Test Bank for Community and Public Health Nursing: Evidence for Practice, 3rd Edition (Chapters 1-25)

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TESTBANKFORCOMMUNITYANDPUBLICHEALTHNURSINGTHIRDEDITIONBYDEMARCOWALSHALLCHAPTERS

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Page1Origin:Chapter1-PublicHealthNursing,11.A nurse is striving to practice patient-centered care at a hospital. Which action bestexemplifiesprovidingpatient-centered care?A)Having a client complete a self-reported functional status indicator and thenreviewingit with theclientB)Explaining to a client the benefits of computer-assisted robotic surgicaltechniques,which thehospital recentlyimplementedC)Recordingaclient'ssignsandsymptomsinanelectronichealthrecordD)Performing continuous glucose monitoring of a client while the client is in thehospitalAns:AFeedback:Patient-centered care considers cultural traditions, personal preferences, values,families, and lifestyles. Clients become active participants in their own care, andmonitoring health becomes the client's responsibility. To help clients and theirhealthcare providers make better decisions, the Agency for Healthcare Research andQuality (AHRQ) has developed a series of tools that empower clients and assistproviders in achieving desired outcomes, including client-reported functional statusindicators. Computer-assisted robotic surgical techniques, electronic health records, andcontinuous glucose monitoring in the hospital are all technological advances inhealthcare, but they do not help the client become a more active participant in his or hercare,and thusarenotgood examplesof patient-centeredcare.Origin:Chapter1-PublicHealthNursing,22.A nurse is caring for an older client who is struggling to manage her type 2 diabetesmellitus. The nurse should recognize which social determinants of this client's health?(Selectall that apply.)A)Householdincomeof$23,000peryearB)ReadinglevelofathirdgraderC)MedicationineffectiveduetoerrorinprescriptionD)OriginallyfromSudanE)No family in the areaAns:A, B, D,EFeedback:The social conditions in which people live, their income, social status, education,literacy, home and work environment, support networks, gender, culture, andavailability of health services are the social determinants of health. These conditionshave animpact on the extent to which a person or community possesses the physical,social, and personal resources necessary to attain and maintain health. A medical erroron the part of the client's primary care provider or nurse would not constitute a socialdeterminantofthe client's health.

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Page23.A nurse successfully persuades an obese client to perform a weekly weigh-in at homeusingadigital scaleandrecordtheweightinalog.Thisstrategyisan exampleof:A)TelehealthB)Healthinformation technologyC)PersonalresponsibilityforhealthD)Evidence-based nursingAns:CFeedback:Personal responsibility for health involves active participation in one's own healththrough education and lifestyle changes. In this case, the client makes a positive changein lifestyle by monitoring body weight weekly. Telehealth is the use of electronicinformation and telecommunications technologies to support long-distance clinicalhealthcare, client and professional health-related education, public health, and healthadministration. Health information technology (HIT) is defined as the comprehensivemanagement of health information and its exchange between consumers, providers,government, and insurers in a secure manner. Evidence-based nursing is the integrationof the best evidence available with clinical expertise and the values of the client toincreasethequalityofcare.Origin:Chapter1-PublicHealthNursing,44.A nurse performs a variety of tasks as part of the nurse's position at a hospital. Whichtaskbest exemplifies public health?A)Reading current nursing journals and integrating the latest research into dailypracticeB)Instructingaclient onhowto best careforasuturesiteat homeC)Participatinginavideoconferencecallwithaclient wholivesinaremoteareaD)Facilitating a community-wide smoking cessation program one month out of theyearAns:DFeedback:Public health is what society does collectively to ensure the conditions exist in whichpeople can be healthy. A community-wide smoking cessation program isa greatexample of a public health intervention, in that it involves the collective effort of societytoimprove thehealthofitsmembers.Reading andapplyingthelatestnursingresearchis an example of evidence-based nursing. Instructing a client on how to best care for asuture site at home is an example of personal responsibility for health, but it is notfocused on the health of the greater community. Participating in a videoconference callwith a client who lives in a remote area is an example of patient-centered care and of aneffectiveimplementationoftechnology,butitisnotparticularlyrelatedtopublichealth.

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Origin:Chapter1-PublicHealthNursing,5Page35.Public health nursing is distinguished from other specialties by adherence to eightprinciples.Which is oneoftheeightdomainsofpublichealth nursingpractice?A)AnalyticassessmentskillsB)InvestigationofdiseaseC)Referralandfollow-upD)Case managementAns:AFeedback:The eight domains of public health nursing practice are as follows: Analytic assessmentskills, policy development and program planning skills, communication skills, culturalcompetency skills, community dimensions of practice skills, public health science skills,financialplanningandmanagementskills,andleadershipandsystems thinkingskills.Investigation of disease, referral and follow-up, and case management are all publichealthnursinginterventionsbut arenotdomainsofpublichealthnursingpractice.Origin:Chapter1-PublicHealthNursing,66.Public health nursing is distinguished from other specialties by adherence to eightprinciples.Which is oneoftheeightdomainsofpublichealth nursingpractice?A)Policydevelopmentand individualplanningskillsB)IndividualdimensionsofpracticeskillsC)FinancialplanningandmanagementskillsD)Leadership and individual critical thinking skillsAns:CFeedback:The eight domains of public health nursing practice are as follows: Analytic assessmentskills, policy development and program planning skills, communication skills, culturalcompetency skills, community dimensions of practice skills, public health science skills,financialplanningandmanagementskills,andleadershipandsystems thinkingskills.

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Origin:Chapter1-PublicHealthNursing,7Page47.Public health nursing is distinguished from other specialties by adherence to eightprinciples.Whicharedomains ofpublichealthnursingpractice?(Selectallthatapply.)A)IntuitiveassessmentskillsB)CommunityorganizationskillsC)CommunicationskillsD)CulturalcompetencyskillsE)Product marketing skillsAns:C, DFeedback:The eight domains of public health nursing practice are as follows: Analytic assessmentskills, policy development and program planning skills, communication skills, culturalcompetency skills, community dimensions of practice skills, public health science skills,financialplanningandmanagementskills,andleadershipandsystems thinkingskills.Origin:Chapter1-PublicHealthNursing,88.Whichwas adutyperformedbydistrict nursesinLiverpool,England, in1865?A)UseepidemiologicknowledgeandmethodsB)EncouragecommunityorganizationC)ReportfactstoandaskquestionsofphysiciansD)Assist physicians with surgery in the newly constructed hospitalsAns:CFeedback:Duties of district nurses in Liverpool, England, in 1865 included the following:Investigate new referrals as soon as possible; report to the superintendent situations inwhich additional food or relief would improve recovery; report neglect of clients byfamily or friends to the superintendent; assist physicians with surgery in the home;maintain a clean, uncluttered home environment and tend fires for heat; teach the clientand family about cleanliness, ventilation, giving of food and medications, and obedienceto thephysician'sorders;set anexamplefor―neatness, order,sobriety,andobedience‖;hold family matters in confidence; avoid interference with the religious opinions andbeliefsofclientsandothers;reportfactstoandaskquestionsofphysicians;andrefertheacutelyillto hospitals and thechronicallyill,poorwithout familyto infirmaries.Using epidemiologic knowledge and methods and encouraging community organizationareprinciplesofpublichealthtoday,not dutiesofdistrict nursesinEnglandin1865.Nurses at that time assisted physicians with surgery in the home, not in newlyconstructedhospitals.

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Origin:Chapter1-PublicHealthNursing,9Page59.WhichisaHealthy People2020goal?A)Decrease the incidence of preventable disease, disability, injury, and prematuredeathB)Reduce health inequity, decrease disparities, and improve the health of certaingroupsC)Createsocial andphysicalenvironmentsthatpromotegoodhealthforallD)Promote healthy development and healthy behaviors for the geriatric stage of lifeAns:CFeedback:TheHealthy People 2020goals are as follows: attain high-quality, longer lives free ofpreventable disease, disability, injury, and premature death (not just to decrease theincidence of these); achieve health equity, eliminate disparities, and improve the healthof all groups; create social and physical environments that promote good health for all;and promote healthy development and healthy behaviors across every stage of life, notjustolderadults.Origin:Chapter1-PublicHealthNursing,1010.A nurse is coordinating a plan to bring vaccinations in a cost-effective way to a ruralcommunity that currently lacks access to them. This is an example of which publichealthintervention?A)SurveillanceB)OutreachC)ScreeningD)Case managementAns:DFeedback:In the intervention of case management, the nurse coordinates a plan or process to bringhealth services and the self-care capabilities of the client together as a common whole inacost-effectiveway.Inthe interventionofsurveillance, thenursemonitorshealthevents through ongoing, systematic collection, analysis, and interpretation of health datafor planning, implementing, and evaluating public health interventions. In theintervention of outreach, the nurse locates populations at risk, provides information,identifies possible actions, and identifies access to services. In the intervention ofscreening, the nurse identifies individuals with unrecognized risk factors orasymptomaticconditions.

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Origin:Chapter1-PublicHealthNursing,11Page611.The nurse is locating populations in her region who are exposed to lead-based paint andproviding them with information regarding the dangers of lead poisoning. This is anexampleofwhich public health intervention?A)SurveillanceB)OutreachC)ScreeningD)Case managementAns:BFeedback:In the intervention of outreach, the nurse locates populations at risk, providesinformation, identifies possible actions, and identifies access to services, which is whatthe nurse is doing in this situation. In the intervention of surveillance, the nurse monitorshealth events through ongoing, systematic collection, analysis, and interpretation ofhealthdataforplanning,implementing,andevaluatingpublichealth interventions.Inthe intervention of screening, the nurse identifies individuals with unrecognized riskfactors or asymptomatic conditions. In the intervention of case management, the nursecoordinates a plan or process to bring health services and the self-care capabilities of theclienttogether as a common wholein a cost-effectiveway.Origin:Chapter1-PublicHealthNursing,1212.Select the great public health achievements in the United States in the 20th century.(Selectall that apply.)A)EliminationofcommoninfectiousdiseasesB)RecognitionoftobaccoasahealthhazardC)FluoridationofdrinkingwaterD)HealthiermothersandbabiesE)Decline in the percentage of obese and overweight peopleAns:B, C, DFeedback:Great public health achievements in the United States in the 20th century include thefollowing: control (not elimination) of common infectious diseases; recognition oftobacco as a health hazard; fluoridation of drinking water; and healthier mothers andbabies. The percentage of overweight and obese people increased over the course of the20thcenturyand continues to increasetoday.

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Origin:Chapter1-PublicHealthNursing,13Page713.Demographic characteristics indicate that people in developed countries are livinglonger, healthier lives, yet tremendous health and social disparities exist. Whichdescribessocial determinants ofhealth?A)What society does collectively to ensure the conditions exist in which people canbehealthyB)Socialconditionsin whichpeopleliveandworkC)Context of preventing disease and disability and promoting and protecting thehealth oftheentirecommunityD)Comprehensive management of health information and itssecure exchangebetweenconsumers,providers,governmentandqualityentities,andinsurersAns:BFeedback:Social determinants of health are the social conditions in which people live and work.Health information technology is the comprehensive management of health informationand its secure exchange between consumers, providers, government and quality entities,and insurers. Public health is what society does collectively to ensure the conditionsexist in which people can be healthy. Public health nursing is a population-basedpractice, defined as a synthesis of nursing and public health within the context ofpreventing disease and disability and promoting and protecting the health of the entirecommunity.Origin:Chapter1-PublicHealthNursing,1414.Whyis therean increasinguseofhome monitoringdevices?(Select allthatapply.)A)Risingnumberofpeoplewith acuteconditionsB)IncreasedneedtodeliverhealthcaretomedicallyunderservedpopulationsC)Advancesintechnologyto assessclients'conditions intheirhomeD)PerformingassessmentsinrealtimeusingInternetvideosystemsE)Decline in the number of older adultsAns:B, C, DFeedback:Home monitoring devices are becoming necessities, due in part to the aging population,the rising number of people with chronic (not acute) conditions, and the need to increasehealthcare delivery to medically underserved populations. Advances in technology,specificallymedicaldevices,sensors,andhigh-speedtelecommunicationnetworks,have made it possible to assess clients' conditions remotely in their homes, either bystoring information for later access or by performing assessments in real time usingInternetvideosystems.Thenumberof olderadultsintheUnitedStatesisincreasing,notdeclining.

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Origin:Chapter1-PublicHealthNursing,15Page815.Personal responsibility for health involves active participation in one's own healththrough education and lifestyle changes. Which exemplify personal responsibility?(Selectall that apply.)A)Reviewingone'sownmedicalrecordsB)Monitoring the positive andnegative effects of prescription and over-the-countermedicationsC)Avoidingtobaccoand recreationaldruguseD)ShowingupforscheduledtestsandproceduresE)Eating the types of foods one most enjoysAns:A,B, C,DFeedback:Personal responsibility for health involves active participation in one's own healththrough education and lifestyle changes. It includes responsibility for reviewing one'sown medical records and monitoring both the positive and negative effects ofprescription and over-the-counter medications. It means showing up for scheduled testsand procedures and avoiding tobacco and recreational drug use. Eating the types offoods one most enjoys is not necessarily responsible, if one most enjoys foods that donotmeet dietaryrecommendations.Origin:Chapter1-PublicHealthNursing,1616.Why has there been an increase in the number of acute and chronically ill peopleresidinginthe communitywhoneed professionalnursingcare?A)Shorterlengthofstayinlong-termcarefacilitiesB)IncreaseinambulatorysurgeryC)Decreaseintheuseofoutpatient clinicsD)Increase in length of stay in emergency departmentsAns:BFeedback:The shorter length of stay in acute care (not long-term care) facilities, as well as theincrease in ambulatory surgery and outpatient clinics, has resulted in more acute andchronicallyillpeopleresidinginthecommunitywhoneedprofessionalnursingcare.

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Origin:Chapter1-PublicHealthNursing,17Page917.Which organization publishes and articulates the essentials of public health nursing,including the activities and accountabilities that are characteristics of practice at alllevelsand settings?A)AssociationofCommunityHealthNurseEducators(ACHNE)B)AmericanNursesAssociation(ANA)C)AmericanPublicHealthAssociation(APHA)D)Association of State and Territorial Directors of Nursing (ASTDN)Ans:BFeedback:The American Nurses Association (ANA) sets the scope and standards for allprofessionalpractice. The publicationPublic Health Nursing: Scope and Standards ofPracticearticulates the essentials of public health nursing, including the activities andaccountabilities that are characteristic of practice at all levels and settings. The QuadCouncil of Public Health Nursing Organizations is an alliance of four national nursingorganizations that addresses public health nursing issues in the United States, composedof the following: Association of Community Health Nurse Educators (ACHNE), ANA'sCongress on Nursing Practice and Economics (CNPE), American Public HealthAssociation (APHA)–Public Health Nursing Section, and Association of State andTerritorialDirectors ofNursing(ASTDN).Origin:Chapter1-PublicHealthNursing,1818.A high school graduate has decided to pursue a career in public health nursing. Whichrepresents the minimum educational credential that this student will need to obtain entryintopublichealth nursingpractice?A)Associate'sB)BaccalaureateC)Master'sD)DoctorateAns:BFeedback:The baccalaureate degree in nursing is the educational credential required for entry intopublic health nursing practice. Master's level education, with specific expertise inpopulation-focusedcare,isrequiredforadvancedpracticeorspecialistpractice.Registered nurses and licensed practical nurses with a diploma or associate's degree mayappropriately practice in community settings where care is directed toward the health orillness of individual clients or families ratherthan populations. A doctorate degree innursing may be required for academic and research positions associated with publichealthnursing.

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Origin:Chapter1-PublicHealthNursing,19Page1019.Who prepared a report for the Massachusetts Sanitary Commission that pointed out thatmuch of the ill health and disability in American cities in 1850 could be traced tounsanitaryconditions?A)ClaraBartonB)DorotheaDixC)LemuelShattuckD)Lillian WaldAns:CFeedback:Lemuel Shattuck prepared a report for the Massachusetts Sanitary Commission thatpointed out that much of the ill health and disability in American cities in 1850 could betraced to unsanitary conditions. Clara Barton achieved widespread recognition duringthe Civil War, distributing supplies to wounded soldiers and caring for the casualtieswith the help of her team of nurses. Dorothea Dix was also an American politicalactivist in the 19th century who became aware of the dreadful conditions in prisons andmental hospitals, and she vigorously lobbied state and federal officials to remedy thesituation.Lillian Waldwasthefounderofpublichealth nursing.Origin:Chapter1-PublicHealthNursing,2020.Who achieved widespread recognition during the Civil War, distributing supplies towoundedsoldiers andcaringforthecasualtieswiththehelp ofateamofnurses?A)ClaraBartonB)DorotheaDixC)LemuelShattuckD)Lillian WaldAns:AFeedback:Clara Barton achieved widespread recognition during the Civil War, distributingsupplies to wounded soldiers and caring for the casualties with the help of her team ofnurses. Dorothea Dix was also an American political activist in the 19th century whobecame aware of the dreadful conditions in prisons and mental hospitals, and shevigorously lobbied state and federal officials to remedy the situation. Lemuel Shattuckprepared a report for the Massachusetts Sanitary Commission that pointed out that muchofthe ill health and disability in American cities in 1850 could be traced to unsanitaryconditions.Lillian Wald wasthefounder ofpublichealth nursing.

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Origin:Chapter1-PublicHealthNursing,21Page1121.Which core functions of the government address the health of its citizens? (Select allthatapply.)A)Providinghealthcaredirectlyto itscitizensB)AssessinghealthcareproblemsC)DevelopinghealthcarepolicythatprovidesaccesstoservicesD)Buildingstate-of-the-arthospitalsE)Ensuring delivery of healthcare services and achievement of desired outcomesAns:B, C, EFeedback:A government has three core functions in addressing the health of its citizens: (1) itassesses healthcare problems, (2) intervenes by developing relevant healthcare policythat provides access to services, and (3) ensures that services are delivered andoutcomes achieved. Although some government agencies, such as the U.S. Departmentof Veterans Affairs, do provide healthcare directly to citizens, this is not a core functionof the government. Building state-of-the-art hospitals is not a core function ofgovernment,either.

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Origin:Chapter2-PublicHealthSystems,1Page11.WhichcharacterizesphysiciansinFrance?A)Physiciansareevenlydistributed betweenruralandurban areasB)About40%ofphysiciansarewomenC)Physicianvisitscan take15to30minutesD)Physicians see about 15 clients a dayAns:CFeedback:Characteristics of physicians in France include that physicians are unevenly distributedbetween rural and urban areas; about 50% of physicians are women; physician visits cantake15 to 30 minutes;and physicians seeabout 10clientsperday.Origin:Chapter2-PublicHealthSystems,22.A nurse is interested in exploring initiatives related to health, poverty, and developmentinAfrica. Whichorganizationwouldmostlikelybeinvolvedin suchaninitiative?A)BillandMelindaGatesFoundationB)LivingProofProjectC)InternationalCommitteeoftheRedCrossD)Oxfam InternationalAns:AFeedback:Philanthropies are organizations that are similar to NGOs but they receive fundingthrough personal endowments. For example, the Bill and MelindaGates Foundationfocuses on health, poverty, and development in Africa, South America, Asia, andAustralia. The Living Proof Project supports vaccine and nutrition programs, as well asdecreasingtheincidenceofdiseasessuchaspolio,HIV/AIDS,and tropical illnesses.Nongovernmental organizations are private agencies that voluntarily use their resourcesto address a variety of healthcare initiatives in the United States. The InternationalCommittee of the Red Cross is known most for its role in disaster relief. OxfamInternationalfocusesspecificallyonissues relatedto hungerand nutritionalhealth.

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Origin:Chapter2-PublicHealthSystems,3Page23.Whichbestdescribesanongovernmentalorganization?A)Agency that is based in only one country but provides services to many othercountriesB)Agency that acquires resources to help others from private rather than publicsourcesC)A group that collects data related to healthcare use across a variety of professionalandserviceparametersD)An organization that uses endowed funds or private fundraising to address theneedsofindividuals, families, and populationsAns:BFeedback:A nongovernmental organization is an agency that acquires resources to help othersfrom private rather than public sources. A bilateral agency is one that is based in onlyone country but provides services to many other countries. Organization for EconomicCooperation and Development is a group that collects data related to healthcare useacross a variety of professional and service parameters. A philanthropic organization isone that uses endowed funds or private fundraising to address the needs of individuals,families,and populations.Origin:Chapter2-PublicHealthSystems,44.Whichbestexemplifiesabilateralagency?A)TheUnitedNationsB)TheWorldHealthOrganization(WHO)C)TheWorldBankD)The U.S. Agency for International Development (USAID)Ans:DFeedback:Bilateral agencies and organizations conduct their services within one specific country.USAID is a good example in the United States. It is a committed initiative that workswith developing countries to enhance systems to fortify the health and welfare ofinternational populations. Multilateral agencies and organizations receive funding fromboth governmental and nongovernmental sources. Examples of multilateral agenciesinclude the United Nations and the WHO. The World Bank is another multilateralorganization. Its major goal is to lend money to countries in need of developing theirinfrastructureon avarietyoffronts.

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Origin:Chapter2-PublicHealthSystems,5Page35.Which public health entities are often regulated by the U.S. federal government? (Selectallthat apply.)A)FoodB)MedicationsC)SchoolhealthD)DevicesE)EnvironmentAns:A,B,D, EFeedback:The federal government plays an important role in the regulation of public health. Publichealth entities of regulation are often related to (1) food, (2) drugs, (3) devices, (4)occupation health, and (5) the environment through the Department of Health andHumanServices.Schoolhealthistypicallyregulatedbystateandlocalgovernments,notthe federalgovernment.Origin:Chapter2-PublicHealthSystems,66.A nurse is coordinating an initiative in the community to make sure that the healthcareneeds of local refugees and asylees are recognized and addressed. Which federal agencyshould this nurse contact, as it is directly involved with the health and healthcare ofrefugeesandasylees in the United States?A)UnitedStates DepartmentofHealthandHumanServicesB)NationalInstitutesofHealthC)AgencyforHealthcareResearch andQualityD)Centers for Disease Control and PreventionAns:AFeedback:The United States Department of Health and Human Services is the federal agency thatis directly involved with the health and healthcare of U.S. citizens or refugees/asylees.The National Institutes of Health, Agency for Healthcare Research and Quality, andCenters for Disease Control and Prevention are three important organizations in whichresearch is undertaken and used effectively to address key healthcare concerns such asHIV screening and care, address adverse events in hospital settings, and promotemeasuresto decrease the ratesofemerginginfectious diseases.

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Origin:Chapter2-PublicHealthSystems,7Page47.Whichbestexemplifiesapublichealth goalin theUnitedStates?A)To restore the ability of an 80-year-old to perform activities of daily living after astrokeB)To lobby for legislation that ensures the accessibility to health insurance on thebasisof one's healthC)TodeveloptreatmentstoaddresssymptomsrelatedtochemotherapyD)To establish a free exercise program at a community center to promote fitness in alow-incomeneighborhood with highobesityratesAns:DFeedback:It is important to review several key components of the function public health servesthrough key initiatives, including a national consensus on goals, provision of systems ofhealth insurance based on risk, not necessarily health, and the role of nongovernmentaldiseasepreventionandhealth promotion.Inthe UnitedStates, publichealthcareincludes disease prevention and health promotion based on science and culturalrelevance. It is not focused on the health of the individual person but of the largerpopulation.Thegoalofpublichealthcareistokeeppopulationshealthythroughalarger―reach‖thanconnectionat theindividual level.Origin:Chapter2-PublicHealthSystems,88.In the United States, the system of healthcare has historically given and continues togivestronger support towhich types ofcare?A)Individualcarewithafocuson cureB)Communitycarewithafocus on cureC)IndividualcarewithafocusonpreventionD)Community care with a focus on preventionAns:AFeedback:The United States and its system of healthcare have historically given and continue togive stronger support to individual rather than community care and cure rather thanprevention.

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Origin:Chapter2-PublicHealthSystems,9Page59.A nurse works predominantly with clients who are active military personnel. Whichpublicallyfunded programprovideshealth benefits tothis population?A)MedicareB)MedicaidC)TRICARED)CHIPAns:CFeedback:Funding for the healthcare system in the United States comes primarily from privatelyowned health insurance companies. Exceptions include programs that are publicallyfunded, such as Medicare, Medicaid, TRICARE (civilian health benefits for militarypersonnel, retirees, and dependents), Children's Health and Insurance Program (CHIP),andVeteransHealth Administration.Origin:Chapter2-PublicHealthSystems,1010.Whichbestdescribesaphilanthropicorganization?A)Agency that is based in only one country but provides services to many othercountriesB)Agency that acquires resources to help others from private rather than publicsourcesC)A group that collects data related to healthcare use across a variety of professionalandserviceparametersD)An organization that uses endowed funds or private fundraising to address theneedsofindividuals, families, and populationsAns:DFeedback:A philanthropic organization is one that uses endowed funds or private fundraising toaddress the needs of individuals, families, and populations. A bilateral agency is onethat is based in only one country but provides services to many other countries. Anongovernmental organization is one that acquires resources to help others from privaterather than public sources. Organization for Economic Cooperation and Development isa group that collects data related to healthcare use across a variety of professional andserviceparameters.

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Origin:Chapter2-PublicHealthSystems,11Page611.Whichcountryspendsthemoston healthcare?A)CanadaB)EnglandC)JapanD)United StatesAns:DFeedback:TheUnitedStates spendsmoreonhealthcarethan does anyotherindustrialized country.Origin:Chapter2-PublicHealthSystems,1212.WhichisthefastestgrowinghealthcareexpenditureintheUnitedStates?A)HealthcaretechnologyB)HospitalcareC)Outpatienttreatmentand surgeryD)Prescription medicationsAns:DFeedback:Although hospital care accounts for the largest share of healthcare spending,prescriptiondrugs arethe fastest growinghealthcareexpenditure.Origin:Chapter2-PublicHealthSystems,1313.National Health Expenditure Accounts are a measure of expenditures on healthcaregoods and services in the United States. In the most recent set of estimates, expenditurestotaledwhat percentageof U.S. health spending?A)2B)3C)4D)5Ans:BFeedback:Government public health activity constitutes an important service category. In the mostrecent set of estimates, expenditures totaled $56.1 billion in 2004, or 3% of total U.S.healthspending(National Health Expenditures,2013).

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Origin:Chapter2-PublicHealthSystems,14Page714.The client is a singlemother of two who earns minimum wage at a part-time job andnever graduated from high school. Which healthcare-related outcomes is the client atincreasedriskfor, basedonher circumstances?(Selectallthat apply.)A)MorbidityB)MortalityC)GeneticdisorderD)DifficultyaccessingcareE)Negative outcomes when receiving careAns:A,B,D, EFeedback:Marginalization often occurs in people who live below the poverty level in the UnitedStates, and these people frequently are poorly educated. In the chapters that follow,higher rates of morbidity, mortality, difficulty in accessing care, and negative outcomeswhen receiving care, will be seen as key issues in such populations. This client'scircumstanceswould notincreaseherriskofexperiencingageneticdisorder.Origin:Chapter2-PublicHealthSystems,1515.The Department of Health and Human Services has identified several areas for whichhealth disparities exist among various demographic groups and need to be addressed.Whichareincludedamongtheseareas?(Selectallthat apply.)A)InfantmortalityB)CancerscreeningC)CardiovasculardiseaseD)DiabetesE)End-stage renal diseaseAns:A,B, C,DFeedback:The Department of Health and Human Services has identified six areas for which it hasoversight and that require effort to reduce disparities. These areas are (1) infantmortality, (2) cancer screening, (3)cardiovascular disease, (4) diabetes, (5) HIV/AIDS,and(6)immunizations.End-stagerenal diseaseisnotan areaoffocus.

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Origin:Chapter2-PublicHealthSystems,16Page816.A nurse in the Canadian healthcare system is concerned because a client has beendenied a surgical procedure that the nurse believes is essential to the client's recovery.Whoshouldthenurseexpect willhavethe mostpowerto reversethis decision?A)NursepractitionerB)PhysiciansC)PrivateinsurancecompanyD)Health administratorAns:DFeedback:The most powerful individuals in the Canadian healthcare system are not physicians buthealth administrators, who put an emphasis on cost efficiency and social responsibility.Private insurance exists to cover services not covered under Medicare, such as visionneeds, dental services, and pharmaceuticals for nonelderly people. This type of privateinsurance is acquired through employment contributions and represents a small portionof total health expenditures (15%). Nurses and nurse practitioners are important to thecare of individuals and communities but play a lesser role in the administration of publichealthcare.Origin:Chapter2-PublicHealthSystems,1717.WhichischaracteristicoftheGermanhealthcaresystem?A)Healthinsurancepaymentsbased onrisk, notincomeB)AmbulatorycareprovidedbycentralizednonprofithospitalsC)Anaveragehospital stayof9daysD)Nurse practitioners operating independentlyAns:CFeedback:The average length of hospital stay in Germany has decreased in recent years from 14 to9 days, still considerably longer than the 5-to 6-day average in the United States. Healthinsurancecoverage ismaintainedbyallcitizenssharingin theeffort tohaveaninsurance pool, and payment is based on income, not risk. Currently, physicians inprivate practice provide ambulatory care, and centralized nonprofit hospitals offer themajority of inpatient care. Nurses in the German healthcare system, called sisters, aremostlydiploma-educatedindividuals workingwithaphysician.

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Origin:Chapter2-PublicHealthSystems,18Page918.WhichtypeofpaymentsystemdoestheNetherlandshave?A)Universallong-termpaymentsystemB)Dual-levelpaymentsystemC)PrivatehealthinsurancelinkedtoemploymentD)Free health insurance paid by the governmentAns:BFeedback:The Netherlands has a dual-level healthcare payment system. All primary and acute careis financed from private mandatoryinsurance. Long-term care for the elderly, the dying,long-term mentally ill, and so on, is covered by money acquired from taxation and isconsidered a―social insurance.‖Origin:Chapter2-PublicHealthSystems,1919.Whichbestdescribesamultilateralagency?A)Isbasedin onlyonecountrybut provides servicestomanyothercountriesB)Isresponsibleforthehealth andwelfareofcitizensnationallyC)ReceivesfundingfrombothgovernmentalandnongovernmentalsourcesD)Acquires resources to help others from private rather than public sourcesAns:CFeedback:A multilateral agency is one that receives funding from both governmental andnongovernmental sources. A bilateral agency is one that is based in only one country butprovides services to many other countries. The Department of Health and HumanServices is a U.S. agency responsible for the health and welfare of citizens nationally. Anongovernmentalorganization(NGO)isanagencythatacquiresresourcestohelpothersfrom private rather than publicsources.Origin:Chapter2-PublicHealthSystems,2020.The International Council of Nurses (ICN) is a federation of more than 130 nationalnurses associations, representing more than 13 million nurses worldwide. In which areaistheInternational Council ofNursesparticularlyactive?A)BasicnursingpracticeB)SecondaryhealthcareC)Women'shealthD)Safe immunization programsAns:CFeedback:ICN is particularly active in international classification of nursing practice; advanced(not basic) nursing practice; entrepreneurship; HIV/AIDS, tuberculosis, and malaria;women's health; primary (not secondary) healthcare; family health; and safe water (notsafeimmunization programs).

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Origin:Chapter2-PublicHealthSystems,21Page1021.A hurricane recently struck a nurse's hometown, and the nurse on behalf of the hospitalis coordinating local relief efforts with nongovernmental organizations (NGOs). Whichorganizationshould thisnursemostexpect towork with inthis situation?A)BillandMelindaGatesFoundationB)LivingProofProjectC)InternationalCommitteeoftheRedCrossD)Oxfam InternationalAns:CFeedback:Nongovernmental organizations are private agencies that voluntarily use their resourcesto address a variety of healthcare initiatives in the United States. The InternationalCommittee of the Red Cross is known most for its role in disaster relief. OxfamInternationalfocusesspecificallyonissues relatedto hungerand nutritionalhealth.Philanthropies are organizations that are similar to NGOs but receive funding throughpersonal endowments. For example, the Bill and Melinda Gates Foundation focuses onhealth, poverty, and development in Africa, South America, Asia, and Australia. TheLiving Proof Project supports vaccine and nutrition programs, as well as decreasing theincidenceofdiseases suchas polio, HIV/AIDS, andtropicalillnesses.

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Origin:Chapter3-HealthPolicy,Politics,andReform,1Page11.The nurse is passionate about research for a cure for pediatric leukemia and has writtenthe state representatives in Congress to urge them to expand federal funding forthisresearch.This behavior is an example ofinvolvement in:A)PolicyB)PoliticsC)PublichealthD)EquityAns:BFeedback:Politics is the process of influencing the allocation of scarce resources, includingfinancial resources, human resources, and time. A policy is a guideline that directsindividuals' behavior toward a specific goal or a deliberate course of action chosen byan individual or group to deal with a problem. Public health is what society doescollectively to ensure that conditions exist in which people can be healthy. Equity inhealthcare refers to care that does not vary in quality because of gender, race, ethnicity,geographiclocation, or socioeconomicstatus.Origin:Chapter3-HealthPolicy,Politics,andReform,22.Which statements regarding the relationship between politics and healthcare are true?(Selectall that apply.)A)Politicshasalimitedeffectonhealthcare.B)The government should be interested in health matters when a problem affects aspecificgroup orawholepopulation.C)Politics hasonlynegativeeffectsonhealthcare.D)RepublicansandDemocratsgenerallyagreeonhealthcarepolicies.E)Political solutions can be achieved at both the federal and state levels.Ans:B, EFeedback:Politics interferes with every aspect of healthcare in the United States. In reference to apolitical issue, the government should be interested in problems that affect a specificgroup or a whole population. There are many examples of the positive role thatgovernments play through policies and legislations, including providing equalopportunity through universal provision of education, healthcare, and often housing andnutrition programs. There is little agreement between the two major U.S. politicalparties (Democrats and Republicans) when it comes to whom, how, what, and whenhealthcare should be provided and who should pay for it. Solutions can be achieved byworkingateither the federal or thestate level.

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Origin:Chapter3-HealthPolicy,Politics,andReform,3Page23.The nurse is interested in taking on a role in the state's political decision-makingprocess. Which political skills will the nurse need to be effective in this role? (Select allthatapply.)A)Abilitytounderstandothers'behaviorsB)SocialskillsC)DiagnosticskillsD)Abilityto networkE)Ability to lie convincinglyAns:A,B,DFeedback:Healthcare professionals have political skills and active roles in healthcare leadership.These skills include the following: social skills and the ability to understand, interpret,and represent one's own and others' behaviors; the ability, qualifications, and power toinfluence others and make changes; the ability to develop, connect, and use differentsocialnetworks;andhavingahighlevelofintegrity,sincerity,andgenuineness.Origin:Chapter3-HealthPolicy,Politics,andReform,44.Whichrepresentsthecorrectorderofeventsinthepolicy-makingprocess?A)1) Policy formulation, 2) policy assessment, 3) policy adoption, 4) policyimplementation,5) policymodification,6) setting anagendaB)1) Setting an agenda, 2) policy formulation, 3) policy assessment, 4) policymodification, 5)policyadoption, 6)policyimplementationC)1) Policy formulation, 2) setting an agenda, 3) policy implementation, 4) policymodification,5)policyassessment, 6)policyadoptionD)1) Setting an agenda, 2) policy formulation, 3) policy adoption, 4) policyimplementation,5) policyassessment, 6)policymodificationAns:DFeedback:The correct order of events in the policy-making process is as follows: 1) setting anagenda, 2) policy formulation, 3) policy adoption, 4) policy implementation, 5) policyassessment,6)policymodification.Anagendamustbesetbeforeapolicyisformulated; this phase involves considering the significance of the problem, the politicalsupport for addressing the problem, and the ability to perceive the viability of proposedalternative solutions for the problem. After the agenda is set, the policy can beformulated. Onceformulated, thepolicymustbeadopted oragreeduponbeforeitcanbe implemented. Only after being implemented can the policy be assessed or evaluatedin terms of its effectiveness. The final step is modifying the policy on the basis oftheresultsofthe assessment.

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Origin:Chapter3-HealthPolicy,Politics,andReform,5Page35.The nurse meets with a group of fellow nurses. They discuss the number of childrenwho have died in hot cars and how likely they are to gain support from their statelegislators to address the problem. The nurses are currently in which step of thepolicy-makingprocess?A)PolicyformulationB)PolicyadoptionC)SettinganagendaD)Policy assessmentAns:CFeedback:Setting an agenda, the first step in the policy-making process, involves considering thesignificance of the problem, the political support for addressing the problem, and theability to perceive the viability of proposed alternative solutions for the problem. Afterthe agenda is set, the policy can be formulated. Once formulated, the policy must beadopted or agreed upon before it can be implemented. Only after being implemented canthe policy be assessed or evaluated in terms of its effectiveness. The final step ismodifyingthe policyon thebasisofthe results oftheassessment.Origin:Chapter3-HealthPolicy,Politics,andReform,66.The hospital board is in the process of developing a policy regarding the use of cellphones within the hospital. At the current meeting, the board has decided to allow use ofcell phones only within certain waiting areas within the hospital, and nowhere else.Whichstageofpolicy-makingdoes thisaction represent?A)PolicyformulationB)PolicyadoptionC)PolicyimplementationD)Policy assessmentAns:BFeedback:Policy adoption is the process of selecting the policy that will be implemented. Policyformulation is the stage in which various policy options are identified and explored.Policy implementation is the stage in which the selected policy is carried out byusinghuman and financial resources. Policy assessment is the stage in which the implementedpolicy is evaluated in terms of its compliance with statuary requirements andeffectiveness.

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Origin:Chapter3-HealthPolicy,Politics,andReform,7Page47.The hospital board is in the process of developing a policy regarding the use of cellphones within the hospital. After 6 months of a policy being in place and weeks ofongoing evaluation of the policy by individual board members, the board decided toexpand the areas where cell phone use is permitted to include all waiting rooms andsomeclientrooms.Whichstageofpolicy-makingdoes thisactionrepresent?A)PolicymodificationB)PolicyadoptionC)PolicyimplementationD)Policy assessmentAns:AFeedback:Policy modification is the step in which a policy that has already been implemented ismaintained, changed, or eliminated on the basis of results of policy assessment. Policyadoption is the process of selecting the policy that will be implemented. Policyimplementation is the stage in which the selected policy is carried out by using humanand financial resources. Policy assessment is the stage in which the implemented policyisevaluatedintermsofitscompliancewithstatuaryrequirementsandeffectiveness.Origin:Chapter3-HealthPolicy,Politics,andReform,88.The nurse applies a cost–benefit analysis to the healthcare model. Which costs are theprimaryconcerns oftheclient?(Select allthat apply.)A)TotalpaymentfortheserviceB)Out-of-pocketpaymentC)SufferingandpainD)ActualanddirectcostofprovidingaserviceE)Psychological costsAns:B, C, EFeedback:Clients are interested in their own out-of-pocket payment, as well as the psychologicalcosts, suffering, and pain, which are difficult to quantify yet have long-lasting negativeeffects. The total payment for the service is usually what matters to the payer. Theprovidersareusuallyconcernedwiththeactual anddirectcost ofprovidingaservice.

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Origin:Chapter3-HealthPolicy,Politics,andReform,9Page59.A client visits the office of an independent nurse practitioner to have routine blood workdone. The client returns 1 week later for a follow-up visit to discuss the results andformulate a new treatment plan. On the basis of the client'sinsurance plan, the client isonly obligated to pay $15 copay for this service. The total payment that the client'sinsurancecompanyprovidesthepractitioner is$180, whichcovers the$80feefora15-minute visit and the $100 cost of laboratory services. On the basis of the nurse'scurrentclientload,$40ofthe$80feeforthevisitcoversoverhead and theremaining$40 is profit. In terms of cost–benefit analysis, which is the actual financial cost to thenurseforprovidingthis service?A)$100B)$15C)$180D)$140Ans:DFeedback:Using cost–benefit analysis, the cost to the provider is the actual and direct cost ofprovidingaservice, which in thiscasewould be$100 forthelaboratoryservices plus$40forofficeoverhead,whichequals$140. Clientsareinterestedintheirownout-of-pocket payment, which in this case would be $15. The actual total payment forthe service is usually what matters to the payer or insurance company, which in this caseis $180.Origin:Chapter3-HealthPolicy,Politics,andReform,1010.A family member receives Medicaid. Which is most likely to limit access of this persontohealthcare?A)Inabilityto findaproviderwhoaccepts MedicaidB)Pre-existingconditionsC)LackofinsuranceD)Large insurance premiumsAns:AFeedback:Those covered by Medicaid have insurance but may experience problems accessingprimary care due to their inability to find a private physician who acceptsMedicaidclients.Out-of-pocket expensesmayalsobeafactorininabilitytoaccess care.Preexisting conditions limited access to private insurance before the passage of thePatient Protection and Affordable Care Act of 2010 but should not limit access tohealthcare in a client covered by Medicaid. Large insurance premiums would not pertaintoMedicaid.

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Origin:Chapter3-HealthPolicy,Politics,andReform,11Page611.A client receives Medicare, has limited income, and lives in a large city. Which factorsarelikelytolimittheclient'sabilitytoaccesshealthcare?(Selectall thatapply.)A)Inabilitytoaffordsupplemental insuranceB)LivinginanurbanenvironmentC)Highout-of-pocketexpensesD)PreexistingconditionsE)Lack of in-network providers in her regionAns:A,CFeedback:The underinsured include older individuals who receive Medicare but cannot affordsupplemental insurance or the out-of-pocket expenses associated with Medicare. Thoseliving in a rural area, not an urban area, would be likely to have difficulty findingavailable healthcare providers. In-network providers would apply to private insurance,notto Medicare.Origin:Chapter3-HealthPolicy,Politics,andReform,1212.Whichmostaccuratelydefinesqualityofcare?A)Degree to which health services increase the likelihood of desired outcomes andareconsistent with current knowledgeB)Improvementofwhatis wrongorunsatisfactoryC)Economic approach or analysis tool used to evaluate the effectiveness of atreatmentor interventionD)Presence of a variety of ethnic, racial, and cultural backgrounds of the workers inaspecificarea suchas the health sectorAns:AFeedback:Quality of care is defined by the Institute of Medicine as the degree to which healthservices for individuals and populations increase the likelihood of desired outcomes andare consistent with current knowledge. Reform is the improvement of what is wrong orunsatisfactory. Cost–benefit is an economic approach or analysis tool used to evaluatethe effectiveness of atreatment or intervention. Workforce diversity is the presence of avariety of ethnic, racial, and cultural backgrounds of the workers in a specific area suchasthehealthsector.

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Origin:Chapter3-HealthPolicy,Politics,andReform,13Page713.A nurse has just finished providing teaching and care to a child with type 1 diabetes. Onthe basis of the five dimensions of healthcare identified by the Institute of Medicine,indicatorsofqualitycareincludethat the child:(Selectall that apply.)A)Safelyself-injectedinsulinintheofficeB)Hasmaintained an appropriateblood glucoselevelconsistentlyfor6 monthsC)Wasseen bythenurse2 hoursafterarrivingforascheduledappointmentD)Received care that was identical to that provided to six other clients of variousracialbackgroundsE)Received instructions directly from the nurse in the office, not via a parentAns:A,B,D, EFeedback:The Institute of Medicine lists the following dimensions of healthcare systems thatshould be considered when quality, cost, and access are examined: 1) safety: avoidinginjuryandharmfrom carethatismeant toaidclients;2)effectiveness:assuringthat―evidence-based‖careisactuallydelivered,byavoidingoveruseofmedicallyunprovencare and underuse of medically sound care; 3) client-centeredness: involving clientsthoroughly in the decision-making process about their care, thereby respecting theirculture, social circumstances, and needs; 4) timeliness: avoiding unwanted delays intreatment; and 5) equality: closing racial, ethnic, gender, and socioeconomic gaps incareand outcomes.Origin:Chapter3-HealthPolicy,Politics,andReform,1414.Nurses are effective and influential shapers of healthcare policy because of theirexpertisein:(Select all that apply.)A)ClinicalpracticeB)AdministrationC)EducationD)PoliticalscienceE)ResearchAns: A, B, C, EFeedback:Nurses' expertise as clinicians, educators, researchers, and administrators lends themmuch power in public policy. Nurses, as a whole, do not typically have expertise inpoliticalscience.

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Origin:Chapter3-HealthPolicy,Politics,andReform,15Page815.Which represent ways nurses can actively engage in policy making? (Select all thatapply.)A)TestifyatcongressionalhearingsB)DisseminateinformationonhealthissuesinthemediaC)ServeasmembersofgoverningboardsD)DocumentclientsymptomsfollowingaphysicalexaminationE)Review articles in recent nursing journalsAns:A,B, CFeedback:In terms of policy making, nurses can 1) provide vital evidence that either supports oropposes a policy, 2) be members of an organization or a group that introduces a specificproblem into the national agenda and identifies the goals and tools needed to implementit, and 3) advocate for and disseminate information on health issues through the media.Nurses may also advocate for their clients by testifying at congressional hearings,healthcare summits, and regional forums regarding the need to eliminate disparities inhealthcare access among various client demographics. The American NursesAssociation works with coalitions and advocates for nurses to serve as members ofgoverning boards in each state, to advance the role and recognition of nurses, to preventpotential declines in quality, and to communicate with the Congress in the prevention ofharmful changes in Medicare. Documenting client symptoms and reviewing articles innursing journals are tasks commonly performed by nurses but are not directly related topolicymaking.Origin:Chapter3-HealthPolicy,Politics,andReform,1616.Which is the primary way that U.S. federal government has encouraged improvedinformationmanagementin thehealthcare system?A)PublishingofguidelinesforincreasedefficiencyinfilingclientrecordsB)Tax deductionsfortheinstallationofnewtelephonesystemsC)Reimbursement and bonuses for physicians and hospitals for adopting electronichealthrecordsD)Grants for hiring office managers trained in health information technologyAns:CFeedback:As established in the American Recovery and Reinvestment Act, physicians who adoptand use electronic health records (EHRs) meaningfully can be reimbursed for theirservices up to $44,000 over 5 years. Similarly, hospitals that effectively utilize EHRsearn an incentive of $2 million through a one-time bonus. The other answers are nottrue.

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