the virus if parents were instructed to keep their children out of school and public places but would not be the first step in a primary prevention program.

3 Screening occurs during the subclinical phase of the natural history of disease to detect the disease and would not be the first step.

4 Educating parents on the importance of keeping their children who have the measles out of school and public places could result in reduced transmission of the measles virus but would not be the first step.

PTS: 1

REF: 28-30

CON: Promoting Health | Health-Care System

3. ANS: 2 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Population Health Promotion, Health Protection, and Risk Reduction > Health Promotion Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Nutrition | Promoting Health | Assessment Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 Ecological determinants of health include “…potable water and sanitation, affordable and clean energy, climate action, life below water, and life on land”. Resource availability is considered a social determinant of health.

2 Social determinants of health, according to the WHO “…are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”.

3 Behavioral determinants of health are at the individual level.

4 Genetic determinants of health are at the individual level.

PTS: 1 REF: 26 CON: Nutrition | Promoting Health | Nursing Roles 4. ANS: 4 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Population Health Promotion, Health Protection, and Risk Reduction > Health Promotion Integrated Processes: Nursing Process, Culture and Spirituality Client Need: Health Promotion and Maintenance Concepts: Nutrition | Promoting Health | Legal Cognitive Level: Application [Applying] Difficulty: Easy

1 2 3 4

Feedback A healthy school menu is an example of an upstream approach and addresses the role healthy nutrition plays in improving health and preventing disease.

Addressing the upstream issue of adequate nutrition to improve health is a primary prevention approach, not tertiary.

A socioecological approach takes into account the role of culture on health.

Combining culturally relevant food choices and a healthy choices menu in a school setting is an example of using an upstream approach within the context of socioecological model.

PTS: 1 REF: 26 CON: Nutrition | Promoting Health | Legal 5. ANS: 1 Objective: 3. Apply public health prevention frameworks to specific diseases.

Page: Heading: Prevention Frameworks > Natural History of Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Concepts: Infection | Critical Thinking

Cognitive Level: Application [Applying] Difficulty: Difficult Feedback 1 The preclinical phase of H1N1 lasts 1 to 2 days, and people who are infected can infect others on the first day. Symptoms develop rapidly, and intervention cannot prevent progression to the clinical phase.

2 This is past the preclinical phase of H1N1. The preclinical phase lasts only 1 to 2 days.

3 This is past the preclinical phase of H1N1. The preclinical phase lasts only 1 to 2 days.

4 This is past the preclinical phase of H1N1. The preclinical phase lasts only 1 to 2 days.

PTS: 1 REF: 29 CON: Infection | Critical Thinking 6. ANS: 4 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Prevention Frameworks > Public Health Prevention Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concepts: Promoting Health Cognitive Level: Knowledge Difficulty: Easy Feedback 1 The clinical level is not a level of prevention in the traditional public health framework.

2 The primary level of prevention includes interventions aimed at preventing disease in those who currently do not have the disease.

3 The tertiary level includes prevention of disability and premature death in those who are already diagnosed with the disease.

4 The secondary level includes screening to help detect disease among persons who are apparently well during the preclinical phase of the disease.

PTS: 1 REF: 30 CON: Promoting Health 7. ANS: 2 Objective: 4. Compare and contrast different levels of health promotion, protection, and risk reduction interventions.

Page: Heading: Prevention Frameworks > Public Health Prevention Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Evidence-Based Practice, Promoting Health Cognitive Level: Comprehension Difficulty: Moderate Feedback 1 Preventable fraction is not the number of cases that actually occur.

2 Preventable fraction includes the portion of the population at risk that actually participates in a program and the number of cases prevented.

3 The preventable fraction includes the number of cases that have been prevented from happening, not the cases that now require intervention.

4 The estimated number of cases with high-risk factors is included in attributable risk.

PTS: 1 REF: 34 CON: Evidence-Based Practice | Promoting Health 8. ANS: 1 Objective: 4. Compare and contrast different levels of health promotion, protection, and risk reduction interventions.

Page: Heading: Prevention Frameworks > Public Health Prevention Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Evidence-Based Practice, Promoting Health; Economics Cognitive Level: Knowledge Difficulty: Moderate Feedback 1 PAR can be used as a measurement of the cost benefit and cost effectiveness of a prevention program, which is based on the strength of the risk factor and the prevalence of the risk factor in a population.

2 PAR can be used to estimate the cost effectiveness of a prevention program. The estimation of the cost effectiveness of a program is a separate issue from whether a program is necessary or not.

3 PAR can be used to estimate the cost effectiveness of a prevention program. There is no measurement of the population ecology, only of the strength and prevalence of the risk factor.

4 PAR can be used to estimate the cost effectiveness of a prevention program. The percent of repeat participants is not a measure of the cost effectiveness of the program when the risk factor has been removed from the targeted population.

PTS: 1 REF: 34 CON: Promoting Health | Economics | Evidence-Based Practice 9. ANS: 3 Objective: 5. Identify health education strategies and chronic disease self-management within the context of prevention frameworks.

Page: Heading: A Primary Prevention Approach: Health Education > Theories of Education Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 Constructivism is a learning theory that includes reflecting on our own experiences and knowledge.

2 Cognitivist focuses on inner mental activity and knowledge that has changed thought patterns through rationally responding to an external stimulus.

3 Bandura’s theory of learning specifically connects understanding, behavior, and environment, and is the best match to their approach using PSAs. The use of PSAs is a good example of this theory because they portray an action and the audience, seeing it as desirable, is encouraged to model or imitate that behavior.

4 Behaviorism includes the theory of classical conditioning, which emphasizes that change comes with an environmental stimulus resulting in a response. Learning is based on reward and punishment by conditioning.

PTS: 1 REF: 37 CON: Evidence-Based Practice | Promoting Health | Nursing Roles

10. ANS: 4 Objective: 5. Identify health education strategies and chronic disease self-management within the context of prevention frameworks.

Page: Heading: A Primary Prevention Approach: Health Education > Theories of Education Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Difficulty: Easy Feedback 1 Pedagogy is the correct use of teaching strategies to provide the best learning.

2 Andragogy is the art and science of helping adults learn.

3 Constructivism is a learning theory that includes reflecting on our own experiences and knowledge.

4 Humanism is defined as self-directed learning through examining personal motivation and goals. It also includes the development of personal actions to fulfill one’s personal motivation and goals.

PTS: 1 REF: 37 CON: Evidence-Based Practice | Promoting Health 11. ANS: 1 Objective: 5. Identify health education strategies and chronic disease self-management within the context of prevention frameworks.

Page: Heading: A Primary Prevention Approach: Health Education > Health Literacy Integrated Processes: Teaching/Learning Client Need: Physiological Integrity; Reduction of Risk Potential Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 Because health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”, the first step before providing Mr. Smith with more information is to check his level of health literacy.

2 Lack of ability to pay for insulin is a real problem and should be included in the nurse’s assessment of Mr. Smith. However, establishing his level of health literacy is the first step because he might not fully understand the need for self-managing his disease with medication.

3 Establishing Mr. Smith’s level of health literacy is the first step because he might not fully understand the need for self-managing his disease with diet.

4 Establishing Mr. Smith’s level of health literacy is the first step because he might not fully understand the need for self-managing his disease through routine monitoring of his A1C. PTS: 1 REF: 38 CON: Promoting Health | Nursing Roles | Evidence-Based Practice 12. ANS: 4 Objective: 6. Describe components of screening from a population and individual perspective.

Page: Heading: A Secondary Prevention Approach: Screening and Early Identification Integrated Processes: Nursing Process

Client Need: Physiological Integrity; Reduction of Risk Potential Cognitive Level: Application Difficulty: Moderate Feedback 1 At-risk alcohol use cannot always be detected based on clinical presentation.

2 Although interaction with treatment modalities is important, it is not the primary reason for screening, which is to detect and provide early interventions for persons engaged in at-risk alcohol use.

3 Alcohol screening is done not only to detect those who meet the criteria for an alcohol use disorder but also to identify those who may be engaged in at-risk drinking.

4 Alcohol screening is done not only to detect those who meet the criteria for an alcohol use disorder but also to identify those who may be engaged in at-risk drinking.

PTS: 1 REF: 42 | 43 CON: Assessment | Promoting Health | Quality Improvement 13. ANS: 2 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Prevention Frameworks > Universal, Selected, and Indicated Prevention Models Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 A universal prevention intervention is one that is applicable to the whole population and is not based on individual risk. The proposed intervention is aimed at a subset of the population at increased risk for deciding not to breastfeed.

2 Indicated prevention interventions are provided to populations with a high probability of developing disease. The proposed intervention is aimed at a subset of the population with an increased risk for deciding not to breastfeed.

3 Primary prevention is not part of the SAMSHA framework.

4 Selective prevention interventions are aimed at a subset of the population that has an increased level of risk for developing disease.

PTS: 1

REF: 33

CON: Diversity | Family | Promoting Health

COMPLETION 14. ANS: 0.1 Feedback: The prevalence of a disease is calculated by dividing the total number of disease cases (100) by the total number of persons in a population (1,000) to equal the total number of cases of disease in a population.

100 ÷ 1,000 = 0.1.

Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Integrated Processes: Nursing Process Heading: Prevention Frameworks > Natural History of Disease

Client Need: n/a Cognitive Level: Application [Applying] Difficulty: Easy PTS: 1 REF: 28 CON: Assessment 15. ANS: 72.7% Feedback: The number of true positives (40) is divided by the total number of people with the disease (true positives plus false negatives = 55) and multiplied by 100 to equal the sensitivity of the instrument. (40/55)  100  72.7%.

Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Screening and Early Identification > Sensitivity and Specificity Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concepts Assessment | Promoting Health Cognitive Level: Application [Applying] Difficulty: Easy PTS: 1

REF: 44-48

CON: Assessment | Promoting Health

MULTIPLE RESPONSE 16. ANS: 1, 2, 5 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Population Health Promotion, Health Protection, and Risk Reduction Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Promoting Health; Assessment; Health Systems Cognitive Level: Application [Applying] Difficulty: Moderate

1 2 3 4 5

Feedback Individual, Relationship, Communication, and Societal are the four concepts included in the model.

Individual, Relationship, Communication, and Societal are the four concepts included in the model.

Policy is not one of the four concepts in the model and would come under the concept of societal determinants.

Genetics is not one of the four concepts in the model and would come under the concept of the individual determinants.

Individual, Relationship, Communication, and Societal are the four concepts included in the model.

PTS: 1

REF: 25

CON: Promoting Health | Assessment

17. ANS: 1, 2, 4, 5 Objective: 6. Describe components of screening from a population and individual perspective.

Page: Heading: Screening and Early Identification > Sensitivity and Specificity Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Assessment | Promoting Health Cognitive Level: Application [Applying] Difficulty: Easy

1 2 3 4 5

Feedback Reliability is the ability of the instrument to give consistent results on repeated trials.

Validity is the degree to which the instrument measures what it is supposed to measure.

Functionality is the quality of being suited to serve a purpose well. This is not one of the attributes by which a measurement tool is always evaluated.

Sensitivity is the ability of the screening test to a give a positive finding when the person truly has the disease or is a true positive.

Specificity is the ability of the screening test to give a negative finding when the person does not have the disease or is a true negative.

PTS: 1 REF: 44 CON: Assessment | Promoting Health 18. ANS: 1, 2, 3 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Prevention Frameworks > Natural History of Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension Difficulty: Moderate

1 2 3

4 5

Feedback A prevalence pot includes the total number of current cases.

A prevalence pot takes into account duration and incidence of the disease.

A prevalence pot is a way of depicting the total number of cases of a disease in a population that takes into account issues related to duration of the disease and the incidence of the disease.

A prevalence pot does not specifically provide information on potential new cases.

A prevalence pot does not determine the amount of medication used.

PTS: 1 REF: 28 | 29 CON: Promoting Health 19. ANS: 1, 2, 3 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective.

Page: Heading: Population Health Promotion, Health Protection, and Risk Reduction Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Concepts: Assessment | Promoting Health | Evidence-Based Practice Cognitive Level: comprehension

Difficulty: Easy

1 2 3 4 5

Feedback Physical environments contribute to the health of populations and individuals.

Social environments, along with physical environments, are key determinants of health for individuals and communities.

Social relations are one of the upstream determinants of health included in the model.

Political systems may support communities but are not specific to the model.

Health care systems may support communities but are not specific to the model.

PTS: 1

REF: 25

CON: Assessment | Promoting Health | Evidence-Based Practice

Chapter 3: Epidemiology and Nursing Practice Multiple Choice Identify the choice that best completes the statement or answers the question.

1. John Snow, considered the founder of epidemiology, realized the source of the London’s cholera epidemic through: 1. Developing a frequency distribution of deaths.

2. Mapping of the food supply.

3. Interviewing the families of the sick.

4. Performing autopsies.

2. The history and development of epidemiology has gone through several developmental phases. The nursing student learns that these phases came about in history in what order?

1. Risk factor phase, infectious disease phase, and sanitary phase 2. Infectious disease phase, risk factor phase, and sanitary phase 3. Sanitary phase, infectious disease phase, and risk factor phase 4. Agent phase, host phase, and environment phase 3. A public health nurse (PHN) is asked by the hospital administration to find out why there are so many pediatric asthma patients coming to the emergency department (ED) for treatment and to develop a plan to reduce admissions by 10%. The PHN knows the first step, prior to developing an intervention, is to understand the multiple risk factors involved. Which framework would best help the PHN understand the multiple risk factors contributing to asthma in this population?

1. The epidemiological triangle 2. The ecological model 3. The epidemiological constants 4. The web of causation 4. Jane works for the public health department with the primary job of conducting outbreak investigations. There has been a recent outbreak of hepatitis A. She has collected data on the number of new cases among the contacts of initial (primary) cases, divided it by the number of people in the population at risk, and then multiplied it by a given multiplier. She is calculating the: 1. Prevalence.

2. Incidence.

3. Secondary attack rate.

4. Attack rate.

5. A public health nurse is comparing the prevalence of type 2 diabetes in two counties in Ohio. From an epidemiological perspective these are: 1. Independent rates.

2. Mortality rates.

3. Dependent rates.

4. Morbidity rates.

6. When comparing the body mass index (BMI) of obese women in two cities, John found that the average BMI of City A was higher than that of City B. However, when he concluded that a woman in City A will have a higher BMI than a woman in City B, his conclusion was an example of .

1. An odds ratio.

2. An ecological fallacy.

3. A causality.

4. A relative risk.

7. To better understand the risk factors for the high prevalence of asthma in her school, the school nurse gets approval to send out an anonymous survey to the parents. She is seeking preliminary data on how many of the students who may have asthma are exposed to secondary smoke. Questions for the parents include information about their children’s history of asthma and whether anyone living in the home smokes. Which study design best describes her study?

1. Case-control study 2. Cross-sectional study 3. Cohort study 4. Outbreak investigation 8. A control or “no disease” group is needed for study on risk factors associated with oral cancer. The nurses conducting the study decide to use a group of patients with skin cancer as their controls because these patients are at the same facility. Having another type of cancer could itself be a risk factor and is a potential limitation in the study. This variable, having another type of cancer, would be called a(n): 1. Confounder.

2. Right censoring.

3. Case-control.

4. Odds ratio.

9. An epidemiologist uses the epidemiological triangle to explain the occurrence of disease by looking at the three main components of the model: the host, the environment, and the agent. The PHN understands that the agent could be one of many types except: 1. Biological and chemical.

2. Nutritive.

3. Physical.

4. Ecological.

10. John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. He has been asked to work with the team that does outbreak investigations and conducts surveillance. As part of John’s work in outbreak investigations, which three precipitating factors, also known as the epidemiological constants, should he consider to help guide these investigations?

1. Person, agent, and time 2. Host, agent, and time 3. Person, place, and environment 4. Person, place, and time 11. John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. He has been asked to work with the team that does outbreak investigations and conducts surveillance. John has also assumed responsibility for surveillance of sexually transmitted infections (STIs). The primary purpose of surveillance of STIs at the local public health department is to be able to: 1. Determine the prevalence of disease over time and provide reports to the state health department.

2. Study person-related variables or factors to help provide increased access to treatment.

3. Calculate percent change in a demographic variable to assess changes over time.

4. Identify a possible rise in cases above the endemic level and take action.

12. John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. He has been asked to work with the team that does outbreak investigations and conducts surveillance. There has been an outbreak of measles in the county that his public health department serves. John was asked to put together an alert to parents related to the outbreak. What is one aspect of this type of outbreak that presents substantial challenges to persons working in a local public health department like John’s?

1. Poor access to medical care 2. Person-to-person transmission 3. Low economic status.

4. Inadequate sanitation systems 13. A young couple with a family history of cystic fibrosis meets with a nurse to ask about preconception testing using genetic markers for early identification of the disease to help them make childbearing decisions. The area of study that has helped health-care providers and families answer these questions is called: 1. The Human Genome Project 2. Behavioral Risk Factor Surveillance System (BRFSS) 3. Ecological epidemiology 4. Genomics 14. In a large urban public health department (PHD), Sam, the PHD’s epidemiologist, is concerned about upward trends related to type 2 diabetes over the past 5 years. To help identify the key risk factors, Sam begins to examine three categories of risk central to epidemiology. These categories include all of the following except: 1. Prevalence 2. Behavioral 3. Environmental 4. Genetic 15. Yin is a nurse in a rural primary care clinic. One of the issues that has arisen is how to address patients who come in asking about testing for BRCA1 and BRCA2, the tumor suppressing genes that, if mutated, may indicate hereditary breast and ovarian cancer. Yin reads up on the issue and tells her colleagues that there are arguments against genetic testing for BRCA1 and BRCA2 that include all of the following except: 1. The cost of the test is high.

2. The evidence to the effectiveness of the test is limited.

3. The test is difficult to perform.

4. Less than 10% of all breast cancers are genetically based.

16. The state public health department has been tracking syphilis, as mandated by the Centers for Disease Control and Prevention, with little change in the incidence rate over time. Recently, however, incidence rates indicate they may have an outbreak. They deploy health-care professionals, including nurses, to further investigate beginning with a review of medical records. The first type of surveillance conducted is an example of surveillance and the second type of surveillance conducted is an example of surveillance.

1. Both are examples of passive surveillance.

2. Passive and active 3. Both are examples of active surveillance.

4. Active and passive Completion Complete each statement.

17. A local health department reports that there are 1,375 smokers in a town of 5,000. Of these smokers, 536 have reported that they have influenza. What percent of smokers have influenza? Round your answer to the nearest whole percent.

18. A PHN is studying the rate of H1N1 in the community. If there are five cases of H1N1 in the community of 1,000 people, what is the prevalence rate?

Multiple Response Identify one or more choices that best complete the statement or answer the question.

19. Renee, a nurse working in a primary care clinic, is conducting a physical assessment of Adam, age 42, who reports multiple medical issues. Renee is concerned and wonders what might explain his poor health. During this visit, she asks Adam about his work history and discovers that he is working in a chemical plant. This information is not sufficient to a direct causal link between possible workplace exposure to toxins and his current medical issues because: (Select all that apply.)

1. Safety records of the plant do not pertain to the health records of the patient.

2. The patient has medical problems that could be caused by lifestyle decisions rather than by working in the plant.

3. Even if Adam has been exposed to toxic substances, the threshold required to have adverse or fatal consequences might not have been reached.

4. There has been little progress on researching the relationship between exposure to toxins and illness.

20. A PHN recognizes that which of the following are types of cohort studies? (Select all that apply.)

1. Prospective 2. Retrospective 3. Historical 4. Longitudinal 5. Statistical

Chapter 3: Epidemiology and Nursing Practice Answer Section MULTIPLE CHOICE 1. ANS: 1 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Introduction > Historical Beginnings Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Comprehension [Understanding] Concept: Assessment, Evidence-Based Practice Difficulty: Easy Feedback 1 Snow developed a frequency distribution of the number of human deaths by placing hash marks on a city street map and realized a cluster of deaths occurred near the Broad Street water pump.

2 Snow developed a frequency distribution of the number of human deaths and found that they were clustered around the Broad Street water pump, not the food supply.

3 Snow developed a frequency distribution of the number of human deaths; he did not interview the families of the sick.

4 Snow developed a frequency distribution of the number of human deaths; he did not perform autopsies.

PTS: 1 REF: 56 | 57 CON: Safety | Infection 2. ANS: 3 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Introduction > Historical Beginnings Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Evidence-Based Practice; Promoting Health Difficulty: Easy Feedback 1 The first phase, the sanitary phase, was due to the theory that sanitation needed to be improved to aid health. During the next phase, the infectious disease phase, germ theory was developed and antibiotics came into production. The third phase, the risk factor phase, turned to reducing risk for disease and prevention.

2 The first phase, the sanitary phase, was due to the theory that sanitation needed to be improved to aid health. During the next phase, the infectious disease phase, germ theory was developed and antibiotics came into production. The third phase, the risk factor phase, turned to reducing risk for disease and prevention.

3 The first phase, the sanitary phase, was due to the theory that sanitation needed to be improved to aid health. During the next phase, the infectious disease phase, germ theory was developed and antibiotics came into production. The third phase, the risk factor phase, turned to reducing risk for disease and prevention.

4 The agent, host, and environment model is the Epidemiology Triangle, which is the

model used in explaining the occurrence of disease.

PTS: 1 REF: 57 | 58 CON: Evidence-Based Practice | Promoting Health 3. ANS: 4 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Introduction > Web of Causation Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Assessment; Promoting Health Difficulty: Moderate Feedback 1 The epidemiological triangle includes the host, agent, and environment. It does not explicitly examine the role of multiple risk factors.

2 The ecological model examines the complex interplay among individual, relationship, community, and societal factors. However, the web of causation model would be a better choice because it helps health-care providers develop more comprehensive strategies to reduce disease- and injury-related morbidity and mortality through primary and secondary prevention measures.

3 The epidemiological constants of person, place, and time are key aspects of an epidemiological investigation. It does not explicitly examine the role of multiple risk factors.

4 The web of causation is a framework used to illustrate the complexity of the multiple factors of illness, injury, and disease, which are determined by multiple causes and are at the same time affected by complex interaction of biological and sociobehavioral determinants of health. This is the best framework for the PHN to use.

PTS: 1 REF: 63 CON: Assessment | Promoting Health 4. ANS: 3 Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Tools of Epidemiology: Demography and Biostatistics > Biostatistics Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Infection Difficulty: Moderate Feedback 1 The prevalence is the total number of accumulated cases of a disease or illness, both new and preexisting, at a given time.

2 Incidence is the number of new cases of a disease of illness at a specific time or over a specific period of time.

3 Secondary attack rate is calculated this way. It is essentially the number of contacts of the initially ill who are now ill.

4 Attack rate is calculated by placing the total number of ill or diseased people in the numerator and dividing by the total number of ill plus well people in the susceptible population.

PTS: 1 REF: 68 CON: Assessment | Infection 5. ANS: 1 Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Tools of Epidemiology: Demography and Biostatistics > Biostatistics Integrated Processes: Nursing Process Client Need: Health Promotion and Safety Cognitive Level: Understanding Concept: Assessment; Evidence-Based Practice Difficulty: Moderate Feedback 1 Independent prevalence rates are rates from two populations independent of one another.

2 Mortality refers to the number of deaths within a given population.

3 Dependent prevalence rates reflect that all of the cases in one rate (county x) are included in the other rate (state Y that includes county x).

4 Morbidity refers to the number or proportion of individuals experiencing a similar disability, illness, or disease.

PTS: 1 REF: 69 | 70 CON: Assessment | Evidence-Based Practice 6. ANS: 2 Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Outbreak Investigations Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Assessment; Critical Thinking Difficulty: Moderate Feedback 1 The odds ratio is defined as the odds of someone among the exposed having a disease or condition compared with the odds of someone among those who were not exposed having the disease or condition.

2 Ecological fallacy is the erroneous assumption that one can draw conclusions for individuals based on group findings, which occurs when the researcher draws conclusions at the individual level based solely on the observations made at the group level.

3 Causality is a finding in a study that actually proves the cause of the reason for the study and doesn’t just establish a relationship between variables.

4 Relative risk is determined by comparing the incidence rate in the exposed group with the incidence rate in the not exposed group.

PTS: 1 REF: 73 CON: Critical Thinking | Assessment | Evidence-Based Practice 7. ANS: 2 Objective: 6. Differentiate cohort and case-control study design and select appropriate measures of effect.

Page: Heading: Descriptive and Analytical Epidemiology > Analytical Epidemiology Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying]

Concept: Promoting Health; Assessment; Evidence-Based Practice Difficulty: Moderate Feedback 1 The case-control study design involves comparing the rate of disease in those exposed to a risk factor to the rate in those who were not exposed to a risk factor. Because the school nurse used an anonymous survey she cannot confirm which students actually have asthma (cases) and which do not (controls).

2 A cross-sectional study examines risk factors and disease using data collected at the same point in time.

3 Cohort studies are studies that follow a specific population, subset of the population, or group of people over a specified period of time.

4 An outbreak investigation occurs in response to elevated levels of a disease or illness within the defined population, including exposure to toxic agents.

PTS: 1 REF: 70 CON: Evidence-Based Practice | Promoting Health | Assessment 8. ANS: 1 Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Descriptive and Analytical Epidemiology > Analytical Epidemiology Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Critical Thinking; Promoting Health Difficulty: Moderate Feedback 1 Confounders are variables that could make it difficult to establish a clear causal link unless adjustments are made for their effects.

2 Right censoring is subject attrition or discontinued participation in a study.

3 Case-control describes the study design, not the type of variable.

4 The odds ratio is defined as the odds of someone among the exposed having a disease or condition compared with the odds of someone among those who were not exposed having the disease or condition.

PTS: 1 REF: 71 CON: Evidence-Based Practice | Critical Thinking | Promoting Health 9. ANS: 4 Objective: 2. Explain the epidemiological triangle.

Page: Heading: Introduction > Epidemiological Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Evidence-Based Practice Difficulty: Easy Feedback 1 An example of a biological agent is an organism. Examples of chemical agents include liquids and gases.

2 A nutritive agent could be a certain dietary component or the lack of a dietary component.

3 4

A physical agent could be a mechanical or atmospheric force, such as an earthquake.

Ecological does not refer to a type of agent. The final agent type is psychological, an example of which could be stress.

PTS: 1 REF: 59 | 60 CON: Promoting Health | Evidence-Based Practice 10. ANS: 4 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Outbreak Investigations Integrated Processes: Nursing Process Client Need: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Infection; Nursing Roles Difficulty: Easy Feedback 1 Person, place, and time are the three constants. Agent is part of the epidemiological triangle.

2 Person, place, and time are the three constants. Host and agent are part of the epidemiological triangle.

3 Person, place, and time are the three constants. Environment is part of the epidemiological triangle.

4 Person, place, and time are the three constants.

PTS: 1 REF: 60 CON: Assessment | Infection | Nursing Roles 11. ANS: 4 Objective: 7. Explain surveillance and the difference between active and passive surveillance.

Page: Heading: Outbreak Investigations Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Nursing Roles; Infection Difficulty: Moderate Feedback 1 Although surveillance includes calculation of prevalence of disease and injury, the main purpose is to establish expected levels of disease and illness in a population.

2 Demography is the study of person-related variables or factors.

3 Percent change is mainly used with demographic variables.

4 Surveillance establishes expected levels of disease and illness in a population.

PTS: 1 REF: 74 | 75 CON: Assessment | Nursing Roles | Infection 12. ANS: 2 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Outbreak Investigations > Communicable Disease Outbreaks Integrated Processes: Nursing Process Client Need: Safe and Effective Environment; Safety and Infection Control Cognitive Level: Application Concept: Infection; Promoting Health; Safety

Difficulty: Easy Feedback 1 John works in a high-income county close to a large city that would have adequate health-care resources.

2 Person-to-person transmission presents substantial challenges to persons working in a public health.

3 Low economic status can result in increased risk for morbidity and mortality related to communicable disease such as measles. However, John works in a high-income county.

4 Inadequate sanitation increases the risk for spread of communicable disease such as measles. However, like other high-income countries, in the absences of disaster, inadequate sanitation is not a major challenge during a communicable disease outbreak.

PTS: 1 REF: 74 CON: Infection | Promoting Health | Safety 13. ANS: 4 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Introduction > Risk Factors > Genetic Risk Factors (Genomics) Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Family; Assessment; Evidence-Based Practice; Difficulty: Easy Feedback 1 The Human Genome Project is a large epidemiological study that is working to understand genetic factors in populations.

2 The BRFSS is a resource that captures population-level trended data for health behavior.

3 Ecological epidemiology is the study of the environmental factors, such as community and living situations, in which a disease has been discovered.

4 The field of genetic epidemiology that seeks to understand the inheritability of factors that have an impact on the development of illness and disease is called genomics.

PTS: 1 REF: 59 CON: Pregnancy | Family | Assessment | Evidence-Based Practice 14. ANS: 1 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Introduction > Risk Factors Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Evidence-Based Practice; Assessment Difficulty: Easy Feedback 1 Prevalence is the total number of accumulated cases of a disease or illness both new and pre-existing at a given time and is a category of risk.

2 Person-related aspects are certainly aligned with behavioral risk factors.

3 Place-related considerations are effectively illustrated by environmental risk factors.

4 Genetic risk is associated with the biological make-up of individuals that provides

protective factors or risk factors for the development of disease.

PTS: 1 REF: 58 | 59 CON: Promoting Health | Evidence-Based Practice | Assessment 15. ANS: 3 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Risk Factors > Genetic Risk Factors (Genomics) Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension Concept: Promoting Health; Evidence-Based Practice; Ethics Difficulty: Moderate Feedback 1 Testing can cost up to $3,000 for those who do not know their family history.

2 The direct benefit of the testing in reducing cancer rates is not known.

3 This is not one of the arguments against screening for BRCA1 and BRCA2.

4 Because so few breast cancer cases are genetically related, questions have been raised about the ethics of universal screening.

PTS: 1 REF: 59 CON: Promoting Health | Nursing Roles | Evidence-Based Practice | Ethics 16. ANS: 2 Objective: 1. Describe aspects of person, place, and time as they relate to epidemiological investigation.

Page: Heading: Surveillance Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Infection; Promoting Health; Nursing Roles Difficulty: Easy Feedback 1 The first is an example of passive surveillance, which is when data is collected based on individuals or institutions that report on health information either voluntarily or by mandate. The second is an example of active surveillance, which involves the deployment of public health professionals including nurses to identify cases of a disease or health condition under surveillance.

2 The first is an example of passive surveillance, which is when data is collected based on individuals or institutions that report on health information either voluntarily or by mandate. The second is an example of active surveillance, which involves the deployment of public health professionals including nurses to identify cases of a disease or health condition under surveillance.

3 The first is an example of passive surveillance ,which is when data is collected based on individuals or institutions that report on health information either voluntarily or by mandate. The second is an example of active surveillance, which involves the deployment of public health professionals including nurses to identify cases of a disease or health condition under surveillance.

4 The first is an example of passive surveillance, which is when data is collected based on individuals or institutions that report on health information either voluntarily or by mandate. The second is an example of active surveillance, which involves the deployment of public health professionals including nurses to identify cases of a disease

or health condition under surveillance.

PTS: 1 REF: 75 CON: Infection | Mobility | Safety | Promoting Health | Nursing Roles COMPLETION 17. ANS: 39% Feedback: The number of reported smokers with influenza (536) is divided by the number of total smokers (1,375) and then multiplied by 100 to get the percent of smokers with influenza. (536/1,375)  100  39%.

Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Tools of Epidemiology: Demography and Biostatistics > Biostatistics Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment Difficulty: Easy PTS: 1 REF: 67 CON: Assessment 18. ANS: 5 per 1,000 Feedback: The prevalence rate is calculated by dividing the existing number of cases (numerator) by the total number of persons in the population (denominator) and multiplying by a constant, expressed as per 1,000 in this case.

Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Tools of Epidemiology: Demography and Biostatistics > Biostatistics Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Easy PTS: 1

REF: 68

CON: Assessment

MULTIPLE RESPONSE 19. ANS: 2, 3 Objective: 5. Apply basic biostatistical methods to analyze epidemiological data.

Page: Heading: Outbreak Investigations > Exposure to Toxins Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety

Difficulty: Moderate

1

2 3

4

Feedback Organizations such as the Environmental Protection Agency (EPA) and the National Institute for Occupational Safety and Health (NIOSH) have monitored safety and researched how to reduce toxic risks because the health and safety of plant workers are, in fact, connected.

Other risk factors for disease should also be considered when determining cause and effect.

Understanding toxic substances and at what threshold they begin to have negative health effects is a continual research process. For this reason, it is difficult to establish a clear cause-and-effect relationship between exposure to toxins and disease.

Organizations including the Environmental Protection Agency (EPA), National Institute for Occupational Safety and Health (NIOSH), CDC, and the Agency for Toxic Substances and Disease Registry (ATSDR) have made substantial gains in research and policy to reduce toxic risks adversely affecting the health of the public

PTS: 1 REF: 74 CON: Safety 20. ANS: 1, 2, 3, 4 Objective: 6. Differentiate cohort and case-control study design and select appropriate measures of effect.

Page: Heading: Descriptive and Analytical Epidemiology > Analytical Epidemiology Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Evidence-Based Practice Difficulty: Easy

1

2

3 4

5

Feedback A prospective study is being performed when participants are enrolled and watched for disease over a long period of time. Because this study follows a group over a specified period of time, it is considered a type of cohort study.

A retrospective study is being performed when participants are asked to report on their medical history. Because this study looks at a group over a specified period of time, it is considered a type of cohort study.

A historical prospective is a combination of retrospective and prospective methods. Because this study follows a group over a specified period of time, it is considered a type of cohort study.

A study that follows a group over a long period of time, such as 30 years or more, is considered a longitudinal study. Because this study follows a group over a specified period of time, it is considered a type of cohort study.

All studies involve the use of statistics, and so this answer does not refer to a cohort study specifically.

PTS: 1

REF: 71 | 72

CON: Evidence-Based Practice

Chapter 4: Introduction to Community Assessment Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. The community members ask Monique what type of data they will need to collect. She explains that they should begin with demographic data that includes: 1. Insurance company preference 2. Vaccination rates 3. Educational levels 4. Disease rates 2. A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. Monique explains to the team that information about the health status of the community would be an important part of their assessment. She explains that this includes all of the following factors except: 1. Mortality rates 2. Morbidity rates 3. Health-care services and resources in the community 4. Prevalence and incidence of disease 3. A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. Monique and the community members discuss the type of assessment they are conducting. They have decided to complete an assessment to include the demographic data about the people living within the community, the assets within the community, such as the local health department capacity, and the identification of problems and issues in the community, such as unmet needs, health disparities, and opportunities for action. The type of assessment they are doing is called a: 1. Rapid needs assessment 2. Comprehensive community assessment 3. Population-focused assessment 4. Health impact assessment 4. A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. To help guide the team, Monique suggests that they chose a tool for the assessment. She explains that one can be obtained from: 1. National Institute of Occupational Safety and Health (NIOSH) 2. Affordable Care Act (ACA) 3. Institute of Medicine (IOM)’s report The Future of Public Health 4. Centers for Disease Control and Prevention (CDC) Community Health Assessment and Group Evaluation (CHANGE) 5. A PHN goes to a factory to find out why employees are missing so many workdays. What type of assessment would be the most appropriate in this case?

1. Setting-specific assessment 2. Health impact assessment 3. Problem or health issue-based assessment 4. Population-focused assessment

6. To develop maintenance and survival strategies for a community in the event of an emergency, a PHN looks for useful places, persons, and systems. This part of the assessment is called: 1. Capacity building.

2. Needs assessment.

3. Participatory research.

4. Asset mapping.

7. A team at a large urban hospital has partnered with other hospitals and the department of health to conduct a comprehensive community assessment. They reviewed a number of possible tools to guide their assessment and chose the Mobilizing for Actions through Planning and Partnerships (MAPP) strategic model. They chose this tool because all but which of the following were included: 1. Assessing, diagnosing, developing an intervention 2. A comprehensive method for evaluating health systems 3. Implementing the intervention 4. Evaluating the effectiveness of the intervention 8. A PHN is using the MAPP model to conduct an assessment within the community and has reached Phase 3, performing the four assessments. The analysis of the legislation, technology, and other external positive and negative influences that have an impact on the promotion and protection of the public’s health is called a: 1. Community themes and strengths assessment.

2. Forces of change assessment.

3. Community health status assessment.

4. Local public health system assessment (LPHSA).

9. A PHN was asked to come to a town that was having some noticeable health problems. Driving through town, the nurse noted that there were many for-sale signs, as well as very little green space and some trash in the street. This pre-assessment phase is called a: 1. Community themes and strengths assessment.

2. Community Health Assessment and Group Evaluation (CHANGE).

3. Community health status assessment.

4. Windshield survey.

10. A relatively permanent statistical subdivision of a county that averages between 2,500 and 8,000 inhabitants is called a: 1. Census block.

2. Secondary data.

3. Census tract.

4. Health-care sector.

11. According to the CHANGE model, the aspect of a community that includes community-wide efforts that have an effect on the social and built environments such as improving food access, walkability or bike-ability, tobacco use or exposure, or personal safety is called the: 1. Community institution or organization sector.

2. Health-care sector.

3. Community-at-large sector.

4. Preventative sector.

12. A community assessment team has decided to do a survey using a type of sampling in which a list of the possible participants is present, and the number needed for the sample is divided into the total population.

From that point, n, every nth person is chosen for the sample. This type of sampling is called: 1. Quota sampling.

2. Convenience sampling.

3. Simple random sampling.

4. Systematic sampling.

13. A community assessment team found that the problem with their surveys of older adults was that there was not enough information on the health-related quality of life (HRQoL) for those over the age of 65 who were not living in a health-care facility. The best approach to assess this population is to do surveys: 1. By personal interview.

2. By mail.

3. By telephone.

4. Online.

14. Charlotte, a PHN, is preparing to volunteer oversees to help a team in a low-income country develop a health program for older adults. Prior to traveling to the country, Charlotte wants to learn more about the demographic age. To do this, she locates a population pyramid for the country and finds that it has a broad base and a small top. This represents: 1. Slow growth.

2. Rapid growth.

3. Equal growth.

4. Mostly older people, with no growth.

15. Charlotte, a PHN, is preparing to volunteer oversees to help a team in a low-income country develop a health program for older adults. Once she arrives, Charlotte convenes a team to conduct an assessment of older adults living in the country. She and the team decided to use the Kinship/Economics/Education/Political/Religious/Associations (KEEPRA) model for observing formal institutions in a community. Which of the following categories assesses the number or availability of recreational centers?

1. Education 2. Kinship 3. Associations 4. Economics 16. Charlotte, a PHN, is preparing to volunteer oversees to help a team in a low-income country develop a health program for older adults. Charlotte and the team completed a community health survey and found that the older adults in the community were underrepresented. They decided to use a qualitative primary data collection method that revolves around conducting a group interview with a group of people with similar backgrounds and/or experiences. This is called: 1. Use of key informants.

2. Use of PhotoVoice.

3. Use of a Health-Related Quality of Life Questionnaire (HRQoL).

4. Use of focus group(s).

Multiple Response Identify one or more choices that best complete the statement or answer the question.

17. The best uses of Geographic Information Systems (GIS) by public health professionals include which of the following? (Select all that apply.)

1. To track intervention outcomes 2. To identify spatial data 3. To display environmental risk factors and health risks 4. To display demographic data 5. To display socioeconomic data

18. A PHN has joined a community team conducting a comprehensive community assessment. The team wants to begin by collecting data through the use of a survey. The PHN encourages them to include a health indicator survey that measures health-related quality of life (HRQoL). The advantages for using this strategy include which of the following? (Select all that apply.)

1. HRQoL is a multidimensional construct that relates peoples’ perceptions of the impact their physical and emotional health have on their quality of life.

2. HRQoL is an indicator of how much health insurance will pay if a person is in the hospital.

3. Including HRQoL items on a survey will provide information on the health of the community that the secondary data does not provide.

4. HRQoL ascertains if an intervention is needed.

5. HRQoL contains information that is quantitative rather than qualitative in nature.

Completion Complete each statement.

19. A public health team wanted to track the changes in a population within their town, particularly a shift in the Hispanic population. Currently, 650 people in the town of 7,600 identified themselves as Hispanic, whereas 10 years ago, only 390 did. The percent change is . Record answer with one decimal place. Do not round.

Chapter 4: Introduction to Community Assessment Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 9. Analyze primary and secondary data to identify strengths and needs of a community.

Page: Heading: Definitions of Community and Community Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 The names of the insurance companies used in a community are not considered demographic information and are not necessary data to collect during a community assessment.

2 Vaccination rates are not considered demographic data. Demographic data include age, gender, socioeconomic indicators, racial or ethnic distributions, and educational levels.

3 Educational levels, as well as age, gender, socioeconomic indicators, and racial or ethnic distributions, are considered demographic data.

4 Disease rates are not considered demographic data. Demographic data include age, gender, socioeconomic indicators, racial or ethnic distributions, and educational levels.

PTS: 1 REF: 78 CON: Assessment | Promoting Health 2. ANS: 3 Objective: 9. Analyze primary and secondary data to identify strengths and needs of a community.

Page: Heading: Definitions of Community and Community Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Assessment Difficulty: Easy Feedback 1 Mortality rates are an indicator of the health status of a community.

2 Morbidity rates are an indicator of the health status of a community.

3 Health-care services and resources in the community are related to the assessment of community structure rather than health status of the community.

4 Prevalence and incidence of disease are indicators of health status of a community.

PTS: 1 REF: 78 CON: Assessment 3. ANS: 2 Objective: 2. Describe six approaches to conducting an assessment (comprehensive community assessment, population focused, setting specific, problem focused, health impact, rapid needs assessments).

Page: Heading: Types of Community Health Assessment > Comprehensive Assessment

Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Nursing Roles; Promoting Health Difficulty: Easy Feedback 1 A rapid needs assessment is a tool that helps establish the extent and possible evolution of an emergency by measuring the present and potential public health impact of the emergency.

2 This definition describes a comprehensive community assessment.

3 A population-focused assessment can be focused on a specific population for purposes of planning and developing intervention programs.

4 A health impact assessment is a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population.

PTS: 1 REF: 79 CON: Assessment | Nursing Roles | Promoting Health 4. ANS: 4 Objective: 2. Describe six approaches to conducting an assessment (comprehensive community assessment, population focused, setting specific, problem focused, health impact, rapid needs assessments).

Page: Heading: Types of Community Health Assessment > Comprehensive Assessment Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 NIOSH is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. It is not a resource for community assessment tools.

2 The ACA is the legislation that requires that assessments should be conducted. It is not a resource for community assessment tools.

3 The IOM’s report The Future of Public Health indicates that improving health in populations or communities has been linked to performing comprehensive assessments.

It is not a resource for community assessment tools.

4 The CDC is a resource for community assessment tools such as the Community Health Assessment and Group Evaluation (CHANGE).

PTS: 1 REF: 79 CON: Assessment | Promoting Health 5. ANS: 1 Objective: 2. Describe six approaches to conducting an assessment (comprehensive community assessment, population focused, setting specific, problem focused, health impact, rapid needs assessments).

Page: Heading: Types of Community Health Assessment > Setting-Specific Assessment Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application Concept: Assessment; Promoting Health Difficulty: Moderate

1 2

3 4

Feedback A setting-specific assessment treats the setting as the community, takes into account the population located in the setting, and looks for factors relevant to the setting.

A health impact assessment is a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population.

A problem or health issue-based assessment focuses on a specific problem or health issue.

A population-focused assessment is an assessment that can be focused on a specific population for purposes of planning and developing intervention programs.

PTS: 1 REF: 80 | 81 CON: Assessment | Promoting Health 6. ANS: 4 Objective: 2. Describe six approaches to conducting an assessment (comprehensive community assessment, population focused, setting specific, problem focused, health impact, rapid needs assessments).

Page: Heading: Concepts of Relevance to Community Assessments > Needs Assessments Versus Asset Mapping Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Safety Difficulty: Moderate Feedback 1 Capacity building is the concept that helps communities understand the deficiencies and obstacles that inhibit their people, governments, and organizations from attaining their goals while enhancing the abilities that will allow them to achieve measurable and sustainable results.

2 Needs assessment is a systematic set of procedures undertaken for the purpose of setting priorities and making decisions about program or organizational improvement and allocation of resources. The priorities are based on identified needs.

3 Participatory research aims at the engagement of members of the community as full partners in the process of assessment. The idea is to use a collaborative approach that combines the knowledge and interest of the community members with the expertise of the professionals.

4 Asset mapping is a combination of finding assets (useful qualities, persons, or things) and mapping—that is, exploring, planning, and locating where they are for a time when they are needed.

PTS: 1 REF: 82 | 83 CON: Assessment | Promoting Health | Safety 7. ANS: 2 Objective: 3. Describe two assessment frameworks (MAPP, CHANGE).

Page: Heading: Assessment Models/Frameworks > Community Health Assessment and Group Evaluation (CHANGE) Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy

1

2 3

4

Feedback The MAPP tool includes the full scope of health planning including assessing, diagnosing, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention.

The MAPP tool does not include a comprehensive method for evaluating health systems.

The MAPP tool includes the full scope of health planning including assessment, diagnosis, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention.

The MAPP tool includes the full scope of health planning including assessment, diagnosis, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention.

PTS: 1 REF: 83-86 CON: Assessment | Promoting Health | 8. ANS: 2 Objective: 3. Describe two assessment frameworks (MAPP, CHANGE).

Page: Heading: Assessment Models/Frameworks > Community Health Assessment and Group Evaluation (CHANGE) Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Assessment; Promoting Health Difficulty: Moderate Feedback 1 A community themes and strengths assessment provides important information about how the residents feel about issues facing the community.

2 A forces of change assessment evaluates what threat or opportunity might affect the health of the community or the local health system. It includes an analysis like the one described in this question.

3 A community health status assessment looks at morbidity and mortality indicators, quality of life indicators, and behavioral risk factors.

4 The LPHSA looks at all the organizations and entities that contribute to the public’s health and how well they collaborate.

PTS: 1 REF: 85 | 86 CON: Assessment | Promoting Health 9. ANS: 4 Objective: 2. Describe six approaches to conducting an assessment (comprehensive community assessment, population focused, setting specific, problem focused, health impact, rapid needs assessments).

Page: Heading: A Comprehensive Community Health Assessment > Windshield Survey Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 A community themes and strengths assessment is an assessment of how the residents feel about their health and quality of life.

2 3 4

The CHANGE model helps communities build an action plan based on assets and needs.

A community health status assessment focuses on quantitative data covering many health indicators, such as mortality and morbidity.

A windshield survey is a drive or walk through the community to observe the community.

PTS: 1 REF: 86-88 CON: Assessment | Promoting Health 10. ANS: 3 Objective: 9. Analyze primary and secondary data to identify strengths and needs of a community.

Page: Heading: A Comprehensive Community Health Assessment > Secondary Community Health Data Collection Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 A census block is an area bounded on all sides by visible features, such as roads, streams, and railroad tracks.

2 Secondary data is data collected for a purpose other than the current assessment such as census data, crime report data, or national health survey data.

3 A census tract is a relatively permanent statistical subdivision of a county that averages between 2,500 and 8,000 inhabitants, and is designed to be homogenous with respect to population characteristics and economic status.

4 A health-care sector includes places where people go to receive preventive care or treatment, or emergency health-care services such as hospitals, private doctors’ offices, and community clinics.

PTS: 1 REF: 89 CON: Assessment 11. ANS: 3 Objective: 2. Describe six approaches to conducting an assessment (comprehensive community assessment, population focused, setting specific, problem focused, health impact, rapid needs assessments).

Page: Heading: A Comprehensive Community Health Assessment > Windshield Survey Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 The community institution or organization sector includes entities within the community that provide a broad range of human services and access to facilities such as childcare settings, faith-based organizations, senior centers, boys and girls clubs, YMCAs, and colleges or universities.

2 The health-care sector includes places where people go to receive preventive care or treatment or emergency health-care services such as hospitals, private doctors’ offices, and community clinics.

3 The community-at-large sector includes community-wide efforts to improve the social

4

and built environments.

A preventative sector is not included in the CHANGE model’s list of sectors.

PTS: 1 REF: 88 CON: Assessment | Promoting Health 12. ANS: 4 Objective: 5. Describe qualitative and quantitative methods to collect primary data for conducting an assessment.

Page: Heading: A Comprehensive Community Health Assessment > Primary Community Health Data Collection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Evidence-Based Practice; Promoting Health Difficulty: Easy Feedback 1 Quota sampling is a type of convenience sampling that involves a fixed number of subjects.

2 Convenience sampling takes into consideration the availability of participants.

3 Simple random sampling uses a list of the eligible individuals and then selection is made based on a random selection.

4 Systematic sampling is used for large populations and involves the method described here.

PTS: 1 REF: 91 CON: Assessment | Evidence-Based Practice | Promoting Health 13. ANS: 1 Objective: 5. Describe qualitative and quantitative methods to collect primary data for conducting an assessment.

Page: Heading: A Comprehensive Community Health Assessment > Primary Community Health Data Collection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Evidence-Based Practice; Assessment; Promoting Health; Informatics Difficulty: Easy Feedback 1 Doing personal interviews has many advantages, such as flexibility, being able to probe for specific answers, being able to observe nonverbal behavior, being able to control the physical environment, and being able to use more complex questions.

2 Mail is not the best method as it is sometimes forgotten or thrown away.

3 In some geographic areas—such as where Amish people live—telephones are not used, so the survey response would be low in those areas.

4 Many older people do not use the computer or go online, so conducting the survey online would result in low participation.

PTS: 1 REF: 90 CON: Evidence-Based Practice | Assessment | Promoting Health | Informatics 14. ANS: 2 Objective: 9. Analyze primary and secondary data to identify strengths and needs of a community.

Page:

Heading: A Comprehensive Community Health Assessment > Evaluating the Assessment Process Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Evidence-Based Practice; Nursing Roles; Promoting Health Difficulty: Easy Feedback 1 A pyramid with indentations that even out from top to bottom indicates slow growth in that population.

2 An expansive pyramid, one with a broad base and narrow top, represents a rapid rate of population growth.

3 A stationary pyramid has a narrow base with equal numbers over the rest of the age groups and it tapers off in the oldest age groups.

4 A declining pyramid is one that has a high proportion of persons in the higher age groups.

PTS: 1 REF: 95-97 CON: Evidence-Based Practice | Nursing Roles | Promoting Health 15. ANS: 3 Objective: 9. Analyze primary and secondary data to identify strengths and needs of a community.

Page: Heading: A Comprehensive Community Health Assessment > Windshield Survey Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Promoting Health; Assessment Difficulty: Easy Feedback 1 Education refers to the observation of schools and other educational institutions such as libraries and museums.

2 Kinship refers to the observation of family and family life.

3 Associations refer to the observation of neighborhood associations, business associations, and recreational centers.

4 Economics refers to the observation of whether the community has a stable economy and whether there are signs of economic growth or decline.

PTS: 1 REF: 88 CON: Evidence-Based Practice | Promoting Health | Assessment 16. ANS: 4 Objective: 5. Describe qualitative and quantitative methods to collect primary data for conducting an assessment.

Page: Heading: A Comprehensive Community Health Assessment > Primary Community Health Data Collection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 Use of key informants requires conducting individual interviews with someone who

2 3 4

comes closest to representing the community.

PhotoVoice involves having community members take photos of their everyday lives.

A HRQoL survey is a quantitative data collection method.

A focus group revolves around conducting a group interview with a group of people with similar backgrounds and/or experiences.

PTS: 1

REF: 91

CON: Assessment | Promoting Health

MULTIPLE RESPONSE 17. ANS: 2, 3, 4, 5 Objective: 6. Describe the use of multiple techniques and tools (geographic information systems [GIS], PhotoVoice) to conduct community assessments.

Page: Heading: A Comprehensive Community Health Assessment > Primary Community Health Data Collection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Nursing Roles; Promoting Health; Informatics; Assessment Difficulty: Moderate

1 2 3

4 5

Feedback GIS is a computer-based program that can be used to collect, store, retrieve, and manipulate location-based information. It is not used to evaluate the success of interventions GIS has the capability to identify spatial data assigned by exact geographical location by geocoding, or address matching.

The Toxic Release Inventory Program run by the EPA uses GIS to examine air emission sites from the Aerometric Information Retrieval System/AIRS Facility Subsystem (AIRS/AFS) database, which is a computer-based repository for information about air pollution in the U.S. GIS has the ability to retrieve noncapital data, such as the demographic data of a location, which aids identification of populations.

GIS has the ability to retrieve noncapital data, such as the socioeconomic data of a location, which could aid proper placement of intervention programs.

PTS: 1 REF: 93 CON: Evidence-Based Practice | Nursing Roles | Promoting Health | Informatics | Assessment 18. ANS: 1, 3, 5 Objective: 5. Describe qualitative and quantitative methods to collect primary data for conducting an assessment.

Page: Heading: A Comprehensive Community Health Assessment > Evaluating the Assessment Process Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Evidence-Based Practice; Promoting Health; Assessment Difficulty: Moderate

1

Feedback HRQoL is as assessment of how a population perceives their quality of life as it pertains to their

2 3 4 5

health.

HRQoL data are not used by health insurance companies to determine amount of payment for health-care services.

A HRQoL survey can provide primary data that gives insight on other public health aspects of the community not available through secondary data.

HRQoL surveys can help identify a person’s perceptions of the general health as well as specific aspects of the physical and mental health. It is not used to identify a specific intervention.

HRQoL surveys such as the CDC survey tool use Likert scales, which is a quantitative method.

PTS: 1

REF: 91

CON: Assessment | Evidence-Based Practice | Promoting Health

COMPLETION 19. ANS: 66.6% Feedback: Percentage change is the change in a variable from one point in time to another. Percentage change = [(new value – old value) / old value]  100. [(650 – 390) / 390]  100  66.6%.

Objective: 5. Describe qualitative and quantitative methods to collect primary data for conducting an assessment.

Page: Heading: A Comprehensive Community Health Assessment > Evaluating the Assessment Process Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity; Assessment; Promoting Health Difficulty: Moderate PTS: 1

REF: 98

CON: Diversity | Assessment | Promoting Health

Chapter 5: Health Program Planning Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The PHNs at the public health department have teamed with the community to help build community capacity. This could include all of the following except: 1. Organizing assets and resources to improve the health of a community.

2. Assessing how many people the community clinic will contain at one time.

3. Working in partnerships and supporting decision making.

4. Identifying root causes of health problems and working on achieving identified outcomes.

2. Once a community health assessment has been completed and the health priority has been established, the first step is to: 1. Identify other effective programs aimed at addressing the identified health priority.

2. Evaluate the capacity to address the health priority.

3. Understand the underlying factors contributing to the problem 4. Develop a program tailored to the community.

3. A community team made up of school administrators, parents, and teachers is in the process of addressing the issue of obesity in school age children. They contact the PHN in their community and discuss possible models for a health program. One of the models that the PHN mentions is the Predisposing, Reinforcing and Enabling factors, and Causes in Educational Diagnosis and Evaluation (PRECEDE) component of the PRECEDE-PROCEED model. The PHN explains that this model begins with: 1. An examination of administrative and organizational issues.

2. A comprehensive community assessment.

3. Preventative programs.

4. Implementation of behavior changes.

4. In general, nurses using the program planning model would begin by: 1. Identifying primary health issues in the community.

2. Implementing an intervention.

3. Selecting effective interventions.

4. Developing measurable process and outcome measures.

5. A group of public health officials want to use the logic model for program design. In this model, when a program’s intended outcome is achieved, this is referred to as successful: 1. Input.

2. Output.

3. Outcome.

4. Impact.

6. Nurse researchers concerned with families at risk for homelessness utilized the logic model to help develop an outreach program in their city. The researchers found a main benefit to the logic model was that they were able to: 1. Use one specific template because all versions of the logic model include the same components.

2. Help stakeholders visualize how the program goal(s) related directly to the objectives.

3. Utilize a circular model for describing the components of the process.

4. Develop a program without having to heavily rely on their assessment findings.

7. A team of nurses and physicians at a community hospital were concerned about the lack of vaccinations among children being seen in the emergency department (ED). They knew that in other states there had been an outbreak of measles and wanted to avoid it in their community. Based on their review of the ED records, they immediately mounted an aggressive vaccine campaign sponsored by the hospital. The program did not succeed. What key component(s) of health program planning did they miss that might explain the failure of the program?

1. Active involvement of the community as a partner 2. Failure to determine if they had enough vaccines on hand 3. Failure to provide enough personnel to administer the vaccines 4. Lack of commitment from other members of the hospital 8. A team of nurses and physicians at a community hospital were concerned about the lack of vaccinations among children being seen in the emergency department (ED). They knew that in other states there had been an outbreak of measles and wanted to avoid it in their community. Following the failure of a vaccine program the hospital team implemented, the team contacted the public health department, and they were referred to Amanda, the PHN overseeing the children’s health program. She acknowledged their concern and told them, in conjunction with the community and the PHD’s communicable disease unit, they were already working on a program to increase vaccination across the life span. Amanda apologized for not including them as key stakeholders and invited them to join the team. Amanda explained that a key concern for the community was social justice. The new members on the team from the hospital were concerned about cost if the program was expanded to include other age groups. All but which of the following would be an example of a lack of social justice? Limiting the program to vaccines for: 1. Those under 12.

2. Those with insurance to pay for administration of the vaccine 3. Those with the ability to meet a co-pay.

4. No one within the context of available resources.

9. A team of nurses and physicians at a community hospital were concerned about the lack of vaccinations among children being seen in the emergency department (ED). They knew that in other states there had been an outbreak of measles and wanted to avoid it in their community. The team finally completed a community assessment using secondary data, including de-identified hospital data. The team members for the hospital had initially analyzed the data and came together to come up with a community diagnosis related to vaccination. Based on the first two parts of a community diagnosis, they had identified the problem, low vaccination rates, and the population affected, children and adolescents. The next two steps in the community diagnosis include: 1. Identifying what resources are available and how to access additional resources.

2. Identifying what the problem is related to and what evidence-based programs could be implemented to address the problem.

3. Identifying what the problem is related to and how the problem is demonstrated.

4. How the problem is demonstrated and how to engage further members of the community in program planning.

10. A PHN is studying an older adult population in a high-rise building. As part of the community diagnosis, there are several factors to be examined, including the factor that is particularly significant when designing the program because it alters the outcome. This factor is called the: 1. Causal factor.

2. Mediating factor.

3. Moderating factor.

4. Antecedent factor.

11. The infection control nurse in the main hospital located in an industrial mill town alerts the public health department to the recent admission of patients with a waterborne illness. Once they had identified a common pathogen, they recognized that the outbreak was confined to poorer members of their community who did not have access to a pool during an extreme heat wave. They had been swimming in the local lake that was supposed to be off limits. All who had gotten sick had submerged their head. This is an example of a 1. Nursing community diagnosis.

2. Social justice issue.

3. Community assessment.

4. Consequence of climate change.

12. A nurse wants to use evidence-based practice (EBP) to develop a program aimed at preventing social isolation in older adults. The first step the nurse should take is to: 1. Do an assessment.

2. Develop a community diagnosis.

3. Consult the literature to create a rationale for intervention.

4. Begin community organizing.

13. A nurse is planning for the community acceptance of a program, estimating resources, developing specific plans for activities, and establishing program management. The nurse is currently working on: 1. Project management.

2. Program evaluation.

3. Program implementation.

4. Program planning.

14. A nurse is working on a type of evaluation that examines how a program actually works and whether any outside environmental events might have an impact on the program. This type of evaluation is called a: 1. Formative evaluation.

2. Process evaluation.

3. Summative evaluation.

4. Program evaluation.

15. A PHN is gathering evaluation information on a program to be used for several purposes, except: 1. To share with the media for public relations.

2. To make improvements on the program.

3. To redefine the population being served.

4. To share with funding agencies.

16. Pressure to slant or misuse the findings of an evaluation from the stakeholders would be what kind of problem?

1. Moral 2. Management 3. Confidentiality 4. Ethical Multiple Response Identify one or more choices that best complete the statement or answer the question.

17. A PHN is evaluating the effectiveness of a health intervention program for children by looking at the program characteristics. According to Lisbeth Schorr’s criteria, the nurse will be looking for which of the following?

(Select all that apply.)

1. Whether the program is meeting all the needs of the children

2.

3.

4.

5.

Whether the program continues to reach out to the families in neighborhoods Whether the program stays true to its goals Whether the staff and managers are able to support the mission of the program Whether the program is able to attract grant money

18. When analyzing evidence-based practice (EBP) literature to see if the information should be used in planning a program, a nurse should look at which of the following? (Select all that apply.)

1. Quantitative and qualitative data from studies 2. Analysis to see if the program is thriving 3. Economic indicators to see if the program is financially stable 4. Indicators of real outcomes and behavior change 5. Indicators of outside factors that might change the program 19. In community organizing, the PHN recognizes that her role is as a: (Select all that apply.)

1. Stakeholder 2. Leader 3. Listener 4. Facilitator 5. Developer of skills 20. When considering the outcomes of a planned intervention, a nurse should measure which of the following types of outcomes? (Select all that apply.)

1. Short-term 2. Medium-term 3. Changes in knowledge, skills, or behavior 4. Long-term 5. Unexpected or unintended outcomes

Chapter 5: Health Program Planning Answer Section MULTIPLE CHOICE 1. ANS: 2 Objective: 2. Identify components of different health planning models.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration Difficulty: Easy Feedback 1 Community capacity refers to the ability of a community to work together to organize their available resources to aid the area.

2 Assessing the capacity of a clinic is not a part of building community capacity.

3 It can be self-sustaining when the community is empowered to make their own decisions about interventions and outcomes.

4 Through collaboration, the community can recognize, evaluate, and address key health problems.

PTS: 1 REF: 107 CON: Promoting Health | Collaboration 2. ANS: 3 Objective: 1. Discuss the use of Healthy People 2020 in health program planning.

Page: Heading: Introduction > Healthy People 2020 Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Easy Feedback 1 Although this is important to do once the underlying factors have been identified, it is not the first step.

2 Although this is important to do during the program development phase, it is not the first step.

3 Understanding the underlying factors contributing to the problem will help in deciding what level of prevention is needed and who is at greatest risk.

4 Program development comes after establishing the underlying factors contributing to the problem.

PTS: 1 REF: 108 | 109 CON: Promoting Health 3. ANS: 2 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Health Program Planning Models Integrated Processes: The nursing process

Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration Difficulty: Easy Feedback 1 When the assessment phase is complete, the model provides guidance on how to examine the administrative and organizational issues that need to be dealt with before implementing a program aimed at improving the community’s health. When a community uses the PRECEDE process, it begins with a comprehensive community assessment process.

2 When a community uses the PRECEDE process, it begins with a comprehensive community assessment process.

3 When a community uses the PRECEDE process, it begins with a comprehensive community assessment process.

4 The PROCEED component includes program implementation. When a community uses the PRECEDE process, it begins with a comprehensive community assessment process.

PTS: 1 REF: 110 CON: Promoting Health | Nursing Roles 4. ANS: 1 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Health Program Planning Models Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Easy Feedback 1 The first step is to identify primary health issues in the community.

2 The fourth step is implementing selected interventions.

3 The third step is selecting effective interventions that will achieve objectives.

4 The second step is to develop measurable process and outcome measures.

PTS: 1 REF: 109 CON: Promoting Health 5. ANS: 2 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Health Program Planning Models Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Easy Feedback 1 Input refers to the resources that are needed and available for the program.

2 Output is the direct product of the activities of the program.

3 An outcome is the intended result or benefit of the planned intervention and what you plan to measure.

4 An impact is the program goal that produces long-term change in the community.

PTS: 1 REF: 111 | 112 CON: Promoting Health 6. ANS: 2 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Health Program Planning Models Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Moderate Feedback 1 Although linear reasoning occurs in all logic models, the model can come in all sizes and shapes, thus there is no one specific template and other components can be added.

2 Using the logic model, stakeholders will be able to see visually how the program goal(s) relate directly to the objectives that, in turn, relate directly to the program activities and the resources available.

3 A logic model moves like a chain of reasoning from the planned work to the intended results in five steps reading from left to right.

4 A logic model is built on the community assessment, a clear identification of the problem, and best solutions within the context of the community in which the program will take place.

PTS: 1 REF: 113 CON: Promoting Health 7. ANS: 1 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Health Program Planning Models Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Key components of program planning include: active involvement of the community as a partner; skill and time to do a competent assessment; shared conclusions with the partners of the needed interventions; and actual program planning, interventions, and evaluation.

2 Although determining if the supply of vaccines was important, that is part of the implementation phase and not a key component of health program planning.

3 Although determining if there were enough personnel to administer the vaccines was important, that is part of the implementation phase and not a key component of health program planning.

4 Although getting commitment from other stakeholders in their organization is important, it does not address two of the key components of health program planning: active involvement of the community as a partner and shared conclusions with the partners of the needed interventions.

PTS: 1 8. ANS: 4

REF: 114

CON: Promoting Health

Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Key Components of Health Program Planning Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Immunity; Promoting Health Difficulty: Easy Feedback 1 Social justice dictates that everyone, not just children, should have access to basic health services.

2 Social justice dictates that everyone should have equal access to basic health services, according to the resources available, not just those who have insurance.

3 Social justice dictates that everyone should have equal access to basic health services, according to the resources available, not just those who have the ability to pay.

4 Social justice dictates that everyone should have equal access to basic health services, according to the resources available.

PTS: 1 REF: 114 | 115 CON: Immunity | Promoting Health 9. ANS: 3 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Community Diagnosis Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health: Critical Thinking; Immunity Difficulty: Moderate Feedback 1 Identifying what resources are available and how to access additional resources comes during the planning stage after the community diagnosis has been completed.

2 Identifying what the problem is related to is one of the next two steps in completing a community nursing diagnosis. Determining what evidence-based programs could be implemented to address the problem comes during the planning stage.

3 Nursing community diagnosis includes four parts: (1) the problem, (2) the population, (3) what the problem is related to (characteristics of the population), and (4) how the problem is demonstrated (indicators of the problem).

4 How the problem is demonstrated is one of the next steps in the community diagnosis process. Engaging further members can occur across the health planning process and is not a specific step in developing the community diagnosis.

PTS: 1 REF: 116 CON: Promoting Health | Critical Thinking | Immunity 10. ANS: 2 Objective: 3. Describe the steps in writing community diagnoses.

Page: Heading: Overview of Health Program Planning > Community Diagnoses Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing; Assessment; Critical Thinking; Promoting Health

Difficulty: Moderate Feedback 1 The causal factors are the factors that caused the problem.

2 Mediating factors occur between the causal factors and the outcomes, and are important when designing the program because they alter outcomes.

3 Moderating factors are factors that can make the problem better or worse.

4 Antecedent factors are behaviors that existed prior to the health problem.

PTS: 1 REF: 117 | 118 CON: Nursing | Assessment | Critical Thinking | Promoting Health 11. ANS: 1 Objective: 3. Describe the steps in writing community diagnoses.

Page: Heading: Overview of Health Program Planning > Community Diagnoses Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking; Promoting Health; Safety Difficulty: Easy Feedback 1 They completed the four parts of nursing community diagnosis by identifying the problem and the population affected, what the problem was related to (characteristics of the population), and how the problem is demonstrated (indicators of the problem).

2 Although differences in access to swimming options during a heat wave can be based on socioeconomic factors, it is one of the main issues related to equal access to such things as basic health services, economic security, adequate housing and food, satisfactory education, and a lack of discrimination based on race or religion.

3 The community assessment is the process during which all of the needed data are collected and analyzed. The community diagnosis occurs after the assessment is completed and prior to beginning the planning phase.

4 Choosing to swim in a lake that increases the risk of becoming ill during an extreme heat wave is not a direct consequence of climate change.

PTS: 1 REF: 116 CON: Critical Thinking | Promoting Health | Safety 12. ANS: 3 Objective: 4. Explain the importance of evidence-based practice in program planning.

Page: Heading: Evidence-Based Practice in Program Planning Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Evidence-Based Practice; Nursing Difficulty: Easy Feedback 1 At this point, an assessment should have already been completed.

2 At this point, a community diagnosis should have already been written.

3 Consulting the literature to create a rationale for intervention is the first step in EBP. 4 Community organizing could be a step after the literature is consulted.

PTS: 1 REF: 118 CON: Promoting Health | Evidence-Based Practice | Nursing 13. ANS: 3 Objective: 5. Describe the process of writing goals, objectives, and activities for a health program.

Page: Heading: Program Implementation Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking; Promoting Health; Management Difficulty: Moderate

1 2 3 4

Feedback Project management is an end-to-end process that includes everything from project planning to implementation.

Program evaluation is the process that analyzes the effectiveness of the program after it has been implemented.

Program implementation encompasses the resources needed for a program as well as the mechanism for putting the program in place.

Program planning is part of the larger health planning process, which includes the assessment, the implementation, the development, and the evaluation of the program.

PTS: 1 REF: 122 CON: Critical Thinking | Promoting Health | Management 14. ANS: 2 Objective: 6. Discuss the different types and value of program evaluation.

Page: Heading: Program Evaluation > Evaluation Models Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Critical Thinking; Promoting Health Difficulty: Easy Feedback 1 A formative evaluation occurs during the development of a program while the activities are being formed and implemented. The evaluation described in this question is a type of formative evaluation, but more specifically it is a process evaluation.

2 A process evaluation studies the process of delivering the program and how the program actually works. It is also important for an evaluator to be aware of any outside environmental events that might influence the program.

3 A summative evaluation occurs at the end of the program, and it judges whether the program achieved the outcome. It also looks at the cost benefit and effectiveness of the program.

4 A program evaluation is the general term that encompasses all types of evaluations.

PTS: 1 REF: 124 CON: Critical Thinking | Promoting Health 15. ANS: 1 Objective: 6. Discuss the different types and value of program evaluation.

Page: Heading: Program Evaluation > Nine Steps of Program Evaluation Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance

Cognitive Level: Application [Applying] Concept: Critical Thinking; Promoting Health; Assessment Difficulty: Moderate Feedback 1 Evaluation information is generally used for the appropriate agencies that directly influence the program’s welfare, not for public disclosure.

2 Evaluation information helps the management team and the participants make the program better.

3 The population of a program sometimes needs to be evaluated to reassess the needs being addressed and the people being helped.

4 The information of a program evaluation can be shared with funding agencies to receive more funding for a successful program.

PTS: 1 REF: 123 | 124 CON: Critical Thinking | Promoting Health | Assessment 16. ANS: 4 Objective: 6. Discuss the different types and value of program evaluation.

Page: Heading: Program Evaluation > Nine Steps of Program Evaluation Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Critical Thinking; Promoting Health; Ethics Difficulty: Easy Feedback 1 A moral problem pertains to one’s personal character issues and has larger implications in an ethical system. This example is not dealing with personal character issues.

2 This is an example of an ethical issue, not a managerial one. If the findings of an evaluation were misused or changed, the ethical issue might become a managerial issue later.

3 Confidentiality would be a problem if the data of the program’s participants were breached.

4 Ethics make up the code of behavior of a group and impact a social system. In this case, the ethics of the health program would be compromised.

PTS: 1

REF: 125

CON: Critical Thinking | Promoting Health | Ethics

MULTIPLE RESPONSE 17. ANS: 1, 2, 3, 4 Objective: 6. Discuss the different types and value of program evaluation.

Page: Heading: Evidence-Based Practice in Program Planning > Resources for Evidence-Based Programs Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Critical Thinking; Promoting Health; Family; Evidence-Based Practice Difficulty: Moderate Feedback

1 2 3 4 5

The program is effective according to Schorr’s criteria if it perseveres in its mission and sees children in the context of their families.

The program is effective according to Schorr’s criteria if it deals with families as parts of neighborhoods.

The program is effective according to Schorr’s criteria if it has a long-term, preventative orientation and a clear mission.

The program is effective according to Schorr’s criteria if it is managed by competent people with good skills and staffed by well-trained individuals.

The program characteristics pertain to the human factor of a health program and not the financial aspects.

PTS: 1 REF: 122 CON: Critical Thinking | Promoting Health | Family | Evidence-Based Practice 18. ANS: 1, 2, 4, 5 Objective: 4. Explain the importance of evidence-based practice in program planning.

Page: Heading: Evidence-Based Practice in Program Planning > Resources for Evidence-Based Programs Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking; Evidence-Based Practice; Promoting Health Difficulty: Moderate

1 2 3 4 5

Feedback Quantitative and qualitative data from studies will help the nurse to know whether the research has solid enough information on which to build a program.

The nurse should analyze the data to see if the program is still thriving and being used.

The economic indicators are not a part of evidence-based practice.

Indicators of real outcomes and behavior change are essential factors as to whether a program should be replicated elsewhere.

Indicators of outside factors that might impact the program, positively or negatively, are important to consider. These factors can help the nurse determine if a program is a good fit for the community.

PTS: 1 REF: 121 CON: Critical Thinking | Evidence-Based Practice | Promoting Health 19. ANS: 3, 4, 5 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Key Components of Health Program Planning Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles; Collaboration Difficulty: Easy

1 2

Feedback A stakeholder is someone that a program will directly impact.

In community organizing, a nurse will want to grow leaders but is not considered to be one.

3 4 5

When a nurse becomes a listener, he or she can more easily digest information and direct it to the correct place.

A nurse will need to be a facilitator and bring the community the resources that it needs.

The nurse can train the community and help them develop the skills they need to improve their health situation.

PTS: 1 REF: 114 CON: Promoting Health | Nursing Roles | Collaboration 20. ANS: 1, 2, 3, 5 Objective: 2. Identify components of different health planning models.

Page: Heading: Overview of Health Program Planning > Health Program Planning Models Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Critical Thinking; Promoting Health Difficulty: Easy

1 2 3 4 5

Feedback Short-term outcomes provide good feedback and direction for the program.

Medium-term outcomes determine whether a program is beneficial.

Changes in knowledge, skills, and behavior are indicators as to whether a program is working.

Long-term refers to the impact of a program rather than the outcomes.

Unexpected or unintended outcomes, although perhaps not part of the program’s goal, will be an important part of the evaluation.

PTS: 1

REF: 112

CON: Critical Thinking | Promoting Health

Chapter 6: Environmental Health Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The health effects of the 2018 Camp Fire on the firefighters and residents of the area demonstrate the relationship between environmental health and personal health. According to the World Health Organization (WHO), the definition of environmental health, the factors external to a person, and related factors that impact behaviors that are addressed in environmental health include all but which of the following?

1. Physical 2. Chemical 3. Biological 4. Governmental 2. John, the nurse manager in a large urban emergency department, was alerted to a number of patients who had come in with a possible exposure to a toxic substance. He begins with the epidemiological triangle to help understand: 1. How the environment brings an agent and host together.

2. How the environment plays a role in the health of individuals, families, and communities.

3. The role of water, air, and waste in environmental health.

4. Both A and B 3. A PHN is working with a team doing a community assessment. She has been tasked with evaluating the community’s access to grocery stores, accessible transportation, outside activities, and the maintenance of its neighborhood buildings. The nurse is evaluating the: 1. Environmental stability.

2. Built environment.

3. Ecological approach.

4. Environmental health.

4. The PHN realizes that the mere presence of an agent, even if it is known to have toxic properties, does not necessarily mean there is a risk to health. Whether or not there is an adverse response to a toxin is primarily influenced by all but which of the following: 1. Its inherent toxicity, that is, ability to cause harm to humans 2. Whether it enters the body and reaches susceptible organs 3. The amount that is present 4. The route of exposure 5. A nurse working the evening shift in the emergency department has been assigned a patient who arrived with a chief complaint of difficulty breathing after mixing household cleaning products. The nurse recognizes that this patient is suffering from exposure to which type of environmental hazard?

1. Biological 2. Mixed 3. Physical 4. Chemical 6. A family survived a dangerous weather event, but now they are suffering through another part of environmental risk: stress, pain, and anxiety. The nurse recognizes that these are the: 1. Physical agents.

2. Mixed exposures.

3. Psychosocial factors.

4. Biological agents.

7. A PHN newly hired by a large urban hospital to run their employee health program decided to take a refresher course on how to do exposure risk assessments, which are used by policy makers and other regulators to evaluate the health effects from an environmental exposure. In these assessments, the final step in the process involves making a judgment about the risk of health problems to those who are exposed. The nurse learns that this is referred to as a(n): 1. Dose-response assessment.

2. Risk characterization.

3. Hazard identification.

4. Exposure assessment.

8. While doing a physical assessment of an older adult, the nurse is concerned about the patient’s history of work exposure to toxic chemicals over his lifetime. Based on reports, the levels of toxin were within normal limits, but the patient had worked in the plant for 50 years. What aspect of the exposure is she most worried about?

1. Half-life 2. Bioaccumulation 3. Latency period 4. Environmental exposure 9. The employee health nurse working for a large urban construction company examines the Air Quality Index (AQI) daily to determine if there are any risks for workers. Today the AQI measures 120 for the city. This means that for employees she will need to: 1. Take no action, because the air quality is good.

2. Take action to inform the employees that the air quality is acceptable, but for some pollutants there may be health concerns.

3. Take action to inform the employees the air quality is hazardous for everyone in the community.

4. Take action to inform employees that air quality is unhealthy for sensitive groups.

10. A nursing instructor is holding a lecture on environmental health and explaining that gene environment interaction: 1. Can directly cause diabetes, pulmonary disease, and breast cancer.

2. Can change the expression of a genetic trait and alter physical aspects.

3. Can have either a protective influence or increase risk for many diseases.

4. Does not demonstrate any noticeable effect from the environment.

11. A PHN is helping to manage a decrease in air quality due to emissions from a chemical plant. Which term best describes the source of the decrease in air quality?

1. Point source 2. Mobile source 3. Area source 4. Community Source 12. A PHN knows that the ambient air standard, which is the highest level of a pollutant in a specific place over a specific period of time that is not hazardous for humans, is most influenced by: 1. Wind patterns.

2. Weather conditions.

3. Population in the area.

4. The surrounding built environment.

13. Particulate matter varies in size, and the size determines the site of the deposition in the respiratory system.

This means: 1. The larger the particulate, the more hazardous it is.

2. The smaller the particulate, the more hazardous it is.

3. The size of the particulate is not important.

4. The lungs and dust masks can take care of the particulates.

14. Access to potable water has increased globally over the past decade. The WHO predicts that by 2025 50% of the world’s population will: 1. Have access to potable water.

2. Live in water stressed areas.

3. Be at risk for waterborne contaminates.

4. None of the above.

15. The nurse epidemiologist at a local health department receives a report that a number of children have elevated lead blood levels. She rules out a number of possible reasons and begins to focus on the local water supply because there had been a change in the water supply. She contacts the epidemiologists that worked on the Flint, Michigan, event. They recommended that she follow the steps they took in their investigation. Their investigation included examining these phases related to the exposure: 1. Prior to the switch, after the switch to the Flint River, after the boil advisory, and after the switch back to the original water source.

2. After the switch to the Flint River, after the boil advisory, after the switch back to the original water source, and after the public health alert.

3. Prior to the switch, after the switch to the Flint River, and after the switch back to the original water source.

4. Prior to the switch, after the boil advisory, and after the switch back to the original water source.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

16. A nursing instructor is giving a lecture on environmental sustainability. The instructor explains that this is a critical issue to the global environment and an important emerging public health issue. Some of the issues addressed within environmental sustainability include which of the following? (Select all that apply.)

1. Preventing environmental exposure 2. Maintaining the funding for research and development for alternative energy 3. The rates in which renewable resources are harvested 4. The rates of depletion of nonrenewable resources 5. The creation of pollution that can continue for an indefinite period of time 17. The PHN understands that the toxicity of chemicals in children is more severe than that in older populations because of which of the following reasons? (Select all that apply.)

1. Children play in outdoor soil, which can be contaminated.

2. Children may ingest substances from unlabeled, repurposed food containers.

3. Children have faster rates of absorption of toxic substances.

4. In urban settings, children may not have adequate places to play.

5. Children have less developed immune systems.

18. To aid a lower income family who is struggling with a pest problem in their home, a PHN recommends a program known as integrated pest management, which offers methods to deter pests. Some of these methods include which of the following? (Select all that apply.)

1.

2.

3.

4.

5.

Caulking and sealing cracks and holes in the home Eating in one place Getting rid of clutter Storing food in sealed containers Making sure the family is vaccinated

19. The public health nursing student learns that the need for environmental justice extends to disadvantaged populations, who, as a result of low income, age, health status, race, or other social indices of susceptibility, are at greatest risk of exposure to environmental hazards because of which of the following problems? (Select all that apply.)

1. Substandard housing 2. Lack of access to health care 3. Lack of nutritious food 4. Lack of safe places to play 5. Employment in risky jobs

Chapter 6: Environmental Health Answer Section MULTIPLE CHOICE 1. ANS: 4 Objective: 1. Describe the role of nursing in environmental health.

Page: Heading: Introduction Integrated Processes: The Nursing Process Client Need: Safe and Effective Care Environment: Cognitive Level: Knowledge [Remembering] Concept: Trauma; Safety Difficulty: Moderate Feedback 1 Physical factors are included in the definition and help to expand the concept beyond food, air, water, soil, dust, consumer products, and waste.

2 Chemical factors are included in the definition and help to expand the concept beyond food, air, water, soil, dust, consumer products, and waste.

3 Biological factors are included in the definition and help to expand the concept beyond food, air, water, soil, dust, consumer products, and waste.

4 Governmental factors are not part of the WHO definition of environmental health.

PTS: 1 REF: 128 CON: Trauma | Safety 2. ANS: 4 Objective: 1. Describe the role of nursing in environmental health.

Page: Heading: The Role of Nursing in Environmental Health > Approaches to Environmental Health Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Safety Difficulty: Moderate

1 2

3 4

Feedback The epidemiological triangle describes the relationship among an agent, host, and environment.

The epidemiological triangle is a framework used to examine human-environment interactions and their potential impact on the health of individuals, families, and communities.

The role of water, air, and waste in environmental health addresses only one point of the epidemiological triangle.

The epidemiological triangle helps the PHN understand the environment that brings an agent and host together, as well as the human-environment interactions that impact the health of individuals, families, and communities.

PTS: 1 REF: 130 | 131 CON: Promoting Health | Safety 3. ANS: 2 Objective: 2. Describe the impact of the built environment on health.

Page: Heading: The Role of Nursing in Environmental Health > Approaches to Environmental Health Integrated Processes: Nursing Process Client Need: Health promotion and maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 Environmental stability is how well a community is able to maintain the health of a population. This question is referring to the built environment.

2 The built environment includes the human-made surroundings created for the daily activities of humans and reflects the range of physical and social elements that make up a community. This question is referring to the built environment.

3 The ecological approach requires an understanding that individuals and populations interact with their environment. This question is referring to the built environment.

4 Environmental health is all the physical, chemical, and biological factors that are external to a person and all the related factors impacting behaviors. This question is referring to the built environment.

PTS: 1 REF: 132 CON: Assessment | Promoting Health 4. ANS: 4 Objective: 4. Examine the concept of exposure to hazardous substances from a cellular to global level.

Page: Heading: Hazardous Substances Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety Difficulty: Easy Feedback 1 The probability that individuals will be adversely affected by a hazardous substance depends on three major factors: (1) its inherent toxicity, that is, ability to cause harm to humans; (2) whether it enters the body and reaches susceptible organs; and (3) the amount that is present.

2 The probability that individuals will be adversely affected by a hazardous substance depends on three major factors: (1) its inherent toxicity, that is, ability to cause harm to humans; (2) whether it enters the body and reaches susceptible organs; and (3) the amount that is present.

3 The probability that individuals will be adversely affected by a hazardous substance depends on three major factors: (1) its inherent toxicity, that is, ability to cause harm to humans; (2) whether it enters the body and reaches susceptible organs; and (3) the amount that is present.

4 For some toxins, the route of exposure may result in increased chance of entry or acceleration of the time it takes to reach susceptible organs; this is not one of the three major factors.

PTS: 1 REF: 132 CON: Safety 5. ANS: 2 Objective: 4. Examine the concept of exposure to hazardous substances from a cellular to global level.

Page:

Heading: Hazardous Substances > Types of Exposures Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Oxygenation; Safety Difficulty: Moderate Feedback 1 Biological exposure can be caused by bacteria, viruses, plant or animal contact, or toxic plants or fungi.

2 Mixed exposure refers to a mixture of two types of exposures, such as cigarette smoking and asbestos. It can also be caused by mixing two toxic chemicals.

3 Physical exposure can be caused by heat and cold, radiation, noise, and vibration. It can also be caused by bodily injury.

4 Chemical exposure can be caused by agents such as pesticides, lead, or cigarette smoke.

PTS: 1 REF: 134 CON: Oxygenation | Safety 6. ANS: 3 Objective: 4. Examine the concept of exposure to hazardous substances from a cellular to global level.

Page: Heading: Hazardous Substances > Types of Exposures Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Trauma; Promoting Health; Safety Difficulty: Easy Feedback 1 A physical agent causes an injurious exchange of energy and physical damage to a person.

2 A mixed exposure is the mixture of two environmental hazards, such as physical and chemical.

3 The psychosocial factor is less commonly acknowledged. However, it is important to recognize that communities and individuals that live in fear or experience stress, panic, and anxiety associated with real or perceived threats are subject to psychosocial conditions that affect not only health and safety but overall well-being.

4 A biological agent can be a bacteria, virus, animal, or toxic plant or fungi that causes a medical reaction.

PTS: 1 REF: 133 CON: Trauma | Promoting Health | Safety 7. ANS: 2 Objective: 4. Examine the concept of exposure to hazardous substances from a cellular to global level.

Page: Heading: Hazardous Substances > Exposure Risk Assessment Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Cognitive Level: Application [Applying] Concept: Nursing Roles; Assessment; Safety Difficulty: Moderate Feedback 1 A dose-response assessment, the second step, is based on experiments and looks for the

2 3 4

correlation between an increase in harmful effects and the increase in the quantity of a substance.

A risk characterization, the last step, pulls together the information gathered in the previous steps to determine the health risk of those affected.

A hazard identification, the first step of an exposure risk assessment, seeks details to input from government information portals about the exposure.

An exposure assessment, the third step, is the consideration of the level, timing, and extent of the exposure.

PTS: 1 REF: 133 CON: Nursing Roles | Assessment | Safety 8. ANS: 2 Objective: 6. List social, behavioral, and physical characteristics that increase susceptibility to health effects associated with environmental exposures.

Page: Heading: Environmental Health and Vulnerable Populations > Older Adults Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing; Assessment, Promoting Health Difficulty: Moderate Feedback 1 Half-life is the time in which half the amount of a certain chemical is excreted out of the body.

2 Over time, chemicals accumulate in the tissues and cause irreparable damage to the body, a process called bioaccumulation.

3 A latency period is the period between exposure to a substance and the actual onset of disease.

4 Environmental exposure is when a living organism comes into contact with a harmful substance.

PTS: 1 REF: 145 CON: Nursing | Safety 9. ANS: 4 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Air > Ambient Air Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Cognitive Level: Application [Applying] Concept: Critical Thinking | Safety; Evidence-Based Practice Difficulty: Moderate Feedback 1 Air quality is considered good at a value of 50 or less.

2 Air quality is considered moderate at a value of 51-100.

3 Air quality is considered hazardous at values of 301 to 5,000.

4 Air quality at values of 101 to 150 are considered unhealthy for sensitive groups.

PTS: 1 REF: 149 | 150 CON: Critical Thinking | Safety | Evidence-Based Practice 10. ANS: 3 Objective: 7. Discuss gene-environment interaction.

Page: Heading: Gene-Environment Interaction Integrated Processes: Nursing Process Client Need: Health Promotion Cognitive Level: Knowledge Concept: Family; Safety Difficulty: Easy Feedback 1 There is research that identifies an increased risk for some diseases but no direct causation.

2 There is no obvious physical effect from the change of the genetic trait.

3 There has been research that supports both positive and negative influences on the genes from environmental exposure.

4 There has been such a correlation between gene expression and environmental exposure that the National Institute on Environmental Health Sciences funded a 5-year initiative to study the interaction.

PTS: 1 REF: 147 CON: Family | Nursing Roles | Safety 11. ANS: 1 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Natural Disasters and Environmental Health Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Cognitive Level: Application [Applying] Concept: Trauma; Critical Thinking; Safety Difficulty: Moderate

1 2 3

4

Feedback Point sources include chemical plants, power plants, refineries, and incinerators.

Mobile sources include buses, trucks, and cars (on-road) and ships, planes, and construction equipment (off-road), Area sources include smaller sources of emission such as gas stations, dry cleaners, commercial heating and cooling systems, railways, and waste disposal facilities such as landfills and wastewater treatment operations.

Point, mobile, and area sources all originate in the community.

PTS: 1 REF: 149 CON: Trauma | Critical Thinking | Safety 12. ANS: 4 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Air > Ambient Air Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Safety Difficulty: Moderate Feedback 1 The wind can briefly improve the air quality, but the location is the key component.

2 3 4

The weather can briefly improve the air quality, but the location is the key component.

The population and the amount of emissions from cars and homes can decrease the quality of the air, but the location plays a key role in the air quality.

The surrounding built environment is the major influence of air quality. Whether or not a community is located next to something like an industrial plant or railroad tracks is a key factor to community health.

PTS: 1 REF: 149 CON: Assessment | Safety 13. ANS: 2 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Air > Ambient Air Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Cognitive Level: Knowledge Concept: Assessment Safety Difficulty: Easy Feedback 1 Larger particulates are removed in the upper airways.

2 Smaller particulates are not removed in the upper airways as are larger particles, and increased levels appear to affect lung function of asthma patients and are associated with lung cancer and cardiovascular deaths.

3 Smaller particulates have a direct effect on the respiratory health of a population.

4 Dust masks do not protect the lungs from the effects of small particles.

PTS: 1 REF: 149 CON: Assessment | Safety 14. ANS: 2 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Potable Water > Safe Water from a Global Perspective Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing Roles; Safety Difficulty: Moderate Feedback 1 As of 2019, 71% of the global population already had access to safely managed drinking water and 89% had access to at least a basic service.

2 According to the WHO, 50% of the global population is projected to live in water stressed areas by 2025.

3 Lack of potable water does increase the risk for organic contaminates that increase the risk for communicable diseases. More than 70% of the global population has access to potable water.

4 According to the WHO, 50% of the global population is projected to live in water stressed areas by 2025 PTS: 1 REF: 152 CON: Nursing Roles | Safety 15. ANS: 1 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Potable Water > Inorganic Water Contaminants Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Safety Difficulty: Moderate Feedback 1 They conducted further assessment by gathering data prior to the switch, after the switch to the Flint River, after the boil advisory, after the switch back to the original water source, and after the public health alert.

2 This list is missing collected prevent data prior to the switch.

3 This list is missing is missing data related to the boil advisory.

4 This list is missing data after the switch.

PTS: 1

REF: 151 | 152

CON: Assessment | Safety

MULTIPLE RESPONSE 16. ANS: 3, 4, 5 Objective: 8. Describe issues related to air and water quality.

Page: Heading: Climate Change and Health Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Cognitive Level: Knowledge Concept: Nursing Roles; Safety Difficulty: Easy

1 2 3 4 5

Feedback Preventing environmental exposure is an indirect goal of sustaining the resources to survive.

Environmental sustainability includes carefully monitoring the dwindling resources to sustain human survival, but it does not include maintaining funding.

Environmental sustainability includes monitoring agriculture and other resources that can be replenished to insure efficiency.

Environmental sustainability includes monitoring nonrenewable resources, such as coal and gas, as these crucial issues have been linked to world conflict.

Environmental sustainability must include the monitoring and regulation of pollution to insure water and air quality.

PTS: 1 REF: 148 CON: Nursing Roles | Safety 17. ANS: 1, 2, 3, 4, 5 Objective: 6. List social, behavioral, and physical characteristics that increase susceptibility to health effects associated with environmental exposures.

Page: Heading: Environmental Health and Vulnerable Populations > Children Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying]

Concept: Nursing; Safety Difficulty: Easy

1

2 3 4 5

Feedback Children playing on the ground and floor may spend their time in the most contaminated areas.

For example, outdoor soil is often contaminated with heavy metals and pesticides, and hand-to-mouth behavior promotes ingestion of both seen and unseen agents.

Children have ingested substances from unlabeled food containers that have been repurposed to hold chemicals or were located in an easily accessible place such as under the sink.

Due to their higher metabolic rate, faster rate of cell growth, and less developed body systems, children absorb chemicals at a quicker rate than older populations.

Without designated places to play safely children may play in more dangerous settings such as streets.

If a child is exposed to a toxic chemical, he or she does not have a fully developed immune system to handle the toxicity.

PTS: 1 REF: 137 CON: Nursing | Safety 18. ANS: 1, 2, 3, 4 Objective: 5. Explain the concept of environmental justice.

Page: Heading: Environmental Justice and the Environment Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Promoting Health; Safety Difficulty: Easy

1 2 3 4 5

Feedback Caulking and sealing cracks and holes in the home keeps pests out and deters them from living in the home.

Eating in one place helps consolidate areas that must be cleaned and limits the food supply of the pests.

Getting rid of clutter gets rid of the hiding places of the pests.

Storing food in sealed containers keeps the pests from finding the food by smell and keeps the food sanitary.

Making sure the family is vaccinated is an example of health protection but is not a strategy for eliminating pests.

PTS: 1 REF: 143 CON: Promoting Health | Safety 19. ANS: 1, 2, 3, 4, 5 Objective: 5. Explain the concept of environmental justice.

Page: Heading: Environmental Justice and the Environment Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nutrition; Economics; Nursing Roles; Safety Difficulty: Easy

1 2 3 4 5

Feedback Disadvantaged populations often live in housing that is affordable for them but not in the best condition. Problems include lead paint and pest infestations.

Disadvantaged populations, due to a lack of insurance, are not able to get the best health care or have options when they are sick.

Disadvantaged populations may not have access to nutritious food or the knowledge of what to eat to keep themselves healthy.

Disadvantaged populations, due to where they live, may not have access to safe or healthy places to play.

Disadvantaged populations may not have a choice in job selection due to a lack of education or skills, and so may be forced to take a riskier job to survive.

PTS: 1

REF: 140

CON: Nutrition | Economics | Nursing Roles | Safety

Chapter 7: Health Disparities and Vulnerable Populations Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse is studying the high infant mortality rate in a community with a mean household income below the poverty level within the larger community served by her hospital. She looks into the problem further and finds that the only prenatal care clinics available that accept Medicaid or offer a sliding scale payment system are not located within the community and require taking three different busses to get there. The lack of access to affordable prenatal care is an example of: 1. Health disparity.

2. Health inequity.

3. Health inequality.

4. Social justice.

2. Which of the following programs was specifically designed to work toward optimal health for all Americans?

1. Racial and Ethnic Approaches to Health (REACH) 2. Universal Health Care 3. Healthy People 4. Agency for Health Care Research and Quality (AHRQ) 3. A nurse working in an urban nurse-managed health clinic located in a neighborhood with a high poverty rate notices that the patients she is seeing with type 2 diabetes are having difficulty controlling their A1C levels.

She suspects that they may be having difficulty accessing their medications due to cost. What would be her first step in addressing the problem?

1. Conduct a focused assessment that includes a patient survey and an evaluation of factors associated with access to medication.

2. Counsel patients on how to obtain health insurance to help with the cost of pharmaceuticals.

3. Develop a patient education information pamphlet related to controlling A1C that is culturally relevant and addresses health literacy levels of the population.

4. Formulate a community diagnosis and enlist stakeholders to help increase assess to diabetic medications.

4. A nurse is performing an assessment of a very economically diverse community and realizes that while comparing income to health outcomes, the nurse must be careful to: 1. Compare only the outcomes of the richest community members to the outcomes of the poorest community members.

2. Recognize that income and outcomes exist on a scale and look across the entire spectrum.

3. Evaluate only the poorest health outcomes and where they land on the income spectrum.

4. Evaluate only the poorest community members and their health outcomes.

5. A nurse is looking at reasons why members of a community are more likely to die from heart disease. The nurse finds several studies that suggest that social factors, such as , are more important than behavioral choices.

1. Smoking 2. High-fat or high-sugar diets 3. Poverty 4. Lack of exercise

6. During a lecture on health disparities, a student asks the instructor how communities with great access to health care can still have poor health outcomes. How should the instructor respond?

1. Social determinants of health determine how people respond to health threats and how they access preventative care.

2. The student is incorrect. Communities with good access to care have good health outcomes.

3. This phenomenon only occurs in communities where the quality of health care is poor.

4. Members of these communities only have access to primary-care providers, which reduces the quality of care they receive.

7. A nurse is working with a group of refugees who recently arrived in the United States after suffering conflict-related violence in their country. The nurse knows that they should be assessed for: 1. Communicable diseases.

2. Injuries related to torture or sexual assault.

3. Mental illness such as post-traumatic stress disorder (PTSD).

4. All of the above.

8. A nurse is assessing a young mother who lost her job. She has no way to support her family and has found herself living on the streets because she doesn’t have any other family in the area. Which of the following should she do first?

1. Look at the broader picture and see if there are any opportunities for policy change.

2. Help her find shelter at the community shelter for women and children.

3. Provide her with information on resources to help her with financial support while she seeks a new job.

4. Ask her to come back in 6 months for a re-evaluation.

9. A community nurse-managed clinic has seen an increase in the number of patients who have immigrated to the U.S. from Central America who are experiencing poorer outcomes than other patients. A nurse working in the clinic decides to take a multiple determinants of vulnerability approach to help understand possible underlying factors for this population. Using that approach, she would take into account all but which of the following as primary factors?

1. Stigma 2. Racism 3. Discrimination 4. Health literacy 10. A public health nurse (PHN) is starting a study of different populations in the community to see which groups have faced marginalization and to what degree. The PHN is looking for evidence that: 1. A group has been discriminated against based on their race or ethnicity.

2. A group has been treated as if they are not important or of little consequence to the rest of society.

3. A group has been labeled by society as possessing a particular characteristic that is not valued, leading to a loss of status.

4. A group has been assigned a negative or positive belief that is believed to apply to the entire group.

11. A nurse is caring for a young man who is squatting in an abandoned factory a mile away from the clinic. The nurse documents that he is experiencing what type of homelessness?

1. Primary 2. Secondary 3. Tertiary 4. He is not homeless because he has an indoor shelter in which to sleep.

12. A nurse received funding to start a mobile health unit to serve the health needs of the homeless population. In addition to a having a good understanding of noncommunicable diseases, what other specialty areas would be helpful in caring for this population?

1. Treatment of substance use disorders 2. Treatment of communicable diseases 3. Treatment of mental health disorders 4. All of the above 13. A nurse is working at a primary care clinic on the Mexican-Californian border. The nurse frequently takes care of refugee families when they first arrive in the United States. When meeting with a new family, the nurse makes sure to inform them that they are eligible for which of the following services?

1. Medicaid 2. Free health insurance for 1 year 3. Housing and food support 4. Free English classes 14. The maternal-child nurse who is fluent in Spanish is working at the public health department located in a “sanctuary city”. She is conducting a home visit with a young mother from Northern Triangle of Central America who arrived in the U.S. in 2017 and is now staying with her brother who is a U.S. citizen. The mother is very frightened and states that she fled her country because of the violence she and her children has experienced. She fears that they will not survive if they go back. The mother is eligible to apply for what status?

1. Asylee 2. Refugee 3. Immigrant 4. Permanent resident Multiple Response Identify one or more choices that best complete the statement or answer the question.

15. A maternal child nurse working in Southern Sudan is faced with lack of which main factors that contribute to the high infant mortality rate? (Select all that apply.)

1. Physicians 2. Electricity 3. Transportation 4. Equipment 16. When conducting a community survey in a larger urban community, two PHNs, Mark and Jane, know that there is great diversity based on socioeconomic status. They know it is important to determine which respondents do not meet the poverty threshold. They understand that this indicator reflects: (Select all that apply.)

1. The Census Bureau adjusts it based on family size and other demographics.

2. A lack of goods and services commonly taken for granted by mainstream society.

3. The method for doing the calculations over the past 40 years has included the increasing cost of medications.

4. The method for doing the calculations over the past 40 years has included increasing the percentage spent on food.

17. A nurse is organizing a round table presentation at a conference. The nurse asks the other participants for suggestions on actions that nurses can take to reduce health disparities in their country. Which of the following suggestions are known to be effective measures nurses can take that focus on the reduction of health disparities? (Select all that apply.)

1. Volunteer with an international organization that supports building infrastructure in underdeveloped areas.

2. Support initiatives that increase physical education classes and healthy school meals.

3. Design and create research studies that address inequities and support vulnerable populations.

4. Discuss social and health disparity information with coworkers to promote awareness.

5. Act as advocates for patients, families, and communities in reducing inequities.

18. A public health nurse (PHN) is performing a community assessment to better understand the underlying factors associated with the increase in the childhood obesity in the community. What social determinants of health should the PHN include in the assessment? (Select all that apply.)

1. Location of primary health providers 2. Nutrition and physical education classes in the public schools 3. Housing security 4. Presence of sidewalks and green space within the community 5. Access to fresh produce 19. A nurse is training for a new job at a community clinic after moving to Central California, an area rich in agriculture and where a large number of migrant workers are employed. The nurse asks about specific social and health issues that the migrant worker population faces, and the nurse supervisor replies: (Select all that apply.)

1. They have difficulty establishing residency in a single location, making them ineligible for government benefits.

2. Most of them lack access to worker’s compensation or disability insurance.

3. Frequent travel and location changes make it difficult for them to establish continuity of care with a single provider.

4. Illegal immigration status is a problem for almost all of them.

5. Language is often a barrier.

20. Two nurses are in the process of developing a nurse-managed free clinic for persons experiencing homelessness. They want to tailor the services for those who are at greatest risk for experiencing homelessness, which includes: (Select all that apply.)

1. Young families 2. White non-Hispanic Americans 3. Single men 4. African Americans 5. Persons diagnosed with a serious mental illness (SMI)

Chapter 7: Health Disparities and Vulnerable Populations Answer Section MULTIPLE CHOICE 1. ANS: 2 Objective: 1. Compare and contrast the concepts of health disparity, equity, and inequality from a local to global perspective.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Diversity; Pregnancy; Assessment; Ethics Difficulty: Difficult

Feedback 1 2 3

4

A health disparity reflects that a health outcome is seen to a greater or lesser extent between populations that may or may not be due to modifiable differences.

A health inequity describes avoidable gaps in health outcomes that are modifiable.

A health inequality is another term for health disparity and reflects that a health outcome is seen to a greater or lesser extent between populations that may or may not be due to modifiable differences.

Social justice related to health involves actions taken to promote equal opportunities to maximize the health of individuals and communities.

PTS: 1 REF: 158 CON: Promoting Health | Diversity | Pregnancy | Assessment | Ethics 2. ANS: 3 Objective: 1. Compare and contrast the concepts of health disparity, equity, and inequality from a local to global perspective.

Page: Heading: Social Determinants of Health, Social Justice, and Social Capital Integrated Processes: The Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Health-Care System Difficulty: Easy

Feedback 1 2 3 4

The Racial and Ethnic Approaches to Health Program, or REACH, was created to increase community-funding programs that minimize health disparities.

Universal health care, while often considered to be the optimal plan to minimize health disparities, does not exist in the United States.

Healthy People is a program established by the CDC that sets goals that work toward optimal health for all Americans.

AHRQ’s mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable.

PTS: 1

REF: 160

CON: Promoting Health | Health-Care System

3. ANS: 1 Objective: 3. Define and explain the role of social determinants of health, social justice in the health of populations.

Page: Heading: Introduction and The Case of the Rubbermaid Storage Box Integrated Processes: Nursing Process Client Need: Physiological Integrity: Pharmacological and Parental Therapies Cognitive Level: Synthesizing Concept: Assessment; Diversity; Metabolism Difficulty: Moderate

Feedback 1

2 3

4

Conducting a focused assessment that includes a patient survey and an evaluation of factors associated with access to medication would help her identify underlying modifiable risk factors and determine if indeed cost of the medication was a contributing factor.

She must first identify the underlying modifiable risk factors and determine if indeed cost of the medication was a contributing factor.

Developing a patient education information pamphlet related to controlling A1C that is culturally relevant and addresses health literacy levels of the population is a possible action plan. However, if patients are unable to access medication due to cost, this approach may not adequately address the problem.

Formulating a community diagnosis occurs after assessment data are collected and is not the first step. Enlisting stakeholders specifically to help increase assess to diabetic medications would occur only after it has been determined that access is a contributing factor.

PTS: 1 REF: 172 CON: Assessment | Promoting Health | Diversity | Critical Thinking | Metabolism 4. ANS: 2 Objective: 3. Define and explain the role of social determinants of health and social justice in the health of populations.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity; Critical Thinking; Evidence-Based Practice; Promoting Health; Economics Difficulty: Moderate

Feedback 1

2

3

Income levels exist on a spectrum and the nurse should be careful to consider all community members along that spectrum, not just the richest and the poorest. It is especially important not to compare the health outcomes of the two extremes of the spectrum to each other.

Income levels exist on a spectrum and the nurse should be careful to consider all community members along that spectrum, not just the richest and the poorest. It is especially important not to compare the health outcomes of the two extremes of the spectrum to each other.

Income levels exist on a spectrum and the nurse should be careful to consider all community members along that spectrum, not just the richest and the poorest. It is especially important not to compare the health outcomes of the two extremes of the

4

spectrum to each other.

Income levels exist on a spectrum and the nurse should be careful to consider all community members along that spectrum, not just the richest and the poorest. It is especially important not to compare the health outcomes of the two extremes of the spectrum to each other.

PTS: 1 REF: 159 CON: Diversity | Critical Thinking | Evidence-Based Practice | Promoting Health | Economics 5. ANS: 3 Objective: 3. Define and explain the role of social determinants of health and social justice in the health of populations.

Page: Heading: Vulnerability at the Population Level Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Perfusion; Evidence-Based Practice Difficulty: Moderate

Feedback 1 2

3 4

Several studies have shown that social determinants of health, such as poverty and stress, may be more important than behavioral choices such as smoking.

Several studies have shown that social determinants of health, such as poverty and stress, may be more important than behavioral choices such as a high-fat or high-sugar diets.

Several studies have shown that social determinants of health, such as poverty and stress, may be more important than behavioral choices.

Several studies have shown that social determinants of health, such as poverty and stress, may be more important than behavioral choices such as lack of exercise.

PTS: 1 REF: 160 | 161 CON: Perfusion | Evidence-Based Practice 6. ANS: 1 Objective: 3. Define and explain the role of social determinants of health and social justice in the health of populations.

Page: Heading: Social Determinants of Health, Health Disparity, and Social Justice Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Difficult

Feedback 1 2

3

Social determinants of health determine how people respond to health threats and how frequently they access preventative measures.

The student is correct. Access to health care does not guarantee good health outcomes.

Community members may not be able to afford accessing such care or may be unable to access care due to busy work schedules.

Access to good health care does not guarantee good health outcomes. If community members are not able to afford health care or are unable to access care due to stressful

4

work schedules, the quality of the care does not matter.

Access to only primary-care providers does not lead to poor health outcomes. Social determinants of health determine how people respond to health threats and how frequently they access preventative measures.

PTS: 1 REF: 160 | 161 CON: Promoting Health | Nursing Roles 7. ANS: 4 Objective: 2. Distinguish groups in our society who are traditionally considered vulnerable.

Page: Heading: Immigrants, Migrants, Refugees, and Asylees > Refugees and Asylees Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Infection; Diversity; Violence; Assessment Difficulty: Easy Feedback 1 Refugees arriving in the United States have likely faced violence or rape in their refugee camps or on the journey to this country. There is also a significantly increased risk of contracting infectious diseases or developing mental illness secondary to the trauma they survived.

2 Refugees arriving in the United States have likely faced violence or rape in their refugee camps or on the journey to this country. There is also a significantly increased risk of contracting infectious diseases or developing mental illness secondary to the trauma they survived.

3 Refugees arriving in the United States have likely faced violence or rape in their refugee camps or on the journey to this country. There is also a significantly increased risk of contracting infectious diseases or developing mental illness secondary to the trauma they survived.

4 Refugees arriving in the United States have likely faced violence or rape in their refugee camps or on the journey to this country. There is also a significantly increased risk of contracting infectious diseases or developing mental illness secondary to the trauma they survived.

PTS: 1 REF: 179 CON: Infection | Diversity | Violence | Assessment 8. ANS: 2 Objective: 5. Develop strategies for reducing vulnerability among various groups.

Page: Heading: Experiencing Homelessness > Impact on Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Critical Thinking; Legal; Safety Difficulty: Moderate Feedback 1 Although it is important that the nurse look at the broader picture to provide opportunities to improve outcomes for other mothers in the community, the priority is to help the mother find safe shelter.

2 Women and children who are homeless are at risk for illness and injury, and should be sheltered in a safe environment before any other action can be taken.

3 Providing the mother with information on financial aid can be done once safe shelter is

4

secured.

Women and children who are homeless are at risk for illness and injury, and should be sheltered in a safe environment before any other action can be taken.

PTS: 1 REF: 173 | 174 CON: Promoting Health | Critical Thinking | Legal 9. ANS: 4 Objective: 2. Distinguish groups in our society who are traditionally considered vulnerable.

Page: Heading: Vulnerability at the Population Level > Multiple Determinants of Vulnerability Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Diversity Difficulty: Moderate Feedback 1 Using a multiple determinants of vulnerability approach acknowledges the overlap of risk across many of the determinants of health. In particular, marginalization, racism, discrimination, and stigma of a population can result in increased vulnerability.

2 Using a multiple determinants of vulnerability approach acknowledges the overlap of risk across many of the determinants of health. In particular, marginalization, racism, discrimination, and stigma of a population can result in increased vulnerability.

3 Using a multiple determinants of vulnerability approach acknowledges the overlap of risk across many of the determinants of health. In particular, marginalization, racism, discrimination, and stigma of a population can result in increased vulnerability.

4 Although low health literacy can contribute to a decreased ability to manage one’s health, it is not one of the primary factors that contributes to vulnerability.

PTS: 1 REF: 166 | 167 CON: Diversity 10. ANS: 2 Objective: 1. Describe the concept of vulnerability from a population perspective.

Page: Heading: Vulnerability at the Population Level > Multiple Determinants of Vulnerability Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Diversity; Assessment Difficulty: Moderate Feedback 1 Being discriminated against based on race or ethnicity is called racism or discrimination.

2 Being treated as if they are of little consequence or not important is called marginalization.

3 Having been labeled by society as possessing a particular characteristic that is not valued, leading to a loss of status is called stigmatization, not marginalization.

4 Assigning a negative or positive belief that is believed to apply to the entire group is called stereotyping, not marginalization.

PTS: 1 11. ANS: 1

REF: 169

CON: Diversity | Assessment

Objective: 3. Demonstrate an understanding of the individual and social determinants of health and their contribution to population vulnerability.

Page: Heading: Experiencing Homelessness Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Communication; Safety Difficulty: Moderate Feedback 1 This young man is experiencing primary homelessness because he is living in an abandoned building, which is not suitable for living.

2 Secondary homelessness is when someone is staying in a temporary housing situation, such as in a shelter or with a family member or friend.

3 Tertiary homelessness is when someone is renting a single room without the security of a fixed place to live.

4 This young man is homeless because he doesn’t have a safe and reliable place to stay.

He is experiencing primary homelessness because he is living in an abandoned building, which is not suitable for living.

PTS: 1 REF: 170 CON: Communication | Safety 12. ANS: 4 Objective: 5. Develop strategies for reducing vulnerability among various groups.

Page: Heading: Experiencing Homelessness > Impact on Health Integrated Processes: Nursing Process Client Need: Psychosocial Integrity; Physiological Integrity Cognitive Level: Analysis [Analyzing] Concept: Addiction; Critical Thinking; Nursing Difficulty: Easy Feedback 1 Members of the homeless population are significantly more likely to suffer from mental disorders, substance use disorders, and communicable diseases.

2 Members of the homeless population are significantly more likely to suffer from mental disorders, substance use disorders, and communicable diseases.

3 Members of the homeless population are significantly more likely to suffer from mental disorders, substance use disorders, and communicable diseases.

4 Members of the homeless population are significantly more likely to suffer from mental disorders, substance use disorders, and communicable diseases.

PTS: 1 REF: 170 | 171 CON: Promoting Health | Critical Thinking | Nursing 13. ANS: 3 Objective: 6. Differentiate the various roles and responsibilities of the nurse when caring for vulnerable populations.

Page: Heading: Immigrants, Migrants, Refugees, and Asylees > Refugees and Asylees Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Diversity; Nursing Roles

Difficulty: Moderate Feedback 1 When refugees first arrive in the United States, they are given food and housing support, health insurance for the first 8 months, and employment training or job placement assistance. They are encouraged to apply for Medicaid at the end of the 8 months, but they would still need to apply and qualify.

2 Refugees are given health insurance for 8 months when they first arrive. They are encouraged to apply for Medicaid at the end of the 8 months, but they still need to apply and qualify.

3 When refugees first arrive in the United States, they are given food and housing support, health insurance for the first 8 months, and employment training or job placement assistance.

4 When refugees first arrive in the United States, they are given food and housing support, health insurance for the first 8 months, and employment training or job placement assistance.

PTS: 1 REF: 180 CON: Promoting Health | Diversity | Nursing Roles 14. ANS: 1 Objective: 2. Distinguish groups in our society who are traditionally considered vulnerable.

Page: Heading: Immigrants, Migrants, Refugees, and Asylees > Refugees and Asylees Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Diversity; Violence; Legal Difficulty: Moderate Feedback 1 An asylee is a person who is looking to escape an oppressive situation in her own country, but who has already made it to the United States. A refugee is someone who is looking to escape their country but who still is living in their home country.

2 A refugee is someone who is looking to escape their country but who still is living in their home country. This woman is an asylee because she has already made it to the United States.

3 She should be applying for asylee status. An asylee is a person who is looking to escape an oppressive situation in her own country, but who has already made it to the United States.

4 She should be applying for asylee status. An asylee is a person who is looking to escape an oppressive situation in her own country, but who has already made it to the United States.

PTS: 1

REF: 178

CON: Diversity | Violence | Legal

MULTIPLE RESPONSE 15. ANS: 1, 2, 4 Objective: 2. Discuss the magnitude of health disparities both in the United States and internationally.

Page: Heading: Disparity, Inequity at the National and Global Level > Cellular to Global Integrated Processes: Nursing Process

Client Need: Safe Effective Care Environment Cognitive Level: Application Concept: Assessment, Diversity, Safety Difficulty: Moderate

1 2 3 4

Feedback Lack of physicians, electricity, equipment, and medication are all factors contributing to the high infant mortality rate.

Lack of physicians, electricity, equipment, and medication are all factors contributing to the high infant mortality rate.

Although transportation may not be as efficient as it could be, it is not one of the main factors contributing to the high infant mortality rate.

Lack of physicians, electricity, equipment, and medication are all factors contributing to the high infant mortality rate.

PTS: 1 REF: 159 CON: Assessment | Diversity | Safety 16. ANS: 1, 2, 4 Objective: 3. Define and explain the role of social determinants of health, social justice in the health of populations.

Page: Heading: Vulnerability at the Population Level; Poverty Integrated Processes: Assessment Client Need: Health promoting and maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Economics Assessment Difficulty: Moderate

1 2 3 4

Feedback The Census Bureau adjusts the poverty threshold based on family size and other demographics.

The poverty threshold reflects lack of goods and services commonly taken for granted by mainstream society.

The percentage of income spent on food has decreased.

The percentage spent on such categories as transportation, health care, and childcare have increased.

PTS: 1 REF: 167 CON: Promoting Health | Economics | Assessment 17. ANS: 2, 3, 4, 5 Objective: 3. Define and explain the role of social determinants of health and social justice in the health of populations.

Page: Heading: Vulnerability at the Population Level > Multiple Determinants of Vulnerability Integrated Processes: The Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking; Evidence-Based Practice; Nursing; Promoting Health; Nursing Roles; Collaboration Difficulty: Easy Feedback

1 2 3 4

5

Volunteering with an international organization that supports building infrastructure in underdeveloped areas targets global rather than national-level outcomes.

Supporting initiatives that increase physical education and healthy meals in schools will improve health outcomes in underserved areas and can help diminish health disparities.

Designing and creating research studies that address health inequities and support vulnerable populations are one way that nurses can reduce health disparities.

Promoting awareness of health disparities through discussions with colleagues and friends is a great way for nurses to reduce health disparities. This helps other nurses be more aware of the issues surrounding health inequities and act in ways to reduce disparities.

Although nurses should always act as advocates for their patients, advocating for particularly vulnerable populations, whether they include patients, their families, or communities, can be an effective way of reducing local disparities.

PTS: 1 REF: 165 | 166 CON: Critical Thinking | Evidence-Based Practice | Nursing | Promoting Health | Nursing Roles | Collaboration 18. ANS: 1, 2, 4, 5 Objective: 6. Compare and contrast population level strategies for improving health among different vulnerable groups.

Page: Heading: Social Determinants of Health, Health Disparity, and Social Justice Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Nutrition; Assessment; Critical Thinking; Promoting Health Difficulty: Moderate

1

2

3 4

5

Feedback Location of primary health providers is an important factor to examine when performing a community health assessment. Lack of access to health care makes a population more vulnerable to health disparities.

Lack of proper nutrition and physical education classes is an important social determinant of health. Without them, students may not have adequate opportunities for physical activity or correct information to make proper food choices.

Housing security, although an important social determinant of health in certain circumstances, does not usually have a direct impact on childhood obesity rates.

The presence or absence of sidewalks and green space within a community can be an important sign of how walkable the community is. A community with a lot of sidewalks and walking paths promotes walking and healthy activity. A community without sidewalks does not.

Access to fresh produce is an important component of health communities. Without nutritious foods, children are at higher risk for obesity and other poor outcomes.

PTS: 1 REF: 162 | 163 CON: Nutrition | Assessment | Critical Thinking | Promoting Health 19. ANS: 1, 2, 3, 5 Objective: 3. Demonstrate an understanding of the individual and social determinants of health and their contribution to population vulnerability.

Page: Heading: Immigrants, Migrant Workers, Refugees, and Asylees > Migrant Workers

Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity; Promoting Health; Assessment; Communication Difficulty: Moderate

1

2 3 4 5

Feedback Migrant workers tend to “follow the job,” meaning that they travel around the country looking for work, which is usually agriculturally based. This can make establishing a residency and accessing government benefits difficult.

Migrant workers usually work long hours and don’t have access to disability insurance or workers compensation.

When traveling around the country for work, it becomes difficult to establish continuity of care with a single provider.

Some migrant workers may be illegal immigrants, but most are legal citizens or residents.

Many migrant workers do not speak English or speak English as a second language. This can lead to difficulties in obtaining culturally appropriate health care.

PTS: 1 REF: 175-178 CON: Diversity | Promoting Health | Assessment | Health-Care System | Communication 20. ANS: 3, 4, 5 Objective: 4. Apply the multiple determinants of vulnerability approach in determining levels of vulnerability of a particular population.

Page: Heading: Experiencing Homelessness > Persons Experiencing Homelessness Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Diversity; Family; Promoting Health; Nursing Roles Difficulty: Moderate

1 2 3 4 5

Feedback Single people are significantly more likely to become homeless than families. This may be in part because of the number of safety nets in place to help families and children.

Hispanic Americans and African Americans are much more likely to become homeless than White non-Hispanic Americans.

Single men are more likely to become homeless than single women or families.

Hispanic Americans and African Americans are much more likely to become homeless than White non-Hispanic Americans The rate of homelessness is higher in persons with an SMI than those without an SMI.

PTS: 1

REF: 171

CON: Diversity | Family | Promoting Health | Nursing Roles

Chapter 8: Communicable Diseases Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse working in a community clinic noticed an unusually large number of patients with a specific type of influenza. The nurse knew that this was occurring in other states as well, making it: 1. A pandemic.

2. Endemic.

3. An epidemic.

4. Both A and B. 2. A nurse who treated a patient with a severe respiratory infection incorporates which of the following preventive measures to ensure the disease will not spread to others?

1. Uses personal protection equipment (PPE) 2. Washes hands frequently 3. Properly cleans patient areas 4. All of the above 3. When a patient shows symptoms of pneumonia, the nurse knows to first understand three key factors about the disease, including: 1. The infectious agent causing the pneumonia.

2. The environment relevant to the transmission of disease from one person to another.

3. Who is at risk for becoming infected.

4. All of the above.

4. A nurse starting a new job in a pediatric clinic is reviewing a list of commonly seen infectious diseases associated with respiratory illnesses related to an increased risk of mortality in children. Which one of these is included on the list?

1. Chickenpox 2. Tuberculosis (TB) 3. Influenza 4. Mumps 5. Each fall, a public health nurse (PHN) working with older adults checks the Centers for Disease Control and Prevention’s flu report that tracks trends across the country knowing that influenza usually peaks in and again in .

1. December, February 2. October, March 3. December, April 4. September, February 6. A nurse volunteering in a clinic in a west African country notices many patients have diarrheal disease. To help set up prevention efforts, which mode of transmission would she not consider?

1. Waterborne 2. Foodborne 3. Person-to-person contact 4. Vectorborne 7. Although many communicable diseases have been eradicated, new ones are appearing or old ones are morphing into new forms. Which of the following fall into the category of those not yet eradicated?

1. Multiple drug resistant tuberculosis (MDRTB)

2. Smallpox 3. West Nile Virus 4. Both A and C 8. A patient showing signs of pneumonia is admitted to a hospital where tests indicate he has highly infectious M. tuberculosis. He has had contact with many patients, employees, and family members despite placing him in isolation. An investigation team should take which of the following steps to find out what went wrong?

1. Identify the index case, the first case identified in a particular outbreak.

2. Identify secondary cases, those patients who were diagnosed with active TB and who had contact with the index patient.

3. Identify all contacts.

4. All of the above 9. When treating patients that may have an active communicable disease, nurses are required to institute appropriate isolation procedures based on the known or suspected agent. These procedures are public health interventions aimed at preventing the spread of disease in: 1. Employees.

2. Community members.

3. Other patients.

4. All of the above.

10. PHNs are involved in protecting the population at large from the spread of infectious agents. They must be able to identify elements of the cycle of communicable disease transmission in their patients, including all of the following except: 1. Reservoir 2. Portal of entry 3. Susceptible host 4. Antibiotics effective against the agent 11. Infection control nurses in two hospitals located in the same county notice an increase in positive labs for Escherichia coli (E. coli) O157:H7 infections in their patients. They then join the investigative team at the public health department to assist in an investigation to determine if there is a possible outbreak. Which of the following lists reflects the order of steps taken in an outbreak investigation?

1. Define a case, collect data on each case, plot an epidemic curve, generate a hypothesis.

2. Generate a hypothesis, define a case, collect data on each case, plot an epidemic curve.

3. Plot an epidemic curve, generate a hypothesis, define a case, collect data on each case.

4. Collect data on each case, define a case, plot an epidemic curve, generate a hypothesis.

12. In the City of Baltimore, a team including a PHN noticed that the prevalence of syphilis in the city had increased by 40%. As part of the investigative team, the nurse and colleagues first determined if the number of cases were above the endemic rate associated with an increased risk for disease. This is called: 1. The epidemic threshold.

2. The epidemic curve.

3. Attack rate.

4. Point source.

13. A nurse working in the emergency department is aware that necrotizing fasciitis (the flesh-eating bug) can be caused by: 1. Staphylococcus aureus.

2. Clostridium perfringens.

3. Bacteroides fragilis.

4. All of the above.

14. While studying communicable diseases, a PHN learns that the main objective is to control the spread of disease by: 1. Changing the environment.

2. Activating the agent.

3. Increasing host resistance.

4. Both A and C. 15. Nurses give vaccinations to help increase host resistance to other diseases. Among the vaccines commonly administered are: 1. Pneumonia.

2. Influenza.

3. Smallpox.

4. Both A and B. 16. Several factors influence the decisions of public health agencies to make vaccines mandatory. These include: 1. Effectiveness of the vaccine.

2. Where the highest risk exists.

3. Where the lowest risk exists.

4. Both A and B. 17. Communicable diseases that a nurse might expect to commonly encounter in patients include: 1. Chickenpox.

2. TB. 3. Influenza.

4. Both A and C. 18. Infectious agents classified as mycoses are what type of agent?

1. Unicellular microorganisms 2. Single-celled animals such as flagellates and amoeboids 3. Parasitic worm-like organisms 4. Fungi 19. A nurse treats a patient with Lyme disease and notes that reservoir to its host.

1. Hookworms 2. Anthropods 3. Protozoa 4. Viruses

act as vectors and transmits the agent from its

Chapter 8: Communicable Diseases Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 3. Investigate the role of culture and environment in the management of an epidemic.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Assessment Difficulty: Easy

1 2 3 4

Feedback A pandemic is a global epidemic.

The term endemic refers to the usual number of cases that occur within a population.

An epidemic occurs when there is an increased occurrence of a specific disease.

For an increase in cases to be referred to as a pandemic, the increase must be occurring globally. The term endemic refers to the usual number of patients with a specific disease that occurs within a population.

PTS: 1 REF: 192 CON: Infection | Assessment 2. ANS: 4 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Introduction > Communicable Diseases and Nursing Practice Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Oxygenation; Infection; Safety Difficulty: Easy Feedback 1 Using PPE is a preventive measure.

2 Washing hands frequently is a preventive measure.

3 Proper cleaning of patient areas is a preventive measure.

4 Using PPE, washing hands frequently, and proper cleaning of patient areas are all preventive measures.

PTS: 1 REF: 193 | 213 CON: Oxygenation | Infection | Safety 3. ANS: 4 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Introduction > Communicable Diseases and Nursing Practice Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control

Cognitive Level: Application [Applying] Concept: Infection; Critical Thinking Difficulty: Moderate Feedback 1 The infectious agent causing the disease is one of three key factors to understand the disease process.

2 The environment relevant to disease transmission is one of three factors to understand the disease process.

3 Determining who is at risk for becoming infected is one of three key factors in understanding the disease process.

4 The infectious agent causing a disease, the environment linked to its transmission, and determining who is at risk are the three key factors in the disease process.

PTS: 1 REF: 193 CON: Infection | Critical Thinking 4. ANS: 3 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Communicable Disease and the Burden of Disease > Infectious Respiratory Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Promoting Health; Infection Difficulty: Moderate Feedback 1 Although chickenpox is an infectious disease associated with respiratory disease, most children are vaccinated against it.

2 Although TB is mainly a respiratory disease, it is rare in the United States and would not be on the list.

3 Influenza is an infectious disease associated with respiratory disease that has a higher mortality rate in children.

4 Although mumps is an infectious disease associated with respiratory disease, most children are vaccinated against it.

PTS: 1 REF: 193 CON: Promoting Health | Infection 5. ANS: 1 Objective: 1. Apply the cycle of transmission to specific communicable diseases.

Page: Heading: Communicable Disease and the Burden of Disease > Infectious Respiratory Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Promoting Health; Nursing Difficulty: Moderate Feedback 1 Influenza peaks in December and February.

2 Influenza peaks in December and February.

3 Influenza peaks in December and February.

4 Influenza peaks in December and February.

PTS: 1 REF: 193 CON: Infection | Promoting Health | Nursing 6. ANS: 4 Objective: 1. Apply the cycle of transmission to specific communicable diseases.

Page: Heading: Communicable Disease and the Burden of Disease > Diarrheal Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Safety Difficulty: Moderate Feedback 1 Diarrheal disease may be spread by infected water.

2 Diarrheal disease may be spread by infected food.

3 Diarrheal disease may be spread by person-to-person contact.

4 Diarrheal diseases are not transmitted by means of vectors such as mosquitos.

PTS: 1 REF: 195 CON: Infection | Safety 7. ANS: 4 Objective: 4. Discuss current issues related to emerging communicable diseases.

Page: Heading: Communicable Disease and the Burden of Disease > Emerging and Reemerging Communicable Diseases Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health; Infection Difficulty: Moderate

1 2 3 4

Feedback MDRTB is a drug-resistant form of TB. Smallpox has been eradicated.

West Nile Virus is a prevalent communicable disease.

West Nile Virus and MDRTB are communicable diseases that have not been eradicated.

PTS: 1 REF: 195 | 196 CON: Promoting Health | Infection 8. ANS: 4 Objective: 2. Describe the steps in an outbreak investigation.

Page: Heading: Communicable Disease and the Burden of Disease > Tuberculosis Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Safety; Critical Thinking Difficulty: Moderate Feedback 1 The first step in this investigation would be identifying the first case.

2 Secondary cases are identified as part of the investigation process.

3 4

Everyone who had contact with the infected patient should be identified.

Some of the steps in an outbreak investigation include identifying the first case, the secondary cases, and all those who had contact with the infected patient.

PTS: 1 REF: 196 | 197 CON: Infection | Safety | Critical Thinking 9. ANS: 4 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Communicable Disease and the Burden of Disease > Tuberculosis Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Safety Difficulty: Easy Feedback 1 Isolation procedures are used to protect employees.

2 Isolation procedures are used to protect community members who may come in contact with the infected patient.

3 Isolation procedures are used to protect other patients from getting the disease.

4 Employees, community members, and other patients are protected when nurses institute appropriate isolation procedures.

PTS: 1 REF: 196 | 197 CON: Infection | Safety 10. ANS: 4 Objective: 1. Apply the cycle of transmission to specific communicable diseases.

Page: Heading: Infectious Agents and the Cycle of Transmission Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment; Infection; Safety Difficulty: Moderate Feedback 1 This is where the agent resides, and the reservoir is often in humans.

2 Portal of entry is how the agent is able to enter the host.

3 Susceptible host reflects the likelihood that a person will become infected with the agent.

4 Although it is important to know which antibiotics are effective against an agent, it is not part of the cycle of transmission.

PTS: 1 REF: 198 CON: Promoting Health | Assessment | Infection | Safety 11. ANS: 1 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Infectious Agents and the Cycle of Transmission > Outbreak Investigation Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control

Cognitive Level: Application [Applying] Concept: Assessment; Infection; Safety Difficulty: Moderate Feedback 1 The first step the team should take is to define a case, they can then collect data on each case, plot an epidemic curve, and generate a hypothesis.

2 The first step the team should take is to define a case, they can then collect data on each case, plot an epidemic curve, and generate a hypothesis.

3 The first step the team should take is to define a case, they can then collect data on each case, plot an epidemic curve, and generate a hypothesis.

4 The first step the team should take is to define a case, they can then collect data on each case, plot an epidemic curve, and generate a hypothesis.

PTS: 1 REF: 202-205 CON: Assessment | Infection | Safety 12. ANS: 1 Objective: 2. Describe the steps in an outbreak investigation.

Page: Heading: Sexually Transmitted and Reproductive Tract Infections> Risk Factors Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Infection; Critical Thinking; Safety Difficulty: Moderate Feedback 1 The epidemic threshold is the number of cases above the endemic rate associated with an increased risk for spread of the disease.

2 The epidemic curve is a graph of the number of cases per day and month.

3 The attack rate is an incidence rate determined by the number of patients ill divided by the number of those who are ill plus those who are well.

4 A point source occurs when the exposure to the infectious agent happened at one point in time.

PTS: 1 REF: 209 | 210 CON: Assessment | Infection | Critical Thinking | Safety 13. ANS: 4 Objective: 4. Discuss current issues related to emerging communicable diseases.

Page: Heading: Communicable Diseases and Communicability Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection Difficulty: Moderate Feedback 1 Staphylococcus aureus bacteria can cause the flesh-eating bug.

2 Clostridium perfringens bacteria can cause the flesh-eating bug.

3 Bacteroides fragilis can cause the flesh-eating bug.

4 Staphylococcus aureus, Clostridium perfringens, and Bacteroides fragilis are three of the bacteria that can cause the flesh-eating bug.

PTS: 1 REF: 211-213 CON: Infection 14. ANS: 4 Objective: 1. Apply the cycle of transmission to specific communicable diseases.

Page: Heading: Controlling Communicable Diseases Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing Roles; Infection; Safety Difficulty: Moderate

1

2 3 4

Feedback The spread of disease can be controlled by changing the environment, such as altering or eliminating a reservoir, controlling the vector, applying personal measures of hygiene, or using aseptic technique.

The agent must be deactivated, not activated, to stop disease spread.

The spread of disease can be stopped by increasing host resistance by administering vaccines, for example.

Changing the environment and increasing host resistance help stop the spread of communicable diseases.

PTS: 1 REF: 213 CON: Nursing Roles | Infection | Safety 15. ANS: 4 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Controlling Communicable Diseases Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health; Infection Difficulty: Moderate

1 2 3 4

Feedback The pneumonia vaccine is given to help increase host resistance.

The influenza vaccine is given to help increase host resistance.

Smallpox has been eradicated.

Both pneumonia and influenza vaccines are among those given to increase host resistance.

PTS: 1 REF: 213 | 214 CON: Promoting Health | Infection 16. ANS: 4 Objective: 4. Discuss current issues related to emerging communicable diseases.

Page: Heading: Controlling Communicable Diseases Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health; Assessment; Infection Difficulty: Moderate

1 2 3 4

Feedback Public health agencies consider the effectiveness of a vaccine before making it mandatory.

Public health agencies consider where the highest risk exists before making a vaccine mandatory.

Low-risk areas do not need mandatory vaccination.

Among other factors, public health agencies consider effectiveness of vaccines and the highest risk areas before calling for mandatory vaccinations.

PTS: 1 REF: 214 CON: Promoting Health | Assessment | Infection 17. ANS: 3 Objective: 4. Discuss current issues related to emerging communicable diseases.

Page: Heading: Communicable Disease and the Burden of Disease > Infectious Respiratory Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection Difficulty: Easy

1 2 3 4

Feedback A nurse might encounter cases of chickenpox in her practice, but it is not common due to effective vaccination.

TB is not commonly encountered in a nurse’s practice.

Influenza is common and is a major public health concern especially with vulnerable populations such as children and older adults.

Although influenza is commonly seen and treated by nurses, chickenpox is not common due to effective vaccination.

PTS: 1 REF: 191 CON: Infection 18. ANS: 4 Objective: 5. Describe the role of the nurse in prevention and treatment of hospital- and community-acquired infections.

Page: Heading: Infectious Agents and the Cycle of Transmission > Agent Characteristics Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Infection Difficulty: Moderate Feedback 1 Bacteria are unicellular organisms.

2 Protozoa are single-celled animals such as flagellates and amoeboids.

3 Helminths are parasitic worm-like organisms.

4 Mycoses are fungi that cause disease.

PTS: 1 19. ANS: 2

REF: 198

CON: Promoting Health | Infection

Objective: 4. Discuss current issues related to emerging communicable diseases.

Page: Heading: Infectious Agents and the Cycle of Transmission > Agent Characteristics Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Infection; Safety Difficulty: Moderate Feedback 1 Hookworms are not vectors for this disease.

2 Anthropods are insects that act as vectors and transmit the agent from its reservoir to its host.

3 Protozoa are not vectors for this disease.

4 Viruses are not vectors for this disease.

PTS: 1

REF: 198

CON: Assessment | Infection | Safety

Chapter 9: Noncommunicable Diseases Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. Nurses working with diabetes patients know that this noncommunicable chronic disease (NCD) has which of the following characteristics? (Select all that apply.)

1. It cannot be prevented by a vaccination.

2. It cannot be cured by a medication.

3. It requires long-term management.

4. It is not affected by weight.

5. It does not require lifestyle changes such as regular exercise.

2. A PHN evaluating an increase in lung cancer cases in a certain area would conduct which of the following epidemiological studies to help understand the rising incidence in cases? (Select all that apply.)

1. Conduct a retrospective cohort study.

2. Examine hospital discharge data.

3. Examine cancer registry data.

4. Conduct a clinical trial to test the intervention chosen.

5. Examine results of a health-related quality-of-life questionnaire.

3. Nurses working with patients who have a noncommunicable disease (NCD) consider it important to know about the burden of disease associated with a specific disease primarily because it does which of the following? (Select all that apply.)

1. Takes into account what impact the disease will have on the community as a whole 2. Provides an overview of the disease’s social and economic impact 3. Helps determine promotion and prevention efforts targeting most common NCDs 4. Does not take into account the cost of treatment 5. Is specific to disease only and does not include injury Multiple Choice Identify the choice that best completes the statement or answers the question.

4. Nurses working with patients who have chronic noncommunicable disease (NCDs) assess them based on specific risk factors. The four common modifiable risk factors that account for much of the NCDs in the U.S. are: 1. Poor nutrition, low physical activity, medication adherence, and tobacco use.

2. Poor nutrition, low physical activity, tobacco use, and alcohol use.

3. Low physical activity, tobacco use, illicit drug use, and poor nutrition.

4. Age, tobacco use, poor nutrition, and low physical activity.

5. When a nurse works with a patient diagnosed with heart disease to help build a plan for long-term management of the disease, which of the following is not one of the common behavioral level risk factors that the patient can modify?

1. Tobacco use 2. Access to health-care services 3. Amount of exercise 4. Nutrition

6. Cardiovascular nurses know that more than a third of adults have two or more risk factors for heart disease and stroke, which may include: 1. High blood pressure.

2. An inactive lifestyle.

3. Both A and B. 4. Normal body weight.

7. A public health nurse (PHN) employs which two type of studies to help determine whether specific risk factors are associated with the development of disease?

1. Case-control study, cohort study 2. Cohort study, cross-sectional survey 3. Cross-sectional study, case-control study 4. Clinical trial, cross-sectional survey 8. Suzanne, a PHN, has taken on an internship with the World Health Organization. She is working with a team focused on reducing heart disease in low-income countries. She is aware that the life expectancy is lower but was not familiar with other measures to help understand the burden of disease. She learns that the further analysis of the burden of disease examines how much the disease, injury, or risk factor contribute to: 1. Overall disability and premature death in the population.

2. Overall capacity in the country to prevent disease and premature death in the population.

3. Overall premature death in the population and infrastructure capacity to prevent disease in the country.

4. Overall capacity with the country to prevent and treat disease.

9. A nurse working with adult patients diagnosed with diabetes noted that most of them were obese and that this is a risk factor not only for developing the disease but for morbidity and mortality associated with the disease.

The nurse knows that a body mass index of indicates a person is obese.

1. 25–29.9 2. 30 3. 18.5–24.9 4. 40 10. A cardiovascular nurse working at a large medical center is examining the evidence on how to help her patients who smoke. Which of the following is an evidence-based behavioral level intervention aimed at reducing harm associated with tobacco use?

1. Implementing a tobacco-free campus policy at the medical center 2. Offering a smoking cessation counseling program to her patients 3. Advocating for stricter package warnings on cigarette packages 4. Asking the public health department to put up billboards near schools to promote prevention of smoking in adolescents 11. A PHN, concerned about the increase in NCDs in a community, could include in his/her assessment of the community which of the following?

1. Socioeconomic risk 2. Genetic predispositions 3. Behavioral factors 4. All of the above 12. A nurse working in a community clinic understands that lack of access to health care can increase the risk for morbidity and mortality related to NCD. Which of the following is not associated with access to care?

1. Available transportation to services 2. Adequate health insurance

3. Adherence to medication regimen 4. Number of health-care providers in the community 13. Nurses working on a medical unit focused on treatment of patients with cardiovascular disease (CVD) decide to put together a program to reduce risk for the development of CVD and reduce morbidity in persons who have already been diagnosed with CVD. They include in their program all but which of the following?

1. How to incorporate healthy eating habits into their daily menu 2. How to get genetic testing 3. How to self-manage CVD 4. How to increase their amount of daily exercise 14. When the nurse is applying the chronic care model when seeing patients, she or he is: 1. Focused on treating an acute care phase of the NCD. 2. Focused on short-term management of the disease.

3. Focused on long-term management of disease.

4. Focused on a primary prevention framework.

15. To educate their patients about the risks of developing NCDs, nurses might share which of the following facts?

1. NCDs are the number one cause of death in the United States.

2. Risk for NCD is not affected by individual behaviors, the environment, and socioeconomic factors.

3. Prevention occurs across the continuum starting with primary prevention during the perinatal period through tertiary prevention measures such as chronic disease self-management (CDSM) programs.

4. Both A and C. 16. When screening a patient for NCD risk, a nurse reviews the social determinants of health, including which of the following?

1. The social gradient 2. Early life 3. Work life 4. All of the above 17. In caring for patients with noncommunicable diseases (NCD), nurses in a primary care clinic must not only understand the pathophysiology of the disease but also must primarily: 1. Focus on the acute stage of disease.

2. Focus on the full continuum of the disease.

3. Focus on screening for disease. Conduct research related to treatment of the disease.

4. Focus on primary prevention.

Chapter 9: Noncommunicable Diseases Answer Section MULTIPLE RESPONSE 1. ANS: 1, 2, 3 Objective: 3. Describe the risk factors at the individual and population levels related to development of a noncommunicable disease.

Page: Heading: Noncommunicable Chronic Diseases Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment Difficulty: Easy

1 2 3 4 5

Feedback Diabetes cannot be prevented by a vaccination.

Diabetes cannot be cured by a medication.

Long-term management of diabetes includes incorporating healthy lifestyle changes such as proper eating, exercise, and weight management in addition to medication.

Long-term management of diabetes includes incorporating healthy lifestyle changes such as proper eating, exercise and weight management in addition to medication.

Long-term management of diabetes includes incorporating healthy lifestyle changes such as proper eating, exercise and weight management in addition to medication.

PTS: 1 REF: 218 | 219 CON: Promoting Health | Metabolism 2. ANS: 1, 2, 3 Objective: 4. Apply current evidence-based population interventions to the prevention of noncommunicable diseases.

Page: Heading: Risk Factors Integrated Processes: Nursing Process Client Need: Health Promotion and Management Cognitive Level: Application [Applying] Concept: Cellular Regulation; Promoting Health; Critical Thinking Difficulty: Moderate

1 2 3 4 5

Feedback A retrospective cohort study would help determine the relative risk of developing disease based on the risk factors specific to the population.

Hospital discharge data can help identify persons who developed the disease.

The cancer registry can help identify persons who developed the disease including those who may no longer live in the identified zip code.

A clinical trial helps determine the effectiveness of an intervention. An intervention is developed after the underlying factors for developing disease are determined.

A health-related quality-of-life questionnaire will not help determine the rising incidence in cases.

PTS: 1 REF: 222-224 CON: Cellular Regulation | Promoting Health | Critical Thinking 3. ANS: 1, 2, 3 Objective: 2. Define the burden of noncommunicable diseases using current epidemiological frameworks.

Page: Heading: Noncommunicable Chronic Diseases > Burden of Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Economics Difficulty: Moderate

1 2 3 4 5

Feedback The burden of disease takes into account the impact on the community as a whole.

The burden of disease takes into account the social and economic impacts.

Estimating the burden of disease helps can help a community prioritize promotion and prevention efforts.

Estimating the burden of disease takes into account treatment costs.

As defined by the WHO, the burden of disease is the overall impact of diseases and injuries at the individual level, at the societal level, or to the economic costs of disease.

PTS: 1

REF: 220

CON: Promoting Health | Economics

MULTIPLE CHOICE 4. ANS: 2 Objective: 3. Describe the risk factors at the individual and population levels related to development of a noncommunicable disease.

Page: Heading: Noncommunicable Diseases in the United States Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Assessment; Nutrition; Addiction Difficulty: Moderate Feedback 1 Poor nutrition, sedentary lifestyle, tobacco use, and alcohol use are common risk factors for development of NCDs. Medication adherence, although important, is related to treatment of a disease once it has occurred rather than a risk factor for developing disease.

2 Poor nutrition, sedentary lifestyle, tobacco use, and alcohol use are common risk factors for development of NCDs. 3 Poor nutrition, sedentary lifestyle, tobacco use, and alcohol use are common risk factors for development of NCDs. Illicit drug use is not one of the common risk factors for development of NCDs. 4 Poor nutrition, sedentary lifestyle, tobacco use, and alcohol use are common risk factors for development of NCDs. Although the risk for developing a NCD increases with age, it is not considered a modifiable risk factor.

PTS: 1

REF: 219

CON: Assessment | Nutrition | Addiction

5. ANS: 2 Objective: 3. Describe the risk factors at the individual and population levels related to development of a noncommunicable disease.

Page: Heading: Noncommunicable Diseases in the United States Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Assessment; Addiction; Sleep, Rest, and Activity Difficulty: Moderate Feedback 1 Tobacco use is a modifiable behavioral risk factor for heart disease.

2 Access to health care is a socioeconomic risk factor rather than a behavioral risk factor.

3 Inactivity is a modifiable behavioral risk factor for heart disease.

4 Nutrition is modifiable behavioral risk factor for heart disease.

PTS: 1 REF: 222 CON: Assessment | Addiction | Sleep, Rest, and Activity 6. ANS: 3 Objective: 3. Describe the risk factors at the individual and population levels related to development of a noncommunicable disease.

Page: Heading: Noncommunicable Diseases in the United States Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Perfusion; Promoting Health Difficulty: Moderate

1 2 3 4

Feedback High blood pressure is a risk factor for heart disease.

An inactive lifestyle is a risk factor for heart disease.

High blood pressure and inactivity are risk factors for heart disease.

Obesity is a risk factor for heart disease, not normal body weight.

PTS: 1 REF: 222 CON: Perfusion | Promoting Health 7. ANS: 1 Objective: 2. Define the burden of noncommunicable diseases using current epidemiological frameworks.

Page: Heading: Risk Factors Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Critical Thinking, Evidence-Based Practice Difficulty: Moderate Feedback 1 A case-control study helps determine the odds ratio of disease occurring based on exposure to a risk factor, and a cohort study helps determine the relative risk of disease occurring based on exposure to a risk factor.

2 A cross-sectional survey provides an estimate of disease status or frequency, but

3

4

because it reflects the data from the same point in time it does not help determine what leads to development of disease.

A cross-sectional survey provides an estimate of disease status or frequency, but because it reflects the data from the same point in time it does not help determine risk for development of disease.

A clinical trial is mainly used to compare treatment groups to control in relation to the effectiveness of interventions, and a cross-sectional survey provides an estimate of disease status or frequency, but because it reflects the data from the same point in time it does not help determine what leads to development of disease.

PTS: 1 REF: 224 CON: Promoting Health | Critical Thinking 8. ANS: 1 Objective: 2. Define the burden of noncommunicable diseases using current epidemiological frameworks.

Page: Heading: Burden of Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Critical Thinking Difficulty: Moderate Feedback 1 Analysis of the burden takes into account how much the disease, injury, or risk factor contributes to overall disability and premature death in the population.

2 The overall capacity in a country to prevent disease is an important factor for development of interventions but is not part of analyzing the burden of disease.

3 The overall capacity in a country to treat disease is an important factor for development of interventions but is not part of analyzing the burden of disease.

4 The overall capacity in a country to prevent and treat disease is an important factor for development of interventions but is not part of analyzing the burden of disease.

PTS: 1 REF: 220 | 221 CON: Assessment | Promoting Health | Critical Thinking 9. ANS: 2 Objective: 3. Describe the risk factors at the individual and population levels related to development of a noncommunicable disease.

Page: Heading: Risk Factors > Behavioral Risk Factors Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Nutrition; Metabolism Difficulty: Moderate

1 2 3 4

Feedback A BMI of 25–29.9 is overweight but not obese.

A BMI  than 30 is considered obese.

A BMI 18.5–24.9 is considered normal weight.

A BMI of 40 or more is considered morbidly obese.

PTS: 1

REF: 225

CON: Nutrition | Metabolism

10. ANS: 2 Objective: 4. Apply current evidence-based population interventions to the prevention of noncommunicable diseases.

Page: Heading: Risk Factors > Behavioral Risk Factors Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Perfusion; Addiction; Nursing Roles Difficulty: Moderate Feedback 1 A tobacco-free campus is a population-level prevention strategy at the organizational level.

2 There is evidence to support that the use of smoking cessation counseling with patients who currently smoke can result in reduction in tobacco use.

3 Advocating for package warnings is an example of policy-level interventions.

4 A series of public service announcements using billboards is an example of a universal population-level prevention strategy.

PTS: 1 REF: 229 CON: Perfusion | Addiction | Nursing Roles 11. ANS: 4 Objective: 4. Apply current evidence-based population interventions to the prevention of noncommunicable diseases.

Page: Heading: Risk Factors > Socioeconomic Risk for Noncommunicable Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Moderate Feedback 1 Socioeconomic risks are associated with the development of NCDs. 2 Genetic predispositions are associated with the development of NCDs. 3 Behavioral risk factors are associated with the development of NCDs. 4 Socioeconomic risk, genetic predispositions, and behavioral factors are all associated with the development of NCDs. PTS: 1 REF: 225-231 CON: Assessment | Promoting Health 12. ANS: 3 Objective: 4. Apply current evidence-based population interventions to the prevention of noncommunicable diseases.

Page: Heading: Disparity and Noncommunicable Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment Difficulty: Moderate Feedback

1 2 3 4

Available transportation is an issue related to access to care because it can make it difficult to see a health-care provider for care of an NCD. Adequate health insurance is an issue related to access to care because the patient may not have the resources to pay out-of-pocket expenses.

Adherence to a medical regimen is a behavioral issue and not directly related to access to care.

The number of health-care providers in a community can impact access to care either positively when there are an adequate number or negatively when there are not enough to serve the community.

PTS: 1 REF: 225 | 232 CON: Promoting Health | Assessment 13. ANS: 2 Objective: 4. Apply current evidence-based population interventions to the prevention of noncommunicable diseases.

Page: Heading: Prevention Strategies for Noncommunicable Diseases Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition; Sleep, Rest, and Activity; Assessment; Promoting Health; Nursing Roles Difficulty: Moderate

1 2 3 4

Feedback Incorporating healthy eating habits into their daily menu helps reduce risk for the development of CVD as well as morbidity related to CVD. Getting genetic testing does not reduce risk, although understanding family history can identify persons who may be at increased risk due to genetic predisposition.

Self-management of CVD can help reduce morbidity.

Adequate exercise can reduce risk for development of CVD as well as morbidity related to CVD.

PTS: 1 REF: 224 | 225 CON: Nutrition | Sleep, Rest, and Activity | Assessment | Promoting Health | Nursing Roles 14. ANS: 3 Objective: 4. Apply current evidence-based population interventions to the prevention of noncommunicable diseases.

Page: Heading: Noncommunicable Chronic Disease Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition; Medication; Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 The chronic care model occurs across the continuum of the disease with a focus on care over time.

2 The chronic care model reframes NCD care within a long-term management framework.

3 The chronic care model reframes NCD care within a long-term management

4

framework.

The chronic care model includes both secondary and tertiary prevention strategies.

PTS: 1 REF: 219 CON: Nutrition | Medication | Promoting Health | Nursing Roles 15. ANS: 4 Objective: Describe the impact of noncommunicable diseases on the health of a population.

Page: Heading: Prevention Strategies for Noncommunicable Diseases Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate

1 2 3 4

Feedback The five leading causes of death in the United States are NCDs. Risk for NCD is affected by individual behaviors, the environment, and socioeconomic factors.

Prevention occurs across the continuum starting with primary prevention during the perinatal period through tertiary prevention measures such as CDSM programs.

The leading causes of death are NCDs, which result from a combination of individual behaviors, the environment, and socioeconomic factors. They require self-management programs.

PTS: 1 REF: 219 | 232 | 233 CON: Promoting Health | Nursing Roles 16. ANS: 4 Objective: 2. Define the burden of noncommunicable diseases using current epidemiological frameworks.

Page: Heading: Disparity and Noncommunicable Disease > Socioeconomic Risk for Noncommunicable Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Moderate

1

2 3 4

Feedback Placement on the social gradient—meaning the further down the social ladder, the greater the incidence of disease and the shorter the life expectancy—is part of NCD risk.

Early life is part of determining NCD risk.

Work life, especially stress, may affect NCD risk.

The social gradient, early life, and work life are all parts of the social determinants of health.

PTS: 1 REF: 231 CON: Assessment | Promoting Health 17. ANS: 2 Objective: 1. Describe the impact of noncommunicable diseases on the health of a population.

Page: Heading: Noncommunicable Chronic Diseases

Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Though the managing acute stages of NCDs is important the full continuum of disease is the focus from primary to tertiary prevention.

2 The full continuum of disease is the focus from primary to tertiary prevention.

3 Screening helps to identify those with an NCD so that treatment can begin. However, the full continuum of disease is the focus from primary to tertiary prevention 4 Primary prevention occurs prior to the development of an NCD. The full continuum of disease is the focus from primary to tertiary prevention PTS: 1

REF: 219 | 232

CON: Promoting Health

Chapter 10: Mental Health Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. Persons who are emotionally healthy are able to: (Select all that apply.)

1. Meet the demands of everyday life.

2. Function in society.

3. Experience alterations in thinking.

4. Adapt to change.

5. Cope with challenges.

2. At her new job at the state department of health in Pennsylvania, Janice is tasked with overseeing a new mental health outreach program. Janice researched what factors at the individual level might be associated with increased risk for developing a SMI. Which of the following are specifically individual-level risk factors that may contribute to the development of mental disorders? (Select all that apply.)

1. Hormonal imbalance 2. Physical trauma 3. Malnutrition 4. Limited educational opportunities 3. At her new job at the state department of health in Pennsylvania, Janice is tasked with overseeing a new mental health outreach program. Her last step at the beginning of her assessment was to identify the greatest risk based on community-level risk factors. What community-level risk factors might she include? (Select all that apply.)

1. High crime rate 2. High poverty rate 3. Lack of mental health services 4. Family instability Multiple Choice Identify the choice that best completes the statement or answers the question.

4. A student nurse is studying stress and mental health. The student nurse learns that is based on an individual’s ability to access protective factors that exist at different levels to withstand chronic stress or recover from traumatic life events.

1. Intervention 2. Support 3. Resilience 4. Therapy 5. To help best use limited resources, the PHN has developed a prevention program for specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder.

1. Indicated 2. Selective 3. Universal 4. Both A and B 6. The nurse wishes to choose a reliable screening tool to help identify patients in her clinic who may have depression. Which of the following tools are used to screen for depression?

1.

2.

3.

4.

Patient Health Questionnaire 2 Center for Epidemiological Studies Depression Scale (CESD-10) Brief Symptom Checklist-18 of the My Mood Monitor (M-3) Both A and B

7. When working with a community assessment team, the PHN stresses that it is important to assess the mental health as well as the physical health of the community. An indicator or indicators of mental health in the community that could be included in the assessment include: 1. Strong social networks.

2. Availability of behavioral health services.

3. Safe place to work and live.

4. Both A and C. 8. At her new job at the state department of health in Pennsylvania, Janice is tasked with overseeing a new mental health outreach program. She begins with an assessment of the population at greatest risk. Based on 12-month prevalence of serious mental illness (SMI) at the national level, which group would be at greatest risk for SMI among those aged 18-44?

1. Males 2. Females 3. Those reporting two or more races 4. American Indian/Alaska Natives 9. At her new job at the state department of health in Pennsylvania, Janice is tasked with overseeing a new mental health outreach program. She found it challenging to estimate the prevalence of mental disorders in the U.S. primarily due to what issue?

1. There is no consensus on what constitutes a mental disorder.

2. HIPAA laws prevent review of medical records.

3. There are no health surveys that include data related to mental health.

4. There is no centralized method of conducting surveillance of mental health disorder.

10.

is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable and results in social disapproval.

1. Indicated prevention 2. Stigma 3. Risk factors 4. Transinstitutionalization

11. A PHN is currently working in a community with a high poverty rate as part of a team to help address the increasing prevalence of serious mental illness especially among adolescents. During a team meeting, the members of the community begin talking about the need to engage more stakeholders including government agencies, grass roots groups, nonprofits, and businesses. Invitations are extended, and many of these stakeholders agree to send representatives who will work in tandem with the team during their planning phase. This interrelationship is called: 1. Indicated prevention.

2. Intersectoral strategies.

3. Health-Related Quality of Life.

4. Institute of Medicine Model of Prevention.

12. Latisha, a recent graduate nurse working in a large urban medical center in the emergency department, noticed that a number of the patients coming in were adolescents who had attempted suicide. The patients she was particularly concerned about were those who identified as LGBTQ+. Latisha reviews current data on prevalence of suicide and suicide attempts and brings the evidence to her nurse manager that LGBTQ+ adolescents are at greater risk for suicide than their peers and suggests that the most likely community risk factors contributing are and .

1. Stigma and shame 2. Family disapproval and shame 3. Culture and family disapproval 4. Stigma and culture 13. Latisha, a recent graduate nurse working in a large urban medical center in the emergency department (ED), noticed that a number of the patients coming in were adolescents who had attempted suicide. The patients she was particularly concerned about were those who identified as LGBTQ+. Latisha requested permission from the nurse manager to conduct a quality improvement project with a focus on screening all adolescent patients that might be at risk for depression. For a comprehensive screening program, which of the following would be included in the program?

1. All adolescent patients will be screened for depression when they are admitted to the ED. 2. Patients with positive screens are referred for further evaluation.

3. Before being discharged, all adolescents will complete a questionnaire specific to depression symptoms and the nurse will notify appropriate persons (for example, a social worker) for those with positive screens.

4. All of the above.

14. A PHN is helping develop an outreach treatment program for adults in the community who have been diagnosed with a mental health disorder. She understands that the burden of treatment was shifted to the community through which of the following: 1. Deinstitutionalization 2. The Affordable Care Act 3. Health reform at SAMSHA 4. Title XIX of the Social Security Act 15. More than 6% of the U.S. adult population is affected by each year. It is the leading cause of disability for people ages 15 to 44 and is more prevalent in women than men.

1. Postpartum depression (PPD) 2. Schizophrenia 3. Major depressive disorder (MDD) 4. Posttraumatic stress disorder (PTSD) 16. During the past decade, the morbidity and mortality rate of serious mental illnesses (SMIs) has increased, showing that persons diagnosed with an SMI die years earlier than those in the general population.

1. 5-10 2. 25-35 3. 10-20 4. 10-15 17. A nurse considering a career in behavioral health learns that the mandates that group health plans of 50 or more persons, which cover mental health and substance use disorders, must provide benefits equivalent to or better than those benefits provided for medical or surgical benefits.

1. Mental Health Parity Act 2. Community Mental Health Centers Act 3. Affordable Care Act

4. None of the above 18. A community health group focused on optimizing the health of a large urban community decides to include mental health as a priority. However, they have limited data on mental health. What would be an example of primary data on the mental health of the community that would help them further determine if it is indeed a priority?

1. Discharge rates for persons with mental health disorder diagnoses from local hospitals 2. Violent crime rate trends over the past year 3. Data from available national surveys such as the National Health Interview Survey, and Behavioral Risk Factor Surveillance System 4. Data they obtained using their community health survey on Health-Related Quality of Life (HRQoL) 19. The World Health Organization (WHO)’s Mental Health Improvements for Nations’ Development (MIND) model includes four components. Which one of the following is not one of the components?

1. Policy, planning, and service development 2. Human rights and legislation 3. Access to appropriate mental health services and quality 4. Poverty and development

Chapter 10: Mental Health Answer Section MULTIPLE RESPONSE 1. ANS: 1, 2, 4, 5 Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Promoting Health Difficulty: Easy

1 2 3 4 5

Feedback Ability to meet the demands of everyday life is a marker of mental health.

Ability to function in society is a marker of mental health.

Alterations in thinking is a marker of possible mental disorder.

Ability to adapt to change is a marker of mental health.

Ability to cope with challenge is a marker of mental health.

PTS: 1 REF: 240 CON: Promoting Health 2. ANS: 1, 2, 3 Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders.

Page: Heading: Behavioral, Biological, Environmental, and Socioeconomic Risk Factors > Individual Level Risk Factors for Mental Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Moderate

1 2 3 4

Feedback Hormonal is an individual-level risk factor.

Physical trauma is an individual-level risk factor.

Malnutrition is an individual-level risk factor.

Lack of educational opportunities is a community-level risk factor.

PTS: 1 REF: 243 CON: Assessment | Promoting Health 3. ANS: 1, 2 Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders.

Page: Heading: Behavioral, Biological, Environmental, and Socioeconomic Risk Factors > Community-Level Risk Factors for Mental Disorders

Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health, Assessment Difficulty: Easy

1 2 3 4

Feedback Living in high-crime areas is a community-level risk factor.

Poverty is a community-level risk factor in the development of mental disorders.

Lack of mental health services is not a risk factor for developing a mental health disorder.

Although family instability often contributes to the development of mental disorders, it is considered an individual/family-level factor.

PTS: 1

REF: 244

CON: Promoting Health | Assessment

MULTIPLE CHOICE 4. ANS: 3 Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders.

Page: Heading: Protective Factors: Building Resilience Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Trauma; Stress; Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Resilience is based on an individual’s ability to access protective factors that exist at different levels to withstand chronic stress or recover from traumatic life events.

Preventive and treatment interventions are useful tools to build on an individual’s natural resilience to promote positive outcomes.

2 Resilience is based on an individual’s ability to access protective factors that exist at different levels to withstand chronic stress or recover from traumatic life events.

Support from family, friends, and community is an important part of strengthening an individual’s resilience.

3 Resilience is based on an individual’s ability to access protective factors that exist at different levels to withstand chronic stress or recover from traumatic life events.

4 Resilience is based on an individual’s ability to access protective factors that exist at different levels to withstand chronic stress or recover from traumatic life events.

Therapy is an important part of an overall treatment plan, in conjunction with intervention, support, and an individual’s capacity for resilience.

PTS: 1 REF: 244 CON: Trauma | Stress | Promoting Health | Nursing Roles 5. ANS: 1 Objective: 4. Apply current evidence-based population-level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations.

Page:

Heading: Prevention of Mental Disorders and Promotion of Mental Health > National Academy of Medicine Model of Prevention Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Moderate

1

2

3

4

Feedback Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those showing early signs of a mental disorder. The purpose of indicated techniques is to delay or reduce the severity of a mental disorder.

Selective prevention includes interventions provided to specific subgroups known to be at high risk for mental disorders owing to biological, psychological, social, or environmental factors but that have not yet been diagnosed with mental disorders.

High-risk subgroups include but are not limited to those with a family history of mental disorders, history of adverse childhood events, or victims of violence.

Universal prevention refers to prevention interventions provided to the entire population, not just those who may be at risk. The interventions include but are not limited to public service announcements provided to the public at large through billboards, media messages (print and electronic), or general health education programs.

Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those showing early signs of a mental disorder. The purpose of indicated techniques is to delay or reduce the severity of a mental disorder. Selective prevention includes interventions provided to specific subgroups known to be at high risk for mental disorders owing to biological, psychological, social, or environmental factors but that have not yet been diagnosed with mental disorders. High-risk subgroups include but are not limited to those with a family history of mental disorders, history of adverse childhood events, or victims of violence.

PTS: 1 REF: 248 CON: Promoting Health 6. ANS: 4 Objective: 5. Describe systems approaches to the promotion of mental health and the prevention and treatment of mental health disorders.

Page: Heading: Prevention of Mental Disorders and Promotion of Mental Health > Secondary Prevention: Screening for Mental Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Mood; Assessment Difficulty: Moderate

1 2 3

Feedback Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10.

Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10.

Tools to screen for depression include the Patient Health Questionnaire 2 and the

4

CESD-10. Screening tools for anxiety disorders include the Brief Symptom Checklist-18 of the My Mood Monitor (M-3).

Tools to screen for depression include the Patient Health Questionnaire 2 and the CESD-10.

PTS: 1 REF: 249 CON: Promoting Health | Mood | Assessment 7. ANS: 4 Objective: 1. Define the global burden of disease related to mental disorders using current epidemiological frameworks.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Psychosocial Integrity, Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment, Critical Thinking Difficulty: Moderate

1 2 3 4

Feedback Strong social networks within a community are associated with improved community-level mental health.

Availability of behavioral health services is focused on treatment at the individual level.

Safe places to work and live within a community are associated with improved community-level mental health.

Both strong social networks and a safe place to live and work within a community are associated with improved community mental health.

PTS: 1 REF: 240 CON: Cognition | Mood | Stress | Promoting Health | Nursing Roles 8. ANS: 3 Objective: 1. Define the global burden of disease related to mental disorders using current epidemiological frameworks.

Page: 227 Heading: Epidemiology of Mental Disorders > Surveillance of Mental Health Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment Difficulty: Moderate Feedback 1 Based on gender, females have a higher prevalence of SMI. 2 Although females have a higher prevalence than males, those reporting two or more races had the highest prevalence of SMI. 3 Those reporting two or more races had the highest prevalence of SMI. 4 Although American Indian/Alaska Natives have a higher prevalence of SMI, those reporting two or more races had the highest prevalence.

PTS: 1 9. ANS: 4

REF: 242

CON: Promoting Health | Assessment

Objective: 1. Define the global burden of disease related to mental disorders using current epidemiological frameworks.

Page: Heading: Epidemiology of Mental Disorders > Surveillance of Mental Health Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Knowledge [Remembering] Concept: Promoting Health, Assessment Difficulty: Moderate Feedback 1 In the U.S., there is a clear definition of what constitutes a mental disorder as evidenced by the HP 2020 definition.

2 Although HIPAA laws restrict access to private health information, most surveillance data come from surveys or from mandated reports to public health departments, not medical record.

3 The CC uses data from eight national health surveys and surveillance systems to collect data on mental health in adults.

4 There are no current centralized methods for conducting surveillance of mental health disorders in the U.S. PTS: 1 REF: 241 CON: Promoting Health | Assessment 10. ANS: 2 Objective: 3. Define the difference between behavioral, biological, environmental, and socioeconomic risk factors related to mental health disorders.

Page: Heading: Cultural Context and Stigma Integrated Processes: Culture and Spirituality Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health, Diversity Difficulty: Moderate Feedback 1 Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable. Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder.

2 Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable.

3 Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable. Risk factors increase an individual’s chance of developing a mental disorder.

4 Stigma is a combination of personal attributes and societal stereotypes related to human characteristics viewed as unacceptable. Transinstitutionalization refers to the growing number of mentally ill persons who are homeless, in jail, in shelters, or in other facilities instead of being home or in a hospital.

PTS: 1 REF: 246 CON: Promoting Health 11. ANS: 2 Objective: 4. Apply current evidence-based population-level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations.

Page: Heading: Prevention of Mental Disorders and Promotion of Mental Health > Promotion of Mental Health and Policy Integrated Processes: Nursing Process Client Need: Psychosocial Integrity, Health promotion and maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration Difficulty: Moderate Feedback 1 Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots groups, nonprofits, and businesses. Indicated prevention addresses specific subgroups at highest risk for development of a mental disorder or those that are showing early signs of a mental disorder.

2 Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots groups, nonprofits, and businesses.

3 Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots groups, nonprofits, and businesses.

Health-Related Quality of Life is the self-perceived impact of physical and emotional health on overall quality of life.

4 Intersectoral strategies engage more than one sector of society with a shared interest such as government agencies, grass roots groups, nonprofits, and businesses. The Institute of Medicine Model of Prevention is a framework for mental disorders that clearly separates prevention into three categories with specific interventions at each level.

PTS: 1 REF: 248 CON: Promoting Health | Collaboration 12. ANS: 4 Objective: 4. Apply current evidence-based population-level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations.

Page: Heading: CULTURAL CONTEXT AND STIGMA Integrated Processes: Nursing Process Client Need: Psychosocial Integrity, health promotion and maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Diversity Sexuality Difficulty: Moderate Feedback 1 Stigma is a form of social disapproval that pervades the attitudes and actions of the community. Shame is an individual-level risk factor.

2 Family disapproval and shame are risk factors at the family/individual level.

3 Family disapproval is a risk factor at the family/individual level.

4 Cultural norms occur at the community level. Stigma is a form of social disapproval that pervades the attitudes and actions of the community.

PTS: 1 REF: 245 | 246 CON: Promoting Health | Nursing Roles | Diversity | Sexuality 13. ANS: 4 Objective: Apply current evidence-based population-level interventions to the prevention of mental disorders and the promotion of optimal mental health for communities and populations.

Page:

Heading: Prevention of Mental Disorders and Promotion of Mental Health > Secondary Prevention: Screening for Mental Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Pregnancy; Mood; Promoting Health; Assessment; Quality Improvement Difficulty: Moderate Feedback 1 Screening, high-risk referrals for further evaluation, and completion of a depression symptom questionnaire would all be part of comprehensive depression screening program.

2 Screening, high-risk referrals for further evaluation, and completion of a depression symptom questionnaire would all be part of comprehensive depression screening program.

3 Screening, high-risk referrals for further evaluation, and completion of a depression symptom questionnaire would all be part of comprehensive depression screening program.

4 Screening, high-risk referrals for further evaluation, and completion of a depression symptom questionnaire were all incorporated.

PTS: 1 REF: 248-251 CON: Mood | Promoting Health | Assessment | Quality Improvement 14. ANS: 1 Objective: 5. Describe systems approaches to the promotion of metal health and the prevention and treatment of mental health disorders.

Page: Heading: Mental Health Policy Related to Treatment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Regulations, Health-Care System Difficulty: Moderate Feedback 1 Deinstitutionalization occurred in the 1970s and shifted the burden of treatment from psychiatric hospitals to the community.

2 The Affordable Care Act focuses on providing adequate and equitable coverage for treatment but was not related to shifting the burden to communities.

3 SAMHSA is a government agency charged with making substance use and mental disorder information, services, and research more accessible. It was not responsible for shifting the burden to communities.

4 Title XIX of the social security act refers to state grants for medical assistance programs.

PTS: 1 REF: 252 CON: Mood | Promoting Health | Assessment | Quality Improvement 15. ANS: 3 Objective: 1. Define the global burden of disease related to mental disorders using current epidemiological frameworks.

Page: Heading: Epidemiology of Mental Disorders > Prevalence of Mental Health Disorders

Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Mood; Promoting Health Difficulty: Moderate Feedback 1 MDD occurs in more than 6% of the adult population each year.

2 MDD occurs in more than 6% of the adult population each year.

3 MDD occurs in more than 6% of the adult population each year.

4 MDD occurs in more than 6% of the adult population each year.

PTS: 1 REF: 242 CON: Mood | Promoting Health 16. ANS: 2 Objective: 1. Define the global burden of disease related to mental disorders using current epidemiological frameworks.

Page: Heading: Epidemiology of Mental Disorders > Prevalence of Mental Health Disorders Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Promoting Health, Assessment Difficulty: Moderate Feedback 1 People diagnosed with a SMI die 10-20 years earlier than the general population, partly due to suicide and injury, chronic disease, and substance abuse.

2 People diagnosed with a SMI die 10-20 years earlier than the general population, partly due to suicide and injury, chronic disease, and substance abuse.

3 People diagnosed with a SMI die 10-20 years earlier than the general population, partly due to suicide and injury, chronic disease, and substance abuse.

4 People diagnosed with a SMI die 10-20 years earlier than the general population, partly due to suicide and injury, chronic disease, and substance abuse.

PTS: 1 REF: 242 CON: Promoting Health 17. ANS: 1 Objective: 5. Describe systems approaches to the promotion of mental health and the prevention and treatment of mental disorders.

Page: Heading: Mental Health Policy Related to Treatment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Health-Care System, Regulations Difficulty: Moderate Feedback 1 The Mental Health Parity Act was signed into law in 2008 and mandates that group health plans of 50 or more persons, which cover mental health and substance use disorders, must provide benefits equivalent to or better than those benefits provided for medical or surgical benefits.

2 The Community Mental Health Centers Act was signed in 1963 and opened the way for

3

4

a network of community mental health centers to provide comprehensive services and continuity of care.

The Affordable Care Act signed into law in 2010 fills in some gaps by requiring Medicaid and plans purchased by small businesses include mental health and substance abuse coverage starting in 2014.

The Mental Health Parity Act was signed into law in 2008 and mandates that group health plans of 50 or more persons, which cover mental health and substance use disorders, must provide benefits equivalent to or better than those benefits provided for medical or surgical benefits.

PTS: 1 REF: 252 CON: Promoting Health | Health-Care System | Regulations 18. ANS: 4 Objective: 5. Describe systems approaches to the promotion of mental health and the prevention and treatment of mental disorders.

Page: Heading: Measure of Mental Health: Health-Related Quality of Life Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Violence; Promoting Health; Critical Thinking; Evidence-Based Practice Difficulty: Moderate Feedback 1 Discharge rates are an example of secondary data.

2 Violent crime rates are an example of secondary data.

3 Surveillance data from national surveys are examples of secondary data.

4 Collected data using the HRQoL survey tool is an example of primary data.

PTS: 1 REF: 247 CON: Violence | Promoting Health | Critical Thinking | Evidence-Based Practice 19. ANS: 3 Objective: 5. Describe systems approaches to the promotion of mental health and the prevention and treatment of mental health disorders.

Page: Heading: Prevention of Mental Disorders and Promotion of Mental Health > Promotion of Mental Health and Policy Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Health-Care Systems, Promoting Health, Collaboration Difficulty: Moderate Feedback 1 Policy, planning, and service development is one of the four components.

2 Human rights and legislation is one of the four components.

3 Access to care is not included in the model because the WHO model stresses an upstream approach.

4 Poverty and development is one of the four components.

PTS: 1

REF: 248

CON: Health-Care System | Promoting Health | Collaboration

Chapter 11: Substance Use and the Health of Communities Multiple Choice Identify the choice that best completes the statement or answers the question.

1. When developing a program to address drug use in the schools, the school nurse wants to make sure that she includes all types of psychoactive substances. In addition to stimulants, inhalants, depressants, and cannabis, psychoactive substances also include which of the following?

1. Dissociative anesthetics 2. Both A and C 3. Hallucinogens 4. Non-narcotics 2. A public health nurse (PHN) researching risk factors for mortality found that causes of preventable deaths.

1. Alcohol, tobacco 2. Opioids, tobacco 3. Cannabis, alcohol 4. Opioids, cannabis

and

are leading

3. Assessment of risk associated with substance use includes determining which of the following?

1. Quantity consumed 2. Frequency of consumption 3. Duration of use 4. All of the above 4. A school nurse working at a high school puts together a school-wide program to educate teens about the harm associated with alcohol use. What level of intervention is this?

1. Universal level of prevention 2. Selective level of prevention 3. Indicated level of prevention 4. None of the above 5. A nurse studying harm associated with substance use learns that alcohol is a causal factor in more than types of diseases and injuries.

1. 200 2. 80 3. 60 4. 10 6. Nurses at a local trauma center were involved in evaluating their hospital’s screening program for at-risk alcohol use. Which of the following steps was part of their plan?

1. Review files on patients admitted with a possible alcohol-related injury.

2. Evaluate the current screening system in use on their unit.

3. Review current screening techniques used in other hospitals.

4. All of the above.

7. Nurses at a local trauma center were involved in evaluating their hospital’s screening program for at-risk alcohol use. The nurses found that, for many of the health care workers, there seemed to be confusion as to what constituted a positive screen. As part of their staff training, they provided information on the levels of risk. They explained a positive screen: 1. Occurs only with those who have an alcohol use disorder.

2. Occurs with a blood alcohol concentration (BAC) to 0.08 grams percent or above.

3. Occurs independent of other risk factors.

4. Occurs when a person’s current level of consumption puts them at risk for adverse health consequences.

8. When a community health nurse conducts an assessment of tobacco-related harm at the population level, she should include which of the possible indicators?

1. Prevalence of childhood asthma 2. Prevalence of chronic obstructive pulmonary disorders 3. Prevalence of lung cancer 4. All of the above 9. A nurse working on a maternity unit became concerned when one of the pregnant patients indicated that she was currently smoking cigarettes. Which of the following adverse effects might eventually affect her unborn child?

1. Low birth weight 2. Increased risk for sudden infant death syndrome (SIDS) 3. Both A and B 4. Lower rates of asthma 10. Which of the following influenced policy-level interventions that led to reduction in tobacco use in the United States?

1. World War II 2. The first Surgeon General’s report on smoking and health 3. The Great Depression 4. All of the above 11. A nurse manager of a primary care clinic providing care to an underserved population in a large urban setting wished to know more about the prevalence of substance use. She began with national statistics and found that the number one substance, other than tobacco and alcohol, used in the United States as of 2017 was: 1. Cocaine.

2. Hallucinogens.

3. Marijuana.

4. Nonmedical use of psychotherapeutics.

12. A 20-year-old man presented to the emergency department (ED) with tactile hallucinations and appeared euphoric, tremulous, anorexic, and had dilated pupils. Based on these facts, the nurse concludes that the patient was most likely using which drug?

1. Methamphetamine 2. Cocaine 3. Alcohol 4. None of the above 13. An emergency department (ED) nurse wants to put together a comprehensive screening program for substance use. When choosing a screening tool for drug use, which of the following might she suggest to the team?

1. The DAST-10 2. Both A and C 3. The National Institute on Drug Abuse (NIDA) ASSIST tool 4. The AUDIT 14. A PHN preparing a proposal on prevention of overdose deaths for the community is worried about the stigma attached to those who use drugs. She understands that stigma:

1. Is a perception that risky substance use is a personal choice and consequences are self-inflicted.

2. Both A and C. 3. Continues to be a barrier for entrance into treatment for the person with a substance use disorder.

4. Encourages persons with a drug use disorder to seek treatment.

15. A team of nurses for a medical surgical unit has been assigned to develop an alcohol screening and brief interventions (SBI) program for their department. Which of the following steps should they take during the development stage?

1. Review current alcohol SBI recommendations from the Joint Commission on Accreditation.

2. Develop a plan to train health-care personnel on the use of the alcohol SBI. 3. Both A and B. 4. Conduct a process evaluation.

16. During a class lecture, a nursing student learned that which of the following are considered psychoactive substances?

1. Depressants 2. Stimulants 3. Both A and B 4. Antidepressants 17. A PHN follows which of these guiding principles on harm reduction when helping clients who are substance users?

1. Clients are responsive to culturally competent, nonjudgmental services delivered in a manner that demonstrates respect for individual dignity, personal strength, and self-determination.

2. Service providers are responsible to the wider community for delivering interventions, which attempt to reduce the economic, social, and physical consequences of drug- and alcohol-related harm and harms associated with other behaviors, or practices that put individuals at risk.

3. Because those engaged in unsafe health practices are often difficult to reach through traditional service venues, the service continuum must seek creative opportunities and develop new strategies to engage, motivate, and intervene with potential clients.

4. All of the above.

18. To help patients who report current tobacco use, a nurse knows which of the following evidence-based approaches for smoking cessation strategies is the most effective?

1. Provide patients counseling options.

2. Review options for medications used for smoking cessation.

3. Both A and B. 4. None of the above.

Chapter 11: Substance Use and the Health of Communities Answer Section MULTIPLE CHOICE 1. ANS: 2 Objective: 1. Describe the impact of substance use on the health of a population.

Page: Heading: Substance Use and the Global Burden of Disease Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing Roles; Addiction Difficulty: Easy

1 2 3 4

Feedback Dissociative anesthetics are psychoactive substances.

Dissociative anesthetics, narcotics, and hallucinogens are among the classes of psychoactive substances.

Hallucinogens are psychoactive substances.

Narcotics are psychoactive substances; non-narcotics are not.

PTS: 1 REF: 257 CON: Nursing Roles | Addiction 2. ANS: 1 Objective: 2. Define the burden of disease related to substance use using current epidemiological frameworks.

Page: Heading: Substance Use and the Global Burden of Disease > The Global Burden of Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Addiction Difficulty: Moderate Feedback 1 Tobacco and alcohol, both legal substances, are leading causes of preventable deaths both globally and in the U.S. Worldwide, tobacco use causes more than 7 million deaths per year and alcohol use causes more than 3 million.

2 Opioids and other drugs besides alcohol and tobacco cause approximately 190,000 deaths globally.

3 Opioids and other drugs besides alcohol and tobacco cause approximately 190,000 deaths globally.

4 Opioids and other drugs besides alcohol and tobacco cause approximately 190,000 deaths globally.

PTS: 1 REF: 256 CON: Promoting Health | Addiction 3. ANS: 4 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Substance Use and the Global Burden of Disease > Measurement and Surveillance

Integrated Processes: Nursing Process Client Need: Psychosocial Integrity; Physiological Integrity Cognitive Level: Application [Applying] Concept: Addiction; Assessment Difficulty: Moderate Feedback 1 Assessment of risk associated with substance use includes quantity, frequency, duration, and pattern of use.

2 Assessment of risk associated with substance use includes quantity, frequency, duration, and pattern of use.

3 Assessment of risk associated with substance use includes quantity, frequency, duration, and pattern of use.

4 Assessment of risk associated with substance use includes quantity, frequency, duration, and pattern of use.

PTS: 1 REF: 257 CON: Addiction | Assessment 4. ANS: 1 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Models for Prevention and Treatment of Substance Use Disorders > HMD Prevention Model Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Addiction Difficulty: Moderate Feedback 1 The universal level of prevention addresses populations regardless of identified risk.

2 The selective level of prevention addresses specific subgroups that are known to be at risk for substance related harm by virtue of biological, psychological, social, or environmental factors.

3 The indicated level of prevention addresses specific subgroups at highest risk for development of a substance use disorder, or those that are showing early signs of substance use disorders.

4 The universal level of prevention addresses populations regardless of identified risk.

PTS: 1 REF: 262 CON: Promoting Health | Addiction 5. ANS: 1 Objective: 1. Describe the impact of substance use on the health of a population.

Page: Heading: Alcohol Use > Consequences of Alcohol Use Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Addiction Difficulty: Moderate Feedback 1 According to the WHO, alcohol is a causal factor in 200 types of diseases and injuries.

2 According to the WHO, alcohol is a causal factor in 200 types of diseases and injuries.

3 4

According to the WHO, alcohol is a causal factor in 200 types of diseases and injuries.

According to the WHO, alcohol is a causal factor in 200 types of diseases and injuries.

PTS: 1 REF: 266 CON: Assessment | Addiction 6. ANS: 4 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Alcohol Use > Screening Brief Intervention and Referral for Treatment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity, Safe and Effective Care Environment; Management of Care Cognitive Level: Application [Applying] Concept: Assessment; Critical Thinking; Addiction; Quality Improvement Difficulty: Moderate Feedback 1 The nurses reviewed files on patients admitted with a possible alcohol-related injury.

2 The nurses evaluated their unit’s current screening system.

3 The nurses reviewed screening techniques used by other institutions.

4 Reviewing alcohol-related injury admissions, checking the current screening system, and reviewing screening systems used by other hospitals were some of the steps taken by nurses to improve their unit’s alcohol substance use disorder screening program.

PTS: 1 REF: 266-268 CON: Assessment | Critical Thinking | Addiction 7. ANS: 4 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Alcohol Use > Policy-Level Interventions to Reduce Alcohol-Related Harm Integrated Processes: Nursing Process Client Need: Psychosocial Integrity; Physiological Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Addiction Difficulty: Moderate Feedback 1 The primary purpose of doing alcohol screening is to determine at-risk alcohol use, which may or may not include having an alcohol use disorder.

2 A BAC is an indicator of possible intoxication and is not a standard screen for at risk alcohol use.

3 The primary purpose of doing alcohol screening is to determine at-risk alcohol use, which includes taking into account other risk factors such as age and use of other medications.

4 The primary purpose of doing alcohol screening is to determine at-risk alcohol use.

PTS: 1 REF: 259 | 260 CON: Promoting Health | Addiction 8. ANS: 4 Objective: 2. Define the burden of disease related to substance use using current epidemiological frameworks.

Page: Heading: Tobacco Use > Policy Level Intervention to Reduce Tobacco-Related Harm Local to Global Integrated Processes: Nursing Process

Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing Roles; Addiction; Assessment Difficulty: Moderate Feedback 1 Children exposed to tobacco smoke in the home have an increased risk for developing asthma.

2 Chronic obstructive pulmonary disorder is an adverse health consequence of tobacco use.

3 Lung cancer is an adverse health consequence of tobacco use.

4 High prevalence of childhood asthma, chronic obstructive pulmonary disorders, and lung cancer are indicators of tobacco-related harm in a community.

PTS: 1 REF: 270 CON: Nursing Roles | Addiction | Assessment 9. ANS: 3 Objective: 1. Describe the impact of substance use on the health of a population.

Page: Heading: Tobacco Use > Vulnerable Populations Across the Life Span Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Addiction Difficulty: Moderate

1 2 3 4

Feedback Babies whose mothers smoke may be smaller than their gestational age.

Babies born to mothers who smoke have a greater risk of SIDS. Babies born to mothers who smoke are smaller, have a greater risk of SIDS, and may develop asthma more frequently than those born to nonsmoking mothers.

Babies born to mothers who smoke are at greater risk to develop asthma.

PTS: 1 REF: 270 CON: Pregnancy | Addiction 10. ANS: 2 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Tobacco Use > Policy Level Intervention to Reduce Tobacco-Related Harm Local to Global Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Addiction; Critical Thinking Difficulty: Moderate Feedback 1 From 1934 through WWII, the number of cigarettes smoked actually increased 300%.

2 This marks the beginning of a period of reduced tobacco use.

3 From 1934 through WWII, the number of cigarettes smoked actually increased 300%.

4 From 1934 through WWII, the number of cigarettes smoked actually increased 300%. It was the first Surgeon General’s report on tobacco use and health that marked the decline in use.

PTS: 1 REF: 271 CON: Addiction | Critical Thinking 11. ANS: 3 Objective: 1. Describe the impact of substance use on the health of a population.

Page: Heading: Drug Use Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing Roles; Addiction Difficulty: Moderate Feedback 1 Less than 1% (0.8%) reported cocaine use (0.5%).

2 Less (0.5%) than 1% reported using hallucinogens.

3 About 9.6% of Americans reported marijuana use.

4 About 2.2% of Americans reported nonmedical use of psychotherapeutics (sedatives, painkillers, stimulants).

PTS: 1 REF: 272 CON: Nursing Roles | Addiction 12. ANS: 1 Objective: 1. Describe the impact of substance use on the health of a population.

Page: Heading: Drug Use Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Addiction Difficulty: Moderate Feedback 1 Methamphetamine use may cause a person to be euphoric, tremulous, anorexic, and to present with dilated pupils.

2 Methamphetamine use may cause a person to be euphoric, tremulous, anorexic, and to present with dilated pupils.

3 Methamphetamine use may cause a person to be euphoric, tremulous, anorexic, and to present with dilated pupils.

4 Methamphetamine use may cause a person to be euphoric, tremulous, anorexic, and to present with dilated pupils.

PTS: 1 REF: 274 CON: Assessment | Addiction 13. ANS: 2 Objective: 4. Describe population-level approaches to the prevention and treatment of substance use disorders.

Page: Heading: Drug Use > Screening and Treatment for Drug Use Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Addiction Difficulty: Moderate

1 2 3 4

Feedback The DAST-10 is used to screen for drug use.

The DAST-10 and the NIDA ASSIST tool are used to screen for drug use.

The NIDA ASSIST tool is used to screen for illicit drug use.

The AUDIT is used to screen for at-risk alcohol use.

PTS: 1 REF: 275 | 276 CON: Assessment | Addiction 14. ANS: 2 Objective: 2. Define the burden of disease related to substance use using current epidemiological frameworks.

Page: Heading: Substance Use, and Stigma Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing Roles; Diversity; Addiction Difficulty: Moderate

1

2

3

4

Feedback Stigma is a perception that risky substance use is a personal choice and consequences are self-inflicted but also continues to be a barrier for entrance into treatment for the person with a substance use disorder.

Stigma is a perception that risky substance use is a personal choice and consequences are self-inflicted, and continues to be a barrier for entrance into treatment for the person with at-risk use or a substance use disorder.

Stigma continues to be a barrier for entrance into treatment for the person with at-risk use or a substance use disorder but also is a perception that risky substance use is a personal choice and consequences are self-inflicted.

Stigma continues to be a barrier for entrance into treatment for the person with at-risk use or a substance use disorder and does not encourage persons with a drug use disorder to seek treatment.

PTS: 1 REF: 276 | 277 CON: Nursing Roles | Diversity | Addiction 15. ANS: 3 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Case Study: Alcohol Use > Screening and Brief Intervention and Referral for Treatment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Critical Thinking; Addiction; Quality Improvement Difficulty: Moderate

1 2 3

Feedback The team should review current alcohol SBI recommendations from the Joint Commission on Accreditation.

The team should develop a plan to train health-care personnel on the use of the alcohol SBI. To develop an alcohol SBI for their department, the team of nurses should review

4

current alcohol SBI recommendations from the Joint Commission on Accreditation, develop a plan to train health-care personnel on the use of the alcohol SBI, and prepare an evaluation plan.

Conducting a process evaluation does not occur during the development phase.

PTS: 1 REF: 268 | 269 CON: Assessment | Promoting Health | Critical Thinking | Addiction | Quality Improvement 16. ANS: 3 Objective: 2. Define the burden of disease related to substance use using current epidemiological frameworks.

Page: Heading: Substance Use and the Global Burden of Disease Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing Roles; Addiction Difficulty: Moderate

1 2 3 4

Feedback Depressants and stimulants are psychoactive substances.

Depressants and stimulants are psychoactive substances.

Depressants and stimulants are psychoactive substances.

Antidepressants are not psychoactive substances.

PTS: 1 REF: 257 CON: Nursing Roles | Addiction 17. ANS: 4 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Models for Prevention and Treatment of Substance Use Disorders > Harm Reduction Model Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing Roles; Critical Thinking; Addiction Difficulty: Moderate Feedback 1 A PHN understands that clients are responsive to culturally competent, nonjudgmental services delivered in a manner that demonstrates respect for individual dignity, personal strength, and self-determination.

2 A PHN understands that service providers are responsible to the wider community for delivering interventions which attempt to reduce the economic, social, and physical consequences of drug- and alcohol-related harm and harms associated with other behaviors or practices that put individuals at risk.

3 A PHN understands that because those engaged in unsafe health practices are often difficult to reach through traditional service venues, the service continuum must seek creative opportunities and develop new strategies to engage, motivate, and intervene with potential clients.

4 PHNs know that a nonjudgmental environment, effective interventions, and new strategies have the potential to more effectively engage with substance use clients.

PTS: 1 REF: 262 | 263 CON: Nursing Roles | Critical Thinking | Addiction 18. ANS: 3 Objective: 3. Apply current evidence-based population interventions to the prevention of harm associated with substance use across the continuum of use.

Page: Heading: Tobacco Use > Screening and Treatment for Tobacco Use Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health; Addiction Difficulty: Moderate

1 2 3 4

Feedback Evidence-based strategies include counseling and medications.

Evidence-based strategies include counseling and medications.

A combination of some form of counseling and medication is more effective than using either one by itself Evidence-based strategies include counseling and medications.

PTS: 1

REF: 271

CON: Promoting Health | Addiction

Chapter 12: Injury and Violence Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse is educating new staff in the emergency department about the types of injuries and illness they might be treating. The nurse mentions that which population is at greatest risk for unintentional injuries?

1. Women under the age of 45 2. Women over the age of 45 3. Men under the age of 45 4. Men over the age of 45 2. A nurse has volunteered with an organization treating women who were the victims of rape as a weapon of war in the Congo. This violence is considered: 1. Community violence.

2. Collective violence.

3. Stranger violence.

4. Interpersonal violence.

3. A PHN working at a large urban public health department is reviewing motor vehicle-associated mortality data to compare the city’s mortality rate (MR) with state and national MRs. Which of the following would provide the most comprehensive database of information?

1. National Violent Death Reporting System 2. Vital Statistics 3. Department of Motor Vehicles 4. Department of Transportation 4. A nurse has seen an increase in infant injuries during motor vehicle crashes due to poor car seat installation.

The nurse wants to consider upstream policies at the population level to address this issue but doesn’t have the time to take on the project. How should the nurse proceed?

1. Reconsider the project at a different time when the workload at his or her primary job lightens.

2. Delegate some of the project tasks to an unlicensed assistive personnel (UAP).

3. Quit the job to dedicate all of his or her time to the project.

4. Consider a collaborative relationship with the public health department and fire and police departments.

5. A nurse is providing fire prevention education to families in the community. Which of the following groups in the United States is not at a higher risk for suffering burns from a fire at home?

1. Men 2. Women 3. Children 4. Older adults 6. A nurse is teaching water safety at the local community pool and mentions that which of the following is the most significant risk factor for drowning?

1. Gender 2. Income 3. Education 4. Age

7. A nurse is performing a home visit for a young mother that lives in the projects in Brooklyn, New York.

There is a young child who is 3 years old living in the apartment as well. The nurse notices that the window guards on the bedroom window are hanging off the building. Which of the following is the best approach to addressing the safety issue?

1. Encourage the woman to call the landlord after the nurse leaves.

2. Call Child Protective Services to report an unsafe living situation.

3. Call the landlord directly to ensure the timely repair of the window guards and encourage the woman to keep the windows closed in the meantime.

4. Call the city to report a bad landlord and complete the paperwork to support evidence of the event.

8. A nurse is working at a high school when a young woman comes down to the nursing office concerned about her boyfriend whom she states is making suicidal comments. How does the nurse proceed?

1. Counsel the young woman about relationship issues.

2. Call the young woman’s parents about her concerns.

3. Inform the school psychologist immediately and notify the boyfriend’s parents.

4. Call the young man down to the nurse’s office for a mental health evaluation.

9. A nurse is working at a suicide prevention hotline and receives a call from a man threatening to end his life.

The most important thing for her to determine is whether the man has: 1. A means or a plan to commit suicide, including whether he has access to a weapon, such as a gun.

2. Been diagnosed with a mental illness.

3. A substance use disorder and is currently using alcohol or drugs.

4. None of the above.

10. Sam, a PHN working in the maternal child division of an urban public health department, has been tasked with developing a child maltreatment home visitation prevention program. He has chosen to use the Nurse Family Partnership Model, which focuses on: 1. Promoting and reinforcing selective protective factors.

2. Identifying families at risk and referring for counseling.

3. Building resilience in children.

4. Improving the link between child protective services and the public health department.

11. Michelle is conducting a routine well baby visit in the home. As part of her visit, she uses the DOVE tool to screen the mother for possible Intimate Partner Violence (IPV). The mother discloses that she is a victim of IPV. What actions are Michelle required to perform?

1. Further assessment, report to the physician, and discussion of a safety plan 2. Provide her with pamphlets on escaping domestic violence, appropriate referrals, and discussion of a safety plan 3. Further assessment, appropriate referrals, and discussion of a safety plan 4. Referral to a shelter for victims of IPV, and report to the physician 12. A young woman presents to a community clinic. She states that she is having severe anxiety and insomnia after suffering an acquaintance rape at school last year. She is unable to go back to college, and her grades are suffering as a result. What does the nurse suspect that this young woman is suffering from?

1. Post-traumatic stress disorder 2. Generalized anxiety disorder 3. Major depression 4. Personality disorder

13. Together with members of the community, a PHN is helping to complete a community assessment of an inner-city neighborhood. One of the issues that has surfaced is the rising level of youth violence. The assessment team decides to work on the establishment of a program aimed at promoting youth development.

Areas included in this approach according the CDC guide include: 1. Promoting family environments that support healthy development.

2. Creating protective community environments.

3. Connecting youth to caring adults and activities.

4. Increasing the presence of law enforcement officers skilled in working with adolescents.

14. A nurse who is about to travel as part of an outreach medical team to a country that has experienced civil war does some research on the nature of war to better understand the context of the violence that has occurred due to war in this country. She learns that war has changed in the last few decades. Which of the following statements is correct?

1. There are more wars currently than in the past.

2. War-related deaths have increased in the past decade.

3. Fewer countries have weapons of mass destruction due to increased world condemnation of such weapons.

4. Reporting of wars and war crimes has increased.

15. A nurse is reviewing the safety procedures and protections in place at the community center. Which of the following show compliance with policies that were put in place to prevent fire-related deaths and injuries?

1. Presence of two regular doors next to the revolving door 2. Brightly lit exit signs 3. Absence of flammable decorations on the walls 4. All of the above 16. A nurse is looking to implement new preventative measures to address the rate of drowning in young children in the community. All of the following policies are examples of primary prevention, except: 1. Swimming instruction for every child.

2. Mandatory installation of locked child-safety fences around all community and private pools.

3. Community-wide CPR instruction.

4. Mandatory use of life jackets for all children on boats.

17. A nurse who has worked in a large urban emergency department for the past 20 years is precepting a new hire. She explains that there has been an increase in admissions due to motor vehicle crashes (MVC) and that there two of the main risk factors for MVC are driving while impaired and distracted driving. What are the three types of distracted driving?

1. Manual, cognitive, and visual 2. Behavioral, environmental, and manual 3. Cognitive, behavioral, and environmental 4. Manual, situational, and visual Completion Complete each statement.

18. A nurse decides to use a Haddon Matrix to evaluate factors that may contribute to patient falls on the medical units of the hospital. What is the minimum number of boxes that should be drawn on the grid to be filled out?

Multiple Response Identify one or more choices that best complete the statement or answer the question.

19. A nurse is working with parents and community members to develop a chemical and medication safety class in their community. Techniques that they should discuss include which of the following? (Select all that apply.)

1. Proper labeling of all household chemicals and medications 2. Keeping household chemicals outside 3. Storing all cleaning materials and medications out of the reach of children 4. Encouraging disposal of medications into the toilet 5. Informing parents not to share any medications with anyone for whom the medication is not prescribed 20. A nurse is teaching a class about emergency preparedness and violence. Which of the following factors are associated with an increased risk of being the victim of violence or intentional harm? (Select all that apply.)

1. Age between 15 and 44 2. Poor mental health 3. Substance use 4. Male gender 5. Low socioeconomic status

Chapter 12: Injury and Violence Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 1. Describe the impact of injury and violence on the health of a population.

Page: Heading: Introduction > Types of Injuries Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Assessment; Safety Difficulty: Moderate Feedback 1 Men, under the age of 45, are at highest risk for unintentional injuries. In addition, children under the age of 19 are also at high risk for unintentional injuries.

2 Men, under the age of 45, are at highest risk for unintentional injuries. In addition, children under the age of 19 are also at high risk for unintentional injuries.

3 Men, under the age of 45, are at highest risk for unintentional injuries. In addition, children under the age of 19 are also at high risk for unintentional injuries.

4 Men, under the age of 45, are at highest risk for unintentional injuries. In addition, children under the age of 19 are also at high risk for unintentional injuries.

PTS: 1 REF: 283 CON: Trauma | Nursing Roles | Safety 2. ANS: 2 Objective: 1. Describe the impact of injury and violence on the health of a population.

Page: Heading: Introduction > Types of Violence Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Violence; Safety Difficulty: Moderate Feedback 1 Community violence occurs within the community and includes stranger and acquaintance violence. The correct answer is collective violence, which describes violence that occurs when a large group of people engages in violence, such as with war crimes.

2 Collective violence occurs when a large group of people engages in violence, such as with war crimes.

3 Stranger violence occurs between strangers within the context of the community. The correct answer is collective violence, which describes violence that occurs when a large group of people engages in violence, such as with war crimes.

4 Interpersonal violence occurs between two individuals within the context of the family or the community. The correct answer is collective violence, which describes violence that occurs when a large group of people engages in violence, such as with war crimes.

PTS: 1

REF: 284

CON: Violence | Safety

3. ANS: 1 Objective: 2. Define the burden of disease related to injury and violence using current epidemiological frameworks.

Page: Heading: Surveillance of Injury and Violence Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Violence; Evidence-Based Practice Difficulty: Moderate Feedback 1 Although Vital Statistics, The Department of Motor Vehicles, and the Department of Transportation all track motor vehicle accidents, the National Violent Death Reporting System is a centralized system that compiles the data from all of these sources. This database is especially helpful to look at injury and violence at the state and population level.

2 Although Vital Statistics tracks motor vehicle accidents, the National Violent Death Reporting System is a centralized system that compiles the data from this and other sources. This database is especially helpful to look at injury and violence at the state and population level.

3 Although the Department of Motor Vehicles tracks motor vehicle accidents, the National Violent Death Reporting System is a centralized system that compiles the data from this and other sources. This database is especially helpful to look at injury and violence at the state and population level.

4 Although the Department of Transportation tracks motor vehicle accidents, the National Violent Death Reporting System is a centralized system that compiles the data from this and other sources. This database is especially helpful to look at injury and violence at the state and population level.

PTS: 1 REF: 285 | 286 CON: Safety | Violence | Evidence-Based Practice 4. ANS: 4 Objective: 4. Understand the role of policy in injury and violence prevention.

Page: Heading: Prevention of Injury and Violence > Nursing Role in Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Critical Thinking; Promoting Health; Collaboration Difficulty: Moderate Feedback 1 This is an important community issue that needs to be addressed, especially if children are being injured at an increasing rate. The nurse should consider a collaborative relationship with the public health department and fire and police departments.

2 These are not appropriate tasks to delegate to a UAP, especially tasks related to assessment. The nurse should consider a collaborative relationship with the public health department and fire and police departments.

3 It is not appropriate to quit a job to work on this project. The nurse should consider a collaborative relationship with the public health department and fire and police departments.

4 The nurse should consider a collaborative relationship with the public health

department and fire and police departments. This still addresses the needs of the community, but also helps distribute the workload and responsibilities among different departments.

PTS: 1 REF: 288 CON: Safety | Critical Thinking | Promoting Health | Collaboration 5. ANS: 1 Objective: 3. Use appropriate frameworks in the assessment of injury and violence.

Page: Heading: Epidemiology of Unintentional Injury: Fire-Related Injuries Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Promoting Health; Safety; Difficulty: Moderate Feedback 1 In the United States, women, children, and older adults are at higher risk for suffering burns from a fire at home. In most situations, children suffer from burns when an adult is not supervising them.

2 In the United States, women, children, and older adults are at higher risk for suffering burns from a fire at home. In most situations, children suffer from burns when an adult is not supervising them.

3 In the United States, women, children, and older adults are at higher risk for suffering burns from a fire at home. In most situations, children suffer from burns when an adult is not supervising them.

4 In the United States, women, children, and older adults are at higher risk for suffering burns from a fire at home. In most situations, children suffer from burns when an adult is not supervising them.

PTS: 1 REF: 290 CON: Promoting Health | Safety 6. ANS: 4 Objective: 5. Apply current evidence-based population interventions to the prevention of injury and violence.

Page: Heading: Epidemiology of Unintentional Injury: Drowning > Risk factors for Drowning Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing Roles Difficulty: Moderate Feedback 1 Age is the most significant risk factor for drowning. Young children are more susceptible to falling into water (including toilets, bathtubs, and buckets), and are more likely to be curious around water. In older adults, swimming ability declines with age.

2 Age is the most significant risk factor for drowning. Young children are more susceptible to falling into water (including toilets, bathtubs, and buckets), and are more likely to be curious around water. In older adults, swimming ability declines with age.

3 Age is the most significant risk factor for drowning. Young children are more susceptible to falling into water (including toilets, bathtubs, and buckets), and are more likely to be curious around water. In older adults, swimming ability declines with age.

4 Age is the most significant risk factor for drowning. Young children are more

susceptible to falling into water (including toilets, bathtubs, and buckets), and are more likely to be curious around water. In older adults, swimming ability declines with age.

PTS: 1 REF: 293 CON: Safety | Nursing Roles 7. ANS: 3 Objective: 4. Understand the role of policy in injury and violence prevention.

Page: Heading: Epidemiology of Unintentional Injury: Falls in Children > Prevention of Falls in Children Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Assessment; Critical Thinking Difficulty: Moderate Feedback 1 The nurse has no way of knowing whether the woman is following up with the landlord appropriately. The nurse can call the landlord directly and use the opportunity to provide education about fall prevention.

2 The woman may not realize the importance of the window guards, or she may have reported them to the landlord several times without response.

3 It is better for the nurse to call the landlord directly, because it conveys the importance of the situation and also ensures that the landlord is called. In addition to keeping the windows closed, the nurse should remove items from the room that the child could climb on to access the window, and also encourage constant supervision until the window guards are repaired.

4 The nurse should give the landlord a chance to repair the window guards, because it is possible that the landlord was unaware of the needed repair.

PTS: 1 REF: 294 | 295 CON: Safety | Assessment | Critical Thinking 8. ANS: 3 Objective: 3. Use appropriate frameworks in the assessment of injury and violence.

Page: Heading: Epidemiology of Self-Directed Violence: Suicide Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Violence; Communication; Ethics; Safety Difficulty: Difficult Feedback 1 This does not validate the young woman’s concerns about her boyfriend. Every suicide threat needs to be taken seriously, and so it is appropriate for the nurse to refer the young man to the school psychologist.

2 This does not address the potential mental health issues of the young man who is making the suicidal threats. It also potentially alienates the trust of the young woman.

3 The nurse should make the appropriate referral and notify his parents about her concerns. Every threat of suicide must be taken seriously, and it is appropriate for the nurse to intervene.

4 It is not appropriate for the nurse to perform the mental health evaluation. It is better that the nurse refers the student to a mental health professional and inform his parents about her concerns.

PTS: 1 REF: 297-299 CON: Violence | Communication | Ethics | Safety 9. ANS: 1 Objective: 3. Use appropriate frameworks in the assessment of injury and violence.

Page: Heading: Epidemiology of Self-Directed Violence: Suicide > Risk Factors for Suicide Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Violence; Safety; Nursing Roles; Assessment Difficulty: Moderate Feedback 1 Having a plan and access to a weapon is one of the biggest risk factors for committing suicide.

2 Having a plan and access to a weapon is one of the biggest risk factors for committing suicide.

3 Having a plan and access to a weapon is one of the biggest risk factors for committing suicide.

4 The correct answer is whether they have a plan and mean to commit suicide. Having a plan and access to a weapon is one of the biggest risk factors for committing suicide.

PTS: 1 REF: 298 | 299 CON: Violence | Safety | Nursing Roles | Assessment 10. ANS: 1 Objective: 5. Apply current evidence-based population interventions to the prevention of injury and violence.

Page: Heading: Epidemiology of Family Violence > Prevention of Child Maltreatment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Safety; Violence; Family; Evidence-Based Practice Difficulty: Difficult Feedback 1 Home visitation programs such as the Nurse Family Partnership Model aimed at the prevention of child maltreatment focus on promoting and reinforcing selective protective factors.

2 Although referring for counseling may be appropriate in some cases, the home visitation programs such as the Nurse Family Partnership Model are aimed at the prevention of child maltreatment focus on promoting and reinforcing selective protective factors.

3 Although building resilience in children is a strategy, the home visitation programs such as the Nurse Family Partnership Model aimed at the prevention of child maltreatment focus on promoting and reinforcing a full range of selective protective factors.

4 Improving the link between child protective services and the public health department is not part of what the home visitation programs are based on.

PTS: 1 REF: 302 CON: Safety | Violence | Promoting Health | Family | Critical Thinking | Evidence-Based Practice 11. ANS: 3 Objective: 3. Use appropriate frameworks in the assessment of injury and violence.

Page: Heading: Epidemiology of Intimate Partner Violence > Prevention of Intimate Partner Violence Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Communication; Safety; Violence; Legal Difficulty: Moderate Feedback 1 Rather than only report to the physician, it is important that the nurse provides an appropriate referral including persons and agencies with expertise in IPV. 2 It may be dangerous for the woman to have written information about escaping domestic violence, especially if her partner finds it.

3 Further assessment, appropriate referrals, and discussion of a safety plan are the actions included in the DOVE program.

4 Based on further assessment, appropriate referrals may or may not include a shelter or the physician.

PTS: 1 REF: 304 CON: Nursing Process | Safety | Violence | Legal 12. ANS: 1 Objective: 1. Describe the impact of injury and violence on the health of a population.

Page: Heading: Epidemiology of Community Violence Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Stress; Sleep, Rest, and Activity; Violence Difficulty: Easy Feedback 1 This young woman is probably suffering from post-traumatic stress disorder, a type of anxiety disorder that occurs after a traumatic event.

2 This young woman is probably suffering from post-traumatic stress disorder, a type of anxiety disorder that occurs after a traumatic event.

3 This young woman is probably suffering from post-traumatic stress disorder, a type of anxiety disorder that occurs after a traumatic event.

4 This young woman is probably suffering from post-traumatic stress disorder, a type of anxiety disorder that occurs after a traumatic event.

PTS: 1 REF: 303 | 305 CON: Assessment | Stress | Sleep, Rest, and Activity | Violence 13. ANS: 4 Objective: 4. Understand the role of policy in injury and violence prevention.

Page: Heading: Epidemiology of Community Violence > Risk and Protective Factors for Community Violence Integrated Processes: Nursing Process Client Need: Health promotion and maintenance Cognitive Level: Application [Applying] Concept: Violence; Safety; Assessment; Evidence-Based Practice Difficulty: Moderate Feedback 1 Promoting family environments that support healthy development is one of the six areas

2 3

4

included in the CDC guide to evidence-based programs aimed at reducing youth violence.

Creating protective community environments is one of the six areas included in the CDC guide to evidence-based programs aimed at reducing youth violence.

Connecting youth to caring adults and activities is one of the six areas included in the CDC guide to evidence-based programs aimed at reducing youth violence and is not related to promoting youth development.

Although increasing the presence of law enforcement officers skilled in working with adolescents may be a strategy, it is not one of the six areas included in the CDC guide to evidence-based programs aimed at reducing youth violence.

PTS: 1 REF: 305 CON: Violence | Safety | Assessment | Evidence-Based Practice 14. ANS: 4 Objective: 2. Define the burden of disease related to injury and violence using current epidemiological frameworks.

Page: Heading: Epidemiology of War: An Example of Collective Violence Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Violence; Assessment Difficulty: Moderate Feedback 1 In fact, there were fewer wars at the beginning of this previous decade than at the beginning of the last.

2 War-related deaths have actually decreased during the last decade. Increased reporting of war atrocities has made it seem like there are increased deaths, when in fact the number of deaths has declined.

3 More countries have developed weapons of mass destruction, including nuclear, biological, and chemical weapons.

4 There has been an increased reporting of wars and war atrocities. Even in situations where formally trained journalists are not present in an area, the use of social media has allowed citizens to still cover these events.

PTS: 1 REF: 306 CON: Violence | Assessment 15. ANS: 4 Objective: 4. Understand the role of policy in injury and violence prevention.

Page: Heading: Epidemiology of Unintentional Injury: Burn-Related Injuries > Prevention of Burn Injuries Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Assessment; Safety; Legal Difficulty: Moderate Feedback 1 All of these show compliance. Fire code regulations are very strict and aim to help prevent the spread of a fire and to help people escape from a fire. The presence of two regular doors next to a revolving door prevents the revolving door from being jammed if a lot of people are trying to exit the building. Brightly lit exit signs guide people through the dark smoke toward the exit. Finally, the absence of decorations on the walls

2

3

4

keeps a fire from spreading along flammable materials.

All of these show compliance. Fire code regulations are very strict and aim to help prevent the spread of a fire, and to help people escape from a fire. The presence of two regular doors next to a revolving door prevents the revolving door from being jammed if a lot of people are trying to exit the building. Brightly lit exit signs guide people through the dark smoke toward the exit. Finally, the absence of decorations on the walls keeps a fire from spreading along flammable materials.

All of these show compliance. Fire code regulations are very strict and aim to help prevent the spread of a fire, and to help people escape from a fire. The presence of two regular doors next to a revolving door prevents the revolving door from being jammed if a lot of people are trying to exit the building. Brightly lit exit signs guide people through the dark smoke toward the exit. Finally, the absence of decorations on the walls keeps a fire from spreading along flammable materials.

All of these show compliance. Fire code regulations are very strict and aim to help prevent the spread of a fire, and to help people escape from a fire. The presence of two regular doors next to a revolving door prevents the revolving door from being jammed if a lot of people are trying to exit the building. Brightly lit exit signs guide people through the dark smoke toward the exit. Finally, the absence of decorations on the walls keeps a fire from spreading along flammable materials.

PTS: 1 REF: 291 CON: Assessment | Safety | Legal 16. ANS: 3 Objective: 4. Understand the role of policy in injury and violence prevention.

Page: Heading: Epidemiology of Unintentional Injury: Drowning > Prevention of Drowning Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 Use of life jackets, installation of child-safety fences around all community and private pools, and swimming instruction for every child are all examples of primary prevention because they aim to prevent drowning in the first place.

2 Use of life jackets, installation of child-safety fences around all community and private pools, and swimming instruction for every child are all examples of primary prevention because they aim to prevent drowning in the first place.

3 Use of life jackets, installation of child-safety fences around all community and private pools, and swimming instruction for every child are all examples of primary prevention because they aim to prevent drowning in the first place. Secondary prevention includes treating the medical issues associated with drowning, such as with CPR. 4 Use of life jackets, installation of child-safety fences around all community and private pools, and swimming instruction for every child are all examples of primary prevention because they aim to prevent drowning in the first place.

PTS: 1 REF: 294 CON: Safety 17. ANS: 1 Objective: 2. Define the burden of disease related to injury and violence using current epidemiological frameworks.

Page:

Heading: Epidemiology of Unintentional Injury: Motor Vehicle Crashes > Risk Factors for Motor Vehicle Crashes Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Violence; Safety; Difficulty: Moderate

1

2

3

4

Feedback Distracted driving is defined as diversion of attention from activities that are critical for safe driving. There are three main types of diversions: visual, taking your eyes of the road; manual, taking your hands of the wheel; or cognitive, taking your mind off of driving.

All of three of the types of distracted driving come under the broader term of behavioral risk factors. Although environmental factors may play a role, they are not specifically related to distracted driving.

All of three of the types of distracted driving come under the broader term of behavioral risk factors. Although environmental factors may play a role, they are not specifically related to distracted driving.

Situational is not a type of risk factor specifically associated with distracted driving.

PTS: 1

REF: 289

CON: Safety

COMPLETION 18. ANS: 12 Feedback: A Haddon Matrix has a minimum of 12 boxes in three rows and four columns. The designated rows refer to the time associated with the event: pre-event, event, and post-event. The columns relate to the constructs included in the Epidemiological Triangle and on preventative measures, and include the host, agent, physical environment, and social environment.

Objective: 3. Use appropriate frameworks in the assessment of injury and violence.

Page: Heading: Determining Risk for Injury or Violence > The Haddon Matrix Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Critical Thinking; Quality Improvement Difficulty: Moderate PTS: 1

REF: 286 | 287

CON: Safety | Critical Thinking | Quality Improvement

MULTIPLE RESPONSE 19. ANS: 1, 3, 5 Objective: 5. Apply current evidence-based population interventions to the prevention of injury and violence.

Page: Heading: Epidemiology of Unintentional Injury: Poisonings > Prevention of Unintentional Poisoning

Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Safety; Trauma; Nursing Roles; Medication Difficulty: Moderate

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Feedback There are several measures that parents can take to prevent accidental poisonings in their children or other household members. These include proper labeling of all household chemicals and medications, storing all cleaning materials and other chemicals out of the reach of children and how the manufacturer intends, encouraging the proper disposal of medications (e.g., not into the toilet due to environmental hazards) and other chemicals, and not sharing any medications with other people.

There are several measures that parents can take to prevent accidental poisonings in their children or other household members. These include proper labeling of all household chemicals and medications, storing all cleaning materials and other chemicals out of the reach of children and how the manufacturer intends, encouraging the proper disposal of medications (e.g., not into the toilet due to environmental hazards) and other chemicals, and not sharing any medications with other people.

There are several measures that parents can take to prevent accidental poisonings in their children or other household members. These include proper labeling of all household chemicals and medications, storing all cleaning materials and other chemicals out of the reach of children and how the manufacturer intends, encouraging the proper disposal of medications (e.g., not into the toilet due to environmental hazards) and other chemicals, and not sharing any medications with other people.

There are several measures that parents can take to prevent accidental poisonings in their children or other household members. These include proper labeling of all household chemicals and medications, storing all cleaning materials and other chemicals out of the reach of children and how the manufacturer intends, encouraging the proper disposal of medications (e.g., not into the toilet due to environmental hazards) and other chemicals, and not sharing any medications with other people.

There are several measures that parents can take to prevent accidental poisonings in their children or other household members. These include proper labeling of all household chemicals and medications, storing all cleaning materials and other chemicals out of the reach of children and how the manufacturer intends, encouraging the proper disposal of medications (e.g., not into the toilet due to environmental hazards) and other chemicals, and not sharing any medications with other people.

PTS: 1 REF: 296 | 297 CON: Safety | Trauma | Nursing Roles | Medication 20. ANS: 1, 2, 3 Objective: 1. Describe the impact of injury and violence on the health of a population.

Page: Heading: Introduction > Types of Injuries Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Violence; Safety; Assessment Difficulty: Moderate Feedback

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Increased risk for violence is associated with people between the ages of 15 and 44, poor mental health, and substance use. It is a community-wide issue and affects people of both genders and all socioeconomic status equally.

Increased risk for violence is associated with people between the ages of 15 and 44, poor mental health, and substance use. It is a community-wide issue and affects people of both genders and all socioeconomic status equally.

Increased risk for violence is associated with people between the ages of 15 and 44, poor mental health, and substance use. It is a community-wide issue and affects people of both genders and all socioeconomic status equally.

Increased risk for violence is associated with people between the ages of 15 and 44, poor mental health, and substance use. It is a community-wide issue and affects people of both genders and all socioeconomic status equally.

Increased risk for violence is associated with people between the ages of 15 and 44, poor mental health, and substance use. It is a community-wide issue and affects people of both genders and all socioeconomic status equally.

PTS: 1

REF: 284

CON: Trauma | Violence | Safety | Assessment

Chapter 13: Health Planning for Local Public Health Departments Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse is beginning employment at a local health department, and reviewing the job description and the functions that fall under the purview of the health department. Which of the following is not one of the six minimum functions as named by the American Public Health Association (APHA)?

1. Vital statistics 2. Public health education 3. Promotion of elder health and safety 4. Environmental sanitation 2. A nurse wishes to involve the local health department in planning a community-wide intervention. The nurse calls the reception area to determine how best to involve the health department and learns that it is run by the local government in conjunction with the local board of health, which is known as a system.

1. Centralized 2. Mixed 3. Decentralized 4. Shared 3. A nurse with experience working in an urban public health department (PHD) has taken a job in rural Wyoming. She finds that a major issue directly related to infrastructure in this new job compared to her other job is: 1. Lack of health literacy.

2. Limited resources and isolation.

3. Health disparity.

4. Decreased life expectancy.

4. A PHN is working in the public health department in San Diego County. After a recent storm, the department begins to conduct water testing to ensure that the ocean water is safe to swim in. Testing results reveal that the level of bacteria is 10 times the acceptable limit. What is the first step the PHD should take?

1. Issue a public health statement informing residents of the risk of swimming.

2. Close the beaches until the levels return to normal.

3. Treat the water with anti-microbial agents.

4. Issue a boil water alert.

5. A nurse is working with a public health department (PHD). They have set a goal to expand their role by including direct, individualized patient care. The PHD has little to no funding available for this project. Which of the following is a key method that PHDs use to fund provision of direct care?

1. Fundraise with local politicians and key business owners.

2. Provide their services on a voluntary basis in one area of the PHD building.

3. Open a federally qualified health center (FQHC).

4. Adjust their budget in other areas to open funds for the project.

6. A nurse working at a PHD received a phone call from a nurse who works on the labor and delivery floor at the local hospital. The nurse reports that they are seeing many more women and their children coming into the hospital with inadequate nutrition. They wish to partner with the PHD on a project that addresses this issue.

Where should they begin?

1. Perform a community and cultural assessment to understand the community in which they are working.

2. Send a questionnaire to all of these women to see why they aren’t utilizing Women, Infants, and Children (WIC) and other governmental services.

3. Place flyers for the WIC program in local physician’s office and the lobby of the hospital.

4. Sign up all women who deliver at the hospital for home visits after discharge from the hospital so their home nutrition habits can be assessed.

7. A nurse is looking to improve communication about emergency situations with the young adults aged 18 to 25. Which of the following methods is likely to be most effective for young adults?

1. Radio alerts 2. Television alerts 3. E-mail alerts 4. Text messages 8. A nurse working in a primary care office is caring for a young woman with a new diagnosis of syphilis. The young woman is horrified and asks the nurse if she has to tell anyone about the diagnosis. How should the nurse respond?

1. “Absolutely not. This is your protected health information, and I can’t release any information unless you give me permission.”

2. “I’ll need to contact the local health department, and they will likely contact your prior sexual partners to be screened as well.”

3. “You should call your previous partners, but I can’t force you to call anyone.”

4. None of the above.

9. A major wildfire has struck a town in California. The firefighters have finally put the fire out, but there are large sections of several communities that have been destroyed. How should the nurse intervene during the immediate recovery phase?

1. Revise the emergency preparedness plans to reflect the problems that have emerged.

2. Go into the community to assess the needs of the displaced residents.

3. Allow the first responders to take control of the situation.

4. None of the above.

10. A PHN is working with coworkers to track an outbreak of a new virus. They need additional help in visualizing the location and density of the cases. What tool should they consider using?

1. GIS 2. EHR 3. Public health systems 4. A map 11. A nurse has been hired by the PHD to perform family planning services. The position was formed as the result of categorical funds obtained from a federal grant. This means that the nurse will need to: 1. Practice according to the guidelines of the federal government.

2. Track time spent in each function to ensure that it meets the grant’s requirements.

3. Invoice the grant at the end of the position.

4. Apply for approval from the state and local governments.

12. A PHN has accepted a new position with the local PHD. While reviewing the records, the PHN notices that the last community health assessment was completed 4 years ago. What should the PHN do?

1. Nothing; the last assessment was only 4 years ago.

2. Perform a brief assessment to become familiar with the community.

3. Perform a full community health assessment, as per protocol.

4. Report the nurses’ negligence for failing to keep up with assessments.

13. A nurse is conducting an assessment of the health of young adults in her community and wishes to begin with information on health risks. What resource would be the best place to begin?

1. GIS 2. BRFSS 3. Healthy People 4. CDC 14. An occupational nurse has a worker complaining of flu-like symptoms. The CDC had recently released an alert regarding a new strain of influenza that has been at epidemic levels in their city. How does the nurse proceed?

1. Send him home to recover.

2. Send him to his primary care provider (PCP) for diagnosis and let the PCP handle reporting the case to the public health department.

3. Notify the PHD and begin epidemiological screening of his coworkers.

4. None of the above.

15. A PHN is counseling a young man who has positive acid-fast bacillus (AFB) sputum-smear results. Which of the following statements about what to expect during his TB treatment is incorrect?

1. He will take several antibiotics for 6 to 9 months.

2. Because his information is protected health information, persons he has been in contact with will not be interviewed.

3. He will need to be observed taking his medication each day.

4. He will need to be on activity restrictions until he is feeling completely recovered.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

16. In the county served by the public health department (PHD), there is a measles outbreak. What steps are usually taken by a PHD to address these types of outbreaks? (Select all that apply.)

1. Mandate vaccinations for school attendance.

2. Carry out mass immunization in an unvaccinated population.

3. Fine person who are not vaccinated.

4. Send out flyers to parents encouraging them to vaccinate their children.

17. A PHN is reviewing the birth data collection forms for birth certificates. The PHN is checking that the forms contain at least which of the following pieces of information? (Select all that apply.)

1. Number of prenatal visits 2. Parental income 3. Type of delivery 4. Congenital defects 5. Parental education 18. A PHN is reviewing immunization rates for the students in the county. The PHN observes that the rate is significantly lower for incoming kindergartners than it has been in years past. After performing a community assessment, the PHN finds that many of the unvaccinated children have parents who have less than a high school education level and whose income is at or below the poverty level. Which of the following interventions may be successful at boosting immunization rates in the county? (Select all that apply.)

1. Mandate that all students be vaccinated before starting public school.

2. Provide a list of places where the students can obtain low-cost immunizations.

3. Prepare a parent handout in simple to understand information in a variety of languages.

4. Send home copies of the CDC immunization requirements for the parents to review.

5. Offer a free vaccination clinic at the school for a week.

19. A nurse has just accepted a job with the local public health department. The nurse will be responsible for monitoring and managing the vital statistics. What data will be tracked? (Select all that apply.)

1. Communicable diseases 2. Births 3. Marriages 4. Divorces 5. Deaths 20. A PHN has decided to use the MAPP tool to address the issue of domestic violence in the community. As the PHD has never used this tool before, the PHN obtains specialized training for which of the following assessment tools? (Select all that apply.)

1. Community Themes and Strengths Assessment 2. Local Public Health System Assessment 3. Forces of Change Assessment 4. Community Health Status Assessment 5. Cultural Health Assessment

Chapter 13: Health Planning for Local Public Health Departments Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 1. Describe the historical development of public health departments (PHDs).

Page: Heading: History of Public Health Departments > Mission of Public Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Health-Care System; Safety Difficulty: Moderate Feedback 1 According to a statement released by the APHA, the six minimum functions that all public health departments must meet are vital statistics, environmental sanitation, communicable disease management, public health labs, promotion of maternal and child health, and public health education.

2 According to a statement released by the APHA, the six minimum functions that all public health departments must meet are: vital statistics, environmental sanitation, communicable disease management, public health labs, promotion of maternal and child health, and public health education.

3 Although promotion of elder health and safety is an important issue in all communities, it is not one of the six functions. According to a statement released by the APHA, the six minimum functions that all public health departments must meet are vital statistics, environmental sanitation, communicable disease management, public health labs, promotion of maternal and child health, and public health education.

4 According to a statement released by the APHA, the six minimum functions that all public health departments must meet are vital statistics, environmental sanitation, communicable disease management, public health labs, promotion of maternal and child health, and public health education.

PTS: 1 REF: 314 CON: Promoting Health | Health-Care System | Safety 2. ANS: 3 Objective: 2. Describe the structure and services of PHDs. Page: Heading: History of Public Health Departments > Structure of Public Health Departments Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Health-Care System; Collaboration Difficulty: Easy Feedback 1 A centralized system is one where the PHD is run by the state board of health and functions under the state authority.

2 A shared or mixed system is one where the PHD is run by multiple groups, including the state health agency, the board of health, and the local government.

3 A decentralized system is one where the PHD is run by the local government either

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with or without the state board of health.

A shared or mixed system is one where the PHD is run by multiple groups, including the state health agency, the board of health, and the local government.

PTS: 1 REF: 315 CON: Promoting Health | Health-Care System | Collaboration 3. ANS: 2 Objective: 2. Describe the structure and services of PHDs. Page: Heading: Role of Public Health Nurses in Public Health Departments > Core Functions Integrated Processes: Nursing process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles; Health-Care System Difficulty: Moderate Feedback 1 Although some rural populations might have lower health literacy, this issue occurs in both rural and urban areas and is not related directly to infrastructure.

2 PHDs located in rural areas are challenged by infrastructural issues related to limited resources and isolation.

3 Health disparity occurs in both rural and urban areas.

4 Although rural areas can experience lower life expectancy, this is not directly related to differences in infrastructure.

PTS: 1 REF: 315 CON: Promoting Health | Nursing Roles | Health-Care System 4. ANS: 2 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Local Health Department Activities > Environmental Health Services Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Critical Thinking; Health-Care System; Safety Difficulty: Moderate Feedback 1 The levels are way too high to simply issue a public health statement. The nurse should close the beaches until bacterial levels return to normal.

2 The nurse should close the beaches until bacterial levels return to normal. The elevated levels pose too great of a risk for swimmers.

3 Treating the ocean with anti-microbial agents isn’t practical. The nurse should close the beaches until the levels return to normal.

4 Tap water does not come from the ocean, so boiling it does not address the problem.

The nurse should close the beaches until the levels return to normal.

PTS: 1 REF: 323 CON: Critical Thinking | Health-Care System | Safety 5. ANS: 3 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Local Health Department Activities > Individual and Community Health Integrated Processes: Nursing Process

Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Economics; Health-Care System Difficulty: Moderate Feedback 1 There are two main ways that a PHD can obtain funding for providing community care.

First, open a FQHC that would receive funding through a federal grant. These FQHCs must provide services in an underrepresented community, provide comprehensive care, and provide care regardless of a patient’s ability to pay. The other option is to partner with a major hospital to fund the PHD in providing specific services instead of these patients using the emergency room.

2 There are two main ways that a PHD can obtain funding for providing community care.

First, open a FQHC that would receive funding through a federal grant. These FQHCs must provide services in an underrepresented community, provide comprehensive care, and provide care regardless of a patient’s ability to pay. The other option is to partner with a major hospital to fund the PHD in providing specific services instead of these patients using the emergency room.

3 There are two main ways that a PHD can obtain funding for providing community care.

First, open a FQHC that would receive funding through a federal grant. These FQHCs must provide services in an underrepresented community, provide comprehensive care, and provide care regardless of a patient’s ability to pay. The other option is to partner with a major hospital to fund the PHD in providing specific services instead of these patients using the emergency room.

4 There are two main ways that a PHD can obtain funding for providing community care.

First, open a FQHC that would receive funding through a federal grant. These FQHCs must provide services in an underrepresented community, provide comprehensive care, and provide care regardless of a patient’s ability to pay. The other option is to partner with a major hospital to fund the PHD in providing specific services instead of these patients using the emergency room.

PTS: 1 REF: 325 CON: Promoting Health | Economics | Health-Care System 6. ANS: 1 Objective: 7. Identify the most frequent activities and services provided by PHDs. Page: Heading: Local Health Department Activities > Individual and Community Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Collaboration; Nutrition Difficulty: Moderate Feedback 1 The nurses should first assess their community and the culture of their community so they understand the population they are trying to help. Once this has been completed, the results can guide the formation of their goals and a plan.

2 The nurses should first assess their community and the culture of their community so they understand the population they are trying to help. Once this has been completed, the results can guide the formation of their goals and a plan.

3 The nurses should first assess their community and the culture of their community so they understand the population they are trying to help. Once this has been completed, the results can guide the formation of their goals and a plan.

4

The nurses should first assess their community and the culture of their community so they understand the population they are trying to help. Once this has been completed, the results can guide the formation of their goals and a plan.

PTS: 1 REF: 328 CON: Assessment | Promoting Health | Collaboration | Nutrition 7. ANS: 4 Objective: 7. Identify the most frequent activities and services provided by PHDs. Page: Heading: Local Health Department Activities > Individual and Community Health Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Safety; Communication Difficulty: Moderate Feedback 1 The young adult population is significantly more likely to have their cell phone with them and able to receive text messages. This generation is more likely to use Internet-based TV and radio services, instead of live TV or radio. E-mail is also a good option, but they may not check their e-mail frequently enough to be a good option for emergencies requiring a rapid response.

2 The young adult population is significantly more likely to have their cell phone with them and able to receive text messages. This generation is more likely to use Internet-based TV and radio services, instead of live TV or radio. E-mail is also a good option, but they may not check their e-mail frequently enough to be a good option for emergencies requiring a rapid response.

3 The young adult population is significantly more likely to have their cell phone with them and able to receive text messages. This generation is more likely to use Internet-based TV and radio services, instead of live TV or radio. E-mail is also a good option, but they may not check their e-mail frequently enough to be a good option for emergencies requiring a rapid response.

4 The young adult population is significantly more likely to have their cell phone with them and able to receive text messages. This generation is more likely to use Internet-based TV and radio services instead of live TV or radio. E-mail is also a good option, but they may not check their e-mail frequently enough to be a good option for emergencies requiring a rapid response.

PTS: 1 REF: 327 | 333 CON: Promoting Health | Safety | Communication 8. ANS: 2 Objective: 7. Identify the most frequent activities and services provided by PHDs. Page: Heading: Local Health Department Activities > Disease Control, Epidemiology, and Surveillance Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Communication; Legal; Health-Care System; Sexuality Difficulty: Moderate Feedback 1 Nurses who work in the community and who make a sexually transmitted infection diagnosis are required by law to report the diagnosis to the local public health department for tracking and follow-up. Prior sexual partners will also need to be

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contacted for testing and treatment, if necessary.

Nurses who work in the community and who make a sexually transmitted infection diagnosis are required by law to report the diagnosis to the local public health department for tracking and follow-up. Prior sexual partners will also need to be contacted for testing and treatment, if necessary.

Nurses who work in the community and who make a sexually transmitted infection diagnosis are required by law to report the diagnosis to the local public health department for tracking and follow-up. Prior sexual partners will also need to be contacted for testing and treatment, if necessary.

Nurses who work in the community and who make a sexually transmitted infection diagnosis are required by law to report the diagnosis to the local public health department for tracking and follow-up. Prior sexual partners will also need to be contacted for testing and treatment, if necessary.

PTS: 1 REF: 330 CON: Communication | Legal | Health-Care System | Sexuality 9. ANS: 2 Objective: 6. Investigate the role of PHDs in community assessment and planning for health needs of the community.

Page: Heading: Local Health Department Activities > Disease Control, Epidemiology, and Surveillance Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Cognitive Level: Application [Applying] Concept: Critical Thinking; Trauma; Safety Difficulty: Difficult Feedback 1 The correct answer is to go into the community to assess the needs of the displaced residents. This is the priority in the immediate aftermath of the disaster. Revising the emergency preparedness plans can wait until the needs of the community have been met.

2 The correct answer is to go into the community to assess the needs of the displaced residents. This is the priority in the immediate aftermath of the disaster.

3 The correct answer is to go into the community to assess the needs of the displaced residents. This is the priority in the immediate aftermath of the disaster. Although the emergency responders should remain in control of the situation, they may need additional resources, such as water, throughout the response.

4 The correct answer is to go into the community to assess the needs of the displaced residents. This is the priority in the immediate aftermath of the disaster.

PTS: 1 REF: 333 CON: Critical Thinking | Trauma | Safety 10. ANS: 1 Objective: 8. Discuss financial and information technology resources needed to support PHDs. Page: Heading: Public Health Department Challenges for the Future > Information Technology Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Informatics Difficulty: Easy Feedback

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The Geospatial Information Systems, or GIS, is software that helps track geographic data in a particular area. The nurse can add geographical and demographic data to help visualize patterns.

The electronic health record, or EHR, is a clinical/patient-based tool. It will not provide the data that the nurse is looking to analyze.

Public health systems are a generic term for the entire public health department and the associated agencies and departments.

A map may be helpful, but it is an archaic tool. In addition, a simple map doesn’t provide the analytical information that the nurse and coworkers will need to properly track the relevant data.

PTS: 1 REF: 336 CON: Infection | Informatics 11. ANS: 2 Objective: 8. Discuss financial and information technology resources needed to support PHDs. Page: Heading: Public Health Department Challenges for the Future > Public Health Department Financing Integrated Processes: Communication and Documentation Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Family; Promoting Health; Communication; Economics; Health-Care System Difficulty: Moderate Feedback 1 Because this position is paid for out of categorical funds, the nurse must track the time spent in each function to ensure that it meets the grant requirements.

2 Because this position is paid for out of categorical funds, the nurse must track the time spent in each function to ensure that it meets the grant requirements.

3 Because this position is paid for out of categorical funds, the nurse must track the time spent in each function to ensure that it meets the grant requirements.

4 Because this position is paid for out of categorical funds, the nurse must track the time spent in each function to ensure that it meets the grant requirements.

PTS: 1 REF: 337 CON: Family | Promoting Health | Communication | Economics | Health-Care System 12. ANS: 3 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Essential Services > Public Health Interventions Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment; Critical Thinking; Health-Care System Difficulty: Moderate Feedback 1 A full community assessment should be performed every 3 to 5 years, so this is a perfect opportunity for the new nurse to become familiar with the community and update the assessment.

2 Full community health assessments should be performed every 3 to 5 years, so the nurse should perform a new assessment.

3 Full community health assessments should be performed every 3 to five 5, so it is time

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for the nurse to update it.

This is not appropriate. Full community health assessments should be performed every 3 to 5 years, so it is well within the normal range.

PTS: 1 REF: 319 CON: Promoting Health | Assessment | Critical Thinking | Health-Care System 13. ANS: 2 Objective: 6. Investigate the role of PHDs in community assessment and planning for health needs of the community.

Page: Heading: Essential Services > Public Health Interventions Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment Difficulty: Moderate

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Feedback The Geospatial Information Systems (GIS) is software that helps track geographic data in a particular area. The nurse can add geographical and demographic data to help visualize patterns. It is not the best place to begin understanding health risk behaviors.

BRFSS is the Behavioral Risk Factor Surveillance System that provides data about risky behaviors countywide. It is the best place to begin understanding health risk behaviors.

Healthy People provides a set of goals and objectives each decade related to optimizing the health of every American. It does not provide data on risk behaviors.

The CDC, or Centers for Disease Control and Prevention, sponsors the BRFSS, but the nurse should check the BRFSS directly.

PTS: 1 REF: 321 CON: Pregnancy | Promoting Health | Assessment 14. ANS: 3 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Local Health Department Activities > Disease Control, Epidemiology, and Surveillance Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Critical Thinking; Communication; Nursing Difficulty: Moderate Feedback 1 The nurse should report the suspected case to the PHD. It is imperative for the health department to have updated and accurate information about transmission and diagnoses of the influenza virus.

2 The nurse should report the suspected case to the PHD in case the worker does not go to his PCP as directed or the PCP does not make the report. It is imperative for the health department to have updated and accurate information about transmission and diagnoses of the influenza virus.

3 The nurse should notify the PHD and begin epidemiological screening of his coworkers.

4

The nurse should notify the PHD and begin epidemiological screening of his coworkers.

PTS: 1 REF: 332 CON: Infection | Critical Thinking | Communication | Nursing 15. ANS: 2 Objective: 6. Investigate the role of PHDs in community assessment and planning for health needs of the community.

Page: Heading: Local Health Department Activities > Disease Control, Epidemiology, and Surveillance Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Medication; Nursing Roles; Infection Difficulty: Moderate Feedback 1 The young man will be on antibiotics for 6 to 12 months.

2 Index patients with positive acid-fast bacillus (AFB) sputum-smear results or pulmonary cavities are the highest priority for contact investigation.

3 Many patients, especially those at high risk for noncompliance, will need to be on directly observed therapy. This means that he will actually need to be observed taking the medications.

4 Patients with tuberculosis will need to remain on activity restrictions until they are feeling well and completely recovered.

PTS: 1

REF: 328-330

CON: Medication | Nursing Roles | Infection

MULTIPLE RESPONSE 16. ANS: 1, 2 Objective: 9. Describe the challenges facing PHDs. Page: Heading: Immunization and Health Protection Programs Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Infection; Safety; Health-Care System Difficulty: Moderate

1 2 3 4

Feedback Vaccinations are mandated by school districts.

If an outbreak of disease occurs, the PHD is often the entity responsible for mass immunization.

In extreme cases such as the measles outbreak in New York City in 2019, a PHD might mandate vaccination for everyone and impose fines, but this not a usual step.

Sending out flyers to parents that merely encourage them to vaccinate their children is not usually done to address an outbreak because usually vaccinations are mandated for school children.

PTS: 1

REF: 317 | 318

CON: Infection | Safety | Health-Care System

17. ANS: 1, 3, 4, 5 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Local Health Department Activities > Data Collection and Analysis: Health and Vital Statistics Integrated Processes: Communication and Documentation Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Communication; Pregnancy Difficulty: Moderate

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Feedback Data that should be on the birth form include birth date, place of birth, parents’ names, neonatal outcomes, risk and protective factors, parental age, parental level of education, race and maternal use of drugs/alcohol/tobacco during pregnancy, number of prenatal visits, type of delivery, and newborn physical data. Parental income is not included.

Data that should be on the birth form include birth date, place of birth, parents’ names, neonatal outcomes, risk and protective factors, parental age, parental level of education, race and maternal use of drugs/alcohol/tobacco during pregnancy, number of prenatal visits, type of delivery, and newborn physical data. Parental income is not included.

Data that should be on the birth form include birth date, place of birth, parents’ names, neonatal outcomes, risk and protective factors, parental age, parental level of education, race and maternal use of drugs/alcohol/tobacco during pregnancy, number of prenatal visits, type of delivery, and newborn physical data. Parental income is not included.

Data that should be on the birth form includes birth date, place of birth, parents’ names, neonatal outcomes, risk and protective factors, parental age, parental level of education, race and maternal use of drugs/alcohol/tobacco during pregnancy, number of prenatal visits, type of delivery, and newborn physical data. Parental income is not included.

Data that should be on the birth form include birth date, place of birth, parents’ names, neonatal outcomes, risk and protective factors, parental age, parental level of education, race and maternal use of drugs/alcohol/tobacco during pregnancy, number of prenatal visits, type of delivery, and newborn physical data. Parental income is not included.

PTS: 1 REF: 324 CON: Promoting Health | Communication | Pregnancy 18. ANS: 1, 2, 3, 5 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Role of Public Health Nurses in Public Health Departments > Core Functions Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Immunity Difficulty: Moderate

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Feedback Parents may not be aware of the need for or importance of immunizations, and mandating them for entry into school makes that clear. Nurses should also be able to provide a list of locations where the parents can obtain the vaccinations for their child at very low cost.

Providing a list of places where students can obtain free or low cost vaccinations is a great option. It helps the parents find a place near them that would be able to provide the service at a low cost.

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Reading material at too high of a scientific level may be too complex for parents with low education. They would do better with materials in their native language in a much simpler tone.

Reading material at that level may be too complex for parents with low education. They would do better with materials in their native language in a much simpler tone.

Because one of the predominant problems is cost, having staff available at the school to provide immunizations to the students for free is a great option. Parental permission would need to be obtained prior to administering any vaccinations to a student.

PTS: 1 REF: 327 CON: Promoting Health | Immunity 19. ANS: 2, 3, 4, 5 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Local Health Department Activities > Data Collection and Analysis: Health and Vital Statistics Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health-Care System; Communication Difficulty: Easy

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Feedback Public health departments are responsible for collecting vital statistics, including births, deaths, marriages, and divorces. Public health departments do track certain communicable and infectious diseases, but this is not included in vital statistics.

Public health departments are responsible for collecting vital statistics, including births, deaths, marriages, and divorces. Public health departments do track certain communicable and infectious diseases, but this is not included in vital statistics.

Public health departments are responsible for collecting vital statistics, including births, deaths, marriages, and divorces. Public health departments do track certain communicable and infectious diseases, but this is not included in vital statistics.

Public health departments are responsible for collecting vital statistics, including births, deaths, marriages, and divorces. Public health departments do track certain communicable and infectious diseases, but this is not included in vital statistics.

Public health departments are responsible for collecting vital statistics, including births, deaths, marriages, and divorces. Public health departments do track certain communicable and infectious diseases, but this is not included in vital statistics.

PTS: 1 REF: 324 CON: Health-Care System | Communication 20. ANS: 1, 2, 3, 4 Objective: 4. Analyze key roles and responsibilities of public health nurses (PHNs) in PHDs. Page: Heading: Essential Services > Public Health Interventions Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Violence; Nursing Roles Difficulty: Moderate

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Feedback The four assessments included in the MAPP tool are the Community Themes and Strengths

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Assessment, The Local Public Health System Assessment, the Forces of Change Assessment, and the Community Health Status Assessment.

The four assessments included in the MAPP tool are the Community Themes and Strengths Assessment, The Local Public Health System Assessment, the Forces of Change Assessment, and the Community Health Status Assessment.

The four assessments included in the MAPP tool are the Community Themes and Strengths Assessment, The Local Public Health System Assessment, the Forces of Change Assessment, and the Community Health Status Assessment.

The four assessments included in the MAPP tool are the Community Themes and Strengths Assessment, The Local Public Health System Assessment, the Forces of Change Assessment, and the Community Health Status Assessment.

The four assessments included in the MAPP tool are the Community Themes and Strengths Assessment, The Local Public Health System Assessment, the Forces of Change Assessment, and the Community Health Status Assessment.

PTS: 1

REF: 321

CON: Assessment | Promoting Health | Violence | Nursing Roles

Chapter 14: Health Planning for Acute Care Settings Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Susan has been assigned a 56-year-old patient in the intensive care unit who is recovering from bypass cardiac surgery. She is primarily providing what level of prevention?

1. Primary 2. Secondary 3. Tertiary 4. Selected 2. A nurse is planning specific interventions aimed at reducing the rate of complications due to uncontrolled blood sugar levels in the diabetes population with repeat admissions to hospital. The word population is primarily being used from the perspective of: 1. Public health context.

2. Hospital setting.

3. Cultural context.

4. None of the above.

3. A nurse working on a medical surgical unit in a large urban hospital is evaluating the hospital’s discharge rate for congestive heart failure and wants to see how it compares with national statistics. Which national resource is available that specifically tracks hospital discharge data?

1. Healthcare Cost and Utilization Project 2. Healthy People 2020 3. Centers for Disease Control and Prevention 4. Institutional Review Board 4. Megan is the nurse chair of the performance improvement committee for a small community hospital. She has been asked to work with the hospital’s community health outreach program team with a focus on cardiovascular disease. Megan begins by reviewing hospital discharge data as part of the initial review of patients with cardiovascular disease. Because she wants to use a taxonomy that categorizes diagnoses into mutually exclusive groups, which taxonomy should she use?

1. ICD10 codes 2. Major diagnostic categories (MDCs) 3. Recidivism rates 4. ALOS statistics 5. Megan is the nurse chair of the performance improvement committee for a small community hospital. She has been asked to work with the hospital’s community health outreach program team with a focus on cardiovascular disease. The team finds that a major issue is treatment of women especially those who present with atypical symptoms. The team asks Megan to partner with the local television station to create a public service announcement (PSA) discussing heart disease in women. Megan incorporates into the PSA the fact that women often experience the symptoms of a heart attack differently than men. These symptoms can include: 1. Abdominal pain.

2. Nausea.

3. Difficulty breathing.

4. All of the above.

6. Megan is the nurse chair of the performance improvement committee for a small community hospital. She has been asked to work with the hospital’s community health outreach program team with a focus on cardiovascular disease. Megan’s report to the performance improvement committee at the hospital results in the decision to examine whether a specific protocol is needed for the care of women presenting to the emergency department (ED) with atypical symptoms of a heart attack. The nurse finds that the average door-to-balloon time – the interval that starts with the patient's arrival in the emergency department and ends when a catheter guidewire crosses the culprit lesion in the cardiac catheter lab – in their hospital is 64 minutes with the longest time being 84 minutes. How does Megan proceed?

1. No need to address this—the average door-to-balloon time is well within the desired guidelines.

2. Perform a hospital and ED assessment to see where these patients are being held up.

3. Mandate EKGs for every patient who comes into the emergency room.

4. Create a separate wing of the ED especially for suspected cardiac patients.

7. Adam is writing a proposal for a performance improvement study related to care of adolescent patients presenting in the emergency department (ED) with suicidal ideation. As part of his study, he wishes to conduct chart reviews for all adolescent patients seen in the ED over the past 6 months. How should he proceed?

1. Obtain the records from the EMR or the medical records department as required by the hospital.

2. Inform the physicians caring for the patients why he needs to review the records prior to conducting the medical record review.

3. Present the proposal to the hospital Institutional Review Board for review and obtain permission from them prior to doing the study.

4. The nurse is not able to use the records because it is a violation of HIPAA. 8. A nurse is reviewing the Healthy People objectives related to cardiovascular disease and stroke and decides to develop an intervention to reduce hospitalizations of older people with heart failure. Which of the following is an example of an intervention at the level of secondary prevention?

1. Conducting a screening program at local senior centers to help identify persons who may have early stages of heart failure.

2. Developing a family-based discharge program for heart failure patients with a history of readmissions in less than thirty days.

3. Having patients who have been diagnosed with heart failure complete a chronic disease self-management program once they have been discharged from the hospital.

4. Conducting a good nutrition and exercise program at the local older adult housing complex.

9. At a large urban hospital, the nursing council is concerned with optimizing post-hospital discharge outcomes for patients. Which of the following actions would the nurses most likely recommend as standard of care?

1. Performing a discharge assessment before each patient leaves the hospital.

2. Performing a home health visit before the patient is discharged to assess if it is a safe environment.

3. Making a referral for post-discharge home health visits for all patients who have been hospitalized.

4. Making a referral to social services for all patients prior to discharge.

10. A nurse is looking to develop a new policy to address the rising rate of central line infections in their medical ICU. The nurse speaks with the nurse manager about utilizing the Plan-Do-Study-Act (PDSA) approach instead of simply developing new ICU protocols. Which of the following is not a benefit of using this system?

1. New protocols can be tested before implementing them throughout the hospital ICUs. 2. The staff can work with manufacturers of the medical equipment to determine how the

central line trays can be arranged more efficiently.

3. They can figure out what works on the large scale fairly quickly.

4. The nurses can figure out what other processes need to be addressed with the new policy changes.

11. A nurse is caring for a young child who is suspected of having meningitis. A spinal tap culture is pending. If it comes back positive for N. meningitidis, from a public health perspective it is important that the nurse: 1. Provide his family with information about the disease in simple to understand language.

2. Inform the public health department, the child’s day care, and other caregivers so they can monitor for symptoms of the infection.

3. Promptly admit the child to the ICU. 4. Double the dose of antibiotics.

12. During her orientation, a new graduate nurse is attending a lecture by the Infection Control Nurse on the prevention of health care-associated infections (HAI). She learns that the following are the major issues related to HAIs: 1. Pneumonia, urinary tract infections, and ventilator-associated infections 2. Sepsis/bacteremias, pneumonia, and urinary tract infections 3. Sepsis/bacteremias, pneumonia, Clostridium difficile infections 4. Pneumonia and urinary tract infections 13. A nurse manager is presenting an in-service to the rest of the nurses on the floor. They are discussing the recent spread of vancomycin-resistant enterococci (VRE) within the hospital and how to prevent transmission on their floor. Which of the following are recommended procedures for reducing transmission?

1. Use of disposable gloves, negative pressure rooms, the use of a disposable gown if washing or turning the patient, or changing diapers 2. Use of disposable gloves, hand washing, reverse isolation 3. Use of masks, hand washing, the use of a disposable gown if washing or turning the patient, or changing diapers 4. Use of disposable gloves, hand washing, the use of a disposable gown if washing or turning the patient, or changing diapers 14. A nurse is answering telephone calls from a triage line. A call comes in from a 62-year-old woman who has complaints of unusual fatigue, abdominal pain, and nausea. She denies eating anything unusual that day.

What should the nurse advise her to do?

1. Rest and take an antacid.

2. Call her physician in the morning.

3. Go to the nearest emergency department.

4. Schedule an appointment with a cardiologist next week.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

15. One of the concerns at a large urban hospital is the increase in Ventilator Associated Pneumonia (VAP) and the hospital board has asked the Infection Control Committee to look into it. Major risk factors for VAP that the infection control nurse states must be included in their initial assessment of the problem include: (Select all that apply.)

1. Length of stay before onset of the disease.

2. Multiple drug-resistant pathogens.

3. Type of ventilator equipment used at the institution.

4. Patient-nurse ratio.

16. A nurse is reviewing the hospital’s statistics in comparison with the Institute for Healthcare Improvement (IHI) “100,000 Lives Campaign” to see what the facility could do to improve safety within the organization.

What statistics should the nurse look at? (Select all that apply.)

1. Use of rapid response teams 2. Central line infections 3. Ventilator-assisted pneumonia 4. Pressure ulcers/wounds 5. Number of falls Other 17. A nurse is teaching a CPR course for non-medical professionals. Place the following steps for performing CPR on an adult in the order in which they should be performed (A-D): A. Chest compressions.

B. Assess the patient.

C. Clear the airway.

D. Administer breaths.

18. A group of nurses is looking to reduce the number of cases of ventilator-associated pneumonia in their hospital. The nurses decide to use the IHI model as their guiding process. Place the following steps in the order in which they should be performed (A-D): A. Study the process from start to finish.

B. Develop a goal statement and determine what will be measured during this process.

C. Proceed with ventilator care process using standard hospital protocols.

D. Make changes to the processes as determined by results of the study.

Completion Complete each statement.

19. A nurse is evaluating the survival rate for victims of motor vehicle accidents (MVAs) who had used seat belts. The following data were reviewed: The total number of MVAs was 548, the total number of deaths was 232, the total number of people wearing seatbelts during their MVA was 476, and the total number of deaths in people wearing seatbelts was 117. What is the survival rate in people wearing seatbelts? Round your answer to the nearest whole number.

Chapter 14: Health Planning for Acute Care Settings Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 1. Describe the relationship between acute care and population health.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Difficulty: Moderate Feedback 1 Primary prevention interventions are aimed at preventing disease or injury in persons currently without disease. Provision of care following open heart surgery focuses on reducing morbidity and preventing mortality in a person who has already been diagnosed with cardiovascular disease.

2 Secondary prevention interventions are aimed at identifying persons with disease among a seemingly well population prior to the development of clinical symptoms with the goal of providing treatment early in the course of the disease. Provision of care following open heart surgery focuses on reducing morbidity and preventing mortality in a person who has already been diagnosed with cardiovascular disease.

3 Tertiary prevention interventions are aimed at treating disease to prevent increased risk of further morbidity or mortality in those already diagnosed with a disease or an injury.

Provision of care following open heart surgery focuses on reducing morbidity and preventing mortality in a person who has already been diagnosed with cardiovascular disease.

4 Selected prevention interventions are aimed at a subgroup of the population at risk for developing a disease but who have not yet been diagnosed with the disease.

PTS: 1 REF: 343 CON: Promoting Health | Nursing Roles | Health-Care System 2. ANS: 2 Objective: 1. Describe the relationship between acute care and population health.

Page: Heading: The Acute Care Setting and Population Health Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Metabolism; Critical Thinking; Health-Care System Difficulty: Easy Feedback 1 When using population in a public health context, it primarily refers to people of the same social, economic, geopolitical or cultural group.

2 When referring to a population in the hospital, or acute care setting, it refers to a group of people who share a particular health concern (such as diabetes, as in this example) or hospital unit.

3 4

When using population in a cultural context, it refers to people of the same ethnic or cultural group.

The correct answer is hospital setting. When referring to a population in this manner, it refers to a group of people who share a particular health concern (such as diabetes, as in this example) or hospital unit.

PTS: 1 REF: 344 CON: Metabolism | Critical Thinking | Health-Care System 3. ANS: 1 Objective: 2. Identify the role of population-level data in the development of the discipline of critical care.

Page: Heading: The Acute Care Setting and Population Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Evidence-Based Practice; Nursing Difficulty: Moderate Feedback 1 The Healthcare Cost and Utilization Project (HCUP) is the Nation’s most comprehensive source of hospital data, including information on in-patient care, ambulatory care, and emergency department visits.

2 Healthy People 2020 has established benchmarks and monitored progress on improving the health of Americans but does not specifically focus on hospital data.

3 The Centers for Disease Control and Prevention’s primary goal is to protect America from health, safety, and security threats, both foreign and in the U.S. Its primary focus is not to track hospital data.

4 The Institutional Review Board is a hospital-specific committee that reviews research projects within the hospital. They evaluate studies to ensure that they comply with standards used when conducting research with human subjects. It does not track hospital data.

PTS: 1 REF: 345 CON: Pregnancy | Evidence-Based Practice | Nursing 4. ANS: 2 Objective: 2. Identify the role of population-level data in the development of the discipline of critical care.

Page: Heading: The Acute Care Setting and Population Health Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Assessment; Evidence-Based Practice; Health-Care System Difficulty: Moderate Feedback 1 ICD10 is a coding system that was developed to relate a very specific diagnosis related to the admission. Although they can be grouped into larger categories, the categories are not system based and not mutually exclusive.

2 MDCs group patients into similar diagnostic groups at their admission to the hospital based on systems. The diagnoses groups are mutually exclusive.

3 Recidivism rates are readmission rates within 30 days of discharge. They do not give insight into hospital admissions based on diagnoses.

4 ALOS stands for average length of stay. It does not give any insight into hospital

discharge diagnoses.

PTS: 1 REF: 345 CON: Assessment | Evidence-Based Practice | Health-Care System 5. ANS: 4 Objective: 3. Discuss the relevance of cohort studies to the delivery of tertiary care.

Page: Heading: Role of Cohort Studies in the Delivery of Acute Care > Women and Cardiovascular Disease Integrated Processes: Teaching/Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Nursing Roles; Promoting Health; Perfusion Difficulty: Moderate Feedback 1 Many women have atypical symptoms of an acute cardiac event, which can include abdominal pain, nausea, difficulty breathing, and fatigue. Some women experience the typical signs associated with a heart attack—chest pain and pressure, and shortness of breath.

2 Many women have atypical symptoms of an acute cardiac event, which can include abdominal pain, nausea, difficulty breathing, and fatigue. Some women experience the typical signs associated with a heart attack—chest pain and pressure, and shortness of breath.

3 Many women have atypical symptoms of an acute cardiac event, which can include abdominal pain, nausea, difficulty breathing, and fatigue. Some women experience the typical signs associated with a heart attack—chest pain and pressure, and shortness of breath.

4 Many women have atypical symptoms of an acute cardiac event, which can include abdominal pain, nausea, difficulty breathing, and fatigue. Some women experience the typical signs associated with a heart attack—chest pain and pressure, and shortness of breath.

PTS: 1 REF: 355 CON: Nursing Roles | Promoting Health | Perfusion 6. ANS: 1 Objective: 3. Discuss the relevance of cohort studies to the delivery of tertiary care.

Page: Heading: Role of Cohort Studies in the Delivery of Acute Care > Women and Cardiovascular Disease Integrated Processes: Nursing Process Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Evidence-Based Practice, Quality Improvement Difficulty: Moderate Feedback 1 The recommended door-to-balloon time is less than 90 minutes, which is well above the hospital’s average.

2 The recommended door-to-balloon time is less than 90 minutes, which is well above the hospital’s average.

3 The recommended door-to-balloon time is less than 90 minutes, which is well above the hospital’s average.

4 The recommended door-to-balloon time is less than 90 minutes, which is well above the hospital’s average.

PTS: 1 REF: 355-358 CON: Evidence-Based Practice | Quality Improvement 7. ANS: 3 Objective: 4. Explain the application of health planning in an acute care setting.

Page: Heading: Role of Cohort Studies in the Delivery of Acute Care > Women and Cardiovascular Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Quality Improvement, Evidence-Based Practice; Legal Difficulty: Moderate Feedback 1 Patient information is protected by HIPAA, which dictates that patient records can only be accessed by clinical staff actively engaged in their care. An Institutional Review Board review and approval is required prior to conducting a study that involves collecting data through a medical record review.

2 An Institutional Review Board review and approval is required prior to conducting a study that involves collecting data through a medical record review. Physician approval is not sufficient for conducting a study that includes collecting data through a medical record review.

3 An Institutional Review Board review and approval is required prior to conducting a study that involves collecting data through a medical record review.

4 Conducting a medical record review can be done without violating HIPAA. It is the Institutional Review Board that determines that a study that includes collecting data through a medical record review does not violate HIPAA and usually requires specific procedures for de-identifying the data set to protect patients’ privacy.

PTS: 1 REF: 357 CON: Quality Improvement | Evidence-Based Practice | Legal 8. ANS: 1 Objective: 4. Explain the application of health planning in an acute care setting.

Page: Heading: Health Planning and Acute Care > Noncommunicable Diseases and Acute Care Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Perfusion; Medication; Promoting Health; Critical Thinking Difficulty: Difficult Feedback 1 Secondary prevention is done to help identify persons who are apparently well who may have a disease for the purpose of beginning treatment prior to the development of clinical disease.

2 This is an example of a tertiary prevention program that aims to slow disease progression after it’s already been diagnosed.

3 This is an example of a tertiary prevention program that aims to slow disease progression after it’s already been diagnosed.

4 Conducting a good nutrition and exercise program is an example of primary prevention: activities that prevent the development of heart failure in the first place.

PTS: 1 REF: 359 CON: Perfusion | Medication | Promoting Health | Critical Thinking

9. ANS: 1 Objective: 1. Describe the relationship between acute care and population health.

Page: Heading: The Acute Care Setting and Population Health > Discharge Status of Hospitalized Patients Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Assessment; Nursing Roles Difficulty: Moderate Feedback 1 Assessing a patient right before discharge can identify gaps in knowledge and other health issues that need to be addressed. Patients should be assessed at the time of admission and at discharge so that the nurse can properly plan individualized discharge instructions.

2 Home health visits prior to discharge are not a standard of care. Instead, the nurse should perform a discharge assessment to determine what, if any, services are needed, which may include home health visits following discharge.

3 Post discharge home health visits are not needed for every patient. There must be a documented need based on a patient’s individual needs. Thus the nurse should perform a discharge assessment to determine what, if any, services are needed.

4 A routine referral to social services is not needed for every patient. Instead, the nurse should perform a discharge assessment to determine what, if any, services are needed, which may include a referral to social services.

PTS: 1 REF: 348 | 358 CON: Assessment | Nursing Roles 10. ANS: 3 Objective: 5. Recognize the basic steps in the quality improvement process.

Page: Heading: Performance Improvement and Acute Care Settings > Why Do We Need PI in Acute Care Settings?

Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Infection; Health-Care System; Quality Improvement Difficulty: Moderate Feedback 1 This is one of the benefits of using the PDSA approach for policy change. This way, new protocols can be tested on a small-scale prior to implementing them throughout the entire hospital.

2 This is one of the benefits of using the PDSA approach. The staff can work with the medical equipment manufacturers and supply team of the hospital to determine how the central line trays can be organized and arranged more efficiently.

3 This is not one of the benefits of using the PDSA approach. Because of the testing and re-testing process, figuring out the process on the large scale can take some time. The benefit, however, is that many of the bugs can be worked out before implementing the process throughout the entire hospital.

4 This is one of the benefits of using the PDSA approach. If the ideal process requires a change in how central line trays are packed or stored, or if other equipment is needed, the nurses can work out the details of the associated changes.

PTS: 1

REF: 361 | 362

CON: Promoting Health | Infection | Health-Care System | Quality Improvement 11. ANS: 2 Objective: 6. Identify key infection control issues related to the acute care setting.

Page: Heading: Infection Control and Acute Care Settings > Cerebrospinal and Post-operative Central Nervous System (CNS) Infections Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Safety; Promoting health Difficulty: Moderate Feedback 1 Although the family will need information about the disease, from a public health perspective it is important to determine if others have been exposed to the child who may be at risk for developing the infection.

2 The nurse should contact the public health department and enlist their help in inform the child’s teacher, day care, or other caregivers so that they can monitor for symptoms in those exposed to the child. They should also be given prophylactic antibiotics to prevent development of the infection.

3 From a public health perspective, the important steps are to identify possible contacts at risk for transmission and to prevent transmission within the hospital. Regardless of what unit he is admitted to, he should be placed under isolation precautions.

4 Doubling the antibiotic dose will not make them more effective. The nurse should, however, make sure that he is being given penicillin G, ceftriaxone, or chloramphenicol (if allergic to penicillin or cephalosporins).

PTS: 1 REF: 364 CON: Infection | Assessment | Safety | Promoting Health 12. ANS: 2 Objective: 6. Identify key infection control issues related to the acute care setting.

Page: Heading: Infection Control and Acute Care Settings Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection Difficulty: Moderate Feedback 1 The major issues include sepsis/bacteremias, pneumonia, and urinary tract infections (UTIs). Ventilator-associated infections are a subset of HAI related to pneumonia.

2 The major issues include sepsis/bacteremias, pneumonia, and urinary tract infections (UTIs).

3 The major issues include sepsis/bacteremias, pneumonia, and urinary tract infections (UTIs). Clostridium difficile is a pathogen linked to HAI and is a concern, but it is not one of the major issues.

4 The major issues include sepsis/bacteremias, pneumonia, and urinary tract infections (UTIs).

PTS: 1 REF: 363 CON: Infection | Medication | Skin Integrity 13. ANS: 4 Objective: 6. Identify key infection control issues related to the acute care setting.

Page: Heading: Infection Control and Acute Care Settings > Health Care-Associated Infections and Multiple Drug-Resistant Organisms Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Nursing Roles; Safety Difficulty: Moderate Feedback 1 For VRE, the best way to reduce patient-to-patient infections within the hospital setting is to use disposable gloves, wash your hands after caring for the patients and use of a disposable gown if washing or turning the patient, or changing diapers. It is not necessary to use a negative pressure room because it is not airborne.

2 For VRE, the best way to reduce patient-to-patient infections within the hospital setting is to use disposable gloves, wash your hands after caring for the patients and use of a disposable gown if washing or turning the patient, or changing diapers. It is not necessary to use reverse isolation.

3 For VRE, the best way to reduce patient-to-patient infections within the hospital setting is to use disposable gloves, wash your hands after caring for the patients and use of a disposable gown if washing or turning the patient, or changing diapers. It is not necessary to use a mask because it is not airborne.

4 For VRE, the best way to reduce patient-to-patient infections within the hospital setting is to use disposable gloves, wash your hands after caring for the patients and use of a disposable gown if washing or turning the patient, or changing diapers.

PTS: 1 REF: 367 CON: Infection | Nursing Roles | Safety 14. ANS: 3 Objective: 3. Discuss the relevance of cohort studies to the delivery of tertiary care.

Page: Heading: Role of Cohort Studies in the Delivery of Acute Care > Women and Cardiovascular Disease Integrated Processes: Nursing Process Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Perfusion; Assessment Difficulty: Moderate Feedback 1 These symptoms are atypical signs of a heart attack and are more often experienced by women than men who are having an acute cardiac event. The nurse should advise her to proceed to the nearest emergency department for an evaluation.

2 These symptoms are atypical signs of a heart attack and are more often experienced by women than men who are having an acute cardiac event. The nurse should advise her to proceed to the nearest emergency department for an evaluation.

3 These symptoms are atypical signs of a heart attack and are more often experienced by women than men who are having an acute cardiac event. The nurse should advise her to proceed to the nearest emergency department for an evaluation.

4 These symptoms are atypical signs of a heart attack and are more often experienced by women than men who are having an acute cardiac event. The nurse should advise her to proceed to the nearest emergency department for an evaluation.

PTS: 1

REF: 355

CON: Perfusion | Assessment

MULTIPLE RESPONSE 15. ANS: 1, 2 Objective: 6. Identify key infection control issues related to the acute care setting.

Page: 371 Heading: Infection Control and Acute Care Settings > Hospital Associated Pneumonia (HAP) and Ventilator Associated Pneumonia (VAP) Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles; Infection; Perfusion; Addiction Difficulty: Moderate

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Feedback Risk factors for developing HAP/VAP also differ based on geography, specific characteristics of the health care setting, length of stay before onset of the disease, and risk factors for multiple drug-resistant (MDR) pathogens.

Risk factors for developing HAP/VAP also differ based on geography, specific characteristics of the health care setting, length of stay before onset of the disease, and risk factors for multiple drug-resistant (MDR) pathogens.

Risk factors for developing HAP/VAP also differ based on geography, specific characteristics of the health care setting, length of stay before onset of the disease, and risk factors for multiple drug-resistant (MDR) pathogens. Type of equipment is not a major risk factor for VAP. Risk factors for developing HAP/VAP also differ based on geography, specific characteristics of the health care setting, length of stay before onset of the disease, and risk factors for multiple drug-resistant (MDR) pathogens. Patient-nurse ratio may be of interest, but it is not one of the major risk factors for VAP.

PTS: 1 REF: 365 CON: Promoting Health | Nursing Roles | Infection | Perfusion | Addiction 16. ANS: 1, 2, 3 Objective: 3. Discuss the relevance of cohort studies to the delivery of tertiary care.

Page: Heading: Performance Improvement and Acute Care Settings > Why Do We Need PI in Acute Care Settings?

Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Safety; Evidence-Based Practice Difficulty: Moderate

1

2

Feedback The six initiatives included in the “100,000 Lives Campaign” include the use of rapid response teams, the delivery of clinically appropriate care for acute cardiac patients, use of medication reconciliation procedures to prevent adverse drug events, prevention of central line infections, prevention of surgical infections, and prevention of ventilator-assisted pneumonia.

The six initiatives included in the “100,000 Lives Campaign” include the use of rapid

3

4

5

response teams, the delivery of clinically appropriate care for acute cardiac patients, use of medication reconciliation procedures to prevent adverse drug events, prevention of central line infections, prevention of surgical infections, and prevention of ventilator-assisted pneumonia.

The six initiatives included in the “100,000 Lives Campaign” include the use of rapid response teams, the delivery of clinically appropriate care for acute cardiac patients, use of medication reconciliation procedures to prevent adverse drug events, prevention of central line infections, prevention of surgical infections, and prevention of ventilator-assisted pneumonia.

The six initiatives included in the “100,000 Lives Campaign” include the use of rapid response teams, the delivery of clinically appropriate care for acute cardiac patients, use of medication reconciliation procedures to prevent adverse drug events, prevention of central line infections, prevention of surgical infections, and prevention of ventilator-assisted pneumonia.

The six initiatives included in the “100,000 Lives Campaign” include the use of rapid response teams, the delivery of clinically appropriate care for acute cardiac patients, use of medication reconciliation procedures to prevent adverse drug events, prevention of central line infections, prevention of surgical infections, and prevention of ventilator-assisted pneumonia.

PTS: 1

REF: 360 | 361

CON: Infection | Safety | Evidence-Based Practice

ORDERED RESPONSE 17. ANS: B, A, C, D Feedback: In 2010, the CPR guidelines were revised. First, the nurse should always assess the patient for the presence or absence of breath sounds and heart rate. Next, the nurse should perform chest compressions at a rate of 100 compressions per minute. Next, the nurse should attempt to clear the airway if blocked, and finally, the nurse should administer breaths as needed.

Objective: 3. Discuss the relevance of cohort studies to the delivery of tertiary care.

Page: Heading: Inpatient Populations > Technology and Acute Care: Cardiopulmonary Resuscitation Integrated Processes: Nursing Process Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Perfusion; Safety Difficulty: Moderate PTS: 1 REF: 352 CON: Perfusion | Safety 18. ANS: B, C, A, D Feedback: Using the IHI process, or PDSA cycle, the nurses are able to test processes and procedures prior to implementing them on a large scale. First, the nurses should develop a goal statement and determine what will be measured during the testing process. Next, they should proceed with the process using hospital protocols, and then study the entire process, start to finish. Finally, they can make changes to the processes as determined by the results of the study process.

Objective: 6. Identify key infection control issues related to the acute care setting.

Page: Heading: Performance Improvement and Acute Care Settings > Why Do We Need PI in Acute Care Settings?

Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Infection; Critical Thinking; Evidence-Based Practice; Quality Improvement Difficulty: Moderate PTS: 1 REF: 360-362 CON: Promoting Health | Infection | Critical Thinking | Evidence-Based Practice | Quality Improvement COMPLETION 19. ANS: 75 Feedback: To determine the survival rate, first determine the number of people who survived an MVA while wearing a seatbelt. To do this, subtract the number of deaths (117) from the total number of people wearing a seatbelt during an MVA (476). This results in 359 people who survived an MVA. Next, divide the total number of people who survived an MVA (359) by the total number of people who had an MVA while wearing a seatbelt (476). This results in a survival rate of about 0.75, meaning that about 75 percent of people who wore seatbelts during an MVA survived.

Objective: 2. Identify the role of population-level data in the development of the discipline of critical care.

Page: Heading: Inpatient Populations > Evolution of Critical Care: Population Driven Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Safety; Trauma; Critical Thinking Difficulty: Difficult PTS: 1

REF: 350

CON: Promoting Health | Safety | Trauma | Critical Thinking

Chapter 15: Health Planning for Primary Care Settings Multiple Choice Identify the choice that best completes the statement or answers the question.

1. When providing care within the context of primary health care, the most important person(s) is/are: .

1. The individual/family 2. The population 3. The primary-care physician 4. The medical specialist 2. A nurse is looking to reduce the number of adolescents in her community that are using tobacco. The nurse implements a community-wide program to raise awareness about the dangers of nicotine use and creates a support group specifically aimed at teens looking to quit smoking. This is an example of: 1. Health protection.

2. Health promotion.

3. Risk reduction.

4. Tertiary prevention.

3. The nurse at a community-based primary care organization is educating newly hired nurses about the process used at the clinic for developing public health programs aimed at benefitting community members whether they attend the clinic or not. The nurse explains that even though the primary care offered at the clinic focuses on caring for an individual, the health promotion activities that they are developing for the community are focused on: 1. The family.

2. The health-care provider.

3. The health-care organization.

4. The population.

4. A young woman presents to her primary care provider. Her mother has just been diagnosed with Huntington’s disease, and several other members of her family have been diagnosed with the condition as well. She wants to know her options regarding testing to see if she is a genetic carrier. From an ethical perspective, what issue would be most important to discuss with the patient?

1. The cost of Huntington’s disease screening 2. Whether the test is available at the local lab 3. What will happen when her insurance finds out the results 4. The fact that there is no known treatment that can alter the progression of the disease 5. A nurse is working with a community center that primarily serves a nearby Native American tribe. The nurse knows that many of the tribe members suffer from type 2 diabetes. Which of the following interventions is an example of a tertiary prevention?

1. Teaching school-aged children healthy exercise.

2. Conducting a blood glucose screening for program for the adults in the community.

3. Actively encouraging patients diagnosed with type 2 diabetes to have foot, eye, and hemoglobin A1C screening tests every 3 months.

4. Publishing a culturally grounded guide about preventing diabetes using input from the tribal leaders and distributing it to all persons who come to the clinic.

6. A nurse is speaking with her accountant about opening a free clinic as a 501(c)(3) organization. The accountant advises the nurse:

1.

2.

3.

4.

To charge patients his or her regular fees.

To waive her professional fees but charge for testing and more advanced care.

To charge a nominal fee if the patient can afford to pay but provide services regardless.

To charge a small fee, usually around 25% of the service value.

7. The public health department (PHD) is concerned about an outbreak of measles that has occurred in a country adjacent to theirs. Although there are currently no reported cases, as one of their actions the PHD reaches out to all the primary care providers to encourage all of their unvaccinated patients to get vaccinated and to encourage the parents of unvaccinated children to get their vaccinations up to date. Such a public health initiative is an example of: 1. A secondary prevention approach related to screening.

2. A primary prevention approach focused on health protection.

3. A primary prevention approach focused on health promotion.

4. A primary prevention approach focused on screening.

8. A nurse working in an inner-city community health clinic is concerned that her patient education efforts related to achieving a healthy lifestyle are not resulting in any substantial changes in her patients. When she discussed this with one mother whose children are struggling with obesity, the mother explained that she is unable to find fresh fruits and vegetables in their neighborhood and resorts to the use of fast food. This information makes the nurse wonder if this is true for other families. What should she do next?

1. Ask families she sees to keep a food journal to see what food substitutions could be made.

2. Perform a problem- or health-issue-based assessment beginning with an assessment of sources of healthy foods such as supermarkets and farmers markets available in the community.

3. Arrange for free bussing from the community center to the closest supermarket.

4. Refer them to the local supplemental nutrition assistance program (SNAP) office to help them obtain benefits.

9. A new strain of flu has emerged, and the CDC has released a new vaccine that is for use in high-risk populations. Which population is most apt to be high-risk?

1. Pregnant women 2. Older adults 3. Children 4. All of the above 10. A nurse has worked at a community health center for many years. Over the last several months, the nurse has noticed a significant decline in community members using the resources available at the clinic. What is the first thing the nurse should do?

1. Begin offering day care services and free transportation to the clinic to make it more convenient.

2. Reach out to former patients to determine why they are no longer returning to the clinic.

3. Perform a community assessment.

4. Begin offering a new patient reduced fee rate.

11. A nurse is meeting with a patient with no history of IV drug use after he has spoken with the doctor and received a diagnosis of hepatitis B and E. The patient expresses concern that someone will find out about his diagnosis. How does the nurse respond? “I can understand that you are concerned about this. .”

1. “You do not need to worry because this patient information is protected by HIPAA, and I am not allowed to provide this information to anyone who is not responsible for your clinical care.”

2. “However, it is your responsibility to inform all of your previous sexual partners.”

3. “However, this is a reportable disease in this state. This means the public health department will ask you for all your possible contacts that might requiring counseling and/or post-exposure prophylaxis.”

4. None of the above.

12. A primary health nurse has observed an increase in the rate of patients being treated for pertussis in her community. The nurse has seen multiple news reports on the issue and knows that this isn’t an isolated problem. The nurse decides to brainstorm strategies to reduce the pertussis rate in her community. First, the nurse should: 1. Consult with local pediatricians about increasing vaccination rates in children.

2. Begin creating patient education materials to distribute in the waiting room.

3. Perform a health and cultural evaluation of her community.

4. Begin offering vaccinations free of charge.

13. A primary care nurse works at the Native American Health Center, a nonprofit organization serving the California Bay Area Native Population. The center has asked her to put together a comprehensive prevention plan related to type 2 diabetes. Which of the following interventions is an example of a primary intervention?

1. Regular foot and eye care 2. Encouraging a healthy diet and weight loss if appropriate 3. Tight blood sugar control with every meal 4. Screening blood glucose yearly 14. In response to the increase in opioid overdoses within their community, a primary care clinic could implement which of the following with patients who are experiencing chronic pain?

1. Screen appropriately.

2. Prescribe appropriately.

3. Use a statewide automated reporting system.

4. Help patients recognize potential problems.

5. All of the above.

15. A primary care nurse is volunteering at lead screening clinic for children living in an inner-city community.

After performing the screening tests, what is the most important thing for the nurse to do for the children with a positive screen?

1. Conduct a home visit.

2. Refer them to a pediatric specialist for further screening and possible treatment.

3. Offer parents educational materials related to reducing lead exposure in children.

4. Conduct a community-wide environmental assessment to determine the source of the lead exposure.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

16. A nurse is working in a primary health-care setting that has had a recent influx of persons immigrating from a West African country. She wants to incorporate cultural components to the care of patients from this country.

What are possible aspects of the culture that she should learn more about? (Select all that apply.)

1. Kinship 2. Source of income 3. Gender roles 4. Value of children

17. A primary care clinic has decided to hire a nurse to serve as the clinic’s case manager. The essence of case management is the incorporation of the client, the family, and the community into meeting the needs of the patient. Based on current evidence related to this approach, it is primarily hoped that this will lead to: (Select all that apply.)

1. Cost containment.

2. Increased patient satisfaction.

3. Improved patient outcomes.

4. Reduced time needed for each patient to spend with his or her primary health care provider.

18. A hospital nurse is admitting a new patient and asks him if he has a primary care provider. He asks the nurse about the benefit of having a primary care provider, and the nurse replies with which of the following? (Select all that apply.)

1. Increased access to health care 2. Decreased health-care costs 3. Focused on care of disease during the acute phase 4. Increased patient education and advocacy 5. Physician-focused treatment 19. A nurse is working with a primary care physician who has made the decision to move to a Patient-Centered Medical Home (PCMH) model of care after reviewing research presented in the latest issue of a prominent medical journal. The nurse is preparing some educational materials to present to the patients and mentions that the benefits of moving to this model of care include which of the following? (Select all that apply.)

1. Care focusing on the whole individual 2. Integrated care 3. Use of highly specialized PCMH physicians 4. Increased access to care 5. Access to private insurance, meaning the patient can move away from Medicaid Completion Complete each statement.

20. A nurse is putting together a public service announcement in conjunction with the local health department in an effort to get more men screened for colorectal cancer. In the absence of other factors, at what age should average, low-risk men have their first colonoscopy?

Chapter 15: Health Planning for Primary Care Settings Answer Section MULTIPLE CHOICE 1. ANS: 1 Objective: 1. Describe the evolution of primary care at the national and global levels.

Page: Heading: Evolution of Primary Care > United States Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Nursing Roles; Evidence-Based Practice; Health-Care System Difficulty: Easy Feedback 1 Although medical providers (both specialists and primary-care providers) are a necessary part of the team, the most important part of the primary care model of health care is the individual patient or family.

2 Although population health is addressed in the primary-care model of health care, the most important member of the primary health-care team is the individual or family.

3 Although medical providers (both specialists and primary-care providers) are a necessary part of the team, the most important part of the primary care model of health care is the individual patient or family.

4 Although medical providers (both specialists and primary-care providers) are a necessary part of the team, the most important part of the primary care model of health care is the individual patient or family.

PTS: 1 REF: 373 CON: Nursing Roles | Evidence-Based Practice | Health-Care System 2. ANS: 2 Objective: 2. Apply the principles of epidemiology to the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Primary Prevention Within the Primary Care Setting Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Addiction Difficulty: Moderate Feedback 1 Health protection or risk reduction involves clinical activities whose goal is to minimize risk for disease. Vaccinations are one example of health protection or risk reduction interventions.

2 Health promotion activities aim to help people make lifestyle changes to achieve better health.

3 Health protection or risk reduction involves clinical activities whose goal is to minimize risk for disease. Vaccinations are one example of health protection or risk reduction interventions.

4

Tertiary prevention aims to minimize the effects of an existing disease process.

PTS: 1 REF: 378 CON: Promoting Health | Addiction 3. ANS: 4 Objective: 2. Apply the principles of epidemiology to the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Primary Prevention Within the Primary Care Setting Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Although they are often delivered at the individual and family level, primary care health promotion programs are developed with a primary focus on the population.

2 Primary care health promotion programs are developed with a primary focus on the population, not health-care providers.

3 Although organization factors such as capacity are a consideration, primary care health promotion programs are developed with a primary focus on the population.

4 Primary care health promotion programs are developed with a primary focus on the population PTS: 1 REF: 378-380 CON: Promoting Health | Nursing Roles 4. ANS: 4 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Secondary Prevention Within the Primary Care Setting Integrated Processes: Caring Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Family; Assessment; Nursing Roles; Ethics Difficulty: Moderate Feedback 1 Although cost for screening can be an ethical issue, the fact that there is no known treatment that can alter the progression of the disease is the most important ethical consideration.

2 Even if the testing is not available at the local lab, it is possible for the lab to send the specimen out for more specialized testing. The fact that there is no known treatment that can alter the progression of the disease is the most important ethical consideration.

3 The Genetic Information Nondiscrimination Act prevents insurance companies from dropping coverage based on genetic testing results. The fact that there is no known treatment that can alter the progression of the disease is the most important ethical consideration.

4 The fact that there is no known treatment that can alter the progression of the disease is the most important ethical consideration.

PTS: 1 REF: 382 CON: Family | Assessment | Nursing Roles | Ethics 5. ANS: 3 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Tertiary Prevention Within the Primary Care Setting Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Metabolism; Assessment Difficulty: Moderate Feedback 1 This is an example of primary prevention. Providing healthy exercise for children helps reduce risk of developing the disease.

2 This is an example of secondary prevention. Conducting blood glucose screening program helps to identify apparently well persons in the community who may have type 2 diabetes.

3 This is an example of tertiary prevention because its goal is to minimize complications (such as eye disease and foot disease) in persons diagnosed with type 2 diabetes.

4 This is an example of primary prevention because its goal is to prevent the development of type 2 diabetes in people who do not have the disease.

PTS: 1 REF: 383 CON: Promoting Health | Metabolism | Assessment 6. ANS: 3 Objective: 2. Apply the principles of epidemiology to the primary care setting.

Page: Heading: Public Primary Care Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Economics; Legal; Health-Care System Difficulty: Moderate Feedback 1 For a free clinic to qualify as a 501 (c)(3) organization, it must provide services independent of a patient’s ability to pay. It could be free, or the patient could be charged a nominal fee. However, the services should be provided regardless of payment received.

2 For a free clinic to qualify as a 501 (c)(3) organization, it must provide services independent of a patient’s ability to pay. It could be free, or the patient could be charged a nominal fee. However, the services should be provided regardless of payment received.

3 For a free clinic to qualify as a 501 (c)(3) organization, it must provide services independent of a patient’s ability to pay. It could be free, or the patient could be charged a nominal fee. However, the services should be provided regardless of payment received.

4 For a free clinic to qualify as a 501 (c)(3) organization, it must provide services independent of a patient’s ability to pay. It could be free, or the patient could be charged a nominal fee. However, the services should be provided regardless of payment received.

PTS: 1 REF: 383 | 384 CON: Economics | Legal | Health-Care System 7. ANS: 2 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Primary Prevention Within the Primary Care Setting; Immunization and Health Protection Integrated Processes: Communication and Documentation Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Immunity Difficulty: Moderate Feedback 1 Screening is primarily a secondary prevention approach used to identify persons who may have a disease, not a health protection approach.

2 Immunization is a primary prevention approach that increases the immunity of the host and is thus an example of health protection.

3 Immunization is a primary prevention approach that increases the immunity of the host and is thus an example of health protection. By contrast, a health promotion approach focuses on changing behaviors linked to risk for disease.

4 Screening is primarily a secondary prevention approach used to identify persons who may have a disease not a health protection approach.

PTS: 1 REF: 380 | 381 CON: Promoting Health | Immunity 8. ANS: 2 Objective: 2. Apply the principles of epidemiology to the primary care setting.

Page: Heading: Primary Prevention Within the Primary Care Setting; Health promotion Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analyzing Concept: Promoting Health; Critical Thinking; Nutrition Difficulty: Difficult Feedback 1 Although keeping a food journal might provide important information related to individual and family food choices, her first step is to determine if there are indeed limited resources within the community for obtaining healthy food.

2 Her first step is determining if there are indeed limited resources within the community for obtaining healthy food. A problem-focused assessment is the best approach for gathering these data.

3 Arranging for free busing is an action step that would occur only after the assessment is completed. At this point she does not have enough information to know if this service is needed.

4 Referring individuals and families to the local supplemental nutrition assistance program (SNAP) office to help them obtain benefits is an action step. At this point she does not have enough information to know if this service is needed.

PTS: 1 9. ANS: 4

REF: 384-386

CON: Promoting Health | Critical Thinking | Nutrition

Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Emerging Primary Care Public Health Issues Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Promoting Health; Infection; Critical Thinking Difficulty: Moderate Feedback 1 Older adults, pregnant women, and children are all known to be especially vulnerable to flu. It is important to follow the CDC guidelines as to who is most vulnerable to a specific strain of flu.

2 Older adults, pregnant women, and children are all known to be especially vulnerable to flu. It is important to follow the CDC guidelines as to who is most vulnerable to a specific strain of flu.

3 Older adults, pregnant women, and children are all known to be especially vulnerable to flu. It is important to follow the CDC guidelines as to who is most vulnerable to a specific strain of flu.

4 Older adults, pregnant women, and children are all known to be especially vulnerable to flu. It is important to follow the CDC guidelines as to who is most vulnerable to a specific strain of flu.

PTS: 1 REF: 389 CON: Promoting Health | Infection | Critical Thinking 10. ANS: 2 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Ongoing Use of Public Health Science in the Primary Care Setting > Communication and Collaboration Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Critical Thinking Difficulty: Difficult Feedback 1 The first logical step is to talk with former patients who are no longer coming to the clinic. This can be followed by a community assessment to determine the status of the community and see if there are any changes within the community and how they impact the health of its members.

2 The first logical step is to talk with former patients who are no longer coming to the clinic. This can be followed by a community assessment to determine the status of the community and see if there are any changes within the community and how they impact the health of its members.

3 The first logical step is to talk with former patients who are no longer coming to the clinic. This can be followed by a community assessment to determine the status of the community and see if there are any changes within the community and how they impact the health of its members.

4 Most free clinics offer their services for free or reduced rates already. It is not likely that too-high fees are the problem. The first logical step is to talk with former patients

who are no longer coming to the clinic. This can be followed by a community assessment to determine the status of the community and see if there are any changes within the community and how they impact the health of its members.

PTS: 1 REF: 392-394 CON: Assessment | Promoting Health | Critical Thinking 11. ANS: 3 Objective: 5. Discuss current policy issues related to the delivery of primary care.

Page: Heading: Ongoing Use of Public Health Science in the Primary Care Setting > Communication and Collaboration Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Communication; Legal; Health-Care System Difficulty: Moderate Feedback 1 The nurse will need to inform the local health department as mandated by the state health department. The health department conducts surveillance of hepatitis B for the purpose of monitoring trends, assessing the burden of disease, identifying infected persons requiring counseling and medical follow-up, identifying contacts of infected persons requiring counseling and/or post-exposure prophylaxis, and identifying/controlling outbreaks.

2 The nurse will need to inform the local health department by laws mandated by the state health department. The health department conducts surveillance of Hepatitis B for the purpose of monitoring trends, assessing the burden of disease, identifying infected persons requiring counseling and medical follow-up, identifying contacts of infected persons requiring counseling and/or post-exposure prophylaxis, and identifying/controlling outbreaks.

3 The nurse will need to inform the local health department by laws mandated by the state health department. The health department conducts surveillance of Hepatitis B for the purpose of monitoring trends, assessing the burden of disease, identifying infected persons requiring counseling and medical follow-up, identifying contacts of infected persons requiring counseling and/or post-exposure prophylaxis, and identifying/controlling outbreaks.

4 The nurse will need to inform the local health department by laws mandated by the state health department. The health department conducts surveillance of Hepatitis B for the purpose of monitoring trends, assessing the burden of disease, identifying infected persons requiring counseling and medical follow-up, identifying contacts of infected persons requiring counseling and/or post-exposure prophylaxis, and identifying/controlling outbreaks.

PTS: 1 REF: 392 | 393 CON: Infection | Communication | Legal | Health-Care System 12. ANS: 3 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Case Study: Pertussis Vaccination Program for Parents Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying]

Concept: Infection; Diversity; Assessment; Promoting Health; Critical Thinking Difficulty: Moderate Feedback 1 The first thing the nurse should do is perform a community health and cultural assessment. This helps her understand the needs of the people within the community. It can also help her develop a customized and appropriate vaccination program.

2 The first thing the nurse should do is perform a community health and cultural assessment. This helps her understand the needs of the people within the community. It can also help her develop a customized and appropriate vaccination program.

3 The first thing the nurse should do is perform a community health and cultural assessment. This helps her understand the needs of the people within the community. It can also help her develop a customized and appropriate vaccination program.

4 The first thing the nurse should do is perform a community health and cultural assessment. This helps her understand the needs of the people within the community. It can also help her develop a customized and appropriate vaccination program.

PTS: 1 REF: 395 CON: Infection | Diversity | Assessment | Promoting Health | Critical Thinking 13. ANS: 2 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Primary Prevention Within the Primary Care Setting Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Metabolism Difficulty: Moderate Feedback 1 Regular foot and eye care, and tight blood sugar control are examples of tertiary interventions. Their purpose is to minimize health complications related to diabetes in someone who has already been diagnosed.

2 Improving diet and losing weight are examples of a primary intervention. The goal is to prevent the patient from getting diabetes in the first place.

3 Regular foot and eye care, and tight blood sugar control are examples of tertiary interventions. Their purpose is to minimize health complications related to diabetes in someone who has already been diagnosed.

4 Yearly blood glucose screening is an example of a secondary intervention. Its purpose is to identify and diagnose people who are in the early stages of diabetes.

PTS: 1 REF: 377 | 378 CON: Promoting Health | Metabolism 14. ANS: 5 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Emerging Primary Care Public Health Issues Integrated Processes: Nursing Process Client Need: Psychosocial integrity Cognitive Level: Application [Applying]

Concept: Addiction; Regulations; Nursing Roles; Medication Difficulty: Moderate Feedback 1 In primary care, it is imperative to screen appropriately, prescribe appropriately, and help patients recognize potential problems.

2 In primary care, it is imperative to screen appropriately, prescribe appropriately, and help patients recognize potential problems.

3 In primary care, it is imperative to screen appropriately, prescribe appropriately, and help patients recognize potential problems.

4 It is important for offices to use a statewide automated reporting system, if available, to cut down on multiple medications and inappropriate refills.

5 In primary care, it is imperative to screen appropriately, prescribe appropriately, and help patients recognize potential problems, and it is important for offices to use a statewide automated reporting system, if available, to cut down on multiple medications and inappropriate refills.

PTS: 1 REF: 390 CON: Addiction | Regulations | Nursing Roles | Medication 15. ANS: 2 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Secondary Prevention Within the Primary Care Setting Integrated Processes: Nursing Process Client Need: Physiological Integrity Cognitive Level: Analysis [Analyzing] Concept: Assessment; Development Difficulty: Moderate Feedback 1 If it is confirmed that the child has lead poisoning, a home visit may be warranted to assess for possible sources of exposure in the home but is not the most important thing to do for the children with a positive screen.

2 The first step the nurse should take is to refer the parents to a pediatric specialist to confirm the results and, if warranted, start treatment. Screening identifies persons who may have the disease. The next step is to confirm a diagnosis.

3 Offering parents educational materials related to reducing lead exposure in children should be done with all parents attending the clinic but is not the most important thing to do for the children with a positive screen.

4 Conducting a community wide environmental assessment to determine the source of the lead exposure would be an important step if a number of children attending the clinic were confirmed to have lead poisoning, but it is not the most important thing to do for the children with a positive screen.

PTS: 1

REF: 382

CON: Assessment | Development

MULTIPLE RESPONSE 16. ANS: 1, 3, 4 Objective: 1. Describe the evolution of primary care at the national and global levels.

Page:

Heading: Cultural Context Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity; Assessment; Promoting Health; Family Difficulty: Moderate

1 2

3 4

Feedback Kinships, gender roles, and value of children are all important cultural aspects that should be considered to help provide care within the context of the immigrant families.

Source of income is not a cultural issue, although it might be important when doing an initial assessment to determine if there are any potential environmental exposures or socioeconomic stresses.

Kinships, gender roles, and value of children are all important cultural aspects that should be considered to help provide care within the context of the immigrant families.

Kinships, gender roles, and value of children are all important cultural aspects that should be considered to help provide care within the context of the immigrant families.

PTS: 1 REF: 394 CON: Diversity | Assessment | Promoting Health | Family 17. ANS: 1, 3 Objective: 1. Describe the evolution of primary care at the national and global levels.

Page: Heading: Tertiary Prevention Within the Primary Care Setting; Case Management Integrated Processes: Nursing Process Client Need: Physiological Integrity Cognitive Level: Applying Concept: Evidence-Based Practice; Economics; Nursing Roles Difficulty: Moderate

1 2

3 4

Feedback Case management has a positive impact on cost containment and improving patient outcomes.

Although this approach may also result in increased patient satisfaction, the primary evidence-based outcomes are the positive impact on cost containment and improving patient outcomes.

Case management has a positive impact on cost containment and improving patient outcomes.

Case management has a positive impact on cost containment and improving patient outcomes. It is not directly associated with the time spent with the primary care provider.

PTS: 1 REF: 383 CON: Evidence-Based Practice | Economics | Nursing Roles 18. ANS: 1, 2, 4 Objective: 1. Describe the evolution of primary care at the national and global levels.

Page: Heading: Evolution of Primary Care > United States Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles; Health-Care System

Difficulty: Moderate

1

2

3

4

5

Feedback Primary care is a patient-centered model of care and focuses on the patient and his or her needs. It encourages increased access to health care, increased education, decreased health-care costs, and preventative care.

Primary care is a patient-centered model of care and focuses on the patient and his or her needs. It encourages increased access to health care, increased education, decreased health-care costs, and preventative care.

Primary care is a patient-centered model of care and focuses on the patient and his or her needs across the continuum of health that includes the care of persons with disease during both acute and chronic stages. It encourages increased access to health care, increased education, decreased health-care costs, and preventative care.

Primary care is a patient-centered model of care and focuses on the patient and his or her needs. It encourages increased access to health care, increased education, decreased health-care costs, and preventative care.

Primary care is a patient-centered model of care and focuses on the patient and his or her needs. It encourages increased access to health care, increased education, decreased health-care costs, and preventative care.

PTS: 1 REF: 373 CON: Promoting Health | Nursing Roles | Health-Care System 19. ANS: 1, 2, 4 Objective: 6. Describe the Patient-Centered Medical Home (PCMH) component of the Affordable Care Act. Page: Heading: Ongoing Use of Public Health Science in the Primary Care Setting > Health-Care Policy and Primary Care Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Health-Care System; Nursing Roles Difficulty: Moderate

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Feedback Patient-centered medical homes are a model of care that focuses on patient-centered care and coordination of medical services. Benefits include patient-centered care focusing on the whole individual, integrated and highly coordinated care, and increased access to care. The patient can keep his same primary care physician and does not need to switch to a different doctor. Finally, the patient can retain his use of Medicaid for care of noncommunicable diseases.

Patient-centered medical homes are a model of care that focuses on patient-centered care and coordination of medical services. Benefits include patient-centered care focusing on the whole individual, integrated and highly coordinated care, and increased access to care. The patient can keep his same primary care physician and does not need to switch to a different doctor. Finally, the patient can retain his use of Medicaid for care of noncommunicable diseases.

Patient-centered medical homes are a model of care that focuses on patient-centered care and coordination of medical services. Benefits include patient-centered care focusing on the whole individual, integrated and highly coordinated care, and increased access to care. The patient can keep his same primary care physician and does not need to switch to a different doctor. Finally, the patient can retain his use of Medicaid for care of noncommunicable

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diseases.

Patient-centered medical homes are a model of care that focuses on patient-centered care and coordination of medical services. Benefits include patient-centered care focusing on the whole individual, integrated and highly coordinated care, and increased access to care. The patient can keep his same primary care physician and does not need to switch to a different doctor. Finally, the patient can retain his use of Medicaid for care of noncommunicable diseases.

Patient-centered medical homes are a model of care that focuses on patient-centered care and coordination of medical services. Benefits include patient-centered care focusing on the whole individual, integrated and highly coordinated care, and increased access to care. The patient can keep his same primary care physician and does not need to switch to a different doctor. Finally, the patient can retain his use of Medicaid for care of noncommunicable diseases.

PTS: 1 REF: 391 | 392 CON: Evidence-Based Practice | Health-Care System | Nursing Roles COMPLETION 20. ANS: 50 Objective: 3. Discuss the integration of primary, secondary, and tertiary care interventions in the primary care setting.

Page: Heading: Epidemiology and Targeted Prevention Levels in Primary Care > Secondary Prevention Within the Primary Care Setting Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Cellular Regulation; Nursing Roles Difficulty: Easy Feedback: Current guidelines recommend a man have his first colonoscopy at age 50, and then every 10 years, assuming the first screening was negative.

PTS: 1 REF: 379 CON: Assessment | Promoting Health | Cellular Regulation | Nursing Roles

Chapter 16: Health Planning with Rural and Urban Communities Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A public health nurse (PHN) has been tasked with addressing the rise in teen pregnancies in her communities.

She wishes to create linkages among agencies that provide care to teens and/or obstetrical care generally.

Which would be her first step based on the six-step guide created by The Center on Education and Training for Employment at The Ohio State University?

1. State the key challenges, articulate why they are better addressed by multiple agencies, and name potential key players.

2. Create a harmonious planning environment among agencies.

3. Assess the need to work in partnership with other agencies.

4. Make sure the members of the partnership are equally representative of the community-at-large in terms of culture, race, and perspective.

2. A nurse is moving to a rural area and beginning work at a health clinic there. The nurse is performing a basic community assessment to prepare for working with this new community. The nurse knows that which of the following is not characteristic of the needs of the rural population?

1. More likely to smoke tobacco and drink alcohol 2. Have less education and higher rate of poverty 3. More likely to have increased dental problems 4. More likely to have a higher life expectancy 3. A nurse is reviewing top 10 priorities from Rural Healthy People 2020 National Survey. Which of the following is not one of the top 10 priorities?

1. Access to quality health services 2. Diabetes 3. Mental health and mental disorders 4. Cancer 4. A nurse has been volunteering at a free clinic located at a community center in a rural area twice a month for several years. Over the last few months, the nurse has noticed that the patient load has increased substantially as the population of this community has aged. It is not feasible for the nurse to spend more time at this center.

What might be the most feasible action she could take to continue to serve the needs of the community?

1. Try to hire a nurse to work at the free clinic.

2. Set up a telehealth arrangement so the nurse can answer simple questions from home or while on the road.

3. Set up a scheduling and triage system so the nurse only sees the neediest patients.

4. Consider closing the free clinic and opening a fee-for-service center.

5. A nurse is working with several community members in an inner-city environment to help address broken windows and damaged buildings in their community. They’ve had several residents volunteer to form a group that will repair the damages and keep the community looking well cared for. This is an example of: 1. Community organization.

2. Community empowerment.

3. Community partnerships.

4. None of the above.

6. A nurse is looking to address teen gang violence in a nearby community using the principles of community organizing. The nurse has spent a great deal of time in the community performing a community assessment and getting to know residents and key stakeholders. What is the next step?

1. Identify core leaders to organize the community around the main issue.

2. Identify clear goals that relate to the overarching goal of reducing teen gang violence.

3. Identify available resources.

4. Create a plan to evaluate their actions.

7. A nurse is working in a family planning clinic that provides treatment for sexually transmitted infections (STIs). The nurse has noticed a significant increase in the incidence rate of STIs in the young women being seen at the clinic and wonders if this is a community-wide problem. Which of the following techniques would be a helpful first step in answering her question?

1. Develop collaborative relationships with other health-care providers in the area concerned with STIs. 2. Perform a comprehensive community assessment.

3. Interview several key stakeholders in the community.

4. Create a federally qualified health center (FQHC).

8. A nurse is working on his or her first community-based participatory research (CBPR) study. An essential factor specific to CBPR research that the nurse should be careful to address is: 1. The ethical protection of human participants.

2. Making sure that community members aren’t directly involved in the research.

3. Ensuring there is a benefit to the community related to the study.

4. Choosing a topic that is neutral to the community.

9. A nurse is considering entering the specialty of parish nursing. Nurses working in this field perform which of the following activities specific to that of a parish nurse?

1. Advocating for individuals within the parish.

2. Improving spiritual health through practices such as grief counseling.

3. Providing health education.

4. Performing health screenings of parish members as needed.

10. A young college student in a rural community has called the health department to get a recommendation for a health center where she could be seen for a chronic health problem. She is uninsured and can’t afford the private clinic in town. The PHN recommends that the student: 1. Visit the local health department for management and treatment of her care.

2. Proceed to the local emergency department.

3. Visit the community health center run by an advanced practice registered nurse (APRN).

4. None of the above.

11. A nursing professor is looking to give students clinical experience in relation to health program planning with a focus on implementation. The professor proposes which of the following projects to the curriculum committee?

1. A community assessment of three different neighborhoods 2. A mock community assessment and health policy development for a hypothetical community 3. A requirement that each student complete a paper about the history of health policy in the United States 4. Placement of students in a local community center that has requested the school partner with them on population-level health interventions they would like to put in place

12. A nurse is performing an assessment of a community where the population totals 55,542 persons and has a population density of 1,000 persons per square mile. How does the nurse classify the area?

1. Rural 2. Suburban 3. Urban cluster 4. Urbanized area 13. A student nurse is reviewing important global communities for ideas about a final research project. The student nurse discovers a movement in Europe that focuses on reducing health disparities and involving the local community in program design and implementation. What program does this describe?

1. Healthy Cities 2. Healthy People 3. Medical Homes 4. Racial and Ethnic Approaches to Community Health 14. Jacob has worked as a PHN in urban areas and has just now moved to a rural area and taken a job in the public health department in charge of county outreach programs. Based on data he recently reviewed from the Federal Office of Rural Health Policy, the following might be programs he should consider except: 1. An oral health program.

2. A chronic disease self-management program.

3. An internet-based health education program.

4. A mobile pharmacy program.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

15. The state public health department in a large northern state has convened a task force to help optimize the health of the populations living in the state’s rural communities by addressing major barriers to promoting optimal health in those rural communities. Which of the following is a major barrier? (Select all that apply.)

1. Decreased access health care 2. Lack of funding for safety net programs 3. Difficulty recruiting physicians, physician assistants, and nurse practitioners 4. Migration of people from other areas 16. For the PHN working in a large urban public health department, what are possible health issues facing the population as a whole? (Select all that apply.)

1. Higher crime rates 2. Higher levels of air pollution 3. Lower socioeconomic status 4. Higher incidence of sexually transmitted infections 17. A nurse is looking to develop a coalition of women’s health providers and experts in the community. Which of the following strategies would be effective in helping to build a coalition? (Select all that apply.)

1. Create detailed objectives and activities 2. Address diversity among the membership 3. Map assets 4. Convene the coalition prior to drafting a mission statement and structure 5. Maintain and evaluate the vitality of the coalition

18. A nurse is speaking with members of a community center about using community organization as a process for change. The nurse explains that there are several specific principles for creating change within the community. Which of the following are examples of these principles? (Select all that apply.)

1. Use nonviolence as a tool.

2. Apply downstream assessment principles.

3. The nurse will provide solutions for the community to follow.

4. Increase the community’s decision-making ability.

5. Aim to minimize social and economic disparities.

19. Nurses at a large urban medical center have noticed that the number of patients with type 2 diabetes being seen at the diabetes clinic with uncontrolled A1C has increased. They have decided to conduct a focused assessment. Which factors specific to the urban environment might be an issue for their population? (Select all that apply.)

1. Not enough pharmacies that carry needed mediations 2. Lack of grocery stores with healthy food choices 3. Increased numbers of patients with different cultural perspectives on food and health 4. Limited access to safe areas for exercise Other 20. A group of nurses wants to develop a collaborative effort that works to reduce the obesity rate in their community. Place the following steps in the order in which they should be performed (A-D): A. Describe the major problems and issues and determine how a partnership would benefit their goals.

B. Identify the key stakeholders within the community and beneficial collaborators.

C. Determine if there is a need to collaborate with other agencies or individuals.

D. Establish mutual goals and a plan that addresses those goals.

Chapter 16: Health Planning with Rural and Urban Communities Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 1. Define and implement the concepts of community partnership, community linkage, and community collaboration.

Page: Heading: Nursing in Partnership with Communities > Definition of Partnership Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Collaboration; Promoting Health; Pregnancy Difficulty: Moderate Feedback 1 Step 2 is to state the key challenges, articulate why they are better addressed by multiple agencies, and name potential key players.

2 Step 5 is to create a harmonious planning environment among agencies, 3 Step 1 is to assess the need to work in partnership with other agencies.

4 Although making sure the members of the partnership are equally representative of the community-at-large in terms of culture, race, and perspective is an important step, it is not specific to creating linkages and is not one of the steps included in the six-step guide created by The Center on Education and Training for Employment at The Ohio State University.

PTS: 1 REF: 399 CON: Collaboration | Promoting Health | Pregnancy 2. ANS: 4 Objective: 2. Identify specific health needs of rural communities and of urban communities.

Page: Heading: Rural Communities Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Moderate Feedback 1 People living in rural populations tend to have increased dental problems, are more likely to drink alcohol and smoke tobacco, and have less education and a higher rate of poverty. They also have a lower life expectancy.

2 People living in rural populations tend to have increased dental problems, are more likely to drink alcohol and smoke tobacco, and have less education and a higher rate of poverty. They also have a lower life expectancy.

3 People living in rural populations tend to have increased dental problems, are more likely to drink alcohol and smoke tobacco, and have less education and a higher rate of poverty. They also have a lower life expectancy.

4 People living in rural communities tend to live further from health-care facilities and often have lower life expectancies.

PTS: 1 REF: 401 | 402 CON: Assessment | Promoting Health 3. ANS: 4 Objective: 3. Discuss potential solutions to decrease disparities in rural areas.

Page: Heading: Rural Communities Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Moderate Feedback 1 Top 10 Priorities from Rural Healthy People 2020 National Survey by rank: included access to quality health services, nutrition and weight status, diabetes, mental health and mental disorders, substance abuse, heart disease and stroke, physical activity and health, older adults, maternal, infant, and child health, tobacco use.

2 Top 10 Priorities from Rural Healthy People 2020 National Survey by rank included access to quality health services, nutrition and weight status, diabetes, mental health and mental disorders, substance abuse, heart disease and stroke, physical activity and health, older adults, maternal, infant, and child health, tobacco use.

3 Top 10 Priorities from Rural Healthy People 2020 National Survey by rank: included access to quality health services, nutrition and weight status, diabetes, mental health and mental disorders, substance abuse, heart disease and stroke, physical activity and health, older adults, maternal, infant, and child health, tobacco use.

4 Top 10 Priorities from Rural Healthy People 2020 National Survey by rank: included access to quality health services, nutrition and weight status, diabetes, mental health and mental disorders, substance abuse, heart disease and stroke, physical activity and health, older adults, maternal, infant, and child health, tobacco use. Cancer was not one of the top 10 priorities.

PTS: 1 REF: 402 CON: Promoting Health 4. ANS: 2 Objective: 3. Discuss potential solutions to decrease disparities in rural areas.

Page: Heading: Rural Communities > Potential Solutions to Decrease Health Disparities in Rural Areas Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Critical Thinking Difficulty: Moderate Feedback 1 Because the nurse is volunteering time, it is likely that the community center would not be able to afford to pay a nurse or other health-care provider. There is also a probable shortage of nurses available for hire.

2 This system would help the nurse answer simple questions or provide immediate advice for common problems. It would likely open up clinic time for patients requiring a more in-depth visit.

3 Although it is true that the nurse would be able to serve the neediest members of the community, there are many people who need health issues addressed. These people could have simple conditions that later escalate into far more serious concerns without

4

timely interventions.

Many people in the rural population have difficulty accessing or affording care. Setting up a fee-for-service-center would likely exclude many community members from receiving needed care.

PTS: 1 REF: 405 CON: Promoting Health | Critical Thinking 5. ANS: 1 Objective: 5. Describe the steps in community organizing and coalition building; identify how these activities can be a useful tool for positive community change.

Page: Heading: Community Organization and Public Health Nursing > Community Organizing Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration; Safety Difficulty: Moderate Feedback 1 Community organization is a process where community members come together to help the community grow by developing goals and strategies to meet those goals.

2 Community empowerment is a process where community members are empowered to make choices and encourages them to transform those choices into specific strategies to effect change.

3 Community partnerships are collaborative relationships where several agencies or organizations in the community come together to accomplish specific goals.

4 The correct answer is community organization, a process where community members come together to help the community grow by developing goals and strategies to meet those goals.

PTS: 1 REF: 409 CON: Promoting Health | Collaboration | Safety 6. ANS: 1 Objective: 5. Describe the steps in community organizing and coalition building; identify how these activities can be a useful tool for positive community change.

Page: Heading: Community Organization and Public Health Nursing > Community Organizing Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Critical Thinking; Collaboration; Violence Difficulty: Moderate Feedback 1 Once the nurse has performed a community assessment and assimilated into the community, it is important to identify core leaders who can be effective at rallying the community around the main issue. Next, the group should establish clear goals and identify available resources. Finally, they should create a plan to evaluate the effectiveness of their actions.

2 Once the nurse has performed a community assessment and assimilated into the community, it is important to identify core leaders who can be effective at rallying the community around the main issue. Next, the group should establish clear goals and identify available resources. Finally, they should create a plan to evaluate the effectiveness of their actions.

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4

Once the nurse has performed a community assessment and assimilated into the community, it is important to identify core leaders who can be effective at rallying the community around the main issue. Next, the group should establish clear goals and identify available resources. Finally, they should create a plan to evaluate the effectiveness of their actions.

Once the nurse has performed a community assessment and assimilated into the community, it is important to identify core leaders who can be effective at rallying the community around the main issue. Next, the group should establish clear goals and identify available resources. Finally, they should create a plan to evaluate the effectiveness of their actions.

PTS: 1 REF: 411 CON: Assessment | Promoting Health | Critical Thinking | Collaboration | Violence 7. ANS: 1 Objective: 5. Describe the steps in community organizing and coalition building; identify how these activities can be a useful tool for positive community change.

Page: Heading: Community Organization and Public Health Nursing > Coalition Building Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Family; Sexuality; Promoting Health; Critical Thinking; Collaboration Difficulty: Moderate Feedback 1 Developing collaborative relationships with other health-care providers in the area would help her gather further data related to trends in STIs and could potentially lead to the building of a community coalition to address the problem.

2 A comprehensive community assessment is broad and helps provide information about the community’s health and possible risk factors for disease and injury in general.

Because she is concerned with a specific health issue, a problem- or health issue-based assessment would be the appropriate approach. Developing collaborative relationships with other health-care providers in the area is a good first step to doing this type of assessment to help identify the extent of the problem.

3 Interviewing several key stakeholders in the community is only one aspect of doing a problem/health issue-focused assessment to help identify the extent of the problem.

4 Creating a FQHC is an intervention and occurs after an assessment is complete and the team comes to the conclusion that this intervention would address the issue.

PTS: 1 REF: 411 | 412 CON: Family | Sexuality | Promoting Health | Critical Thinking | Collaboration 8. ANS: 3 Objective: 6. Discuss the potential role of the nurse and the impact on the health-care system in community-based participatory research, parish nursing, healthy communities/healthy cities, nurse-managed clinics, and community academic partnerships.

Page: Heading: Community Organization and Public Health Nursing > Community-Based Participatory Research Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Evidence-Based Practice; Ethics

Difficulty: Difficult Feedback 1 A specific factor in CBPR research is that the research will benefit the community related to the study. Ethical protection of human subjects is important in all research.

2 Community members are full partners in all aspects of the study.

3 CBPR requires protection of the community. This includes determining that the study will benefit the community.

4 When performing CBPR projects, it is first important to conduct a study that will benefit the community.

PTS: 1 REF: 412 | 413 CON: Promoting Health | Evidence-Based Practice | Ethics 9. ANS: 2 Objective: 6. Discuss the potential role of the nurse and the impact on the health-care system in community-based participatory research, parish nursing, healthy communities/healthy cities, nurse-managed clinics, and community academic partnerships.

Page: Heading: Population Nursing Roles in the Community > Parish Nursing/Faith Community Nursing Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Grief and Loss; Spirituality; Nursing; Nursing Roles Difficulty: Moderate Feedback 1 Parish nurses perform a lot of roles similar to traditional nursing roles, such as advocacy. But they also provide spiritual care through shared beliefs. An example of this is in providing grief counseling. Their shared faith will guide the counseling process significantly more than nurses who don’t work within the parish setting.

2 Parish nurses perform a lot of roles similar to traditional nursing roles, such as providing health screening and education. But they also provide spiritual care through shared beliefs. An example of this is in providing grief counseling. Their shared faith will guide the counseling process significantly more than nurses who don’t work within the parish setting.

3 Parish nurses perform a lot of roles similar to traditional nursing roles, such as providing health education. But they also provide spiritual care through shared beliefs.

An example of this is in providing grief counseling. Their shared faith will guide the counseling process significantly more than nurses who don’t work within the parish setting.

4 Parish nurses perform a lot of roles similar to traditional nursing roles, such as providing health screening. But they also provide spiritual care through shared beliefs.

An example of this is in providing grief counseling. Their shared faith will guide the counseling process significantly more than nurses who don’t work within the parish setting.

PTS: 1 REF: 413 CON: Grief and Loss | Spirituality | Nursing | Nursing Roles 10. ANS: 3 Objective: 6. Discuss the potential role of the nurse and the impact on the health-care system in community-based participatory research, parish nursing, healthy communities/healthy cities, nurse-managed clinics, and community academic partnerships.

Page: Heading: Population Nursing Roles in the Community > Nurse-Managed Health Centers

Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health-Care System; Communication Difficulty: Moderate Feedback 1 Local health departments in general do not provide care for chronic health conditions.

The correct answer is to visit the community center run by the APRN. These nurse-managed health centers are great resources for underserved populations and especially people who are uninsured.

2 It is not appropriate for the young woman to visit the emergency department for management of chronic health conditions. The correct answer is to visit the community center run by the APRN. These nurse-managed health centers are great resources for underserved populations and especially people who are uninsured.

3 The correct answer is to visit the community center run by the APRN. These nurse-managed health centers are great resources for underserved populations and especially people who are uninsured.

4 The correct answer is to visit the community center run by the APRN. These nurse-managed health centers are great resources for underserved populations and especially people who are uninsured.

PTS: 1 REF: 414 CON: Health-Care System | Communication 11. ANS: 4 Objective: 6. Discuss the potential role of the nurse and the impact on the health-care system in community-based participatory research, parish nursing, healthy communities/healthy cities, nurse-managed clinics, and community academic partnerships.

Page: Heading: Population Nursing Roles in the Community > Community Academic Partnerships Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Conducting a community assessment is only the beginning of the health planning process and does not include implementation.

2 A mock community assessment and health policy development for a hypothetical community does not include the implementation phase of health planning.

3 A requirement that each student complete a paper about the history of health policy in the United States is not related to health program planning and implementation.

4 Having the students placed in a local community center that has requested the school partner with them on population-level health interventions they would like to put in place would provide students an opportunity to learn about program planning with a focus on implementation.

PTS: 1 REF: 415 CON: Promoting Health | Nursing Roles 12. ANS: 4 Objective: 1. Describe the unique characteristics of rural and urban environments.

Page: Heading: Urban Communities > Definitions of Urban

Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 Rural areas are those areas not classified as urban or suburban, usually with a population less than 2,500.

2 A suburb is a residential area on the outskirts of the nearby urban community.

3 An urban cluster has between 2,500 and 50,000 people living within its borders.

4 An urbanized area has a population of 50,000 or more people and has a population density of 1,000 persons per square mile.

PTS: 1 REF: 403 | 407 CON: Assessment | Promoting Health 13. ANS: 1 Objective: 6. Discuss the potential role of the nurse and the impact on the health-care system in community-based participatory research, parish nursing, healthy communities/healthy cities, nurse-managed clinics, and community academic partnerships.

Page: Heading: Population Nursing Roles in the Community > Healthy Cities and Health Communities Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Health-Care System; Nursing Roles Difficulty: Moderate Feedback 1 Healthy Cities is a European program that focuses on reducing health disparities and also involves the local community in program planning and implementation.

2 Healthy People is an American program that looks to improve the health of all Americans by setting a number of specific goals and objectives to be completed within a specified amount of time.

3 Medical homes are a concept that improves access to care, especially in rural areas. It does not address health-care policy.

4 Racal and Ethnic Approaches to Community Health is an American program funded by the CDC that aims to reduce health disparities based on race and ethnicity.

PTS: 1 REF: 414 CON: Promoting Health | Health-Care System | Nursing Roles 14. ANS: 2 Objective: 1. Describe the unique characteristics of rural and urban environments and 2. Identify specific health needs of rural communities and of urban communities. Discuss the potential role of the nurse and the impact on the health-care system in community-based participatory research, parish nursing, healthy communities/healthy cities, nurse-managed clinics, and community academic partnerships.

Page: Heading: Rural Communities Integrated Processes: The Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Health-Care Systems, Assessment Difficulty: Moderate Feedback

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One-third of rural dwellers lose all of their teeth by age 65 for lack of dental services and fluoridation.

Rural residents experience greater rates of chronic disease than any other segment of the U.S. population.

Because more than 50% of rural Americans lack access to 25 Mbps/3 Mbps of bandwidth, the benchmark for Internet speed according to the Federal Communications Commission, an Internet-based program might not be available for a large number of county households.

Some 2,000 rural communities have only one pharmacist, who often is the only local health-care provider.

PTS: 1

REF: 404 | 405

CON: Health-Care System | Assessment

MULTIPLE RESPONSE 15. ANS: 1, 2, 3 Objective: 2. Identify specific health needs of rural communities and of urban communities.

Page: Heading: Rural Communities > Specific Health Needs of Rural Communities Integrated Processes: The Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Assessment; Health Systems Difficulty: Difficult

1 2 3 4

Feedback The biggest health problem facing the rural community is an inability to access health care.

Local governments in rural areas often lack the resources and capability to establish safety net programs.

Despite the original intentions of the ACA, attempts to increase the number of health-care providers in rural areas may not have been successful.

Migration of people from other areas is occurring in urban rather than rural communities.

PTS: 1 REF: 404 CON: Promoting Health | Nursing Roles 16. ANS: 1, 2 Objective: 2. Identify specific health needs of rural communities and of urban communities.

Page: Heading: Urban Communities > Characteristics of the Urban Population Integrated Processes: The Nursing Process Client Need: Safe and Effective Care Environment: Infection Control and Safety Cognitive Level: Analysis [Analyzing] Concept: Violence, economics, safety Difficulty: Moderate

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Feedback Urban areas have higher rates of crime, which can impact the entire population of the city.

2 3 4

High levels of air pollution impact the entire population residing in the city.

Lower socioeconomic status affects only a portion of the population living in a city.

Higher incidence of STIs affects only a portion of the population living in a city.

PTS: 1 REF: 408 CON: Violence | Economics | Safety 17. ANS: 1, 2, 3, 5 Objective: 5. Describe the steps in community organizing and coalition building; identify how these activities can be a useful tool for positive community change.

Page: Heading: Community Organization and Public Health Nursing > Coalition Building Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Female Reproduction; Promoting Health; Collaboration Difficulty: Moderate

1 2 3 4 5

Feedback Objectives and activities must be detailed and address diversity among the membership, assets must be mapped, and the vitality of the coalition must be maintained and evaluated.

Objectives and activities must be detailed and address diversity among the membership, assets must be mapped, and the vitality of the coalition must be maintained and evaluated.

Objectives and activities must be detailed and address diversity among the membership, assets must be mapped, and the vitality of the coalition must be maintained and evaluated.

The coalition must be convened after careful preparation that includes drafting a mission statement and structure, which will be finalized at a later date.

Objectives and activities must be detailed and address diversity among the membership, assets must be mapped, and the vitality of the coalition must be maintained and evaluated.

PTS: 1 REF: 411 CON: Female Reproduction | Promoting Health | Collaboration 18. ANS: 1, 4, 5 Objective: 5. Describe the steps in community organizing and coalition building; identify how these activities can be a useful tool for positive community change.

Page: Heading: Community Organization and Public Health Nursing > Community Organizing Integrated Processes: Communication and Documentation Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration; Nursing Roles Difficulty: Moderate

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Feedback The seven principles are to use nonviolence as a tool, look upstream for root causes of the problem and look to improve the situation for all residents, encourage the community to work together to solve their problems, aim to minimize social and economic disparities, increase the community’s decision-making ability, promote social equality for those who wish to participate in leadership roles, and consider the environment and sustainability.

The seven principles are to use nonviolence as a tool, look upstream for root causes of the problem and look to improve the situation for all residents, encourage the community to work together to solve their problems, aim to minimize social and economic disparities,

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4

5

increase the community’s decision-making ability, promote social equality for those who wish to participate in leadership roles, and consider the environment and sustainability.

The seven principles are to use nonviolence as a tool, look upstream for root causes of the problem and look to improve the situation for all residents, encourage the community to work together to solve their problems, aim to minimize social and economic disparities, increase the community’s decision-making ability, promote social equality for those who wish to participate in leadership roles, and consider the environment and sustainability.

The seven principles are to use nonviolence as a tool, look upstream for root causes of the problem and look to improve the situation for all residents, encourage the community to work together to solve their problems, aim to minimize social and economic disparities, increase the community’s decision-making ability, promote social equality for those who wish to participate in leadership roles, and consider the environment and sustainability.

The seven principles are to use nonviolence as a tool, look upstream for root causes of the problem and look to improve the situation for all residents, encourage the community to work together to solve their problems, aim to minimize social and economic disparities, increase the community’s decision-making ability, promote social equality for those who wish to participate in leadership roles, and consider the environment and sustainability.

PTS: 1 REF: 410 CON: Promoting Health | Collaboration | Nursing Roles 19. ANS: 2, 3, 4 Objective: 2. Identify specific health needs of rural communities and of urban communities.

Page: Heading: Urban Communities > Characteristics of the Urban Population Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing Roles; Promoting Health; Stress; Safety Difficulty: Moderate

1 2 3 4

Feedback Urban areas usually have enough pharmacies. The issue is more apt to be the ability to pay for the medications rather than the physical availability of pharmacies.

Some urban neighborhoods are actually food deserts where access to stores that carry healthy foods is limited.

Urban areas are experiencing a high rate of migration from other countries.

Many urban communities, especially those areas with high crime and low socioeconomic status, have limited access to safe areas for exercise for many of the neighborhoods within the city.

PTS: 1

REF: 408

CON: Nursing Roles | Promoting Health | Stress | Safety

ORDERED RESPONSE 20. ANS: C, A, B, D Feedback: The first step would be to determine if there is a need to collaborate with other agencies or individuals. Next, the nurses would need to describe the major problems and issues and determine how a partnership would benefit their goals. Then, they should identify key players and who would be willing to partner on the project. Finally, the team should establish mutual goals and a plan that addresses those goals.

Objective: 4. Define and implement the concepts of community partnership, community linkage, and community collaboration.

Page: Heading: Nursing in Partnership with Communities > Definition of Partnership Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition; Promoting Health; Critical Thinking; Collaboration Difficulty: Moderate PTS: 1 REF: 411 CON: Nutrition | Promoting Health | Critical Thinking | Collaboration

Chapter 17: Health Planning for Maternal-Infant and Child Health Settings Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Doreen, a maternal-child health nurse, has volunteered to go to a country in Sub-Saharan Africa and work with other nurses there to help develop programs aimed at reducing the maternal and infant mortality rates.

Doreen begins to examine the maternal mortality rate (MMR) and finds that there is an overall downward trend. However, she notices that since 1990 the MMR trended upward in: 1. The United States.

2. Switzerland.

3. Spain.

4. South Sudan.

2. A team of community health nurses is visiting a community where they want to address tobacco use in pregnant women, but they only have a short amount of time to prepare for their trip. What is their first step?

1. Create a fishbone diagram.

2. Assess the community for social and demographic data.

3. Create objective, easy to assess goals.

4. Identify populations more likely to use tobacco.

3. A nurse working in a prenatal community clinic wants to focus on reducing premature birth and knows that which of the following is a possible cause?

1. Bacterial infection 2. Psychological stress 3. Hypertension 4. All of the above 4. Doreen, a maternal-child health nurse working in Sub-Saharan Africa, has joined a local team of nurses, and they are building a program to help improve access to perinatal care. As part of their planning process, the team wishes to include the under-5 mortality rate. This represents: 1. The number of children under 5 who died per 1,000 live births.

2. The number of children under 5 who died per every 10,000 live births.

3. The probability of a child born in a specific year dying before the age of 5 per 1,000 births.

4. The probability of a child born in a specific year dying before the age of 5 per 10,000 births.

5. Doreen, a maternal-child health nurse working in Sub-Saharan Africa, has joined a local team of nurses, and they are building a program to help improve access to perinatal care. Doreen and her colleagues learn that there is funding in place to provide low-cost and free contraceptives to women, but the unplanned pregnancy rate has not changed, despite the program being in effect for 2 years. What should be the team’s first step?

1. Develop culturally relevant educational materials to distribute to women of childbearing age.

2. Conduct an outreach program to the communities to distribute contraceptives.

3. Host community focus groups with the communities they serve that include a cross-section of women to help learn about their views of contraceptives and the current program.

4. Begin looking for grants to increase funding so they can establish a women’s health and family planning center in the community.

6. A pediatric nurse is putting together a series of educational handouts to give to moms when they come in for well-baby visits. What is the most important piece of information to include on the handout about healthy sleep habits?

1. Dress the baby in lightweight, loose-fitting clothes.

2. Put the baby to sleep on his or her back.

3. Don’t begin strict sleep training until the baby is at least 3 to 4 months old.

4. Use a lightweight, small blanket if the room is cold.

7. The nurses working in a large urban medical center labor and delivery unit are concerned about the increase in the maternal mortality rate among African America women. They begin by linking the information from the medical records with the death certificate records. What risk factors associated with increased risk for MMR will not be apparent through this review?

1. Amount of prenatal care 2. Number of weeks gestation 3. Systemic racism 4. Complications of pregnancy 8. The PHN working in the maternal and child health division of a large urban public health department suggests that, to help improve pregnancy outcomes, the PHD should take an upstream approach. Which of the following best describes this type of approach?

1. Hiring doulas to assist women during delivery.

2. Increasing the number of well-baby home visits.

3. Increasing the number of childbirth classes.

4. Implementing a preconception health outreach program for women thinking of becoming pregnant.

9. A public health nurse, newly hired by a rural public health department in South Carolina, is interested in learning more about pregnancy outcomes in the county and the state compared to national level data. She begins with national and state statistics on rates for C-sections and low birth weight. All of the following are appropriate data sources to use except: 1. PeriStats.

2. Office of Minority Health.

3. PRAMS. 4. PubMed. 10. A nurse is beginning to work with a local community to address rising obesity rates in pregnant women.

Which of the following statements about setting goals during the planning process is correct?

1. Both long- and short-term goals must be identified.

2. Only short-term goals should be identified initially.

3. Goals should be formed first to help guide the community assessment.

4. The goals should address negative health outcomes.

11. Nurses working in a parental clinic located in a rural county in Kentucky are concerned about fetal exposure to tobacco. With almost a quarter of the women reporting tobacco use, the nurses decide to implement a program to help reduce fetal exposure. Which of the following would not be a recommended approach to reducing fetal risk?

1. Offering a smoking cessation peer-led support group at the clinic.

2. Offering referrals for nicotine replacement.

3. Screening all women for tobacco use and secondhand smoke exposure.

4. Recommended that the women who use tobacco switch to E-cigarettes.

12. A nurse working on the postpartum unit of the hospital is providing post-discharge planning for a young woman 3 days after delivery. The young woman shares that she is a single mom who lost her part-time job because of the pregnancy and has no one to help her at home. She doesn’t have any supplies for the baby and does not have a crib. How does the nurse respond?

1. Delay discharging the baby until the mother can demonstrate that she has the needed supplies.

2. Refer the mother to the local home visiting program for new mothers and children less than 5 years of age to help link her with services.

3. File a report with child protective services to remove the baby from a potentially unsafe environment.

4. Refer the mother for further psychological evaluation.

Other 13. A nurse is working with the community council and several representatives from the school district to find ways to address health disparities related to pregnancy in the community. They decide to use the nominal group process as a means to expedite their planning. Place the following steps in the order in which they should be followed (A–D): A. The group votes to rank the different categories in order of importance.

B. Each member brainstorms as many issues related to health disparities in pregnancy as possible and writes their ideas on small pieces of paper.

C. Make sure everyone is in agreement that they will support or agree with whatever decisions the group makes.

D. The group facilitator arranges and sorts the group ideas into different categories, usually onto a large board in the front of the room.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

14. Doreen, a maternal-child health nurse, has volunteered to go to a country in Sub-Saharan Africa and work with other nurses there to help develop programs aimed at reducing the maternal and infant mortality rates.

Doreen is familiar with the top five leading causes of infant mortality in the U.S. She realizes that the top five causes are globally different and will require different strategies. Which of the following is among the top five causes of infant mortality in the U.S. that is not one of the top five causes globally?

1. Sudden infant death syndrome (SIDS) 2. Preterm birth 3. Diarrhea and malaria 4. Pneumonia 15. At a large urban hospital, the nurse manager of the labor and delivery unit is aware that over the past 5 years there has been an influx of immigrants into their community who come from such diverse parts of the world such as Asia and Africa. She notices that there has been little attention to addressing cultural issues related to the birth experience and wishes to institute a culturally relevant care environment. What aspects of the birthing experience might differ based on culture? (Select all that apply.)

1. Personal control during the birthing process 2. Support from the partner 3. Care provided by providers 4. Pain during childbirth.

16. A nurse is working at a community-based prenatal clinic. Recently, the nurse and physician have started evaluating outcomes and discovered a rise in pregnancy complications, especially in their overweight and obese patients. After performing their community assessment, the staff sets a goal to reduce complications in their pregnant patients by 15% in 3 years. Which of the following are likely to be the most effective interventions? (Select all that apply.)

1. Establish an office policy that any patient undergoing IVF have a BMI under 30.

2. Place patient education materials about weight and pregnancy in the reception area.

3. Include a weight and blood pressure assessment as part of the initial visit and subsequent visits as appropriate.

4. Partner with a nutritionist who specializes in the care and management of overweight women.

5. Hold weekly seminars and weight loss support groups.

17. A nurse is looking to lower the high teen pregnancy rate at the local high school. The nurse has performed an assessment and begun work on developing goals to address the pregnancy rate. Which of the following concerns should be considered when working with and educating this population? (Select all that apply.)

1. It is illegal in some communities to provide sexual education to teens.

2. The teen needs parental permission to participate.

3. Teens are not interested in sexuality education.

4. Teens do not usually respond to school programs.

5. Educational content and programs are often regulated by school policy.

Completion Complete each statement.

18. A nurse is examining the maternal and infant health in a large metropolitan area. A total of 120,262 women delivered babies last year. Of that total, 15 women died during childbirth. What is the maternal mortality rate expressed per 100,000 births? Round to the nearest tenth.

19. A nurse is looking to calculate the teen pregnancy birth rate for a city in 2014. There are 62,578 females between the ages of 15 and 19 living in the city. There are 1,019 live births reported among this age group.

What is the teen pregnancy birth rate expressed per 1,000 live births in women aged 15–19 years? Round to the nearest tenth.

Chapter 17: Health Planning for Maternal-Infant and Child Health Settings Answer Section MULTIPLE CHOICE 1. ANS: 1 Objective: 1. Describe maternal, infant, and child health from a global and national perspective.

Page: Heading: Trends in Maternal, Infant, and Child Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Pregnancy; Promoting Health; Nursing; Assessment Difficulty: Moderate Feedback 1 Since 1987, rates of maternal mortality in the United States (U.S.) have risen from 7.2 to a high of 17.8 maternal deaths per 100,000 births in 2016.

2 Maternal mortality rate is declining in Switzerland and throughout the world. In the United States, however, maternal mortality rate has trended upward.

3 Maternal mortality rate is declining in Spain and throughout the world. In the United States, however, maternal mortality rate has trended upward.

4 Maternal mortality rate is declining in South Sudan and throughout the world. In the United States, however, maternal mortality rate has trended upward.

PTS: 1 REF: 420 CON: Pregnancy | Promoting Health | Assessment | Nursing 2. ANS: 1 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Assessment; Critical Thinking; Nursing Difficulty: Moderate Feedback 1 Fishboning is a good first step for performing a focused assessment, which is what the nurses need to do because they only have a short time to prepare. It identifies root causes of a complicated issue that can be used to compare with issues they find in their community to see if they are significant.

2 Fishboning is a good first step for performing a focused assessment, which is what the nurses need to do because they only have a short time to prepare. It identifies root causes of a complicated issue that can guide the nurse’s assessment.

3 Before setting goals, the nurses should assess the community and their needs.

Fishboning is a good first step for performing a focused assessment.

4 This would likely be identified during the community assessment. Fishboning is a good first step for performing a focused assessment, which is what the nurses need to do because they only have a short time to prepare.

PTS: 1 REF: 430 CON: Pregnancy | Promoting Health | Assessment | Critical Thinking | Nursing 3. ANS: 4 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Prematurity and Low Birth Weight Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Nursing Difficulty: Difficult Feedback 1 Bacterial infection, psychological stress, and maternal hypertension are all associated with increased risk for preterm labor.

2 Bacterial infection, psychological stress, and maternal hypertension are all associated with increased risk for preterm labor.

3 Bacterial infection, psychological stress, and maternal hypertension are all associated with increased risk for preterm labor.

4 Bacterial infection, psychological stress, and maternal hypertension are all associated with increased risk for preterm labor.

PTS: 1 REF: 435 | 436 CON: Pregnancy | Promoting Health | Nursing 4. ANS: 3 Objective: 1. Describe maternal, infant, and child health from a global and national perspective.

Page: Heading: Trends in Maternal, Infant, and Child Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Assessment; Promoting Health; Nursing Difficulty: Easy Feedback 1 The under-5 mortality rate of children is technically not a rate.

2 The under-5 mortality rate of children is technically not a rate 3 The under-5 mortality rate of children represents the probability of a child born in a specific year dying before the age of 5 per 1,000 births.

4 The under-5 mortality rate of children represents the probability of a child born in a specific year dying before the age of 5 per 1,000 births.

PTS: 1 REF: 423 CON: Pregnancy | Assessment | Promoting Health | Nursing 5. ANS: 3 Objective: 4. Integrate cultural perspectives into planning for maternal, infant, and child health interventions.

Page: Heading: Population Focus in Maternal, Infant, and Child Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Critical Thinking; Assessment; Female Reproduction; Nursing Difficulty: Moderate

1 2 3 4

Feedback The first step for the team is to figure out why the program isn’t working by conducting focus groups with the women in the communities they serve.

The first step for the team is to figure out why the program isn’t working by conducting focus groups with the women in the communities they serve.

The first step for the team is to figure out why the program isn’t working by conducting focus groups with the women in the communities they serve.

The first step for the team is to figure out why the program isn’t working by conducting focus groups with the women in the communities they serve.

PTS: 1 REF: 428-433 CON: Pregnancy | Critical Thinking | Assessment | Female Reproduction | Nursing 6. ANS: 2 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Evidenced based practice; Promoting Health; Nursing; Safety; Pregnancy Difficulty: Moderate Feedback 1 Although it is important to dress the baby appropriately for sleep (not too warm or too cold), clothing shouldn’t fit too loosely, or it becomes a suffocation or strangulation hazard. The most important piece of information to include is the instruction to put the baby to sleep on his or her back, which drastically reduces the risk of SIDS. 2 The most important piece of information to include is the instruction to put the baby to sleep on his or her back, which drastically reduces the risk of SIDS. 3 The most important piece of information to include is the instruction to put the baby to sleep on his or her back, which drastically reduces the risk of SIDS. 4 Using a small blanket is inappropriate for very small babies as it can be a suffocation or strangulation hazard. The most important piece of information to include is the instruction to put the baby to sleep on his or her back, which drastically reduces the risk of SIDS. PTS: 1 REF: 426 | 427 CON: Nursing Roles | Promoting Health | Nursing | Safety | Pregnancy 7. ANS: 3 Objective: 1. Describe maternal, infant, and child health from a global and national perspective.

Page: Heading: Maternal Mortality Rate, Vulnerable Populations, and MMR in the U.S. Integrated Processes: Nursing Process Client Need: Safe, Effective Care Environment Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Assessment Difficulty: Moderate

1

Feedback Access to prenatal care is a social determinant of health associated with increased risk

2

3

4

for maternal mortality, but this information is available in the medical record.

Number of weeks gestation is associated with increased risk for infant mortality but is not one of the major risk factors for maternal mortality. This information is available in the medical record.

Higher MMR for African American women goes beyond social determinants of health and includes systemic racism that can occur in health care. Evidence of systematic racism will require a more intensive assessment than just a medical record review.

Complications of pregnancy are associated with increased risk for both maternal and infant mortality. This information is available in the medical record.

PTS: 1 REF: 424 | 425 CON: Pregnancy | Promoting Health | Assessment 8. ANS: 4 Objective: 2. Identify key concerns for public health planning for maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Upstream to Prevention Across Maternal-Child Health Continuum Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Assessment; Promoting Health; Nursing; Critical Thinking Difficulty: Difficult Feedback 1 Upstream approaches to care involve planning interventions that focus on the root causes (social, economic, and political) to improve health outcomes. Hiring doulas is not an upstream approach because it does not address root causes.

2 Upstream approaches to care involve planning interventions that focus on the root causes (social, economic, and political) to improve health outcomes. Increasing the number of well-baby visits is not an upstream approach because it does not address root causes.

3 Upstream approaches to care involve planning interventions that focus on the root causes (social, economic, and political) to improve health outcomes. Childbirth classes are not an upstream approach because they do not address root causes.

4 Upstream approaches to care involve planning interventions that focus on the root causes (social, economic, and political) to improve health outcomes. A preconception health program prior to pregnancy is an example of an upstream approach because it promotes healthy living prior to pregnancy.

PTS: 1 REF: 427 CON: Pregnancy | Assessment | Promoting Health | Nursing | Critical Thinking 9. ANS: 4 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Assessment; Promoting Health; Evidence-Based Practice; Difficulty: Moderate Feedback

1 2 3 4

PeriStats, government agencies such as the Office of Minority Health, and PRAMS will provide the statistics related to pregnancy outcomes.

PeriStats, government agencies such as the Office of Minority Health, and PRAMS will provide the statistics related to pregnancy outcomes.

PeriStats, government agencies such as the Office of Minority Health, and PRAMS will provide the statistics related to pregnancy outcomes.

PubMed compiles a list of peer-reviewed studies that may be helpful for future research, but it is not a direct source of national and state data.

PTS: 1 REF: 428 CON: Pregnancy | Assessment | Promoting Health | Evidence-Based Practice | 10. ANS: 1 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Critical Thinking; Promoting Health; Nursing; Nutrition Difficulty: Easy Feedback 1 When setting goals, the nurse should select both short- and long-term goals.

2 When setting goals, the nurse should select both short- and long-term goals.

3 Goals should be set after the community assessment and should address the findings.

Goals should guide the evaluation process after interventions are implemented.

4 Goals must address positive health outcomes.

PTS: 1 REF: 428 | 438 CON: Pregnancy | Critical Thinking | Promoting Health | Nursing | Nutrition 11. ANS: 4 Objective: 4. Integrate cultural perspectives into planning for maternal, infant, and child health interventions.

Page: Heading: The Case of the Teenage Pregnancy Epidemic> Tobacco Use and Pregnancy Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Synthesis Concept: Assessment; Pregnancy; Diversity; Nutrition; Promoting Health; Nursing Difficulty: Moderate Feedback 1 The main components of a smoking cessation program include counseling and nicotine replacement.

2 The main components of a smoking cessation program include counseling and nicotine replacement.

3 Both tobacco use by the mother and exposure to secondhand smoking increase the risk for adverse maternal and infant outcomes.

4 E-cigarettes pose a threat as well because they contain nicotine, and nicotine is a known reproductive toxicant that has adverse effects on fetal brain development.

PTS: 1 REF: 431 | 432 CON: Assessment | Pregnancy | Diversity | Nutrition | Promoting Health | Nursing 12. ANS: 2 Objective: 2. Identify key concerns for public health planning for maternal, infant, and child health.

Page: Heading: Maternal-Infant and Early Childhood Home Visiting > The Affordable Care Act and Maternal, Infant, and Early Child Home Visiting Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Pregnancy; Family; Critical Thinking; Health-Care System Difficulty: Difficult Feedback 1 This case does not reflect immediate danger to the infant, and the mother has requested assistance. The appropriate intervention would be to refer her to a Maternal Infant and Early Child Home Visiting Program (MIECHV).

2 The appropriate intervention would be to refer her for home care services to a Maternal Infant and Early Child Home Visiting Program (MIECHV).

3 This case does not reflect immediate danger to the infant, and the mother has requested assistance. The appropriate intervention would be to refer her for home care services to a Maternal Infant and Early Child Home Visiting Program (MIECHV).

4 This case does not reflect psychological instability of the mother, and the mother has requested assistance. The appropriate intervention would be to refer her for home care services to a Maternal Infant and Early Child Home Visiting Program (MIECHV).

PTS: 1 REF: 440 | 441 CON: Pregnancy | Family | Critical Thinking | Health-Care System ORDERED RESPONSE 13. ANS: C, B, D, A Feedback: Nominal group process is a way to expedite decision making in a large group setting. The first step is to make sure everyone is in agreement that they will support or agree with whatever decisions the group makes. Next, every participant receives a small pad of paper and is instructed to brainstorm as many issues as possible, writing their ideas on the small pieces of paper. Next, the facilitator collects the idea and arranges and sorts the group ideas into different categories, usually onto a large board in the front of the room. Finally, the group votes to rank the different categories in order of importance and priorities are set.

Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Collaboration; Pregnancy; Critical Thinking Difficulty: Moderate PTS: 1

REF: 432

CON: Collaboration | Pregnancy | Critical Thinking

MULTIPLE RESPONSE 14. ANS: 1 Objective: 1. Describe maternal, infant, and child health from a global and national perspective.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Nursing; Assessment Difficulty: Moderate

1

2 3 4

Feedback The top five leading causes of death globally are preterm birth complications, pneumonia, birth asphyxia, diarrhea, and malaria. Sudden infant death syndrome is among the top five leading causes of infant mortality in the U.S. Preterm birth complications are one of the top five causes of infant mortality both in the U.S. and globally.

Diarrhea and malaria are not among the top five causes of infant mortality in the U.S. Pneumonia is not among the top five leading causes of infant mortality in the U.S.

PTS: 1 REF: 420 | 423 CON: Pregnancy | Promoting Health | Assessment | Nursing 15. ANS: 1, 2, 3, 4 Objective: 2. Identify key concerns for public health planning for maternal, infant, and child health.

Page: Heading: Cultural Contexts for Pregnancy and Childbirth in the United States Integrated Processes: Nursing Process Client Need: Safe, Effective Care Environment Cognitive Level: Application [Applying] Concept: Pregnancy; Diversity; Family Difficulty: Moderate

1

2

3

4

Feedback Culture shapes expectations at birth. Expectations include personal control during the birthing process, support from the partner, care provided by providers, health of the baby, and pain during childbirth.

Culture shapes expectations at birth. Expectations include personal control during the birthing process, support from the partner, care provided by providers, health of the baby, and pain during childbirth.

Culture shapes expectations at birth. Expectations include personal control during the birthing process, support from the partner, care provided by providers, health of the baby, and pain during childbirth.

Culture shapes expectations at birth. Expectations include personal control during the birthing process, support from the partner, care provided by providers, health of the baby, and pain during childbirth.

PTS: 1 REF: 421 CON: Pregnancy | Critical Thinking | Promoting Health | Nursing Diversity | Family

16. ANS: 1, 3, 4, 5 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Assessment; Critical Thinking; Promoting Health; Nursing Difficulty: Moderate

1 2

3

4

5

Feedback This can be effective because it gives the patients a goal and a clear consequence for not losing their weight.

Simply placing educational materials in the waiting area would likely not be effective because it requires that patients take the initiative and take the materials if they are interested. There are many patients who would likely not get involved.

Addressing weight and blood pressure is essential in helping people lose weight. Many overweight women ignore their weight and having a direct conversation and continued accountability can be helpful.

A nutritionist can be a great partner for the practice to collaborate with i to help their patients lose weight. The nutritionist can help create meal plans and provide support and accountability.

This would likely be very effective. Group support is essential for weight loss to be effective.

PTS: 1 REF: 431-433 CON: Pregnancy | Assessment | Critical Thinking | Promoting Health | Nursing 17. ANS: 2, 5 Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Critical Thinking; Assessment Difficulty: Moderate

1

2 3 4 5

Feedback Teaching sexual education is not illegal, though many states will leave it up to each school board to determine if and how they approach it in the classroom. In addition, some states may have laws that specify what is taught, for example, abstinence only.

Some states, towns, communities, or school boards do require that parents give permission prior to certain activities or programs if the teens are underage.

Teens are often very curious and have a lot of questions about sexuality and sexual health issues.

School programs can be very effective in educating young people about reproductive health, drug education, and other issues affecting their well-being.

Most states will leave it up to each school board to determine if and how they approach it in

the classroom. In addition, some states may have laws that specify what is taught, for example, abstinence only.

PTS: 1 REF: 429 CON: Pregnancy | Promoting Health | Critical Thinking | Assessment COMPLETION 18. ANS: 12.5 Feedback: To determine the maternal mortality rate per 100,000 births, divide the number of women who died during childbirth (15) by the number of births (120,262). Then multiply by 100,000. (15 ÷ 120262)  100,000  12.5.

Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Trends in Maternal, Infant, and Child Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Assessment; Promoting Health; Nursing Difficulty: Moderate PTS: 1 REF: 420 CON: Pregnancy | Assessment | Promoting Health | Nursing 19. ANS: 16.3 Feedback: To calculate the teen pregnancy birth rate, divide the number of teen births (1,019) by the total number of women in this age range (62,578). Multiply that answer by 1,000 to determine the number of teen births per 1,000 live births to females aged 15 to 19. (1,019 ÷ 62,578)  1,000  16.28.

Objective: 3. Apply health promotion planning to maternal, infant, and child health.

Page: Heading: Population Focus in Maternal, Infant, and Child Health > Review of Assessment and Planning in Maternal, Infant, and Child Health Settings Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Pregnancy; Promoting Health; Assessment; Nursing Difficulty: Moderate PTS: 1

REF: 429

CON: Pregnancy | Promoting Health | Assessment | Nursing

Chapter 18: Health Planning for School Settings Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A school nurse is assessing the health education component of the Whole School, Whole Community, Whole Child (WSCC) program at one of the elementary schools she covers. Which of the following is not a part of this component of WSCC? 1. A qualified trained person teaches the program.

2. The program is run for children in first through fifth grade.

3. It assists students in maintaining and improving health.

4. The comprehensive health education curriculum addresses the physical, emotional, social, and mental health of its students and families.

2. A school nurse recently accepted a position to run a school-based health center. The school uses the WSCC model. Under the health services component of this model, all but which of the following is a service that she will provide to students?

1. Treatment for TB 2. Acute care evaluation 3. Noncommunicable disease management 4. Health education 3. One of the roles of the school nurse is health protection for the students. This includes: 1. Monitoring vaccinations among children and adolescents to assure compliance with state mandates.

2. Conducting classes on healthy eating.

3. Administering flu vaccines.

4. Both A and C. 4. A school nurse has just been promoted to overseeing the nursing care provided in the school district. She is reviewing the vaccination compliance level across all grades. Based on her review of vaccine recommendations from the Advisory Committee on Immunization Practices, she is updating the parent information sheet to include the recommendation that all children the age of 6 months of age or older receive the vaccine for yearly.

1. Influenza 2. Measles-Mumps-Rubella 3. Varicella 4. There are no recommendations for a yearly vaccine.

5. A new school nurse is reviewing the procedures put in place by the prior nurse, a woman with more than 30 years of experience. The nurse notices that a school-wide scoliosis screening occurs every fall. How does the new nurse proceed?

1. Continue performing the scoliosis screenings each year.

2. Only continue scoliosis screening on students who are symptomatic.

3. Eliminate scoliosis screenings altogether.

4. Check state screening guidelines to see what is required for school nurses in the state.

6. A school nurse is performing a quarterly inspection of the health equipment used in the school health clinic.

The nurse’s priority is to make sure which piece of equipment is present and working properly?

1. Code cart 2. Automated external defibrillator (AED)

3. Otoscope 4. Flowmeter 7. A school nurse is updating the designated medical emergency response plan. Once the plan is in place, it is recommend that she should do all of the following except: 1. Identify who within the system is authorized to make emergency medical decisions.

2. Practice the plan once each year.

3. Make sure AEDs are available in the school 4. Teach multiple staff members first aid and cardiopulmonary resuscitation.

8. A parent has called the school nurse’s office to discuss her daughter’s new diagnosis of type 1 diabetes. The parent is inquiring about what role the nurse will play in managing her care while the girl is in school. The key role of the nurse is to: 1. Encourage self-care.

2. Administer insulin.

3. Manage the student’s dietary intake.

4. Provide daily blood glucose monitoring.

9. A school nurse has observed a slight increase in teacher absenteeism due to illness and decides to implement several new programs to boost employee wellness. What is the nurse’s first step?

1. Send out questionnaires to all of the staff members to see what type of programs they would be interested in.

2. Set a goal to reduce absenteeism by 5% within the next year.

3. Start a yearly health fair to set goals for the following year.

4. Implement a staff-wide weight loss competition.

10. A nurse has observed that a particular fifth grade student visits the office two to three times each week with stomach aches, headaches, and vague complaints of not feeling well. This has been continuing for several months. What is the most appropriate action for the nurse to take?

1. Refuse to see the child anymore.

2. Call his parents to discuss his symptoms and the need to be evaluated by his pediatrician.

3. Send the child home until he obtains medical clearance to return.

4. Refer him to the school psychiatrist for mental evaluation.

11. A new high school nurse is reviewing the sex education materials and finds them completely outdated, without any mention of contraception or sexually transmitted infections. What should the nurse do first?

1. Revise the materials and begin implementing the new program.

2. Look into state and local regulations that might impact the development of a new program.

3. Leave the materials as is, but create a new presentation that includes the omitted topics.

4. Schedule a meeting with parent representatives to discuss changing the program.

12. The middle school nurse has been asked by one of the teachers about one of the students who always sits in the back of the classroom and never participates in classroom discussions. The teacher also noticed that the student always enters and leaves the classroom by herself. Based on this, the school nurse asks the student to stop in and see her. The student is at first quiet and says little, but then states she has been feeling low. The nurse should: 1. Assure the student that things will seem better soon and send her back to class.

2. Call the students’ parents and let them know she is concerned and would like to refer the student for further assessment and possible treatment.

3. Assure the teacher that quiet students aren’t necessarily at risk but to keep an eye on the student and let her know if there is any change.

4. Because it is apparent that the other students are avoiding this student, implement a

school-wide anti-bullying campaign.

13. A school nurse is beginning work at a new elementary charter school. As the nurse is developing screening policies for the students in the school, which of the following must be included?

1. Scoliosis screening 2. Hearing and vision screening 3. Both scoliosis and hearing and vision screening 4. It depends on what the state mandates.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

14. A school nurse working in a private school is training a new school nurse. Which of the following federal laws influence their practice? (Select all that apply.)

1. Elementary and Secondary Education Act 2. Children’s Health Insurance Program (CHIP) 3. Family Educational Rights and Privacy Act 4. Child Abuse Prevention and Treatment Act 5. The School Nurse Act 15. According to the WHO, efforts to improve health in school-aged children and adolescents will improve health through the reduction of adverse health behaviors. These include: (Select all that apply.)

1. Tobacco use.

2. Alcohol and substance use.

3. Active lifestyle.

4. Dietary and hygienic practices that cause disease.

5. Failure to complete high school.

16. A school nurse has recently noticed an increase in the number of students suffering from asthma attacks while in the school building and suspects it may be due to the school environment. The nurse knows that the school, although cleaned frequently, is in a very old building. What steps could the nurse take? (Select all that apply.)

1. Review student health records and obtain statistics on the number of students being diagnosed with asthma and having asthma attacks while in school over the last 10 years.

2. Instruct the custodial staff to replace the ventilation and furnace systems.

3. Obtain a copy of the EPA Indoor Air Quality Tools for School Action Kit and work with her colleagues within the school to develop a practical plan for addressing air quality in the school.

4. Send letters home to the parents of affected kids requesting follow-up with their pediatricians.

5. Secure funding to increase the number of cleaning personnel for the school.

17. An elementary school nurse is caring for many students in the office. The school nurse has an assistant who is not a registered nurse. The nurse wishes to set up a process for determining which tasks can be delegated to the unlicensed assistive personnel (UAP). What things should the nurse consider when making the decision?

(Select all that apply.)

1. The needs of the student 2. The complexity of the task 3. The American Nursing Association scope and standards of nursing practice 4. The state regulations 5. The stability of the student

18. A school nurse is speaking with one of the teachers in the elementary school. The teacher is discussing one of the students who has just transferred to the school from another state. He is disruptive in the classroom, is frequently out of his chair, and not paying attention to what the rest of the class is doing. According to the student’s record he has been diagnosed with attention deficit hyperactive disorder (ADHD). The nurse suggests to the teacher that they utilize a care coordination approach to help the student. This approach requires that interventions are: (Select all that apply.)

1. Goal oriented.

2. Based on interventions used for all students with ADHD. 3. Based on the specific needs of the child.

4. Evaluated based on their impact.

Other 19. A nurse wants to help lower the rate of absenteeism among school-age children in his community. Place the following steps of the nursing process in the order in which the nurse should carry them out (A–D): A. Implementation B. Evaluation C. Assessment D. Planning

Chapter 18: Health Planning for School Settings Answer Section MULTIPLE CHOICE 1. ANS: 2 Objective: 3. Describe the components and tenets of the student-centered Whole School, Whole Community, Whole Child model.

Page: Heading: Whole School, Whole Community, Whole Child > WSCC Components Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Nursing; Promoting Health Difficulty: Moderate Feedback 1 A qualified trained person provides health education.

2 WSCC programs run from kindergarten through 12th grade.

3 The goal is to motivate and assist students in maintaining and improving health.

4 The comprehensive health education curriculum addresses the physical, emotional, social, and mental health of its students and families.

PTS: 1 REF: 451 CON: Assessment | Nursing | Promoting Health 2. ANS: 1 Objective: 3. Describe the components and tenets of the student-centered Whole School, Whole Community, Whole Child model.

Page: Heading: Whole School, Whole Community, Whole Child > WSCC Components > Health Services Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance; Physiological integrity Cognitive Level: Application [Applying] Concept: Assessment; Nursing; Promoting Health Difficulty: Moderate Feedback 1 Treatment for TB is done through the public health department.

2 Under the WSCC model, health services include emergency services, acute care evaluations, noncommunicable disease management, health education, and preventive services.

3 Under the WSCC model, health services include emergency services, acute care evaluations, noncommunicable disease management, health education, and preventive services 4 Under the WSCC model, health services include emergency services, acute care evaluations, noncommunicable disease management, health education, and preventive services PTS: 1 REF: 453 CON: Assessment | Nursing | Promoting Health | Sexuality 3. ANS: 4 Objective: 6. Describe the role of policy in understanding school nursing practice.

Page: Heading: Population-Based School Nursing Practice > Immunizations Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Immunity; Nursing; Promoting Health; Critical Thinking Difficulty: Moderate

1

2 3

4

Feedback Monitoring vaccinations among children and adolescents to assure compliance with state mandates is an important school nurse role. Vaccines boost the immunity of the host and are an example of health protection. Part of this protection requires monitoring the vaccine status of students to help achieve herd immunity.

Conducting classes on healthy eating is an example of health promotion in that it promotes healthy behaviors rather than health protection.

School-located vaccination programs have become a viable option for reaching the target populations. Vaccines boost the immunity of the host and are an example of health protection.

Surveillance of vaccine compliance and administration of vaccines are both examples of health protection.

PTS: 1 REF: 455-457 CON: Immunity | Nursing | Promoting Health | Critical Thinking 4. ANS: 1 Objective: 5. Discuss other school nursing interventions focused on health teaching, advocacy, and policy development.

Page: Heading: Population-Based School Nursing Practice > Vaccinations > Surveillance and Vaccinations Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Immunity; Nursing; Promoting Health Difficulty: Moderate Feedback 1 The Advisory Committee on Immunization Practices, a division of the CDC, recommends that everyone aged 6 months or older receive an annual influenza vaccination.

2 The Advisory Committee on Immunization Practices, a division of the CDC, recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age.

3 The Advisory Committee on Immunization Practices, a division of the CDC, recommends all children get two doses of the Varicella (chickenpox) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age 4 The Advisory Committee on Immunization Practices, a division of the CDC, recommends that everyone aged 6 months or older receive an annual influenza vaccination.

PTS: 1 5. ANS: 4

REF: 457

CON: Immunity | Nursing | Promoting Health

Objective: 6. Discuss the role of policy in understanding school nursing practice.

Page: Heading: Population-Based School Nursing Practice > Tertiary Prevention Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Nursing; Regulations Difficulty: Moderate Feedback 1 Screening requirements vary by state, so the nurse should check the state guidelines before making any decisions whether to continue routine screenings.

2 Screening requirements vary by state, so the nurse should check the state guidelines before making any decisions whether to continue routine screenings.

3 Screening requirements vary by state, so the nurse should check the state guidelines before making any decisions whether to continue routine screenings.

4 Screening requirements vary by state, so the nurse should check the state guidelines before making any decisions whether to continue routine screenings.

PTS: 1 REF: 460 | 467 CON: Assessment | Promoting Health | Nursing | Regulations 6. ANS: 2 Objective: 3. Describe the components and tenets of the student-centered Whole School, Whole Community, Whole Child model.

Page: Heading: Population-Based School Nursing Practice > Tertiary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing; Critical Thinking Difficulty: Moderate Feedback 1 Schools do not routinely have a code cart on site. This is especially true when there isn’t a physician on site to manage medical emergencies.

2 AEDs were designed to be used by laypeople. The school should not only ensure that a properly functioning AED is present on school grounds but also that there are several people who are able to work the defibrillator.

3 An otoscope is a useful tool to have, however, it is not the priority piece of equipment to have on site. In the event of a medical emergency, it is imperative that the AED is functioning properly.

4 A flowmeter is a useful tool to have, however, it is not the priority piece of equipment to have on site. In the event of a medical emergency, it is imperative that the AED is functioning properly.

PTS: 1 REF: 463 CON: Safety | Nursing | Critical Thinking 7. ANS: 2 Objective: 4. Describe the roles, responsibilities, and interventions of school nurses in providing wellness care, episodic care, and care to children with noncommunicable illnesses or behavioral health problems.

Page: Heading: Public Health Interventions and School Nursing Roles Tertiary Prevention> Life-Threatening Emergencies in the School Setting Integrated Processes: The Nursing Process

Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Immunity; Nursing; Nursing Roles; Safety Difficulty: Moderate Feedback 1 It is recommended to identify who within the system is authorized to make emergency medical decisions.

2 It is recommended that schools practice the plan at least a few times each year.

3 It is recommended that AEDs are available in the school.

4 Life-threatening emergencies require training and skills in first aid and cardiopulmonary resuscitation.

PTS: 1 REF: 462 | 463 CON: Nursing | Nursing Roles | Safety 8. ANS: 1 Objective: 4. Describe the roles, responsibilities, and interventions of school nurses in providing wellness care, episodic care, and care to children with noncommunicable illnesses or behavioral health problems.

Page: Heading: Population-Based School Nursing Practice > Tertiary Prevention Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Metabolism; Nursing; Nursing Roles Difficulty: Moderate Feedback 1 The school nurse has an important role in encouraging self-care, which includes increasing knowledge and skills such as blood glucose testing, insulin injection, preparation of the insulin, diet management, and hypoglycemic treatment.

2 Although the nurse can administer insulin as ordered by the primary care provider, her key role is to increase the student’s skills in self-managing the disease, including self-administration of the insulin.

3 The nurse cannot control what the patient eats each day. The school nurse can certainly provide counseling about healthy food choices but cannot regulate her diet.

4 Although the nurse can check blood glucose levels when needed, her key role is to increase the student’s skills in self-managing the disease including self-monitoring of blood glucose levels.

PTS: 1 REF: 464 CON: Metabolism | Nursing | Nursing Roles 9. ANS: 1 Objective: 3. Describe the components and tenets of the student-centered Whole School, Whole Community, Whole Child model.

Page: Heading: Whole School, Whole Community, Whole Child > Employee Wellness Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing; Assessment; Critical Thinking Difficulty: Moderate Feedback 1 The nurse should assess the needs of the staff prior to implementing any new policies.

2

3

4

The nurse should wait to implement any policies until the school nurse knows what health measures the staff needs or is interested in. Assessing the needs of the staff comes first.

The nurse should wait to implement any policies until the school nurse knows what health measures the staff needs or is interested in. Assessing the needs of the staff comes first.

The nurse should wait to implement any policies until the school nurse knows what health measures the staff needs or is interested in. Assessing the needs of the staff comes first.

PTS: 1 REF: 454 | 455 CON: Promoting Health | Nursing | Assessment | Critical Thinking 10. ANS: 2 Objective: 5. Discuss the role of school nurses in addressing health disparities and social determinants of health among vulnerable students.

Page: Heading: Population-Based School Nursing Practice > Tertiary Prevention Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Assessment; Nursing; Communication Difficulty: Moderate Feedback 1 There is clearly something going on with this student and to refuse to see him is unfair to the student.

2 This is the most appropriate intervention. The school nurse should have a discussion with the parents about his or her concerns and recommend an evaluation with the pediatrician to rule out physical causes for his symptoms.

3 The child should be evaluated by his physician, but there is no need to keep him out of school until medical clearance is obtained.

4 It is not appropriate to refer the child to the school psychiatrist without speaking with his parents first. The nurse should call his parents and discuss his or her concerns before proceeding.

PTS: 1 REF: 466 CON: Assessment | Nursing | Communication 11. ANS: 2 Objective: 6. Describe the role of policy in understanding school nursing practice.

Page: Heading: Population-Based School Nursing Practice > Sexuality and Sex Education Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Sexuality; Nursing; Promoting Health; Nursing Roles; Regulations Difficulty: Moderate Feedback 1 The first step is to determine what current state and local regulations are in place related to sex education in the schools. Revising the program would occur later and must be in compliance with state and local laws.

2 The first step is to determine what current state and local regulations are in place related to sex education in the schools.

3

4

The first step is to determine what current state and local regulations are in place related to sex education in the schools. Creating a new presentation would occur later and must be in compliance with state and local laws.

Seeking input from parents could provide valuable insight into current parental support or objections to changes in the sex education program. However, the first step is to determine what current state and local regulations are in place related to sex education in the schools.

PTS: 1 REF: 458 CON: Sexuality | Nursing | Promoting Health | Nursing Roles | Regulations 12. ANS: 2 Objective: 5. Discuss the role of school nurses in addressing health disparities and social determinants of health among vulnerable students.

Page: Heading: Tertiary Prevention> Mental Health Disorders Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Violence; Communication; Nursing Roles; Nursing Difficulty: Difficult Feedback 1 The nurse should utilize the opportunity to speak with the student and assess her for a possible mental health issues that may require further assessment intervention.

2 The nurse should call the student’s parents and suggest that the student be referred for further assessment and possible treatment. Adolescents who have untreated mental health issues are more likely to experience higher rates of suicide, violence, school dropout, family dysfunction, juvenile incarceration, alcohol, drug use, and unintentional injuries. Assessment by a mental health professional is warranted.

3 Due to the increased risk of suicide, violence, school dropout, family dysfunction, juvenile incarceration, alcohol, drug use, and unintentional injuries, the best action is to refer the student for further assessment rather than have the teacher observe the student.

4 There is no evidence that the student is being bullied, although this may be the underlying reason; referring for further assessment is the best action.

PTS: 1 REF: 465-467 CON: Violence | Communication | Nursing Roles | Nursing 13. ANS: 4 Objective: 6. Describe the role of policy in understanding school nursing practice.

Page: Heading: Population-Based School Nursing Practice > Secondary Prevention Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Nursing Roles; Nursing; Promoting Health; Regulations Difficulty: Moderate Feedback 1 Each state has its own regulations about what screening must occur in the school setting. Some will require scoliosis screening and others won’t. The same applies with hearing and vision screening. School nurses are responsible for knowing what is required in their own state.

2 Each state has its own regulations about what screening must occur in the school

3

4

setting. Some will require hearing and vision screening and others won’t. The same applies with scoliosis screening. School nurses are responsible for knowing what is required in their own state.

Each state has its own regulations about what screening must occur in the school setting. Some will require scoliosis screening and others won’t. The same applies with hearing and vision screening. School nurses are responsible for knowing what is required in their own state.

Each state has its own regulations about what screening must occur in the school setting. School nurses are responsible for knowing what is required in their own state.

PTS: 1 REF: 460 CON: Assessment | Nursing Roles | Nursing | Promoting Health | Regulations MULTIPLE RESPONSE 14. ANS: 1, 2, 4 Objective: 6. Describe the role of policy in understanding school nursing practice.

Page: Heading: Advocacy > Policy Development and Enforcement Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Legal; Promoting Health; Nursing Roles; Nursing Difficulty: Moderate

1 2

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4 5

Feedback The Elementary and Secondary Education Act provides federal funding to improve academic achievement. It also is involved in setting educational policies and reforms.

School nurses play a unique role in being able to advocate for their students and help eligible parents enroll in CHIP. This health coverage may help students get much-needed health care.

The Family Educational Rights and Privacy Act guarantees privacy protection of educational records for both students and their families. This only applies, however, to schools receiving federal funding, and private schools do not receive federal funding.

The Child Abuse Prevention and Treatment Act requires that nurses and other educational professionals report suspicions of child abuse and neglect to the appropriate professionals.

The School Nurse Act does not exist.

PTS: 1 REF: 471 CON: Legal | Promoting Health | Nursing Roles | Nursing 15. ANS: 1, 2, 4 Objective: 7. Discuss challenges to school health nursing for the future 2020 objectives.

Page: Heading: Challenges for the Future Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing; Promoting Health; Safety; Nutrition Difficulty: Moderate

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2 3

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5

Feedback According to the WHO, efforts to improve health in school-aged children and adolescents will improve health through the reduction of adverse health behaviors that include tobacco use, behavior that results in injury and violence, alcohol and substance use, dietary and hygienic practices that cause disease, sedentary lifestyle, sexual behavior that causes unintended pregnancy, and disease.

An active lifestyle is not one of the listed adverse health behaviors.

According to the WHO, efforts to improve health in school-aged children and adolescents will improve health through the reduction of adverse health behaviors that include tobacco use, behavior that results in injury and violence, alcohol and substance use, dietary and hygienic practices that cause disease, sedentary lifestyle, sexual behavior that causes unintended pregnancy, and disease.

According to the WHO, efforts to improve health in school-aged children and adolescents will improve health through the reduction of adverse health behaviors that include tobacco use, behavior that results in injury and violence, alcohol and substance use, dietary and hygienic practices that cause disease, sedentary lifestyle, sexual behavior that causes unintended pregnancy, and disease.

Failure to complete high school is not one of the listed adverse health behaviors.

PTS: 1 REF: 472 | 473 CON: Nursing | Promoting Health | Safety | Nutrition 16. ANS: 1, 3 Objective: 3. Describe the components and tenets of the student-centered Whole School, Whole Community, Whole Child model.

Page: Heading: Whole School, Whole Community, Whole Child > Physical Environment Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing; Promoting Health; Oxygenation; Critical Thinking Difficulty: Difficult

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Feedback Obtaining information on the trends in asthma over the past 10 years will help the nurse establish baseline data on the extent of the problem. In addition, the school nurse should obtain the EPA guide and work with her colleagues within the school to develop a practical plan for addressing air quality in the school.

This is a costly approach that would be undertaken by school administration only after confirming that this was actually needed. Instead she should start with an assessment of the issue, which would include a problem-focused assessment. She could also use the EPA Air Quality Tools for Schools Action Kit and work with her colleagues within the school to develop a practical plan for addressing air quality in the school.

Promoting a healthy school environment is important for all children, especially for children with asthma. The school nurse could use the EPA Indoor Air Quality Tools for School Action Kit and work with her colleagues within the school to develop a practical plan for addressing air quality in the school.

It doesn’t address the bigger issue that there may be environmental issues within the school building itself contributing to the increase in asthma attacks among students while inside the school.

This is a costly approach that would be undertaken by school administration only after confirming that this was actually needed. Instead she should start with an assessment of

the issue, which would include a problem-focused assessment. She could also use the EPA Air Quality Tools for Schools Action Kit and work with her colleagues within the school to develop a practical plan for addressing air quality in the school.

PTS: 1 REF: 454 CON: Safety | Nursing | Promoting Health | Oxygenation | Critical Thinking 17. ANS: 1, 2, 4, 5 Objective: 5. Discuss the role of school nurses in addressing health disparities and social determinants of health among vulnerable students.

Page: Heading: Population-Based School Nursing Practice > Tertiary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Metabolism; Collaboration; Nursing Roles; Nursing; Critical Thinking Difficulty: Difficult

1 2 3

4 5

Feedback One of the considerations is the needs of the student.

One of the considerations is the complexity of the task.

There is potential conflict between state laws and nursing scope and standards so it is important to begin with checking the state laws on delegation of nursing tasks within the school.

It is important to begin with checking the state laws on delegation of nursing tasks within the school.

One of the considerations is the stability of the student.

PTS: 1 REF: 467 CON: Metabolism | Collaboration | Nursing Roles | Nursing | Critical Thinking 18. ANS: 1, 3, 4 Objective: 4. Describe the roles, responsibilities, and interventions of school nurses in providing wellness care, episodic care, and care to children with noncommunicable illnesses or behavioral health problems.

Page: Heading: Tertiary Prevention > Episodic Care in the School Setting Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Development; Assessment; Critical Thinking; Nursing Difficulty: Moderate

1 2 3 4

Feedback Care coordination interventions are goal-oriented, based on the specific needs of the child, and evaluated based on their impact.

Care coordination interventions are individualized based on the individual needs of the student.

Care coordination interventions are goal-oriented, based on the specific needs of the child, and evaluated based on their impact.

Care coordination interventions are goal-oriented, based on the specific needs of the child, and evaluated based on their impact.

PTS: 1

REF: 463 | 464

CON: Development | Assessment | Critical Thinking | Nursing

ORDERED RESPONSE 19. ANS: C, D, A, B Feedback: The nursing process is a series of five steps used to guide nursing care and interventions. The first step is to assess the situation. Second, the nurse sets goals and plans interventions. Third, the nurse carries out the interventions. Finally, the nurse evaluates the outcome and effectiveness of the interventions. Afterward, the nurse documents all of the data and interventions in the appropriate place.

Objective: 1. Define school nursing.

Page: Heading: Introduction Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking; Promoting Health Difficulty: Easy PTS: 1

REF: 448

CON: Critical Thinking | Promoting Health

Chapter 19: Health Planning for Older Adults Multiple Choice Identify the choice that best completes the statement or answers the question.

1. After working in a pediatric unit for the past 5 years, Jan has decided to take a new job where she will be working with older adults. She wants to learn more about aging. Jan begins with looking into the aging process and learns that it reflects .

1. Chronological age and history of exposure to communicable diseases.

2. Biological age and nutritional status.

3. Chronological age and biological age.

4. Chronological age.

2. After working in a pediatric unit for the past 5 years, Jan has decided to take a new job where she will be working with older adults. She wants to learn more about aging. Jan decides to review theories of aging to better understand it. One theory she finds has to do with the damaging effects of molecules with unpaired electrons. This represents what theory of aging?

1. Free-radical theory 2. Cross-linkage theory 3. Protein synthesis errors 4. Genetic theories 3. After working in a pediatric unit for the past 5 years, Jan has decided to take a new job where she will be working with older adults. She wants to learn more about aging. Jan has begun her new job and is learning ways to help older patients age well who are living in a long-term care facility. The most important thing in caring for these patients is to: 1. Assist them with their activities of daily living.

2. Provide ample time to rest and relax.

3. Keep them socially engaged and active.

4. Minimize stress and responsibilities.

4. A nurse has noticed an increase in the number of older patients in the community coming down with pneumonia from influenza each winter. In addition to increasing access to the influenza vaccine each winter, which intervention would address the biggest risk factor associated with developing pneumonia for this particular age group?

1. Increasing hand washing 2. Improving nutrition by increasing access to healthy foods and prepared meals 3. Getting more restorative sleep 4. Increasing exercise through community programs 5. A nurse has set up a workshop in the senior community center to teach the residents who are newly diagnosed with diabetes how to manage their disease and inject insulin. The nurse documents this on the paperwork to the nursing manager as which type of intervention?

1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Universal prevention

6. A nurse is working at a specialized clinic for patients with chronic obstructive pulmonary disease (COPD).

Each year, the nurse recommends that patients get the influenza vaccine from their primary care provider but notices that there are a lot of older women who do not get the vaccine, despite the recommendations. What should the nurse do first?

1. Print educational materials about the importance of yearly flu shots.

2. Set up low-cost transportation to local primary care providers for the women.

3. Start offering the flu shot at the COPD clinic.

4. Perform a focused community assessment to determine why these women aren’t getting the flu shot.

7. Two nurses are talking about the number of patients that are admitted to the hospital each week due to falls in the home. They decide to partner up with the local senior center to design a community program aimed at reducing falls in the senior population. Which of the following interventions would likely be most effective?

1. Create printed material that the seniors can take home and use to assess their home.

2. Train volunteers to go into the homes of seniors at high risk for falls to assess their homes and help improve the home environment.

3. Provide an exercise program in the community center to increase agility and balance.

4. Pair up seniors at high risk with a volunteer caretaker who can help with chores and run errands.

8. An older woman, accompanied by her daughter, arrives in the emergency department complaining of shortness of breath. The triage nurse notices that the woman is covered with scabies and bed bug bites. After admitting her for evaluation, what should the nurse do first?

1. Arrange for a dermatology consult.

2. Review proper skin care and hygiene with the daughter.

3. Report suspected elder neglect to adult protective services (APS).

4. Screen the patient for possible elder maltreatment using the geriatric assessment instrument.

9. A naturally occurring retirement community is defined as: 1. A community that provides housing and health care across the continuum from independent living to skilled nursing care.

2. Residential housing with supports, transportation, individual assessment, and coordination of nonprofessional service.

3. Community-based health promotion programs aimed at improving quality of life of older adults while maintaining them in their own home.

4. A residential facility that provides skilled nursing care to those in need of rehabilitation or long-term care.

10. A nurse is performing an admissions assessment on a 93-year-old woman with abdominal pain. The woman is unable to remember certain facts about her medical history or current medications. What is the nurse’s first step?

1. Document her as slightly forgetful, consistent with age.

2. Inform the physician about her declining mental status.

3. Conduct further screening to determine mental status and memory.

4. Speak with the physician about ordering medication for dementia.

11. A home health nurse regularly sees older adults being cared for in their home by family members. As part of her health assessment at each visit, the nurse must also include: 1. Caregiver stress and burnout.

2. Financial responsibilities.

3. Health insurance status.

4. Expected needs over the coming year.

12. A nurse is beginning a new position with a home-care agency that provides hospice care. The nurse learns that the primary role of the nurse providing hospice care is to: 1. Provide for the patient’s medical needs at the end of life.

2. Help the patient stay active until their death.

3. Assist the patient and family through the dying process and toward a good death.

4. Provide hygiene and personal care when the family is unable to perform these skills.

13. A nurse is admitting a new patient into the hospice program. A key consideration that establishes rapport and helps develop a patient/family centered plan for end-of-life care and decisions is: 1. The culture and heritage of the patient.

2. Mental status and competence.

3. Patient’s physical health status.

4. Health-care benefits.

Completion Complete each statement.

14. A nurse is counseling a 68-year-old man in good health about his alcohol use. The man asks how many drinks he should limit himself to each week. The nurse replies that he should have no more than drinks per week.

15. A nurse is examining population data in the community and wants to determine the aged dependency ratio in order to figure out the relationship between community workers who are still in the workforce and those who are not. The total population of the community is 15,703. There are 3,625 children, ages 0 to 14 years old; 7,201 people aged 15 to 64; and 4,877 people aged 65 and over. What is the aged dependency ratio? Round to the nearest whole number.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

16. After working in a pediatric unit for the past 5 years, Jan has decided to take a new job where she will be working with older adults. She wants to learn more about aging. Jan is beginning to have a better understanding of the aging process and supportive caring that she can provide. She also wants to learn more about the aging population to help her distinguish changes that are due to natural aging from those that are due to diseases or other causes. She turns to The Baltimore Longitudinal Study of Aging (BLSA) and finds: (Select all that apply.)

1. Lifestyle choices can decrease or increase the development of disease.

2. Changes in body composition is a predictor for the development of diabetes.

3. Some changes in short-term memory are associated with aging in the absence of disease.

4. Changes in the circulatory system are not related to the aging process.

17. A large regional medical center has decided to include screening for past and present at-risk alcohol use as part of all new admissions, including older adults. The decision was based on what facts? (Select all that apply.)

1. Alcohol use in older adults has a more potent effect due to the physiological changes of aging.

2. The duration of elevated blood alcohol increases as we age.

3. Older adults are at increased risk for having an alcohol use disorder.

4. There are potential medication interactions with alcohol.

5. Alcohol use increases the risk of liver damage.

18. A nurse educator is having a discussion with students about the aging of the U.S. population. Which of the following are possible reasons for why our life span is increasing? (Select all that apply.)

1. Decreased education 2. Better access to quality health care 3. Increased average income 4. Improved physical environment 5. Increased urbanization 19. A nurse is looking to create program with the community that addresses keys to promoting healthy aging.

Which of the following should she consider that has a primary prevention focus? (Select all that apply.)

1. A social activity such as the “senior” prom with persons living in an independent living community 2. An immunization program 3. A colorectal screening program 4. A blood glucose monitoring program for persons diagnosed with type 2 diabetes 5. An exercise program for persons with arthritis and joint problems

Chapter 19: Health Planning for Older Adults Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 2. Describe demographic and social trends in an aging America.

Page: Heading: Health of Aging Populations > Who is Old? Integrated Processes: Nursing Assessment Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health Difficulty: Moderate

1 2 3

4

Feedback Although exposure to communicable diseases can accelerate the aging process, aging is a product of both chronological age and biological age.

Although inadequate nutrition can accelerate the aging process, aging is a product of both chronological age and biological age.

Aging is a product of both chronological age and biological age. Persons in low-income countries may age faster due to inadequate nutrition, exposure to communicable diseases, and poorer living conditions.

Aging is a product of both chronological age and biological age.

PTS: 1 REF: 480 CON: Nursing | Nursing Roles | Promoting Health 2. ANS: 1 Objective: 3. Define successful aging and determinants of health in the older population.

Page: Heading: Determinants of Aging and Health > Theories of Aging Integrated Processes: Nursing Assessment Client Need: Physiological integrity Cognitive Level: Application [Applying] Concept: Evidence-Based Practice Difficulty: Difficult

1

2 3 4

Feedback The free-radical theory stems from the observation that older adults are more prone to the damaging effects of free radicals, that is, molecules with unpaired electrons, and have lower levels of protectant free-radical scavengers.

The cross-linkage, or connective tissue, theory describes the chemical reactions that create strong bonds among molecular structures that are normally separate.

Another theoretical viewpoint of aging suggests that aging occurs as a result of the accumulation of errors in protein synthesis over time, leading to impaired cell function.

There are theories on programmed aging, or a biological or genetic clock, that determines how an individual’s original pool of genetic material is played out in an orderly manner.

PTS: 1

REF: 485

CON: Evidence-Based Practice

3. ANS: 3 Objective: 3. Define successful aging and determinants of health in the older population.

Page: Heading: Determinants of Aging and Health > Theories of Aging Integrated Processes: Caring Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate

1

2

3

4

Feedback According to psychosocial theories of aging, older adults who remained socially active and engaged in their life and community were observed to be happier and age better.

This is especially true when comparing active seniors with peers who were beginning to withdraw from their life.

According to psychosocial theories of aging, older adults who remained socially active and engaged in their life and community were observed to be happier and age better.

This is especially true when comparing active seniors with peers who were beginning to withdraw from their life.

According to psychosocial theories of aging, older adults who remained socially active and engaged in their life and community were observed to be happier and age better.

This is especially true when comparing active seniors with peers who were beginning to withdraw from their life.

According to psychosocial theories of aging, older adults who remained socially active and engaged in their life and community were observed to be happier and age better.

This is especially true when comparing active seniors with peers who were beginning to withdraw from their life.

PTS: 1 REF: 486 CON: Nursing | Promoting Health | Nursing Roles 4. ANS: 2 Objective: 4. Describe the main health issues facing older adults.

Page: Heading: Aging, Health, Disability, and Disease > Communicable Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nutrition; Infection; Critical Thinking; Nursing Difficulty: Difficult Feedback 1 Older adults are more likely to contract communicable diseases as a result of malnutrition, decreased immunity, and the presence of comorbid diseases. Improving nutritional status is an intervention that would likely have a positive effect on this population.

2 Older adults are more likely to contract communicable diseases as a result of malnutrition, decreased immunity, and the presence of comorbid diseases. Improving nutritional status is an intervention that would likely have a positive effect on this population.

3 Older adults are more likely to contract communicable diseases as a result of malnutrition, decreased immunity, and the presence of comorbid diseases. Improving nutritional status is an intervention that would likely have a positive effect on this

4

population.

Older adults are more likely to contract communicable diseases as a result of malnutrition, decreased immunity, and the presence of comorbid diseases. Improving nutritional status is an intervention that would likely have a positive effect on this population.

PTS: 1 REF: 490 CON: Promoting Health | Nutrition | Infection | Critical Thinking | Nursing 5. ANS: 3 Objective: 5. Apply current frameworks related to prevention of illness and injury in older adults.

Page: Heading: Aging, Health, Disability, and Disease > Noncommunicable Diseases Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Metabolism; Communication; Promoting Health; Nursing; Nursing Roles Difficulty: Moderate Feedback 1 This is an example of tertiary prevention. Primary prevention interventions include the reduction of risk factors associated with disease in a healthy population without the disease. Secondary prevention measures include those that focus on screening and early detection and treatment of disease. Tertiary interventions focus on interventions aimed at decreasing the risk of morbidity and mortality. Universal prevention is provided to all members of the population without consideration of individual risk.

2 This is an example of tertiary prevention. Primary prevention interventions include the reduction of risk factors associated with disease in a healthy population without the disease. Secondary prevention measures include those that focus on screening and early detection and treatment of disease. Tertiary interventions focus on decreasing the risk of morbidity and mortality. Universal prevention is provided to all members of the population without consideration of individual risk.

3 This is an example of tertiary prevention. Primary prevention interventions include the reduction of risk factors associated with disease in a healthy population without the disease. Secondary prevention measures include those that focus on screening and early detection and treatment of disease. Tertiary interventions focus on decreasing the risk of morbidity and mortality. Universal prevention is provided to all members of the population without consideration of individual risk.

4 This is an example of tertiary prevention Primary prevention interventions include the reduction of risk factors associated with disease in a healthy population without the disease. Secondary prevention measures include those that focus on screening and early detection and treatment of disease. Tertiary interventions focus on decreasing the risk of morbidity and mortality. Universal prevention is provided to all members of the population without consideration of individual risk.

PTS: 1 REF: 492 CON: Metabolism | Communication | Promoting Health | Nursing | Nursing Roles 6. ANS: 4 Objective: 5. Apply current frameworks related to prevention of illness and injury in older adults.

Page: Heading: Aging, Health, Disability, and Disease > Communicable Disease Integrated Processes: Nursing Process

Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Oxygenation; Infection; Assessment; Promoting Health; Critical Thinking Difficulty: Moderate Feedback 1 The nurse should first perform a focused community assessment, including interviews with key stakeholders in the targeted community, to determine why the women aren’t getting their flu shot. Once the assessment has been performed, then it is appropriate for the nurse to consider which interventions would be appropriate.

2 The nurse should first perform a focused community assessment, including interviews with key stakeholders in the targeted community, to determine why the women aren’t getting their flu shot. Once the assessment has been performed, then it is appropriate for the nurse to consider which interventions would be appropriate.

3 The nurse should first perform a focused community assessment, including interviews with key stakeholders in the targeted community, to determine why the women aren’t getting their flu shot. Once the assessment has been performed, then it is appropriate for the nurse to consider which interventions would be appropriate.

4 The nurse should first perform a focused community assessment, including interviews with key stakeholders in the targeted community, to determine why the women aren’t getting their flu shot. Once the assessment has been performed, then it is appropriate for the nurse to consider which interventions would be appropriate.

PTS: 1 REF: 488 | 491 CON: Infection | Assessment | Promoting Health | Critical Thinking 7. ANS: 2 Objective: 5. Apply current frameworks related to prevention of illness and injury in older adults.

Page: Heading: Aging, Health, Disability, and Disease > Injury and Violence in the Older Adult Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing; Critical Thinking; Collaboration; Safety Difficulty: Difficult Feedback 1 This is a good idea, but it may be difficult for older adults to secure rugs, install grab bars, or move furniture. The most effective intervention would be to train volunteers to go into the homes of seniors (who volunteered for the program), assess their home, and perform the necessary changes right away.

2 The most effective intervention would be to train volunteers to go into the homes of seniors (who volunteered for the program), assess their home, and perform the necessary changes right away.

3 Increasing exercise to improve agility and balance can be helpful. However, the most effective intervention would be to train volunteers to go into the homes of seniors (who volunteered for the program), assess their home, and perform the necessary changes right away.

4 Having someone assist them with their ADLs or errands can provide some benefit in the short term. However, it does not provide any long-term benefits. The most effective intervention would be to train volunteers to go into the homes of seniors (who volunteered for the program), assess their home, and perform the necessary changes right away.

PTS: 1 REF: 494 CON: Promoting Health | Nursing | Critical Thinking | Collaboration | Safety 8. ANS: 4 Objective: 10. Articulate key ethical issues related to aging in our society.

Page: Heading: Aging, Health, Disability, and Disease > Injury and Violence in the Older Adult Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Skin Integrity; Family; Violence; Nursing Roles Difficulty: Moderate Feedback 1 A general practitioner can usually treat scabies and bed bug bites. The priority for the nurse is to first screen the patient for possible elder maltreatment and, if the screen is positive, report to APS. 2 Although it is appropriate to review proper hygiene with the daughter/caregiver, the priority for the nurse is to first screen the patient for possible elder maltreatment and, if the screen is positive, report to APS. 3 The nurse should first screen the patient for possible elder maltreatment and, if the screen is positive, report to APS. 4 The nurse should first screen the patient for possible elder maltreatment and, if the screen is positive, report to APS. PTS: 1 REF: 494 | 495 CON: Skin Integrity | Family | Violence | Nursing Roles 9. ANS: 2 Objective: 7. Identify community resources for helping older adults age in place.

Page: Heading: Aging in Place > Naturally Occurring Retirement Community Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Critical Thinking; Health-Care System Difficulty: Moderate Feedback 1 A continuing care retirement community provides housing and health care across the continuum from independent living to skilled nursing care.

2 Naturally occurring retirement communities include residential housing with supports, transportation, individual assessment, and coordination of nonprofessional service.

3 Aging in place approach uses community-based health promotion programs aimed at improving quality of life of older adults while maintaining them in their own home.

4 Skilled nursing facilities provide skilled nursing care to those in need of rehabilitation or long-term care.

PTS: 1 REF: 499 CON: Critical Thinking | Health-Care System 10. ANS: 3 Objective: 10. Articulate key ethical issues related to aging in our society.

Page: Heading: Dementia and Alzheimer’s Disease: Impact on the Older Adult Population Integrated Processes: Nursing Process

Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Cognition; Comfort; Nursing Difficulty: Difficult Feedback 1 It is important not to assume that a lack of recall is due to age. The nurse should first screen the patient in relation to memory and mental status.

2 Prior to informing the physician, the nurse should screen the patient to determine mental status and memory.

3 Screening is the first step to help identify current mental status as well as identify the person in the early stages of dementia.

4 Screening is the first step to help determine if the patient may be in the early stages of dementia. If the patient has a positive screen then a referral should be made for further assessment and diagnosis before the initiation of treatment.

PTS: 1 REF: 501 CON: Assessment | Cognition | Comfort | Nursing 11. ANS: 1 Objective: 7. Identify community resources for helping older adults age in place.

Page: Heading: Dementia and Alzheimer’s Disease: Impact on the Older Adult Population > Caregiving Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress; Assessment; Nursing Difficulty: Moderate Feedback 1 People who are caregivers to their family members are at significant risk for burnout and stress related to providing care. The nurse should discuss this and explain options available for caregivers.

2 Financial responsibilities are not part of the health assessment.

3 Although health insurance status is often determined prior to the visit to establish eligibility for care, it is not part of the health assessment.

4 Expected needs over the year may be part of setting long-term goals, but it is not part of the health assessment.

PTS: 1 REF: 501 | 502 CON: Stress | Assessment | Nursing 12. ANS: 3 Objective: 8. Describe age-specific models of health-care delivery across the continuum from wellness to end-of-life care.

Page: Heading: Hospice and End-Of-Life Care Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Nursing; Nursing Roles; Grief and Loss; Health-Care System Difficulty: Moderate Feedback 1 Providing for physical needs is part of the role of hospice care; the physician will provide for the medical needs. More importantly, the nurse should assist the patient and

2

3 4

family through the dying process and toward a good death.

The most important part of hospice care is to assist the patient and family through the dying process and toward a good death. This may include helping the patient stay active for some time, but it is not the primary role.

The primary role of hospice care is to assist the patient and family through the dying process and toward a good death.

Providing for physical needs is part of the role of hospice care. More importantly, the nurse should assist the patient and family through the dying process and toward a good death.

PTS: 1 REF: 502 CON: Nursing | Nursing Roles | Grief and Loss | Health-Care System 13. ANS: 1 Objective: 8. Describe age-specific models of health-care delivery across the continuum from wellness to end-of-life care.

Page: Heading: Hospice and End-Of-Life Care > Cultural Context Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Diversity; Nursing; Assessment; Grief and Loss; Health-Care System Difficulty: Moderate Feedback 1 The patient’s culture and heritage play a significant role in their view on death and how they approach this time in their life. It is crucial to perform a cultural assessment so that the nurse can help the patient and his or her family to a peaceful death.

2 Mental status and competence is a part of the standard admission assessment and should be included every time the nurse sees the patient. The patient’s culture and heritage play a significant role in their view on death and how they approach this time in their life. It is crucial to perform a cultural assessment so that the nurse can help the patient and his or her family to a peaceful death.

3 Physical disease progression is a part of the standard admission assessment and should be considered every time the nurse sees the patient. The patient’s culture and heritage play a significant role in their view on death and how they approach this time in their life. It is crucial to perform a cultural assessment so that the nurse can help the patient and his or her family to a peaceful death.

4 Health-care benefits were likely checked before the patient was admitted to the hospice.

It should not play a role in the way nursing care is provided. The patient’s culture and heritage play a significant role in their view on death and how they approach this time in their life. It is crucial to perform a cultural assessment so that the nurse can help the patient and his or her family to a peaceful death.

PTS: 1 REF: 503 | 504 CON: Diversity | Nursing | Assessment | Grief and Loss | Health-Care System COMPLETION 14. ANS: 7

Feedback: Men and women 65 years of age and older who are also in good health should drink no more than 7 drinks per week.

Objective: 5. Apply current frameworks related to prevention of illness and injury in older adults.

Page: Heading: Substance Use in Older Adults > Alcohol and Older Adults Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Addiction; Nursing; Nursing Roles; Promoting Health Difficulty: Moderate PTS: 1 REF: 498 CON: Addiction | Nursing | Nursing Roles | Promoting Health 15. ANS: 68 Feedback: To calculate the aged dependency ratio, divide the number of people aged 65 and over (4,877) by the number of people between the ages of 15 and 64 (7,201) and multiply that by 100. (4,877 ÷ 7,201)  100  68.

Objective: 2. Describe demographic and social trends in an aging America.

Page: Heading: Health of Aging Populations > An Aging America Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking; Nursing; Promoting Health Difficulty: Moderate PTS: 1

REF: 483

CON: Critical Thinking | Nursing | Promoting Health

MULTIPLE RESPONSE 16. ANS: 1, 3 Objective: 3. Define successful aging and determinants of health in the older population.

Page: Heading: Key Aging Research < The Baltimore Longitudinal Study of Aging Integrated Processes: The Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Evidence-Based Practice; Promoting Health Difficulty: Easy

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Feedback Lifestyle choices impact the development of disease.

Metabolism and nutrition in aging, including body composition, are predictors for the development of diabetes.

Some changes in short-term memory are associated with aging in the absence of disease.

There are normal age-related circulatory system changes.

PTS: 1 REF: 486 | 487 CON: Evidence-Based Practice | Promoting Health | Nursing | Nursing Roles 17. ANS: 1, 2, 4, 5 Objective: 8. Describe age-specific models of health-care delivery across the continuum from wellness to end-of-life care.

Page: Heading: Substance Use in Older Adults > Alcohol and Older Adults Integrated Processes: Nursing Process Client Need: Physiological Integrity; Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Addiction; Nursing; Promoting Health; Assessment Difficulty: Moderate

1 2 3 4 5

Feedback Alcohol has a more potent effect due to the physiological changes of aging.

The decreased ability to metabolize alcohol results in a longer duration of elevated blood alcohol and increases the risk of liver damage.

A smaller percentage of older adults report heavy drinking than other age groups.

About 62.5% of older adults are using medications with potential alcohol interactions.

Alcohol use increases the risk of liver damage.

PTS: 1 REF: 497 | 498 CON: Addiction | Nursing | Promoting Health | Assessment 18. ANS: 2, 3, 4, 5 Objective: 2. Describe demographic and social trends in an aging America.

Page: Heading: Health of the Aging Population > An Aging America Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing; Nursing Roles Difficulty: Moderate

1 2 3 4 5

Feedback Increased average income and level of education have both been associated with increased life expectancy.

Better access to quality health care is associated with improved health outcomes and increased life expectancy.

Increased average income and level of education have both been associated with increased life expectancy.

Improved physical environment has been linked with increases in life expectancy due to better sanitation, decreased risk of infection, and improved food quality.

Increased urbanization has been associated with modest increases in life expectancy due to improved access to quality health care and better food.

PTS: 1 REF: 479-481 CON: Promoting Health | Nursing | Nursing Roles 19. ANS: 1, 2 Objective: 3. Define successful aging and determinants of health in the older population.

Page:

Heading: Aging, Health, Disability, and Disease > Communicable Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition; Promoting Health; Nursing; Critical Thinking Difficulty: Moderate

1 2 3 4 5

Feedback Maintaining social contact is key to healthy aging. This program is done with older adults in independent living and is therefore primary prevention focused.

Immunization is a key to healthy aging and is done to prevent disease from occurring and is therefore a primary prevention program.

Screening for cancer is a key to healthy aging with a secondary prevention focus.

Blood glucose monitoring is a key to healthy aging and when provided to those already diagnosed with type 2 diabetes for a focus on tertiary promotion.

An exercise program is a key to healthy aging when provided to those already diagnosed with arthritis or joint problems for a focus on tertiary promotion.

PTS: 1

REF: 491 | 492

CON: Nutrition | Promoting Health | Nursing | Critical Thinking

Chapter 20: Health Planning for Occupational and Environmental Health Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse is starting a new job as an occupational and environmental health nurse (OEHN) for a large corporation. The nurse wants to ensure that the company’s health and safety practices align with nursing standards of practice in this specialty area. What organization should the nurse check with to determine nursing standards?

1. ABOHN 2. AAOHN 3. NIOSH 4. OSHA 2. An occupational nurse is starting a new position with a company with 35 employees. The nurse asks to see the OSHA 300 form but is told that the company is not required to use that form. How does the nurse reply?

1. “You’re right. The OSHA 300 logs are voluntary.”

2. “You’re right. The OSHA 300 logs should be kept when a company has 50 employees.”

3. “That’s incorrect. The OSHA 300 logs should be kept when a company has at least 10 employees.”

4. “Each employee is required to keep their own logs and report injuries as applicable.”

3. A nursing student is doing a project using the Occupational Safety and Health (OSH) program to evaluate a local workplace. What is the first step?

1. Evaluate the workplace, looking for hazards.

2. Perform a community and workplace cultural assessment.

3. Perform medical screening on all employees.

4. Collect routine health data on all employees.

4. A nurse is describing the employee health prevention measures available to members of the hospital staff. The nurse explains that the use of personal protective equipment is an example of: 1. Primary prevention.

2. Secondary prevention.

3. Tertiary prevention.

4. Quaternary prevention.

5. A nurse is preparing a lecture about caring for the needs of the American workforce. Which of the following statements is incorrect?

1. The American workforce is becoming more knowledge based.

2. Most Americans are employed at their first job at 18 years of age.

3. The predominant health issue affecting the workforce is diseases associated with a sedentary lifestyle.

4. The American workplace is becoming more diverse.

6. A public health nurse (PHN) is volunteering at a clinic that provides care to migrant workers who work in the fields in their community. In addition to routine health assessments, what work-related potential health issue would be important for the nurse to include as part of her routine screening?

1. Hearing loss 2. Skin cancer 3. Diabetes 4. Heart failure

7. A worker has been exposed to a chemical that he is not used to working with. How should the OEHN proceed with treatment?

1. Quickly use water to rinse the chemical off and perform an assessment of the exposed skin.

2. Consult the material safety data sheet (MSDS) for more information on how to treat the exposure.

3. Call an ambulance and have a coworker bring a sample of the chemical with the victim to the hospital.

4. Encourage self-care and have the worker come back if he experiences any other symptoms.

8. A PHN is working as an occupational nurse for a mining company. Which of the following is an example of a secondary prevention policy that the nurses can implement to address the high risk of pulmonary disorders found in miners?

1. Respirator use for everyone working in the mine 2. Routine lung cancer and pulmonary disease screening 3. Job transfers for workers with pulmonary changes from the mine to an administrative position 4. Installation of a high-powered air filtration system in the mine 9. A nurse is beginning a new position on the medical floor of a hospital. A patient is being admitted with symptoms consistent with tuberculosis. What personal protective equipment does the nurse need when caring for the patient?

1. Gloves 2. Gloves and mask 3. Gloves, mask, and gown 4. Gloves, gown, and respirator 10. A nurse is working as an occupational nurse with a coal mining company. The nurse frequently observes workers sitting next to the entrance of the mine and eating lunch. The nurse knows that this poses a serious health risk. What is the nurse’s first step?

1. Speak with several workers to see why they are eating next to the entrance of the mine.

2. Have management install hand-washing stations next to the entrance so workers can wash their hands before eating.

3. Establish a break room in a portable trailer so that workers have a place to go eat lunch.

4. Host a wellness seminar so that the nurse can provide information to the workers.

11. A nurse is preparing to perform physical exams for a group of new employees. What information is the most crucial to the proper evaluation of the new employees’ health?

1. Medical records 2. Job description 3. Latest blood test results 4. Vaccination records 12. A nurse has noticed that the average age of the workers in a factory is starting to increase. In anticipation of the needs of this population of workers, which program would likely be effective in keeping these workers safe?

1. Beginning a fitness program for workers to build muscle, flexibility, and balance.

2. Reducing hours.

3. Decreasing lighting and frightening noises.

4. Implementing an early retirement program.

13. An OEHN is speaking with an employee who was injured on the job several weeks ago. It may be several more weeks before he is able to return to work. The nurse refers him to to discuss payment during his time off.

1. Long-term disability 2. Workers’ compensation 3. Social security 4. A no-fault attorney 14. A nurse is working in a large primary health-care clinic. Most of the staff members work at their desks and there are always baked goods from patients in the break room. The nurse wishes to implement positive healthy changes for the staff members. What is the first step she should take prior to developing a health promotion program in the office?

1. Conduct a health risk appraisal (HRA).

2. Offer a smoking cessation program.

3. Mandate yearly screenings for hypertension and diabetes.

4. Develop a biggest loser competition.

15. An OEHN at a large electronics factory wishes to implement new programs to improve employee health and well-being. To help identify environmental factors that may place employees at risk for illness or injury, the OEHN should: 1. Conduct a workplace assessment.

2. Conduct physical exams of the employees.

3. Conduct a health risk appraisal (HRA).

4. Conduct an occupational and environmental history of the employees.

16. An OEHN is reviewing the disaster preparedness plan of the factory where she works. The OEHN doesn’t see any mention of how to handle a catastrophic leak of a dangerous chemical, commonly used in the factory, which could potentially impact the surrounding community. Working together, the managers and the OEHN come up with actions to take to reduce the likelihood of a leak, which included improving the system that stores and delivers the chemical. In what part of the preparedness plan should this information be included?

1. Preparedness 2. Response 3. Mitigation 4. Recovery Multiple Response Identify one or more choices that best complete the statement or answer the question.

17. A nurse is starting a position with a large agricultural farm in the central California valley, where most of the employees are migrant workers. This farm has never before employed an OEHN, and so the nurse wants to establish a healthy living program tailored to the migrant workers. What information and assistance would be particularly helpful for this population? (Select all that apply.)

1. Information on exposure to pesticides 2. Information on reducing risk for skin cancer 3. Financial assistance for education 4. Signage in the workplace in their native language 5. Immigration assistance 18. An OEHN is performing an employee health evaluation for a new female worker who will be working on a construction site. What information is particularly relevant to the assessment? (Select all that apply.)

1. Fit of PPE

2.

3.

4.

5.

Hearing and vision assessment Family situation Previous medical records Job description

19. An occupational nurse is asked to perform a walk-through assessment of the factory where he or she works.

What type of information should the nurse include in the assessment? (Select all that apply.)

1. Obvious dangers or hazards 2. The presence or absence of safe walkways 3. Observations of noise levels 4. The use of personal protective equipment 5. The physical activity of the workers 20. A nurse is working on an oncology floor and explaining to the new nurses the safety measures required when handling chemotherapy. The nurse describes multiple levels of control, including which of the following?

(Select all that apply.)

1. Elimination 2. Engineering controls 3. Warnings 4. Administrative controls 5. Personal protective equipment

Chapter 20: Health Planning for Occupational and Environmental Health Answer Section MULTIPLE CHOICE 1. ANS: 2 Objective: 1. Define occupational health and occupational and environmental nursing.

Page: Heading: Occupational and Environmental Health Nursing Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Nursing; Regulations; Safety Difficulty: Easy Feedback 1 The ABOHN, or Accreditation Board for Occupational Health Nursing, is responsible for certifying nurses in the specialty of occupational health nursing. It is not involved in setting nursing practice standards.

2 The AAOHN, or American Association of Occupational Health Nursing, is the professional nursing organization for occupational health nurses. It develops and sets the scope and standards of practice for OEHNs. 3 NIOSH is the National Institute for Occupational Safety and Health, and is also a federal agency. Its purpose is to engage in research, educational programs, and training in workplace safety. It is not involved in setting nursing practice standards.

4 OSHA is the Occupational Safety and Health Association. It is a federal organization that oversees workplaces and makes sure that employees are protected and working in a safe environment. It is not involved in setting nursing practice standards.

PTS: 1 REF: 512 CON: Evidence-Based Practice | Nursing | Regulations | Safety 2. ANS: 3 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Key Agencies in Occupational Health > Occupational Safety and Health Administration Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing; Regulations; Safety Difficulty: Moderate Feedback 1 The OSH Act requires that OSHA 300 logs be kept by any company that employs more than 10 people. The logs keep track of fatalities, incidence rates for workplaces injuries and illnesses.

2 The OSH Act requires that OSHA 300 logs be kept by any company that employs more than 10 people. The logs keep track of fatalities, incidence rates for workplaces injuries and illnesses.

3 The OSH Act requires that OSHA 300 logs be kept by any company that employs more than 10 people. The logs keep track of fatalities, incidence rates for workplaces injuries and illnesses.

4

The OSH Act requires that OSHA 300 logs be kept by any company that employs more than 10 people. The logs keep track of fatalities, incidence rates for workplaces injuries and illnesses. These logs are kept by the administration and are not self-reported.

PTS: 1 REF: 513 CON: Safety | Nursing | Regulations | Safety 3. ANS: 1 Objective: 4. Discuss controlling hazards and reducing injuries in the workplace.

Page: Heading: Occupational Safety and Health (OSH) Program Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing; Nursing Roles; Critical Thinking Difficulty: Moderate Feedback 1 The first step of the OSH process is to evaluate the workplace, looking for all hazards and risks. Next, the OEHN nurse provides a plan to manage those risks and evaluates its effectiveness through environmental monitoring and medical screening of employees. Health data is collected as needed.

2 The first step of the OSH process is to evaluate the workplace, looking for all hazards and risks. Next, the OEHN nurse provides a plan to manage those risks and evaluates its effectiveness through environmental monitoring and medical screening of employees. Health data is collected as needed.

3 The first step of the OSH process is to evaluate the workplace, looking for all hazards and risks. Next, the OEHN nurse provides a plan to manage those risks and evaluates its effectiveness through environmental monitoring and medical screening of employees. Health data is collected as needed.

4 The first step of the OSH process is to evaluate the workplace, looking for all hazards and risks. Next, the OEHN nurse provides a plan to manage those risks and evaluates its effectiveness through environmental monitoring and medical screening of employees. Health data is collected as needed.

PTS: 1 REF: 513 CON: Safety | Nursing | Nursing Roles | Critical Thinking 4. ANS: 1 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Occupational Safety and Health (OSH) Program > Primary, Secondary, and Tertiary Prevention Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing Roles Difficulty: Moderate Feedback 1 Primary prevention includes measures taken to prevent injury or illness. Use of personal protective equipment is an example of primary prevention.

2 Secondary prevention involves screening and monitoring for injury or illness for early recognition.

3 Tertiary prevention includes treating the illness or injury.

4 Quaternary prevention includes measures that look to identify patients who are at risk

for being medically over treated.

PTS: 1 REF: 513 CON: Safety | Nursing Roles 5. ANS: 2 Objective: 2. Describe the relationship between the work environment, workplace exposures, and worker health and safety.

Page: Heading: Occupational Safety and Health (OSH) Program > Worker Populations Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing Roles; Promoting Health Difficulty: Moderate Feedback 1 As manufacturing and service jobs are moved internationally, American jobs are becoming more and more knowledge and creativity based.

2 Most young people begin working their first job at age 14 or 15.

3 As manufacturing jobs turn to more creative and knowledge-based jobs, American workers are more sedentary and having problems with obesity, hypertension, and diabetes.

4 The American workforce is becoming more diverse, requiring cultural assessment and sensitivity from the nurse.

PTS: 1 REF: 514 CON: Nursing Roles | Promoting Health 6. ANS: 2 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Exposures in the Work Place > Physical Exposures Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Assessment; Cellular Regulation; Safety Difficulty: Moderate Feedback 1 Migrant workers generally aren’t exposed to physical conditions that would increase their risk for hearing loss.

2 Migrant workers are outside in the sun for a majority of the day. If they are not careful about using sunscreen, their risk for developing skin cancer is significantly higher.

3 Migrant workers don’t have a higher risk of developing diabetes as a result of their profession. In fact, the increased physical activity is good for maintaining low blood sugar levels.

4 Migrant workers don’t have a higher risk of developing heart failure as a result of their profession. In fact, the increased physical activity is good for heart health.

PTS: 1 REF: 516 CON: Promoting Health | Assessment | Cellular Regulation | Safety 7. ANS: 2

Objective: 3. Discuss the concept of toxicology and the relevance to understanding and preventing occupational diseases.

Page: Heading: Exposures in the Work Place > Chemical Exposures Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Safety; Nursing; Trauma Difficulty: Moderate Feedback 1 Before using water to rinse the chemical off the skin, it is important to know if that is the correct first aid measure. The MSDS provides crucial information on the chemical properties, health hazards, as well as emergency and first aid procedures. Rinsing with water may not be the recommended first aid measure.

2 The MSDS provides crucial information on the chemical properties, health hazards, as well as emergency and first aid procedures.

3 It may be crucial to start emergency procedures right away to prevent further damage due to the exposure; the MSDS provides crucial information on the chemical properties, health hazards, as well as emergency and first aid procedures. Rinsing with water may not be the recommended first aid measure. However, it is important to contact emergency personnel as soon as possible.

4 Chemical exposures can result in serious injury and illness. It is important to begin the appropriate emergency and first aid procedures as soon as possible. The MSDS provides crucial information on the chemical properties, health hazards, as well as emergency and first aid procedures.

PTS: 1 REF: 516 CON: Safety | Nursing | Trauma 8. ANS: 2 Objective: 2. Describe the relationship between the work environment, workplace exposures, and worker health and safety.

Page: Heading: Occupational Safety and Health (OSH) Program > Primary, Secondary, and Tertiary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Oxygenation; Assessment; Nursing; Safety Difficulty: Moderate Feedback 1 Mandatory use of respirators is an example of a primary prevention intervention because its goal is to prevent pulmonary disease from occurring in the first place.

2 Routine lung cancer and pulmonary disease screenings is an example of a secondary prevention intervention. The goal is for early recognition and treatment.

3 Job transfers out of the mine and into administrative positions for workers with pulmonary dysfunction is an example of tertiary prevention. It is treating or managing the health problem after it has occurred.

4 Installation of a high-powered air filtration system is an example of a primary prevention intervention because its goal is to prevent pulmonary disease from occurring in the first place.

PTS: 1

REF: 513

CON: Oxygenation | Assessment | Nursing | Safety

9. ANS: 4 Objective: 4. Discuss controlling hazards and reducing injuries in the workplace.

Page: Heading: Exposures in the Work Place > Biological Exposures Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Infection; Oxygenation; Safety; Nursing Difficulty: Moderate Feedback 1 Gloves are always required when caring for patients. In addition, a respirator must be used when caring for a patient with tuberculosis. A respirator is a mask that covers the mouth and nose and requires a special fit test prior to use. The respirator must be completely sealed to the wearer’s face to prevent bacteria or other airborne particles from being inhaled. A gown must also be worn.

2 Gloves are always required when caring for patients. In place of a standard surgical mask, a respirator must be used when caring for a patient with tuberculosis. A respirator is a mask that covers the mouth and nose and requires a special fit test prior to use. The respirator must be completely sealed to the wearer’s face to prevent bacteria or other airborne particles from being inhaled. A gown must also be worn.

3 Gloves are always required when caring for patients. In place of a standard surgical mask, a respirator must be used when caring for a patient with tuberculosis. A respirator is a mask that covers the mouth and nose and requires a special fit test prior to use. The respirator must be completely sealed to the wearer’s face to prevent bacteria or other airborne particles from being inhaled.

4 When caring for a patient with tuberculosis gloves, respirator and gown are required personal protective equipment. A respirator is a mask that covers the mouth and nose and requires a special fit test prior to use. The respirator must be completely sealed to the wearer’s face to prevent bacteria or other airborne particles from being inhaled. A respirator must be used when caring for a patient with tuberculosis.

PTS: 1 REF: 517 CON: Infection | Oxygenation | Safety | Nursing 10. ANS: 1 Objective: 6. Explain the role of the occupational and environmental health nurse in the development, management, and evaluation of occupational health programs.

Page: Heading: Routes of Exposure Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing; Safety; Critical Thinking Difficulty: Moderate Feedback 1 The first step would be to establish why the workers are eating outside the mine. Do they have insufficient time to go to the break room? Is there a break room? Are they unaware of the need to wash their hands? Once the nurse knows why this behavior is occurring, he or she can then create a plan to address it.

2 The first step would be to establish why the workers are eating outside the mine. Do they have insufficient time to go to the break room? Is there a break room? Are they unaware of the need to wash their hands? Once the nurse knows why this behavior is

3

4

occurring, he or she can then create a plan to address it.

The first step would be to establish why the workers are eating outside the mine. Do they have insufficient time to go to the break room? Is there a break room? Are they unaware of the need to wash their hands? Once the nurse knows why this behavior is occurring, he or she can then create a plan to address it.

The first step would be to establish why the workers are eating outside the mine. Do they have insufficient time to go to the break room? Is there a break room? Are they unaware of the need to wash their hands? Once the nurse knows why this behavior is occurring, he or she can then create a plan to address it.

PTS: 1 REF: 515 CON: Nursing | Safety | Critical Thinking 11. ANS: 2 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Occupational and Environmental History Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Assessment; Nursing; Safety; Promoting Health Difficulty: Moderate Feedback 1 Part of the health assessment may include a review of the workers’ medical records, such as their latest blood test results. This is not the most crucial part of the health assessment. It is more important that the nurse have an accurate job description to anticipate for what type of injuries or illnesses the worker may be more at risk and what will be the physical demands of the job.

2 It is very important that the nurse have an accurate job description to anticipate for what type of injuries or illnesses the worker may be more at risk and what will be the physical demands of the job.

3 Part of the health assessment may include a review of the workers’ medical records, such as their latest blood test results. This is not the most crucial part of the health assessment. It is more important that the nurse have an accurate job description to anticipate for what type of injuries or illnesses the worker may be more at risk and what will be the physical demands of the job.

4 Part of the health assessment may include a review of the workers’ medical records, such as their latest blood test results. This is not the most crucial part of the health assessment. It is more important that the nurse have an accurate job description to anticipate for what type of injuries or illnesses the worker may be more at risk and what will be the physical demands of the job.

PTS: 1 REF: 521 CON: Assessment | Nursing | Safety | Promoting Health 12. ANS: 1 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Vulnerable Workers > Older Adults in the Workforce Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying]

Concept: Promoting Health; Safety; Nursing; Critical Thinking Difficulty: Moderate Feedback 1 Implementing a fitness program to build muscle, flexibility, and balance can be an effective way to reduce the risk for falls or other injuries. It can also reduce weight and the risk for developing chronic illness.

2 Simply reducing hours does not address the safety issues that arise for older adults.

Implementing a fitness program to build muscle, flexibility, and balance can be an effective way to reduce the risk for falls or other injuries. It can also reduce weight and the risk for developing chronic illness.

3 Older workers will need better lighting and louder noises or alarms due to declining sensory perception in the older adult. Implementing a fitness program to build muscle, flexibility, and balance can be an effective way to reduce the risk for falls or other injuries. It can also reduce weight and the risk for developing chronic illness.

4 Early retirement may not be an option for many of the workers and does not address the issue of safety for workers who do not retire. Implementing a fitness program to build muscle, flexibility, and balance can be an effective way to reduce the risk for falls or other injuries. It can also reduce weight and the risk for developing chronic illness.

PTS: 1 REF: 522 CON: Promoting Health | Safety | Nursing | Critical Thinking 13. ANS: 2 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Roles of the OEHN > Case Management Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Nursing; Health-Care System; Legal; Safety Difficulty: Moderate Feedback 1 Most employers do not provide long-term disability insurance. In addition, being out of work for only a few weeks does not qualify one for long-term disability. The nurse should refer him to the employer’s workers’ compensation insurer.

2 When a worker is injured on the job, the employer’s workers’ compensation insurance should provide income benefits and medical bills.

3 Social security doesn’t pay for workers injured on the job. The nurse should refer him to the employer’s workers’ compensation insurer.

4 A no-fault attorney typically doesn’t represent a worker who was injured on the job.

The nurse should refer him to the employer’s workers’ compensation insurer.

PTS: 1 REF: 527 CON: Nursing | Health-Care System | Legal | Safety 14. ANS: 1 Objective: 6. Explain the role of the occupational and environmental health nurse in the development, management, and evaluation of occupational health programs.

Page: Heading: Roles of the OEHN > Workplace Health Promotion Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing]

Concept: Promoting Health; Critical Thinking; Nursing Difficulty: Difficult Feedback 1 A health risk appraisal is a questionnaire completed by employees. This will help identify who is at risk for injury or disease based on health behaviors.

2 First the nurse would need to determine if any of the employees smoked through the information obtained in the HRA questionnaires.

3 Screening is an example of a secondary prevention program.

4 Although weight loss and healthy eating are excellent primary prevention programs, it is first important to know if any of the staff members have an issue with weight.

PTS: 1 REF: 529 CON: Promoting Health | Critical Thinking | Nursing 15. ANS: 1 Objective: 6. Explain the role of the occupational and environmental health nurse in the development, management, and evaluation of occupational health programs.

Page: Heading: Workplace Assessment (Workplace Walkthrough) Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Assessment; Promoting Health; Nursing Difficulty: Moderate Feedback 1 A workplace assessment is a walkthrough of the workplace to determine what safety plans are in place, and what deficiencies need to be addressed that place employees at risk for illness or injury.

2 A physical exam is at the individual level rather than the environmental level.

3 An HRA is a questionnaire that all employees can fill out to assess personal and health habits. It does not take into account the workplace environment.

4 An occupational and environmental history is the initial screening that is performed upon new employment with the company and is done at the individual level.

PTS: 1 REF: 519 CON: Assessment | Promoting Health | Nursing 16. ANS: 3 Objective: 6. Explain the role of the occupational and environmental health nurse in the development, management, and evaluation of occupational health programs.

Page: Heading: Emerging Issues in Occupational Health > Emergency Preparedness and Disaster Management Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing Difficulty: Moderate Feedback 1 The preparedness phase is when the capacity to respond to a disaster is evaluated and assured.

2 The response phase is when support is provided to persons and communities during the disaster.

3 Mitigation is the effort to reduce loss of life and property by lessening the impact of

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disasters and usually occurs before a disaster occurs.

The recovery phase describes the time when systems are returned to a pre-disaster functional state.

PTS: 1

REF: 530 | 531

CON: Safety | Nursing

MULTIPLE RESPONSE 17. ANS: 1, 2, 4 Objective: 5. Identify vulnerable worker populations.

Page: Heading: Vulnerable Workers > Immigrant or Foreign-Born Persons in the Workforce Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity; Nursing; Nursing Roles; Promoting Health; Safety Difficulty: Moderate

1 2 3

4 5

Feedback Migrant workers are at increased risk of exposure to pesticides.

Migrant workers are at increased risk for prolonged UV exposure of the skin.

It is not within the nurse’s scope of practice to help them obtain financial assistance for education; the nurse can, however, help them access government programs for food or health care.

It is important to put health and safety signage in their native language.

It is not within occupational health nurses’ scope of practice to address immigration issues.

The focus of OEHN is to promote health and prevent illness and injury.

PTS: 1 REF: 524 CON: Diversity | Nursing | Nursing Roles | Promoting Health | Safety 18. ANS: 1, 2, 3, 5 Objective: 5. Identify vulnerable worker populations.

Page: Heading: Vulnerable Workers > Women in the Workforce Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Assessment; Nursing; Safety Difficulty: Moderate

1 2 3 4 5

Feedback Most PPE for construction workers were designed to fit a man. It is especially important to make sure that all of the required equipment fits the female worker appropriately.

A current vision and hearing assessment is crucial for all workers on a construction site, both for their safety and the safety of others around them.

Having a conversation about her family situation can help provide insight into potential stressors or problems with work/life balance.

Previous medical records aren’t necessary for the OEHN to perform the assessment.

An accurate job description is essential for the nurse to understand exactly what the worker

will be doing in her position. It will help guide the assessment.

PTS: 1 REF: 523 CON: Assessment | Nursing | Safety 19. ANS: 1, 2, 3, 4, 5 Objective: 4. Discuss controlling hazards and reducing injuries in the workplace.

Page: Heading: Workplace Assessment (Workplace Walkthrough) Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing; Safety; Assessment; Critical Thinking Difficulty: Moderate

1 2 3 4 5

Feedback Obvious dangers/hazards need to be addressed immediately. For example, exposed wiring and floors with trip hazards need to be corrected before someone gets injured.

There should be clearly denoted pathways showing where it is safe to walk or stand, especially in work areas with heavy machinery.

Workers in a very noisy environment are at a high risk for future hearing loss. If noise levels are not at an acceptable level, the nurse should recommend the use of hearing protection.

Workers should be encouraged to use PPE as needed, and the nurse should be able to determine if additional PPE is recommended.

The way that the workers are required to move their bodies can give insight into potential injuries or overuse. For example, repetitive lifting or twisting motions can be damaging to the lower back.

PTS: 1 REF: 519 | 520 CON: Nursing | Safety | Assessment | Critical Thinking 20. ANS: 2, 3, 4, 5 Objective: 7. State methods of worker protection and safety as well as health promotion strategies in the occupational health setting.

Page: Heading: Controlling Hazards and Injuries in the Workplace > Hierarchy of Controls Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing Roles; Medication Difficulty: Moderate

1 2 3 4

5

Feedback There is no alternative to chemotherapy that can be substituted in this situation.

Chemotherapy is mixed in the pharmacy under a ventilation hood. This prevents the exposure of multiple staff members and visitors on the floor to the chemotherapy.

Every bag of chemotherapeutic agents must have a warning label affixed to the IV bag or vial informing the nurse and other staff about the dangers of the drug.

Frequent housekeeping and cleaning of the rooms and drug storage aid in minimizing exposure. In addition, the staff is well educated about the dangers of the drugs and how to manage spills.

At a minimum, gloves should be worn when handling or administering chemotherapy.

PTS: 1

REF: 519

CON: Safety | Nursing Roles | Medication

Chapter 21: Health Planning, Public Policy, and Finance Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse is working with local government officials and political lobbyists to prompt a vote to improve the school lunch program. The nurse knows that this is an example of: 1. Advocacy.

2. Public health policy.

3. Health equity.

4. Public health economics.

2. A nurse is preparing to teach a class on public health policy and its impact on nursing practice. Which of the following statements is incorrect and should be excluded from the lecture?

1. Nursing scope of practice as determined by state nurse practice acts is included in public health policy.

2. Nurses are affected by public health policy both professionally and personally.

3. Changing health policy does not fall within the scope of nursing practice.

4. Some federal and payroll tax exemptions are an example of public health policy.

3. A nurse is caring for a young man complaining about the state of the health-care system. He argues that health care should be left to the free market economy. To explain why relying on the free market is not practical, the nurse responds: 1. “There are too many health-care providers to support the health-care system in a free market economy.”

2. “A free market system is difficult to implement because during emergencies, patients and their families are unable to properly research local emergency care options.”

3. “The American health-care system is already based on a free market system.”

4. “A free market economy is based on the sale of goods, and does not apply to the health-care system.”

4. A nurse is working at a local community health center. The nurse is speaking with an elderly Native American man who lives on a nearby reservation. He reports that many members of his tribe are struggling to afford health care especially the increased cost of insulin for those with type 2 diabetes. What program should the nurse suggest that the gentleman contact for further assistance?

1. Indian Health Services 2. Medicaid 3. Medicare 4. The American Diabetes Association 5. A nurse is looking to create policies that would reduce the rate of adolescent E-cigarette use in the local community. Who would be the most important group to consult with when performing a community assessment?

1. Physicians and educators 2. Adolescents living in the community 3. Public health experts 4. Local shop owners and community council members 6. A school nurse is evaluating the lunch program in the district after a student had a serious anaphylactic reaction to peanuts. The school is located in a community where the median income is only slightly above the poverty level. What new policy would make the most sense in this school?

1. Mandate that all students purchase their food on campus and not bring any food into the building.

2. Obtain funding to provide free school lunches for everyone.

3. Make the school a completely peanut-free campus.

4. Ensure that every classroom has access to an EpiPen in case of future reactions.

7. There has been a measles outbreak in the county, and the public health officials have called an open meeting to decide what steps they could take to try and reach the immunity threshold among children in the county.

They are considering possibly mandating that all children be vaccinated. There is an objection from a community member attending the meeting that this approach violates the rights of individuals. Based on public health policy, the chair of the committee’s most likely response is: 1. The rights of individuals always outweigh the collective good.

2. The collective good always outweighs the rights of individuals.

3. Public health policy is based on governmental interests and not the collective good or individual rights.

4. Public health policy is based on the assumption that society has the right to collectively assure conditions for healthy people while taking into account the rights of individuals.

8. A nurse is working with the local representative to pass a law raising the legal age for purchasing tobacco to 21 years old. It has been passed into the committee phase of the legislative process. How should the nurse prepare for the next step?

1. Contact all of the local legislators to lobby for passing of the bill.

2. Encourage local citizens to vote on the bill and promote a local grass roots campaign base in the community.

3. Prepare evidence-based research and current clinical studies to support their position and educate committee members about the medicine behind nicotine addiction in youths.

4. Inform local store owners about the impending change in the law.

9. An occupational health nurse is speaking with union representatives about a long-standing problem with insufficient safety equipment at a local surgical center. Where does the nurse suggest they report the problem?

1. OSHA 2. JCAHO 3. City council 4. The medical director 10. A team of nurses working at a children’s hospital wish to address the issue of vaccination regulations in their state after seeing a number of children be admitted with preventable childhood diseases. They have decided to put together a petition to the state to change the laws related to vaccine exemptions at the state level. They wish to begin finding good sources of evidence-based practice that could help provide the basis for these policy changes. Which resource would be most helpful?

1. The AHRQ Clinical Guide 2. The Cochran Reviews 3. The CDC Community Guide 4. All of the above 11. A school nurse is concerned that, despite federal funding for the school lunch program, there is still an issue with a high obesity rate in the school district. The nurse found that, despite the highest rate of federal funding for any local school in their district and increased nutrition standards to improve the quality of food, students in the school had the highest obesity rate in the district. What should the school nurse do next?

1. Request additional funding.

2. Conclude that the new foods offered are not sufficient and the school should revert back to the type of meals offered in the past.

3. Interview the students and the parents to learn more about use of the lunch program and current activity levels.

4. Request that the school begin a school breakfast program as well so that students have increased access to healthy foods.

12. An interdisciplinary team working at the public health department is seeking to obtain funding for a community outreach health clinic in an underserved neighborhood. They have been asked to include a budget for the clinic and a plan for obtaining funding. The team is specifically utilizing: 1. Health economics.

2. Public health economics.

3. Market economy.

4. Federal funding guidelines.

13. The nurse responsible for outbreak surveillance in a southern Florida public health department in the summer of 2016 was informed that there had been reported cases of the Zika virus. The PHD did not have sufficient funds to address the outbreak. Due to confirmed cases, the CDC allocated funds to this PHD. This included funds for: (Select all that apply.)

1. Enhancing epidemiologic surveillance.

2. Providing perinatal care to pregnant women in the county who might have been infected with the virus.

3. Instituting county-wide mosquito control.

4. Contributing data to the U.S. Zika registry.

14. A nurse is having a discussion with a patient about who should be responsible for overseeing the public health system and the health of American citizens. The patient states that each person should be responsible for his or her own health. The nurse replies that the American Constitution gives this power to: 1. Federal government.

2. State governments.

3. Local governments.

4. Private insurance companies.

15. A nurse is caring for a young child with a severe ear infection in a hospital emergency department. The nurse asks the mother why it took so long for the child to get care, and the mother stated that she couldn’t afford medical bills and that they didn’t qualify for Medicaid. The mother decided not to get health insurance to save money. Once the child has received medical attention, what program does the nurse recommend to the mother?

1. WIC 2. CHIP 3. Medicare 4. TANF 16. A nurse is having a discussion with a coworker about frustration at the slow rate of positive health policy change. The nurse has attempted to contact the local policy maker about the need to expand public transportation availability for community members struggling to get to work but has not received a response.

What might the coworker suggest?

1. Visiting the representative’s local office to complain about the lack of response 2. Trying again after the next election 3. Getting a group of nurses and local residents to work together to make their needs known 4. Writing a formal letter of complaint 17. The school nurse is involved in multiple activities related to public health policy. Which of the following is an example of public health policy advocacy?

1. Reporting a newly diagnosed case of Listeria to the public health department 2. Informing students and parents about the need for flu vaccinations at the beginning of the school term 3. Doing height and weight screenings 4. Working with the school board to add nutrition classes in the middle school curriculum Other 18. A nurse has noticed an increase in at-risk drug and alcohol use in the young adult population in the community. The nurse has teamed up with another nurse to formulate a policy that they could put forward to the town council that would address this health concern. Place the following steps in the order in which they should be performed (A–D): A. Brainstorm a list of possible policy interventions.

B. Perform an assessment of the community, looking at social information, the available resources, and needs of the community.

C. Examine the efficiency, effectiveness, and equity of policy alternatives.

D. Establish goals, working with a representative of the young adults living in the community.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

19. A nurse is teaching a class on the basic principles of health insurance. The nurse asks the class about benefits of the Affordable Care Act to American citizens. What are some possible responses? (Select all that apply.)

1. Expansion of Medicaid to include more people 2. Coverage of young people under the age of 26 on their parents’ health insurance policy 3. Universal health coverage for all citizens 4. Mandatory employer-paid coverage for all employees 5. Expansion of access to and coverage of preventative care

Chapter 21: Health Planning, Public Policy, and Finance Answer Section MULTIPLE CHOICE 1. ANS: 1 Objective: 1. Discuss the role of policy in optimizing health for populations.

Page: Heading: The Legislative Process and Public Health Policy > Participation of Nurses in Health Policy Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition; Nursing Roles; Collaboration Difficulty: Moderate Feedback 1 Advocacy is the process of actively engaging in activities to effect changes to improve the health of populations.

2 Public health policies are guidelines that are put into place with the intention of improving the health and well-being of a population. Advocacy is the process of working on a population’s behalf to improve and enforce public health policies.

3 Health equity is a state of equality as it pertains to health outcomes and access.

Advocacy is the process of actively engaging in activities to effect changes to improve the health of populations.

4 Public health economics examines the financial aspect of public health policies. It concerns not only the cost of implementing changes, but also the efficiency and effectiveness of these policies. Advocacy is the process of actively engaging in activities to effect changes to improve the health of populations.

PTS: 1 REF: 537 | 556 CON: Nutrition | Nursing Roles | Collaboration 2. ANS: 3 Objective: 1. Discuss the role of policy in optimizing health for populations.

Page: Heading: Introduction Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Regulations; Nursing Roles Difficulty: Moderate Feedback 1 State nurse practice acts fall under the umbrella of public health policy because they are designed to protect the public as the recipients of nursing care. Thus, a nurse’s scope of practice is included in public health policy.

2 For the nursing profession, public health policy is a two-way street—it affects their personal lives as well as their professional role of advocacy.

3 Changing public health policy does fall within the scope of nursing practice in that nurses are responsible for identifying, interpreting, and implementing public health laws, regulations, and policies.

4 Although taxes are not regularly thought of as public health policy, the policy of exempting employer-sponsored health benefits from income and payroll taxes has

influenced employers to offer health benefits in lieu of increased salaries.

PTS: 1 REF: 537 | 538 CON: Promoting Health | Regulations | Nursing Roles 3. ANS: 2 Objective: 2. Describe the role of policy in the delivery of health care in the United States.

Page: Heading: Public Health Policy and the U.S. Health-Care System Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing Roles; Economics; Health-Care System Difficulty: Difficult Feedback 1 In many areas, there are too few health-care providers or specialists to support a free market system, meaning that there are too few “sellers” of health-care services.

2 One of the principles of a free market system is that consumers have all of the information necessary to make a decision. In emergent situations, patients are unable to research the cost or quality of local health-care providers.

3 The American health-care system is similar in some ways to a free market system.

However, there are many qualities of a free market system that do not apply to the American system.

4 A free market economy is based on the sale of goods or services, not just physical products.

PTS: 1 REF: 538 CON: Nursing Roles | Economics | Health-Care System 4. ANS: 1 Objective: 2. Describe the role of policy in the delivery of health care in the United States.

Page: Heading: Public Health Policy and the U.S. Health-Care System > Special Populations Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge [Remembering] Concept: Diversity; Promoting Health; Health-Care System; Economics Difficulty: Moderate Feedback 1 Indian Health Services is a federal program that aims to provide health care to members of federally recognized Native American tribes.

2 Medicaid is a federal program that provides financial aid to families and individuals living below the federal poverty line. It may be of some assistance to residents of the reservation, but families and individuals might not qualify based on their income.

3 Medicare is a federally funded program that provides financial assistance for medical care to people over the age of 65. Younger members of the tribe wouldn’t qualify for care under Medicare.

4 The American Diabetes Association may provide information for those with type 2 diabetes as well as advocate for affordable insulin but does not directly assist persons who are having difficulty paying for their medication.

PTS: 1 REF: 542 CON: Diversity | Promoting Health | Health-Care System | Economics

5. ANS: 2 Objective: 3. Apply public health principles to public health policy planning.

Page: Heading: Principles of Public Health Planning > Health Policy Assessment and Planning Process Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Promoting Health; Critical Thinking; Addiction Difficulty: Difficult Feedback 1 Physicians and educators can provide insight into adolescent risk behaviors but may not understand firsthand the context of adolescent E-cigarette use within the community.

As part of the assessment, the adolescents themselves are the most important to group to consult with.

2 Adolescents living in the community would be most important to consult. They could offer valuable insight into why teens are smoking and ways to prevent more teens from smoking.

3 Public health could offer valuable input related to adolescent E-cigarette use from a broader perspective but may not have firsthand knowledge of the context of adolescent E-cigarette use within the community. Teenagers residing in the community would be most important to consult. They could offer valuable insight into why teens are smoking and ways to prevent more teens from smoking.

4 Local shop owners and community council members are important stakeholders to include in the assessment. However, as part of the assessment the adolescents themselves are the most important to group to consult with.

PTS: 1 REF: 546 CON: Promoting Health | Critical Thinking | Addiction 6. ANS: 3 Objective: 3. Apply public health principles to public health policy planning.

Page: Heading: Principles of Public Health Policy > Ethical and Cultural Implications of Policy Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Synthesis Concept: Immunity; Nutrition; Diversity; Economics; Critical Thinking; Nursing; Safety; Quality Improvement Difficulty: Difficult Feedback 1 Although this would be an effective method at reducing the number of peanuts on campus and thus preventing anaphylactic reactions in allergic kids, this is likely not financially possible for the parents of most students in that school.

2 This could be an effective method for reducing allergens in school food, but it would likely be difficult to obtain sufficient funding to run and manage a completely free school food program.

3 This is the best option because it allows the children in the school to still bring their own food. However, keeping peanuts out of food brought into the school maintains a safe environment for students with allergies.

4 While having access to an EpiPen will help reduce the time until a child receives treatment for an allergy, it is better to prevent reactions from happening in the first place.

PTS: 1 REF: 552 CON: Immunity | Nutrition | Diversity | Economics | Critical Thinking | Nursing | Safety | Quality Improvement 7. ANS: 4 Objective: 4. Identify ethical issues related to public health policy.

Page: Heading: Principles of Public Health Policy > Ethical and Cultural Implications of Policy Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity; Ethics; Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Both the interests of individuals and collective interests are important and should be considered when setting public health policy.

2 Both the interests of individuals and collective interests are important and should be considered when setting public health policy.

3 Both the interests of individuals and collective interests are important and should be considered when setting public health policy.

4 Both the interests of individuals and collective interests are important and should be considered when setting public health policy.

PTS: 1 REF: 552 CON: Diversity | Ethics | Promoting Health | Nursing Roles 8. ANS: 3 Objective: 5. Examine the role of nurses in public health policy.

Page: Heading: The Legislative Process and Public Health Policy Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Addiction; Evidence-Based Practice; Promoting Health; Collaboration; Regulations Difficulty: Moderate Feedback 1 The bill needs to be passed by the committee and submitted to the full House of Representatives or Senate to be written and published before being added to the calendar in the House or Senate. Next, it is debated by the full membership who will then vote for or against the bill.

2 Citizens do not vote on bills in the committee phase of the legislative process. The next step is for the bill to be debated in a committee before it is either approved or denied.

3 The next step is for the bill to be debated by a specialized committee. If approved, the bill will be moved onto the legislative calendar. It is extremely important for the nurse to educate committee members about the medicine behind nicotine addiction in youths.

4 There is still a long way for the bill to go before it becomes law. The bill needs to be passed by the committee and submitted to the full House of Representatives or Senate to be written and published before being added to the calendar in the House or Senate.

Next, it is debated by the full membership who will then vote for or against the bill.

PTS: 1 REF: 555 CON: Addiction | Evidence-Based Practice | Promoting Health | Collaboration | Regulations

9. ANS: 1 Objective: 5. Examine the role of nurses in public health policy.

Page: Heading: Public Health Policy and the U.S. Health-Care System > Occupational Safety and Health Administration Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Critical Thinking; Regulations; Legal Difficulty: Easy Feedback 1 The Occupational Safety and Health Administration was created to improve workplace safety and provide workers with a safe place they can report problems.

2 The Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, is an organization that provides oversight to surgical centers and hospitals and sets certain patient safety goals.

3 The city council is not the appropriate place to report a workplace safety problem. The Occupational Safety and Health Administration (OSHA) was created for that purpose.

4 Because this has been an ongoing issue, it is likely that the medical director is already aware of the problem but hasn’t taken action to fix the problem. The workers should report the problem to the Occupational Safety and Health Administration (OSHA) anonymous tip line.

PTS: 1 REF: 542 CON: Safety | Critical Thinking | Regulations | Legal 10. ANS: 4 Objective: 1. Discuss the role of policy in optimizing health for populations.

Page: Heading: Principles of Public Health Policy > Evidence-Based Practice Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Evidence-Based Practice; Promoting Health; Nursing Roles; Regulations Difficulty: Moderate Feedback 1 The AHRQ has clinical guidelines related to evidence-based practices.

2 The Cochrane Review provides reviews of interventions and rates the level of the evidence to support the intervention.

3 The CDC Task Force on Community Preventive Services provides an overview of evidence-based practices at the community level called the Community Guide.

4 The Community Guide, The Clinical Guide, and The Cochrane Reviews all provide a review of evidenced-based practices.

PTS: 1 REF: 550 CON: Evidence-Based Practice | Promoting Health | Nursing Roles | Regulations 11. ANS: 3 Objective: 2. Describe the role of policy in the delivery of health care in the United States.

Page: Heading: Public Health Policy and the U.S. Health-Care System Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance

Cognitive Level: Analysis [Analyzing] Concept: Economics; Nutrition; Critical Thinking; Promoting Health Difficulty: Difficult Feedback 1 There is no evidence to suggest that spending more money would improve the obesity rate. In fact, the school has the highest rate of federal funding in the district and the highest rate of obesity, leading to the conclusion that increased spending is not actually related to better outcomes. The first step is to do an assessment starting with a survey of students and parents about use of the school lunch program and student level of physical activity.

2 The nurse needs to conduct an assessment first before concluding that the foods offered is the problem. The first step is to do an assessment starting with a survey of students and parents about use of the school lunch program and student level of physical activity.

3 The first step is to do an assessment starting with a survey of students and parents about use of the school lunch program and student level of physical activity.

4 This is one possible solution, but the school shouldn’t implement any changes until they know why the school still has a high rate of obesity. The first step is to do an assessment starting with a survey of students and parents about use of the school lunch program and student level of physical activity.

PTS: 1 REF: 548 CON: Economics | Nutrition | Critical Thinking | Promoting Health 12. ANS: 2 Objective: 6. Describe U.S. governmental policies related to the financing of health care.

Page: Heading: Public Health Finance > Finance Terms Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Economics; Health-Care System; Nursing Roles; Promoting Health; Sexuality Difficulty: Moderate Feedback 1 Health economics looks at the process for understanding the supply and demand of health-care services.

2 Public health economics examines the financing of public health from a governmental perspective with a focus on the delivery of public health goods and services and the financing of public health programs.

3 A market economy is an economic system based on the sale of goods and does not apply to the health-care system.

4 Local health departments obtain funding from various sources, mostly the state and their own local government, although they may qualify to apply for federal funding.

PTS: 1 REF: 558 CON: Economics | Health-Care System | Nursing Roles | Promoting Health | Sexuality 13. ANS: 2 Objective: 1. Discuss the role of policy in optimizing health for populations.

Page: Heading: Public Health Funding < Local Funding Integrated Processes: Nursing Process

Client Need: Communication and Documentation Cognitive Level: Application [Applying] Concept: Sexuality; Communication; Legal Difficulty: Moderate Feedback 1 CDC funds were awarded to public health partners, including all state public health departments and selected local public health departments, to combat the virus, including surveillance.

2 CDC funds were awarded to public health partners, including all state public health departments and selected local public health departments, to combat the virus. This did not include care for individuals who contracted the virus.

3 CDC funds were awarded to public health partners, including all state public health departments and selected local public health departments, to combat the virus. This included funds for mosquito control.

4 CDC funds were awarded to public health partners, including all state public health departments and selected local public health departments, to combat the virus. This included funds for contributing data to the U.S. Zika registry.

PTS: 1 REF: 560 CON: Sexuality | Communication | Legal 14. ANS: 2 Objective: 6. Describe U.S. governmental policies related to the financing of health care.

Page: Heading: Public Health Finance > Public Health Funding Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Legal; Nursing Roles Difficulty: Moderate Feedback 1 The U.S. Constitution gives each state the power to oversee the public health system and the health of its citizens.

2 The U.S. Constitution gives each state the power to oversee the public health system and the health of its citizens.

3 The U.S. Constitution gives each state the power to oversee the public health system and the health of its citizens.

4 The U.S. Constitution gives each state the power to oversee the public health system and the health of its citizens.

PTS: 1 REF: 559 CON: Legal | Nursing Roles 15. ANS: 2 Objective: 6. Describe U.S. governmental policies related to the financing of health care.

Page: Heading: Funding Access to Care > Government Health Insurance Programs Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health-Care System; Economics; Sensory Perception Difficulty: Easy Feedback

1

2 3 4

WIC, or Women, Infants, and Children, is a federal grant program that provides nutritional supplements to women, infants, and children who qualify. WIC does not provide health coverage.

CHIP is the Children’s Health Insurance Program and is appropriate for families who make too much money to qualify for Medicaid but still can’t afford medical coverage.

Medicare is a government program that provides health-care coverage to people over the age of 65.

TANF, or Temporary Assistance for Needy Families, is a temporary income support program. It does not provide health coverage.

PTS: 1 REF: 562 CON: Health-Care System | Economics | Sensory Perception 16. ANS: 3 Objective: 5. Examine the role of nurses in public health policy.

Page: Heading: The Legislative Process and Public Health Policy > Participation of Nurses in Health Policy Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles; Legal Difficulty: Moderate Feedback 1 Visiting the office may or may not get the suggestions recognized. He or she may not even be in the office. Politicians tend to respond better to large groups of constituents where not responding might affect their ability to get reelected.

2 Waiting until the next election is not an effective way to get the community needs addressed. Politicians tend to respond better to large groups of constituents where not responding might affect their ability to get reelected.

3 Politicians tend to respond better to large groups of constituents where not responding might affect their ability to get reelected.

4 Writing a letter of complaint may or may not get the suggestions acknowledged or enforced. Politicians tend to respond better to large groups of constituents where not responding might affect their ability to get reelected.

PTS: 1 REF: 556 CON: Promoting Health | Nursing Roles | Legal 17. ANS: 4 Objective: 1. Discuss the role of policy in optimizing health for populations.

Page: Heading: The Legislative Process and Public Health Policy > Participation of Nurses in Health Policy Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Nutrition; Promoting Health; Regulations; Nursing Roles Difficulty: Moderate Feedback 1 This is an example of an existing public health policy and not an example of nursing advocacy. Advocacy is the process of actively engaging in activities to change health policies and improve the health of populations.

2 This is an example of an existing school policy and not an example of nursing advocacy. Advocacy is the process of actively engaging in activities to change health

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policies and improve the health of populations.

This is an example of existing school policy. Advocacy is the process of actively engaging in activities to change health policies and improve the health of populations.

This is an example of advocacy because the nurse is actively engaging in activities to effect changes to improve the health of populations.

PTS: 1

REF: 556

CON: Nutrition | Promoting Health | Regulations | Nursing Roles

ORDERED RESPONSE 18. ANS: B, D, A, C Feedback: The first step in the nursing process or policy process is to perform a community assessment, looking at the needs of the community, the available resources, and the social data pertaining to community members. Next, the nurse should establish specific goals and objectives. Working with local teens and other community members invested in the policy would be helpful in generating effective goals. A list of possible policy interventions should then be generated, followed by a thorough evaluation of each of the alternatives.

Objective: 3. Apply public health principles to public health policy planning.

Page: Heading: Principles of Public Health Policy > Health Policy Assessment and Planning Process Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Addiction; Assessment; Critical Thinking; Promoting Health Difficulty: Moderate PTS: 1 REF: 546 CON: Addiction | Assessment | Critical Thinking | Promoting Health MULTIPLE RESPONSE 19. ANS: 1, 2, 5 Objective: 2. Describe the role of policy in the delivery of health care in the United States.

Page: Heading: Public Health Policy and the U.S. Health-Care System > Patient Protection and Affordable Care Act (ACA) of 2010 Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles; Health-Care System; Legal Difficulty: Easy

1 2 3

Feedback The Affordable Care Act includes a provision to expand access to Medicaid to include adults/families under 133% of the federal poverty line.

The Affordable Care Act allows parents to keep children up to the age of 26 on their health plan.

The Affordable Care Act does not provide universal health coverage for all citizens. Rather,

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its goal is to expand access and minimize cost for consumers. It also aims to improve health outcomes and reduce health inequities.

The Affordable Care Act does not require that all employers offer insurance coverage. This provision only requires employers with 50 or more employees to offer coverage.

The Affordable Care Act does expand access to and coverage of more preventative health services.

PTS: 1 REF: 541 CON: Promoting Health | Nursing Roles | Health-Care System | Legal

Chapter 22: Health Planning for Emergency Preparedness and Disaster Management Multiple Choice Identify the choice that best completes the statement or answers the question.

1. A nurse is attending a training session on disaster management and is surprised to learn that: 1. True emergency preparedness and disaster management is a continuous cycle and has no beginning or end.

2. There are four stages of the disaster preparedness framework.

3. There are three stages of the disaster preparedness framework.

4. Emergency preparedness and disaster management should only occur at the local level.

2. A nurse is reviewing the disaster and emergency plans for the hospital before updating them. What characteristic needs to be addressed, as it is not helpful in a disaster preparedness plan?

1. The plan is broad in scope and able to address multiple types of disasters.

2. The plan is comprehensive and contains plans for advanced preparation, disaster management, and post-disaster evaluation.

3. The plan stresses autonomy and independence from nearby organizations.

4. The plan includes information about long-term management of the aftereffects of the disaster.

3. A nurse is working at a high school serving as a community shelter during a hurricane. In the surge after the storm, the basement starts filling with floodwaters and then the power shuts off. As a result, the nurse, as indicated in the plan in the event of flooding, contacts the local coast guard to assist in relocating people in the shelter to an unaffected elementary school across town. This is an example of: 1. Mitigation.

2. Response.

3. Triage.

4. Recovery.

4. A public health nurse (PHN) is working with a community after a major wildfire. The fire has been completely contained and will be put out shortly. How does the nurse proceed?

1. Return home and allow the local firefighters to finish putting the fire out.

2. Contact the federal government to ask for assistance in managing the wildfire.

3. Wait another day or two until the fire is confirmed to be out and then return home.

4. Begin surveillance and assess for incidences of respiratory disease related to the fires.

5. A nurse is speaking at a city council meeting in a coastal town on the northeastern coast of the United States.

The nurse is explaining that, to protect the rest of the town, the city council needs to restrict people from building homes directly adjacent to the beach . A resident stands up, angry, and demands to know why he can’t purchase property there. From the perspective of safety for the community as a whole, the nurse replies: 1. “People living directly adjacent to the beach are at greater risk for property damage from seawater.”

2. “Deforestation along the coast can increase risk and severity of strong storm surges during hurricanes or coastal storms.”

3. “Remote areas can be more difficult to evacuate in case of an emergency.”

4. “All community members need to be able to access the coastline in case of an emergency evacuation.”

6. A PHN has been dispatched to communities along the New Madrid fault in Missouri because the area has seen a recent increase in seismic activity. The nurse is working with the communities to put policies in place that focus on mitigating the potential damages from future earthquakes. Which of the following is an example of an effective policy change related to mitigation?

1. Require a post-earthquake meeting to discuss the town’s response.

2. Create an emergency preparedness plan.

3. Update building ordinances to be more resistant to seismic activity.

4. Make the Director of the City Health Department in charge of all emergency response needs.

7. A nurse is at the beach with friends when one of them begins to complain about dizziness and fatigue. It is a particularly hot day in the middle of a heat wave. How should the nurse react?

1. Call an ambulance.

2. Tell the friend to close her eyes, rest, and have her take some slow deep breaths.

3. Give the friend some cool water.

4. Leave the beach with the friend and have her sit in an air-conditioned car while drinking an electrolyte replacement drink.

8. A nurse is working with a local television station on a public service announcement meant to educate residents on how to prepare for tornadoes. What advice does the nurse give in the event that a tornado is imminent?

1. Watch for the coming storm at the windows.

2. Immediately take shelter in a basement away from any windows.

3. Take shelter in a large room under a blanket.

4. As soon as the alarm goes off, gather your emergency supplies and head to the nearest community shelter.

9. A nurse is working at a hospital in Hawaii. A neighboring island has been evacuated due to a volcanic eruption. The hospital has been put on alert that they will be receiving injured people from the evacuated island. What types of injuries or illnesses should the nurse and other staff be prepared to treat?

1. Burns 2. Respiratory disease 3. Severe lacerations or other traumatic injuries 4. All of the above 10. A nurse is volunteering with the local fire department and is sitting in on a class about dealing with wildfires.

The instructor is talking about strategies for fighting a fire that is burning below the forest floor in the humus layer of the soil. This is known as what type of fire?

1. Wildfire 2. Ground fire 3. Surface fire 4. Crown fire 11. A nurse is taking care of several patients who were injured as a result of a pipe bomb explosion. The current patient has ruptured eardrums and traumatic injuries to his lower extremities due to flying debris. How does the nurse document these injuries?

1. Primary 2. Secondary 3. Primary and tertiary 4. Primary and secondary

12. Two nurses are assisting paramedics at the site of a large accident with many injured people. During the initial response, their first priority is to: 1. Notify the media so they can assist in informing the community of what happened.

2. Triage victims according to the severity of their injuries.

3. Interview victims and witnesses to determine what happened.

4. Notify clergy and mental health professionals to assist survivors at the site.

13. A nurse is responding to the scene of a small plane crash in the community. First responders are on the scene treating victims, but they have asked the nurse to notify the appropriate federal authorities. The nurse informs: 1. The FBI. 2. The FAA. 3. FEMA. 4. The Department of Homeland Security.

14. A nurse is working very closely with a community after a small plane crashed into an apartment complex and killed many of its residents. Now that the crash site is being cleaned in the days after the crash, what is the priority for this community?

1. Screen for and manage depression, anxiety, and post-traumatic stress disorder.

2. Establish an emergency management plan.

3. Hold a community debriefing about what happened.

4. Encourage residents to get back to their regular routines as soon as possible.

15. A nurse is working with the state department of health. Weather forecasters are anticipating that several communities will be impacted by a severe hurricane that will likely decimate the coastline of their community. The county government has ordered a voluntary evacuation for those living along the coast.

Which of the following statements is incorrect?

1. Use of the Emergency Alert System by broadcasters during an emergency is voluntary.

2. The county should consider mandatory evacuations if residents chose to not evacuate as suggested.

3. There should be a legal plan in place to deal with residents who are not complying with instructions.

4. A shelter should be established to help vulnerable residents and people who are not able to find somewhere to stay.

16. A prison nurse has received notification that there is a powerful storm system approaching the prison that is likely to cause tornados in the area, putting the prison and prisoners at risk. The nurse is reviewing the emergency response plan, which should include: 1. Plans for the safety of first responders.

2. Plans for the protection and safety of prisoners and staff.

3. Plans for the safety of the general public.

4. All of the above.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

17. A nurse is organizing a disaster drill for the hospital. Which factors should the nurse consider while organizing the drill? (Select all that apply.)

1. They should be scheduled regularly .

2. The materials should be specific to the expected surge at that facility during a disaster.

3. They should only involve a few key staff members.

4. They should maintain the organizational function of the facility.

5. In addition to the actual drill, the entire staff and volunteers should undergo a continuing education in-service.

18. A PHN has been sent to the site of a nuclear accident to assist in setting up long-term surveillance. The PHN will want to monitor cases of which of the following diseases? (Select all that apply.)

1. Heart disease 2. Leukemia 3. Mental illness 4. Thyroid disease 5. Diabetes 19. A nurse has just been promoted to serve on the disaster preparedness committee of the hospital. The nurse’s role during a disaster is to collect emergency information and distribute it to public health officials as required. What information should the nurse collect? (Select all that apply.)

1. Staffing needs 2. Supply inventory and shortages 3. Name, social security number, and phone number of every employee responding to the disaster 4. Budget needs of the hospital 5. Number of patients who have already been treated and who still need care Other 20. A nurse is reviewing the disaster preparedness cycle with other nurses in the hospital. Order the five key concepts of the framework from first step to fifth step.

A. Recovery B. Preparedness C. Assessment D. Response E. Evaluation

Chapter 22: Health Planning for Emergency Preparedness and Disaster Management Answer Section MULTIPLE CHOICE 1. ANS: 1 Objective: 3. Discuss the five areas of focus in emergency and disaster planning: (1) preparedness, (2) mitigation, (3) response, (4) recovery, and (5) evaluation.

Page: Heading: Emergency Preparedness and Disaster Management > Emergency Preparedness Theoretical Framework Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Nursing Roles Difficulty: Moderate Feedback 1 Emergency preparedness and disaster management is a continuous cycle and has no beginning or end.

2 There are five components of the disaster preparedness framework—preparedness, mitigation, response, recovery, and evaluation.

3 There are five components of the disaster preparedness framework—preparedness, mitigation, response, recovery, and evaluation.

4 Emergency preparedness and disaster management must occur at the local (community), state, national, and global levels.

PTS: 1 REF: 572 CON: Safety | Nursing Roles 2. ANS: 3 Objective: 2. Appreciate the unique role of nurses during disasters and public health emergencies.

Page: Heading: Emergency Preparedness and Disaster Management > Disaster Planning Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Critical Thinking; Assessment; Collaboration; Management; Safety Difficulty: Moderate Feedback 1 A disaster preparedness plan should be broad in scope and able to address multiple types of disasters, yet also comprehensive and contain plans for advanced preparation, disaster management, and post-disaster evaluation. It should also include information about long-term management of the aftereffects of the disaster. Finally, the plan should stress collaboration and cooperation with nearby organizations.

2 A disaster preparedness plan should be broad in scope and able to address multiple types of disasters, yet comprehensive and contain plans for advanced preparation, disaster management, and post-disaster evaluation. It should also include information about long-term management of the aftereffects of the disaster. Finally, the plan should stress collaboration and cooperation with nearby organizations.

3 The plan should stress collaboration and cooperation with nearby organizations. In

4

addition, a disaster preparedness plan should be broad in scope and able to address multiple types of disasters, yet comprehensive and contain plans for advanced preparation, disaster management, and post-disaster evaluation. It should also include information about long-term management of the aftereffects of the disaster.

A disaster preparedness plan should be broad in scope and able to address multiple types of disasters, yet comprehensive and contain plans for advanced preparation, disaster management, and post-disaster evaluation. It should also include information about long-term management of the aftereffects of the disaster. Finally, the plan should stress collaboration and cooperation with nearby organizations.

PTS: 1 REF: 573 CON: Critical Thinking | Assessment | Collaboration | Management | Safety 3. ANS: 2 Objective: 3. Discuss the five areas of focus in emergency and disaster planning: (1) preparedness, (2) mitigation, (3) response, (4) recovery, and (5) evaluation.

Page: Heading: Emergency Preparedness and Disaster Management > Disaster Planning Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Safety; Collaboration Difficulty: Moderate Feedback 1 Mitigation is the process of planning for the harm or impact of a disaster, which usually occurs before the disaster occurs.

2 The response phase is the actual implementation of the disaster plan.

3 Triage is the process of sorting victims or situations according to the level of severity of injury or damage.

4 Recovery is the process of returning the community back to its prior state. This may include rebuilding infrastructure or relocating populations.

PTS: 1 REF: 576 CON: Trauma | Safety | Collaboration 4. ANS: 4 Objective: 6. Describe the process of epidemiological surveillance during community disaster mitigation and recovery.

Page: Heading: Disaster Epidemiological Surveillance > Postimpact Epidemiological Surveillance Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis [Analyzing] Concept: Oxygenation; Trauma; Safety; Critical Thinking; Assessment Difficulty: Moderate Feedback 1 It is known that respiratory illnesses increase after a major wildfire. The nurse should remain on site to monitor for and track respiratory disease cases until the numbers of such cases return to the community baseline.

2 It is known that respiratory illnesses increase after a major wildfire. The nurse should remain on site to monitor for and track respiratory disease cases until the numbers of such cases return to the community baseline.

3 It is known that respiratory illnesses increase after a major wildfire. The nurse should

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remain on site to monitor for and track respiratory disease cases until the numbers of such cases return to the community baseline.

It is known that respiratory illnesses increase after a major wildfire. The nurse should remain on site to monitor for and track respiratory disease cases until the numbers of such cases return to the community baseline.

PTS: 1 REF: 577 CON: Oxygenation | Trauma | Safety | Critical Thinking | Assessment 5. ANS: 2 Objective: 1. Describe the impact of natural and manmade disasters on population health.

Page: Heading: Natural Disasters > Cyclones, Hurricanes, and Typhoons Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Safety; Nursing Roles Difficulty: Moderate Feedback 1 Although this fact may be correct, it does not impact the entire town. Deforestation along the coast can increase risk and severity of strong storm surges during hurricanes or coastal storms.

2 Deforestation along the coast can increase risk and severity of strong storm surges during hurricanes or coastal storms.

3 Although this fact may be correct, it does not impact the entire town. Deforestation along the coast can increase risk and severity of strong storm surges during hurricanes or coastal storms.

4 Deforestation along the coast can increase risk and severity of strong storm surges during hurricanes or coastal storms. The coast would be an extremely dangerous place to be during a hurricane or large coastal storm.

PTS: 1 REF: 579 CON: Trauma | Safety | Nursing Roles 6. ANS: 3 Objective: 4. Apply the emergency preparedness theoretical framework to a public health disaster scenario.

Page: Heading: Natural Disasters > Earthquakes Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Safety; Critical Thinking Difficulty: Moderate Feedback 1 This is part of the evaluation, or recovery phase of disaster management. Updating building codes and ordinances to require that buildings are more resistant to seismic activity is an example of mitigation because it reduces the impact of the earthquake.

2 This is an example of the preparedness step. Updating building codes and ordinances to require that buildings are more resistant to seismic activity is an example of mitigation because it reduces the impact of the earthquake.

3 Updating building codes and ordinances to require that buildings are more resistant to seismic activity is an example of mitigation because it reduces the impact of the earthquake.

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This is part of the emergency preparedness plan and is an example of the preparedness step. Updating building codes and ordinances to require that buildings are more resistant to seismic activity is an example of mitigation because it reduces the impact of the earthquake.

PTS: 1 REF: 580 | 581 CON: Trauma | Safety | Critical Thinking 7. ANS: 4 Objective: 1. Describe the impact of natural and manmade disasters on population health.

Page: Heading: Natural Disasters > Extreme Heat Integrated Processes: Nursing Process Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Critical Thinking; Assessment; Thermo-Regulation; Fluid and Electrolyte Balance Difficulty: Moderate Feedback 1 An ambulance is not needed at this point, because the friend is likely suffering from heat exhaustion and not heat stroke. However, if the nurse does not act quickly, the friend could become significantly more ill.

2 This could be very dangerous for the friend. Not getting her out of the heat or rehydrating her could rapidly progress her heat exhaustion to heat stroke.

3 Drinking cool water can be effective, however, the friend needs to get out of the heat immediately and rehydrate using an electrolyte replacement solution.

4 The friend needs to cool off immediately. She should leave the beach and sit in an air-conditioned car. She also needs to rehydrate by drinking an electrolyte replacement solution.

PTS: 1 REF: 581 CON: Critical Thinking | Assessment | Thermo-Regulation | Fluid and Electrolyte Balance 8. ANS: 2 Objective: 1. Describe the impact of natural and manmade disasters on population health.

Page: Heading: Natural Disasters > Tornadoes Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Safety; Nursing Roles Difficulty: Moderate Feedback 1 When a tornado may be coming through, it is important to immediately get into the emergency shelter and listen to a radio or TV for news and updates. It is important to stay away from the windows in case flying debris breaks the glass.

2 The best place to take shelter is in the basement or in a designated storm shelter. If neither is available, people should take shelter in an inside closet or bathroom with something heavy protecting the head.

3 The best place to take shelter is in the basement or in a designated storm shelter. If neither is available, people should take shelter in an inside closet or bathroom with something heavy protecting the head.

4 Waiting until the sirens go off to start gathering supplies is dangerous. People should immediately take shelter in a basement away from any windows.

PTS: 1 REF: 583 CON: Trauma | Safety | Nursing Roles 9. ANS: 4 Objective: 1. Describe the impact of natural and manmade disasters on population health.

Page: Heading: Natural Disasters > Volcanic Eruptions Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Oxygenation; Skin Integrity; Critical Thinking; Safety Difficulty: Moderate Feedback 1 People can experience burns or injuries from lateral blasts, or sideways-directed volcanic explosions. Respiratory illnesses due to inhalation of ash and other toxic gases or irritants are also common.

2 People can experience burns or injuries from lateral blasts, or sideways-directed volcanic explosions. Respiratory illnesses due to inhalation of ash and other toxic gases or irritants are also common.

3 People can experience burns or injuries from lateral blasts, or sideways-directed volcanic explosions. Respiratory illnesses due to inhalation of ash and other toxic gases or irritants are also common.

4 People can experience burns or injuries from lateral blasts, or sideways-directed volcanic explosions. Respiratory illnesses due to inhalation of ash and other toxic gases or irritants are also common.

PTS: 1 REF: 584 CON: Trauma | Oxygenation | Skin Integrity | Critical Thinking | Safety 10. ANS: 2 Objective: 1. Describe the impact of natural and manmade disasters on population health.

Page: Heading: Natural Disasters > Wildfires Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Safety; Nursing Roles Difficulty: Moderate Feedback 1 Wildfire is a generic title for a fire that is burning out of control in the forest or across large areas of land.

2 A ground fire burns below the forest floor, usually down in the humus layer of the soil.

These fires are usually started by lightning strikes.

3 A surface fire burns along the forest floor. It typically moves very slowly but can be extremely damaging.

4 A crown fire burns along the tops of the trees, and easily jumps from tree to tree.

PTS: 1 REF: 587 CON: Trauma | Safety | Nursing Roles 11. ANS: 4 Objective: 2. Appreciate the unique role of nurses during disasters and public health emergencies.

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Heading: Manmade Disasters > Blast Events Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Violence; Communication Difficulty: Moderate Feedback 1 The ruptured eardrums are a primary injury, but the injuries to his lower limbs that resulted from flying debris are secondary injuries.

2 The injuries to his lower extremities are secondary injuries, but the ruptured eardrums are a primary injury.

3 The ruptured eardrums are a primary injury, and the injuries to his lower limbs that resulted from flying debris are secondary injuries.

4 The ruptured eardrums are a primary injury, and the injuries to his lower limbs that resulted from flying debris are secondary injuries.

PTS: 1 REF: 587 | 588 CON: Trauma | Violence | Communication 12. ANS: 2 Objective: 5. Describe the structure and organization of local and national disaster mitigation efforts.

Page: Heading: Disaster Response Structure and Organization > Disaster Triage and Patient Tracking Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Critical Thinking; Safety Difficulty: Moderate Feedback 1 The first priority is to treat victims in the most efficient manner possible, by using the principles of triage.

2 Triage is the most effective way to sort patients according to the severity of their treatment. It allows first responders to appropriately manage the care of a large number of people, and help get patients to where they will receive the best care.

3 The first priority is to treat victims in the most efficient manner possible, by using the principles of triage.

4 Attending to the mental health and religious needs of the victims, survivors, and workers is important. However, the first priority is to treat victims in the most efficient manner possible, by using the principles of triage.

PTS: 1 REF: 589 | 590 CON: Trauma | Critical Thinking | Safety 13. ANS: 2 Objective: 5. Describe the structure and organization of local and national disaster mitigation efforts.

Page: Heading: Disaster Response Structure and Organization > Federal Response and Organization Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Critical Thinking; Communication; Safety; Legal Difficulty: Easy Feedback

1 2 3 4

The FAA, or Federal Aviation Administration, has jurisdiction over all airplane crashes and accidents.

The FAA has jurisdiction over all airplane crashes and accidents.

The FAA has jurisdiction over all airplane crashes and accidents.

The FAA has jurisdiction over all airplane crashes and accidents.

PTS: 1 REF: 590 CON: Trauma | Critical Thinking | Communication | Safety | Legal 14. ANS: 1 Objective: 7. Recognize the role of functional needs support services to optimize the health outcomes of vulnerable populations affected by a disaster event.

Page: Heading: Mental Health and Disaster > Mental Health Interventions Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Trauma; Stress; Mood; Assessment; Critical Thinking Difficulty: Difficult Feedback 1 The mental health affects after a traumatic event can be devastating for individuals and communities. It is important to implement interventions that can assist community members in getting help for depression, anxiety, or post-traumatic stress disorder.

2 It is important to establish an emergency management plan if the community doesn’t have one. However, it is more important for community members to be able to access mental health assistance if needed.

3 A community debriefing may be painful for the community residents to sit through immediately after the crash and it is recommended that a debriefing should occur 2 to 3 days after the event.

4 It is important for residents to get back to their regular life. However, it is more important for community members to be able to access mental health assistance if needed.

PTS: 1 REF: 599 | 600 CON: Trauma | Stress | Mood | Assessment | Critical Thinking 15. ANS: 1 Objective: 7. Recognize the role of functional needs support services to optimize the health outcomes of vulnerable populations affected by a disaster event.

Page: Heading: Public Health Law > Legal Considerations: Quarantine and Evacuation Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Trauma; Communication; Safety Difficulty: Moderate Feedback 1 In times of a disaster or emergency, the emergency alert system must be utilized by broadcasting companies to disseminate emergency information to residents; it is not voluntary.

2 If people refuse to heed voluntary evacuation orders, the state should consider mandatory evacuations, to prevent first responders from being put at risk when rescuing

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people.

Part of the emergency preparedness plan should include how the police will handle people who refuse to obey evacuation orders.

The most vulnerable people in the community, who are also the most likely to be impacted by the storm, will probably need assistance in the evacuation.

PTS: 1 REF: 595 | 596 CON: Trauma | Communication | Safety 16. ANS: 4 Objective: 7. Recognize the role of functional needs support services to optimize the health outcomes of vulnerable populations affected by a disaster event.

Page: Heading: Vulnerable Populations and Disaster > Incarcerated Populations Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Assessment; Nursing; Trauma; Safety Difficulty: Moderate Feedback 1 When a prison is faced with a weather or other emergency situation, there is a significant risk to the inmates and staff, to the first responders providing care to the prisoners, and to the community in the event of an inadvertent prisoner release. All of the above must be addressed in the prison emergency plan, as well as mitigation plans in case of an escape.

2 When a prison is faced with a weather or other emergency situation, there is a significant risk to the inmates and staff, to the first responders providing care to the prisoners, and to the community in the event of an inadvertent prisoner release. All of the above must be addressed in the prison emergency plan, as well as mitigation plans in case of an escape.

3 When a prison is faced with a weather or other emergency situation, there is a significant risk to the inmates and staff, to the first responders providing care to the prisoners, and to the community in the event of an inadvertent prisoner release. All of the above must be addressed in the prison emergency plan, as well as mitigation plans in case of an escape.

4 When a prison is faced with a weather or other emergency situation, there is a significant risk to the inmates and staff, to the first responders providing care to the prisoners, and to the community in the event of an inadvertent prisoner release. All of the above must be addressed in the prison emergency plan, as well as mitigation plans in case of an escape.

PTS: 1

REF: 599

CON: Assessment | Nursing | Trauma | Safety

MULTIPLE RESPONSE 17. ANS: 1, 2, 4, 5 Objective: 4. Apply the emergency preparedness theoretical framework to a public health disaster scenario.

Page: Heading: Disaster Response Structure and Organization > Health-Care Facility Disaster Response Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control

Cognitive Level: Application [Applying] Concept: Nursing Roles; Safety; Health-Care System Difficulty: Moderate

1 2 3

4 5

Feedback Training drills should be conducted regularly, so as to allow new staff to participate and current staff to improve their skills.

The materials and drill should aim to be specific to the actual number of patients that would be expected in case of an actual emergency.

The drill should involve many people, from many different departments. It should allow observers to get an idea of exactly how an actual emergency will run within the organization.

Good disaster plans will maintain the organizational function of the facility and prevent confusion between senior staff members.

It is important for everyone in the organization to undergo continuing education training so that they understand their role in an emergency.

PTS: 1 REF: 592 | 593 CON: Nursing Roles | Safety | Health-Care System 18. ANS: 2, 3, 4 Objective: 6. Describe the process of epidemiological surveillance during community disaster mitigation and recovery.

Page: Heading: Manmade Disasters > Radiation Exposure Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Critical Thinking; Assessment; Trauma; Cellular Regulation; Metabolism Difficulty: Moderate

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2

3

4

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Feedback Exposure to radiation has been linked with increased risk of leukemia, mental illness, thyroid disease and solid cancers. It is especially important to track cases among the people living in the affected communities.

Exposure to radiation has been linked with increased risk of leukemia, mental illness, thyroid disease and solid cancers. It is especially important to track cases among the people living in the affected communities.

Exposure to radiation has been linked with increased risk of leukemia, mental illness, thyroid disease and solid cancers. It is especially important to track cases among the people living in the affected communities.

Exposure to radiation has been linked with increased risk of leukemia, mental illness, thyroid disease and solid cancers. It is especially important to track cases among the people living in the affected communities.

Exposure to radiation has been linked with increased risk of leukemia, mental illness, thyroid disease and solid cancers. It is especially important to track cases among the people living in the affected communities.

PTS: 1 REF: 589 CON: Critical Thinking | Assessment | Trauma | Cellular Regulation | Metabolism 19. ANS: 1, 2, 5

Objective: 4. Apply the emergency preparedness theoretical framework to a public health disaster scenario.

Page: Heading: Disaster Epidemiological Surveillance > Emergency Information Systems Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Safety; Collaboration; Critical Thinking; Communication Difficulty: Moderate

1 2 3

4 5

Feedback The nurse should collect information about staffing needs or shortages.

The nurse should collect information about what supplies or staff is needed to continue to provide emergency care.

During an emergency, the public health officials do not need all of this information about the staff working at the hospital. They may need information about how many staff (and what degree of qualifications).

Budget needs of the hospital should not be included in the information provided to the public health officials. It can be addressed as needed during the recovery phase.

The nurse should track the number and names of all the patients who have already received care, and those who are still waiting for care. The nurse needs to include information about the number of available beds, and how many patients they could accommodate in an emergency situation.

PTS: 1 REF: 577 CON: Safety | Collaboration | Critical Thinking | Communication ORDERED RESPONSE 20. ANS: C, E, D, A, E CEDAE Feedback: The disaster preparedness cycle is the steps needed to properly prepare for and manage a disaster in the community. The first step is preparedness, or the process of proactively planning for disasters and emergency situations. The second step is mitigation, the process of planning for the harm or impact of a disaster, and also the steps needed to lessen those effects. Next is the response step, which is the actual response to the disaster. Next, recovery is the process of returning the community back to its prior state and finally evaluation is the process of evaluating the effectiveness of the emergency plan and providing information on how to improve the process in the future. Assessment is not a separate step in the framework and is conducted across the continuum of emergency preparedness and disaster management.

Objective: 3. Discuss the five areas of focus in emergency and disaster planning: (1) preparedness, (2) mitigation, (3) response, (4) recovery, and (5) evaluation.

Page: Heading: Emergency Preparedness and Disaster Management > Emergency Preparedness Theoretical Framework Integrated Processes: Teaching/Learning Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Nursing Roles; Safety

Difficulty: Easy PTS: 1

REF: 575 | 576

CON: Nursing Roles | Safety