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

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    TEST BANK FOR COMMUNITY AND PUBLIC HEALTH NURSING THIRD EDITION BY DEMARCO WALSH ALLCHAPTERS

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    Page 1 Origin: Chapter 1 - Public Health Nursing, 1 1. A nurse is striving to practice patient - centered care at a hospital. Which action best exemplifies providing patient - centered care? A) Having a client complete a self - reported functional status indicator and then reviewing it with the client B) Explaining to a client the benefits of computer - assisted robotic surgical techniques, which the hospital recently implemented C) Recording a client's s igns and symptoms in an electronic health record D) Performing continuous glucose monitoring of a client while the client is in the hospital Ans: A Feedback: Patient - centered care considers cultural traditions, personal preferences, values, families, and life styles. Clients become active participants in their own care, and monitoring health becomes the client's responsibility. To help clients and their healthcare providers make better decisions, the Agency for Healthcare Research and Quality (AHRQ) has develop ed a series of tools that empower clients and assist providers in achieving desired outcomes, including client - reported functional status indicators. Computer - assisted robotic surgical techniques, electronic health records, and continuous glucose monitorin g in the hospital are all technological advances in healthcare, but they do not help the client become a more active participant in his or her care, and thus are not good examples of patient - centered care. Origin: Chapter 1 - Public Health Nursing, 2 2. A nurse is caring for an older client who is struggling to manage her type 2 diabetes mellitus. The nurse should recognize which social determinants of this client's health? (Select all that apply.) A) Household income of $23,000 per year B) Reading l evel of a third grader C) Medication ineffective due to error in prescription D) Originally from Sudan E) No family in the area Ans: A, B, D, E Feedback: The social conditions in which people live, their income, social status, education, literacy, home and work environment, support networks, gender, culture, and availability of health services are the social determinants of health. These conditions have an impact on the extent to which a person or community possesses the physical, social, and personal resources necessary to attain and maintain health. A medical error on the part of the client's primary care provider or nurse would not constitute a social det erminant of the client's health.

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    Page 2 3. A nurse successfully persuades an obese client to perform a weekly weigh - in at home using a digital scale and record the weight in a log. This strategy is an example of: A) Telehealth B) Health information technology C) Personal responsibility for health D) Evidence - based nursing Ans: C Feedback: Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. In this case, the client makes a positive change in lifestyle by monitoring body weight weekly. Telehealth is the use of electroni c information and telecommunications technologies to support long - distance clinical healthcare, client and professional health - related education, public health, and health administration. Health information technology (HIT) is defined as the comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner. Evidence - based nursing is the integration of the best evidence available with clinical expertise and the values of the client to in crease the quality of care. Origin: Chapter 1 - Public Health Nursing, 4 4. A nurse performs a variety of tasks as part of the nurse's position at a hospital. Which task best exemplifies public health? A) Reading current nursing journals and integrating the lat est research into daily practice B) Instructing a client on how to best care for a suture site at home C) Participating in a videoconference call with a client who lives in a remote area D) Facilitating a community - wide smoking cessation program one month out of the year Ans: D Feedback: Public health is what society does collectively to ensure the conditions exist in which people can be healthy. A community - wide smoking cessation program is a great example of a public health intervention, in that it involves the collective effort of society to improve the health of its members. Reading and applying the latest nursing research is an example of evidence - based nursing. Instructing a client on how to best care for a suture site at home is an example of personal responsibility for health, but it is not focused on the health of the greater community. Participating in a videoconferenc e call with a client who lives in a remote area is an example of patient - centered care and of an effective implementation of technology, but it is not particularly related to public health.

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    Origin: Chapter 1 - Public Health Nursing, 5 Page 3 5. Public health nursi ng is distinguished from other specialties by adherence to eight principles. Which is one of the eight domains of public health nursing practice? A) Analytic assessment skills B) Investigation of disease C) Referral and follow - up D) Case management Ans: A Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public heal th science skills, financial planning and management skills, and leadership and systems thinking skills. Investigation of disease, referral and follow - up, and case management are all public health nursing interventions but are not domains of public health nursing practice. Origin: Chapter 1 - Public Health Nursing, 6 6. Public health nursing is distinguished fr om other specialties by adherence to eight principles. Which is one of the eight domains of public health nursing practice? A) Policy development and individual planning skills B) Individual dimensions of practice skills C) Financial planning and management skills D) Leadership and individual critical thinking skills Ans: C Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cult ural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills.

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    Origin: Chapter 1 - Public Health Nursing, 7 Page 4 7. Public health nursing is distinguished from other specialties by adherence to eight principles. Which are domains of public health nursing practice? (Select all that apply.) A) Intuitive assessment skills B) Community organization skills C) Communication skills D) Cultural competency skills E) Product marketing skills Ans: C, D Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skil ls, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills. Origin: Chapter 1 - Public Health Nursing, 8 8. Which was a duty performed by district nurses in Liverpool, England, in 1865? A) Use epidemiologic knowledge and methods B) Encourage community organization C) Report facts to and ask questions of physicians D) Assist physicians with surgery in the newly constructed hospitals Ans: C Feedback: Duties of district nurses in Liverpool, England, in 1865 included the following: Investigate new referrals as soon as possible; report to the superintendent situations in which additional food or relief would improve recovery; report neglect of c lients by family or friends to the superintendent; assist physicians with surgery in the home; maintain a clean, uncluttered home environment and tend fires for heat; teach the client and family about cleanliness, ventilation, giving of food and medication s, and obedience to the p h y sicia n ' s o r d e rs; s e t an e x a mple f or ― n ea t n e ss , o r d e r, s o b r i e t y , a nd o b e die nce ‖ ; hold family matters in confidence; avoid interference with the religious opinions and beliefs of clients and others; report facts to and ask questions of physicians; and refer the acutely ill to hospitals and the chronically ill, poor without family to i nfirmaries. Using epidemiologic knowledge and methods and encouraging community organization are principles of public health today, not duties of district nurses in England in 1865. Nurses at that time assisted physicians with surgery in the home, not in newly constructed hospitals.

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    Origin: Chapter 1 - Public Health Nursing, 9 Page 5 9. Which is a Healthy People 2020 goal? A) Decrease the incidence of preventable disease, disability, injury, and premature death B) Reduce health inequity, decrease disparities, and improve the health of certain groups C) Create social and physical environments that promote good health for all D) Promote healthy development and healthy behaviors for the geriatric stage of life Ans: C Feedback: The Healthy People 2020 goals are as follows: attain high - quality, longer lives free of preventable disease, disability, injury, and premature death (not jus t to decrease the incidence of these); achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote healthy development and healthy behaviors acros s every stage of life, not just older adults. Origin: Chapter 1 - Public Health Nursing, 10 10. A nurse is coordinating a plan to bring vaccinations in a cost - effective way to a rural community that currently lacks access to them. This is an example of which public health intervention? A) Surveillance B) Outreach C) Screening D) Case management Ans: D Feedback: In the intervention of case management, the nurse coordinates a plan or process to bring health services and the self - care capabilities of the client together as a common whole in a cost - effective way. In the intervention of surveillance, the nur se monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions. In the intervention of outreach, the nurse locates populations at risk, pr ovides information, identifies possible actions, and identifies access to services. In the intervention of screening, the nurse identifies individuals with unrecognized risk factors or asymptomatic conditions.

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    Origin: Chapter 1 - Public Health Nursing, 11 Page 6 11. The nurse is locating populations in her region who are exposed to lead - based paint and providing them with information regarding the dangers of lead poisoning. This is an example of which public health intervention? A) Surveillance B) Outreach C) Screening D) Case management Ans: B Feedback: In the intervention of outreach, the nurse locates population s at risk, provides information, identifies possible actions, and identifies access to services, which is what the nurse is doing in this situation. In the intervention of surveillance, the nurse monitors health events through ongoing, systematic collectio n, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions. In the intervention of screening, the nurse identifies individuals with unrecognized risk factors or asymptomatic conditions. In the intervention of case management, the nurse coordinates a plan or process to bring health services and the self - care capabiliti es of the client together as a common whole in a cost - effective way. Origin: Chapter 1 - Public Health Nursing, 12 12. Select the great public health achievements in the United States in the 20th century. (Select all that apply.) A) Elimination of common infecti ous diseases B) Recognition of tobacco as a health hazard C) Fluoridation of drinking water D) Healthier mothers and babies E) Decline in the percentage of obese and overweight people Ans: B, C, D Feedback: Great public health achievements in the United States in the 20th century include the following: control (not elimination) of common infectious diseases; recognition of tobacco as a health hazard; fluoridation of drinking water; and healthier mothers and b abies. The percentage of overweight and obese people increased over the course of the 20th century and continues to increase today.

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    Origin: Chapter 1 - Public Health Nursing, 13 Page 7 13. Demographic characteristics indicate that people in developed countries are living longer, healthier lives, yet tremendous health and social disparities exist. Which describes social determinants of health? A) What society does collectively to ensure the cond itions exist in which people can be healthy B) Social conditions in which people live and work C) Context of preventing disease and disability and promoting and protecting the health of the entire community D) Comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers Ans: B Feedback: Social determinants of health are the social conditions in which people live and work. Health information technology is the comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities , and insurers. Public health is what society does collectively to ensure the conditions exist in which people can be healthy. Public health nursing is a population - based practice, defined as a synthesis of nursing and public health within the context of p reventing disease and disability and promoting and protecting the health of the entire community. Origin: Chapter 1 - Public Health Nursing, 14 14. Why is there an increasing use of home monitoring devices? (Select all that apply.) A) Rising number of people with acute conditions B) Increased need to deliver healthcare to medically underserved populations C) Advances in technology to assess clients' conditions in their home D) Performing assessments in real time using Internet video systems E) Decline in the number of older adults Ans: B, C, D Feedback: Home monitoring devices are becoming necessities, due in part to the aging population, the rising number of people with chronic (not acute) conditions, and the need to increase healthcare delivery to medically underserved populations. Advances in technology, specifically medical devices, sensors, and high - speed telecommunication networks, ha ve made it possible to assess clients' conditions remotely in their homes, either by storing information for later access or by performing assessments in real time using Internet video systems. The number of older adults in the United States is increasing, not declining.

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    Origin: Chapter 1 - Public Health Nursing, 15 Page 8 15. Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. Which exemplify personal responsibility? (Select all that apply.) A) Reviewing one's own medical records B) Monitoring the positive and negative effects of prescription and over - the - counter medications C) Avoiding tobacco and recreational drug use D) Showing up for scheduled tests and procedures E) Eating the types of foods one most enjoys Ans: A, B, C, D Feedback: Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. It includes responsibility for reviewing one's own medical records and monitoring both the positive and negative effects of prescr iption and over - the - counter medications. It means showing up for scheduled tests and procedures and avoiding tobacco and recreational drug use. Eating the types of foods one most enjoys is not necessarily responsible, if one most enjoys foods that do not m eet dietary recommendations. Origin: Chapter 1 - Public Health Nursing, 16 16. Why has there been an increase in the number of acute and chronically ill people residing in the community who need professional nursing care? A) Shorter length of stay in long - term care facilities B) Increase in ambulatory surgery C) Decrease in the use of outpatient clinics D) Increase in length of stay in emergency departments Ans: B Feedback: The shorter length of stay in acute care (not long - term care) facilities, as well as the increase in ambulatory surgery and outpatient clinics, has resulted in more acute and chronically ill people residing in the community who need professional nursing care.

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    Origin: Chapter 1 - Public Health Nursing, 17 Page 9 17. Which organization publishes and articulates the essentials of public health nursing, including the activities and accountabilities that are characteristics of practice at all levels and settings? A) Association of Community Health Nurse Educators (ACHNE) B) American Nurses Association (ANA) C) American Public Health Association (APHA) D) Association of State and Territorial Directors of Nursing (ASTDN) Ans: B Feedback: The American Nurses Association (ANA) sets the scope and standards for all professional practice. The publication Public Health Nursing: Scope and Standards of Practice articulates the essentials of public health nursing, including the activities and accountabilities that are characteristic of practice at all levels and settings. The Quad Cou ncil of Public Health Nursing Organizations is an alliance of four national nursing organizations that addresses public health nursing issues in the United States, composed of the following: Association of Community Health Nurse Educators (ACHNE), ANA's Co ngress on Nursing Practice and Economics (CNPE), American Public Health Association (APHA) – Public Health Nursing Section, and Association of State and Territorial Directors of Nursing (ASTDN). Origin: Chapter 1 - Public Health Nursing, 18 18. A high school graduate has decided to pursue a career in public health nursing. Which represents the minimum educational credential that this student will need to obtain entry into public health nursing practice? A) Associate's B) Baccalaureate C) Master's D) Doctorate Ans: B Feedback: The baccalaureate degree in nursing is the educational credential required for entry into public health nursing practice. Master's level education, with specific expertise in population - focused care, is required for advanced prac tice or specialist practice. Registered nurses and licensed practical nurses with a diploma or associate's degree may appropriately practice in community settings where care is directed toward the health or illness of individual clients or families rather than populations. A doctorate degree in nursing may be required for academic and research positions associated with public health nursing.

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    Origin: Chapter 1 - Public Health Nursing, 19 Page 10 19. Who prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions? A) Clara Barton B) Dorothea Dix C) Lemuel Shattuck D) Lillian Wald Ans: C Feedback: Lemuel Shattuck prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions. Clara Barton achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casu alties with the help of her team of nurses. Dorothea Dix was also an American political activist in the 19th century who became aware of the dreadful conditions in prisons and mental hospitals, and she vigorously lobbied state and federal officials to reme dy the situation. Lillian Wald was the founder of public health nursing. Origin: Chapter 1 - Public Health Nursing, 20 20. Who achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with th e help of a team of nurses? A) Clara Barton B) Dorothea Dix C) Lemuel Shattuck D) Lillian Wald Ans: A Feedback: Clara Barton achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with the help of her team of nurses. Dorothea Dix was also an American political activist in the 19th century who bec ame aware of the dreadful conditions in prisons and mental hospitals, and she vigorously lobbied state and federal officials to remedy the situation. Lemuel Shattuck prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions. Lillian Wald was the founder of public health nursing.

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    Origin: Chapter 1 - Public Health Nursing, 21 Page 11 21. Which core functions of the government address the health of its citizens? (Select all that apply.) A) Providing healthcare directly to its citizens B) Assessing healthcare problems C) Developing healthcare policy that provides access to services D) Building state - of - the - art hospitals E) Ensuring delivery of healthcare services and achievement of desired outcomes Ans: B, C, E Feedback: A government has three core functions in addressing the health of its citizens: (1) it assesses healthcare problems, (2) interve nes by developing relevant healthcare policy that provides access to services, and (3) ensures that services are delivered and outcomes achieved. Although some government agencies, such as the U.S. Department of Veterans Affairs, do provide healthcare dire ctly to citizens, this is not a core function of the government. Building state - of - the - art hospitals is not a core function of government, either.

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    Origin: Chapter 2 - Public Health Systems, 1 Page 1 1. Which characterizes physicians in France? A) Physicians are evenly distributed between rural and urban areas B) About 40% of physicians are women C) Physician visits can take 15 to 30 minutes D) Physicians see about 15 clients a day Ans: C Feedback: Characteristics of physicians in France include that physicians are unevenly distributed between rural and urban areas; about 50% of physicians are women; physician visits can take 15 to 30 minutes; and physicians see about 10 clients per day. Origin: Chapter 2 - Public Health Systems, 2 2. A nurse is interested in exploring initiatives related to health, poverty, and development in Africa. Which organization would most likely be involved in such an initiative? A) Bill and Melinda Gates Foundation B) Living Proof Project C) International Committee of the Red Cross D) Oxfam International Ans: A Feedback: Philanthropies are organizations that are similar to NGOs but they receive funding through personal endowments. For example, the Bill and Melinda Gates Foundation focuses on health, poverty, and development in Africa, South America, Asia, and Australia. The Living Proof Project supports vaccine and nutrition programs, as well as decreasing the incidence of diseases such as polio, HIV/AIDS, and tropi cal illnesses. Nongovernmental organizations are private agencies that voluntarily use their resources to address a variety of healthcare initiatives in the United States. The International Committee of the Red Cross is known most for its role in disaster relief. Oxfam International focuses specifically on issues related to hunger and nutritional health.

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    Origin: Chapter 2 - Public Health Systems, 3 Page 2 3. Which best describes a nongovernmental organization? A) Agency that is based in only one country but provides services to many other countries B) Agency that acquires resources to help others from private rather than public sources C) A group that collects data related to healthcare use across a variety of profession al and service parameters D) An organization that uses endowed funds or private fundraising to address the needs of individuals, families, and populations Ans: B Feedback: A nongovernmental organization is an agency that acquires resources to help others fro m private rather than public sources. A bilateral agency is one that is based in only one country but provides services to many other countries. Organization for Economic Cooperation and Development is a group that collects data related to healthcare use a cross a variety of professional and service parameters. A philanthropic organization is one that uses endowed funds or private fundraising to address the needs of individuals, families, and populations. Origin: Chapter 2 - Public Health Systems, 4 4. Which best exemplifies a bilateral agency? A) The United Nations B) The World Health Organization (WHO) C) The World Bank D) The U.S. Agency for International Development (USAID) Ans: D Feedback: 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 works with developing countries to enhance systems to fortify the health and welfare of international populations. Multilateral agencies and organizations receive funding from both governmental and nongovernmental sources. Examples of multilateral agencies include the United Nations and the WHO. The World Bank is another multilateral organiz ation. Its major goal is to lend money to countries in need of developing their infrastructure on a variety of fronts.

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    Origin: Chapter 2 - Public Health Systems, 5 Page 3 5. Which public health entities are often regulated by the U.S. federal government? (Select all that apply.) A) Food B) Medications C) School health D) Devices E) Environment Ans: A, B, D, E Feedback: The federal government plays an important role in the regulation of publ ic health. Public health 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 and Human Services. School health is typically regulated by state and local governments, not the federal government. Origin: Chapter 2 - Public Health Systems, 6 6. A nurse is coordin ating an initiative in the community to make sure that the healthcare needs of local refugees and asylees are recognized and addressed. Which federal agency should this nurse contact, as it is directly involved with the health and healthcare of refugees an d asylees in the United States? A) United States Department of Health and Human Services B) National Institutes of Health C) Agency for Healthcare Research and Quality D) Centers for Disease Control and Prevention Ans: A Feedback: The United States Department of Health and Human Services is the federal agency that is 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, an d Centers for Disease Control and Prevention are three important organizations in which research is undertaken and used effectively to address key healthcare concerns such as HIV screening and care, address adverse events in hospital settings, and promote measures to decrease the rates of emerging infectious diseases.

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    Origin: Chapter 2 - Public Health Systems, 7 Page 4 7. Which best exemplifies a public health goal in the United States? A) To restore the ability of an 80 - year - old to perform activities of daily living after a stroke B) To lobby for legislation that ensures the accessibility to health insurance on the basis of one's health C) To develop treatments to address symptoms related to chemotherapy D) To establish a free exercise program at a community center to promote fitness in a low - income neighborhood with high obesity rates Ans: D Feedback: It is important to review several key components of the function public health serves through key initiative s, including a national consensus on goals, provision of systems of health insurance based on risk, not necessarily health, and the role of nongovernmental disease prevention and health promotion. In the United States, public healthcare includes disease pr evention and health promotion based on science and cultural relevance. It is not focused on the health of the individual person but of the larger population. The goal of public healthcare is to keep populations healthy through a larger ― reac h‖ than c onn ec tion a t the individual lev e l. Origin: Chapter 2 - Public Health Systems, 8 8. In the United States, the system of healthcare has historically given and continues to give stronger support to which types of care? A) Individual care with a focus on cure B) Community care with a focus on cure C) Individual care with a focus on prevention D) Community care with a focus on prevention Ans: A Feedback: The United States and its system of healthcare have historically given and continue to give stronger support to individual rather than community care and cure rather than prevention.

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    Origin: Chapter 2 - Public Health Systems, 9 Page 5 9. A nurse works predominantly with clients who are active military personnel. Which publically funded program provides health benefits to this population? A) Medicare B) Medicaid C) TRICARE D) CHIP Ans: C Feedback: Funding for the healthcare system in the United States comes primarily from privately owned health insurance companies. Exceptions include programs that are publically funded, such as Medicare, Medicaid, TRICARE (civilian health benefits for military perso nnel, retirees, and dependents), Children's Health and Insurance Program (CHIP), and Veterans Health Administration. Origin: Chapter 2 - Public Health Systems, 10 10. Which best describes a philanthropic organization? A) Agency that is based in only one country but provides services to many other countries B) Agency that acquires resources to help others from private rather than public sources C) A group that collects data related to healthcare use across a variety of profession al and service parameters D) An organization that uses endowed funds or private fundraising to address the needs of individuals, families, and populations Ans: D Feedback: A philanthropic organization is one that uses endowed funds or private fundraising to a ddress the needs of individuals, families, and populations. A bilateral agency is one that is based in only one country but provides services to many other countries. A nongovernmental organization is one that acquires resources to help others from private rather than public sources. Organization for Economic Cooperation and Development is a group that collects data related to healthcare use across a variety of professional and service parameters.

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    Origin: Chapter 2 - Public Health Systems, 11 Page 6 11. Which country spends the most on healthcare? A) Canada B) England C) Japan D) United States Ans: D Feedback: The United States spends more on healthcare than does any other industrialized country. Origin: Chapter 2 - Public Health Systems, 12 12. Which is the fastest growing healthcare expenditure in the United States? A) Healthcare technology B) Hospital care C) Outpatient treatment and surgery D) Prescription medications Ans: D Feedback: Although hospital care accounts for the largest share of healthcare spending, prescription drugs are the fastest growing healthcare expenditure. Origin: Chapter 2 - Public Health Systems, 13 13. National Health Expenditure Accounts are a measure of expenditur es on healthcare goods and services in the United States. In the most recent set of estimates, expenditures totaled what percentage of U.S. health spending? A) 2 B) 3 C) 4 D) 5 Ans: B Feedback: Government public health activity constitutes an important service category. In the most recent set of estimates, expenditures totaled $56.1 billion in 2004, or 3% of total U.S. health spending (National Health Expenditures, 2013).

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    Origin: Chapter 2 - Public Health Systems, 14 Page 7 14. The client is a single mother of two who earns minimum wage at a part - time job and never graduated from high school. Which healthcare - related outcomes is the client at increased risk for, based on her circumstances? (Select all that apply.) A) Morbidity B) Mortality C) Genetic disorder D) Difficulty accessing care E) Negative outcomes when receiving care Ans: A, B, D, E Feedback: Marginalization often occurs in people who live below the poverty level in the United States, and these people frequently are poorly educated. In the chapte rs that follow, higher rates of morbidity, mortality, difficulty in accessing care, and negative outcomes when receiving care, will be seen as key issues in such populations. This client's circumstances would not increase her risk of experiencing a genetic disorder. Origin: Chapter 2 - Public Health Systems, 15 15. The Department of Health and Human Services has identified several areas for which health disparities exist among various demographic groups and need to be addressed. Which are included among these areas? (Select all that apply.) A) Infant mortality B) Cancer screening C) Cardiovascular disease D) Diabetes E) End - stage renal disease Ans: A, B, C, D Feedback: The Department of Health and Human Services has identified six areas for which it has oversight and that require effort to reduce disparities. These areas are (1) infant mortality, (2) cancer screening, (3) cardiovascular disease, (4) diabetes, (5) HIV/AIDS, and (6) immunizations. End - stage renal disease is not an area of focus.

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    Origin: Chapter 2 - Public Health Systems, 16 Page 8 16. A nurse in the Canadian healthcare system is concerned because a client has been denied a surgical procedure that the nurse believes is essential to the client's recovery. Who should the nurse expect will have the most power to reverse this decision? A) Nurse practitioner B) Physicians C) Private insurance company D) Health administrator Ans: D Feedback: The most powerful individuals in the Canadian healthcare system are not physicians but health administrators, who put an emphasis on cost efficiency and social responsibility. Private insurance exists to cover services not covered under Medicare, such as v ision needs, dental services, and pharmaceuticals for nonelderly people. This type of private insurance is acquired through employment contributions and represents a small portion of total health expenditures (15%). Nurses and nurse practitioners are impor tant to the care of individuals and communities but play a lesser role in the administration of public healthcare. Origin: Chapter 2 - Public Health Systems, 17 17. Which is characteristic of the German healthcare system? A) Health insurance payments based on risk, not income B) Ambulatory care provided by centralized nonprofit hospitals C) An average hospital stay of 9 days D) Nurse practitioners operating independently Ans: C Feedback: The average length of hospital stay in Germany has decreased in recent yea rs from 14 to 9 days, still considerably longer than the 5 - to 6 - day average in the United States. Health insurance coverage is maintained by all citizens sharing in the effort to have an insurance pool, and payment is based on income, not risk. Currently, physicians in private practice provide ambulatory care, and centralized nonprofit hospitals offer the majority of inpatient care. Nurses in the German healthcare system, called sisters, a re mostly diploma - educated individuals working with a physician.

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    Origin: Chapter 2 - Public Health Systems, 18 Page 9 18. Which type of payment system does the Netherlands have? A) Universal long - term payment system B) Dual - level payment system C) Private health insurance linked to employment D) Free health insurance paid by the government Ans: B Feedback: The Netherlands has a dual - level healthcare payment system. All primary and acute care is financed from private mandatory insurance. Long - term care for the elderly, the dying, long - term mentally ill, and so on, is covered by money acquired from taxation and is c onsid er e d a ― so c i a l insu r a n ce . ‖ Origin: Chapter 2 - Public Health Systems, 19 19. Which best describes a multilateral agency? A) Is based in only one country but provides services to many other countries B) Is responsible for the health and welfare of citizens nationally C) Receives funding from both governmental and nongovernmental sources D) Acquires resources to help others from private rather than public sources Ans: C Feedback: A multilateral agency is one that receives funding from both governmental and nongovernmental sources. A bilateral agency is one that is based in only one country bu t provides services to many other countries. The Department of Health and Human Services is a U.S. agency responsible for the health and welfare of citizens nationally. A nongovernmental organization (NGO) is an agency that acquires resources to help other s from private rather than public sources. Origin: Chapter 2 - Public Health Systems, 20 20. The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations, representing more than 13 million nurses worldwide. In which area is the International Council of Nurses particularly active? A) Basic nursing practice B) Secondary healthcare C) Women's health D) Safe immunization programs Ans: C Feedback: 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 (not safe immunization programs).

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    Origin: Chapter 2 - Public Health Systems, 21 Page 10 21. A hurricane recently struck a nurse's hometown, and the nurse on behalf of the hospital is coordinating local relief efforts with nongovernmental organizations (NGOs). Which organization should this nurse most expect to work with in this situation? A) Bill an d Melinda Gates Foundation B) Living Proof Project C) International Committee of the Red Cross D) Oxfam International Ans: C Feedback: Nongovernmental organizations are private agencies that voluntarily use their resources to address a variety of healthcare initiatives in the United States. The International Committee of the Red Cross is known most for its role in disaster relief. Oxfam I nternational focuses specifically on issues related to hunger and nutritional health. Philanthropies are organizations that are similar to NGOs but receive funding through personal endowments. For example, the Bill and Melinda Gates Foundation focuses on h ealth, poverty, and development in Africa, South America, Asia, and Australia. The Living Proof Project supports vaccine and nutrition programs, as well as decreasing the incidence of diseases such as polio, HIV/AIDS, and tropical illnesses.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 1 Page 1 1. The nurse is passionate about research for a cure for pediatric leukemia and has written the state representatives in Congress to urge them to expand federal funding for this research. This behavior is an example of involvement in: A) Policy B) Politics C) Public health D) Equity Ans: B Feedback: Politics is the process of influencing the allocation of scarce resources, including financial resources, human resources, and time. A policy is a guideline that directs individuals' behavior toward a specific goal or a deliberate course of action chosen by an individual or group to deal with a problem. Public health is what society does collectively to ensure that conditions exist in which people can be healthy. Equity in healthcare refers to care that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status. Origin: Chapter 3 - Health Policy, Politics, and Reform, 2 2. Which statements regarding the relationship between politi cs and healthcare are true? (Select all that apply.) A) Politics has a limited effect on healthcare. B) The government should be interested in health matters when a problem affects a specific group or a whole population. C) Politics has only negative effects on healthcare. D) Republicans and Democrats generally agree on healthcare policies. E) Political solutions can be achieved at both the federal and state levels. Ans: B, E Feedback: Politics interferes with every aspect of healthcare in the United States. In reference to a political issue, the government should be interested in problems that affect a specific group or a whole population. There are many examples of the positive role th at governments play through policies and legislations, including providing equal opportunity through universal provision of education, healthcare, and often housing and nutrition programs. There is little agreement between the two major U.S. political part ies (Democrats and Republicans) when it comes to whom, how, what, and when healthcare should be provided and who should pay for it. Solutions can be achieved by working at either the federal or the state level.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 3 Page 2 3. The nurse is interested in taking on a role in the state's political decision - making process. Which political skills will the nurse need to be effective in this role? (Select all that apply.) A) Ability to understand others' behaviors B) Social skills C) Diagnostic skills D) Ability to network E) Ability to lie convincingly Ans: A, B, D Feedback: 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 to influence others and make changes; the ability to develop, connect, and use different social networks; and having a high level of integrity, sincerity, and genuineness. Origin: Chapter 3 - Health Policy, Politics, and Reform, 4 4. Which represents the correct order of events in the policy - making process? A) 1) Policy formulation, 2) policy assessment, 3) policy adoption, 4) policy implementation, 5) policy modification, 6) setting an agenda B) 1) Setting an agenda, 2) policy formulation, 3) pol icy assessment, 4) policy modification, 5) policy adoption, 6) policy implementation C) 1) Policy formulation, 2) setting an agenda, 3) policy implementation, 4) policy modification, 5) policy assessment, 6) policy adoption D) 1) Setting an agenda, 2) policy for mulation, 3) policy adoption, 4) policy implementation, 5) policy assessment, 6) policy modification Ans: D Feedback: The correct order of events in the policy - making process is as follows: 1) setting an agenda, 2) policy formulation, 3) policy adoption, 4) policy implementation, 5) policy assessment, 6) policy modification. An agenda must be set before a policy is formul ated; this phase involves considering the significance of the problem, the political support for addressing the problem, and the ability to perceive the viability of proposed alternative solutions for the problem. After the agenda is set, the policy can be formulated. Once formulated, the policy must be adopted or agreed upon before it can be implemented. Only after being implemented can the policy be assessed or evaluated in terms of its effectiveness. The final step is modifying the policy on the basis of the results of the assessment.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 5 Page 3 5. The nurse meets with a group of fellow nurses. They discuss the number of children who have died in hot cars and how likely they are to gain support from their state legislators to address the problem. The nurses are currently in which step of the policy - m aking process? A) Policy formulation B) Policy adoption C) Setting an agenda D) Policy assessment Ans: C Feedback: Setting an agenda, the first step in the policy - making process, involves considering the significance of the problem, the political support for addressing the problem, and the ability to perceive the viability of proposed alternative solutions for the prob lem. After the agenda is set, the policy can be formulated. Once formulated, the policy must be adopted or agreed upon before it can be implemented. Only after being implemented can the policy be assessed or evaluated in terms of its effectiveness. The fin al step is modifying the policy on the basis of the results of the assessment. Origin: Chapter 3 - Health Policy, Politics, and Reform, 6 6. The hospital board is in the process of developing a policy regarding the use of cell phones within the hospital. At the current meeting, the board has decided to allow use of cell phones only within certain waiting areas within the hospital, and nowhere e lse. Which stage of policy - making does this action represent? A) Policy formulation B) Policy adoption C) Policy implementation D) Policy assessment Ans: B Feedback: Policy adoption is the process of selecting the policy that will be implemented. Policy formulation 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 by using human and financial resources. Policy assessment is the stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 7 Page 4 7. The hospital board is in the process of developing a policy regarding the use of cell phones within the hospital. After 6 months of a policy being in place and weeks of ongoing evaluation of the policy by individual board members, the board decided to expand the areas where cell phone use is permitted to include all waiting rooms and some c lient rooms. Which stage of policy - making does this action represent? A) Policy modification B) Policy adoption C) Policy implementation D) Policy assessment Ans: A Feedback: Policy modification is the step in which a policy that has already been implemented is maint ained, changed, or eliminated on the basis of results of policy assessment. Policy adoption is the process of selecting the policy that will be implemented. Policy implementation is the stage in which the selected policy is carried out by using human and f inancial resources. Policy assessment is the stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness. Origin: Chapter 3 - Health Policy, Politics, and Reform, 8 8. The nurse applies a cost – benefit analysis to the healthcare model. Which costs are the primary concerns of the client? (Select all that apply.) A) Total payment for the service B) Out - of - pocket payment C) Suffering and pain D) Actual and direct cost of providing a service E) Psychological costs Ans: B, C, E Feedback: Clients are interested in their own out - of - pocket payment, as well as the psychological costs, suffering, and pain, which are difficult to quantify yet have long - lasting negative effects. The t otal payment for the service is usually what matters to the payer. The providers are usually concerned with the actual and direct cost of providing a service.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 9 Page 5 9. A client visits the office of an independent nurse practitioner to have routine blood work done. The client returns 1 week later for a follow - up visit to discuss the results and formulate a new treatment plan. On the basis of the client's insurance plan, the client is only obligated to pay $15 copay for this service. The total payment that the client's insurance company provides the practitioner is $180, which covers the $80 fee for a 15 - minute visit and the $100 cost of laboratory services. On the basis of the nurse's current client load, $40 of the $80 fee for the visit covers overhead and the remaining $40 is profit. In terms of cost – benefit analysis, which is the actual financial c ost to the nurse for providing this service? A) $100 B) $15 C) $180 D) $140 Ans: D Feedback: Using cost – benefit analysis, the cost to the provider is the actual and direct cost of providing a service, which in this case would be $100 for the laboratory services plus $40 for office overhead, which equals $140. Clients are interested in their own out - of - pocket payment, which in this case would be $15. The actual total payment for the service is usually what matters to the payer or insurance comp any, which in this case is $180. Origin: Chapter 3 - Health Policy, Politics, and Reform, 10 10. A family member receives Medicaid. Which is most likely to limit access of this person to healthcare? A) Inability to find a provider who accepts Medicaid B) Pre - existing conditions C) Lack of insurance D) Large insurance premiums Ans: A Feedback: Those covered by Medicaid have insurance but may experience problems accessing primary care due to their inability to find a private physician who accepts Medicaid clients. Out - of - pocket expenses may also be a factor in inability to access care. Preexisting conditions limited access to private insurance before the passage of the Patient Protection and Affordable Care Act of 2010 but should not limit access t o healthcare in a client covered by Medicaid. Large insurance premiums would not pertain to Medicaid.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 11 Page 6 11. A client receives Medicare, has limited income, and lives in a large city. Which factors are likely to limit the client's ability to access healthcare? (Select all that apply.) A) Inability to afford supplemental insurance B) Living in an urban environment C) High out - of - pocket expenses D) Preexisting conditions E) Lack of in - network providers in her region Ans: A, C Feedback: The underinsured include older individuals who receive Medicare but cannot afford supplemental insurance or the out - of - pocket exp enses associated with Medicare. Those living in a rural area, not an urban area, would be likely to have difficulty finding available healthcare providers. In - network providers would apply to private insurance, not to Medicare. Origin: Chapter 3 - Health Policy, Politics, and Reform, 12 12. Which most accurately defines quality of care? A) Degree to which health services increase the likelihood of desired outcomes and are consistent with current knowledge B) Improvement of what is wrong or unsatisfactory C) Economic approach or analysis tool used to evaluate the effectiveness of a treatment or intervention D) Presence of a variety of ethnic, racial, and cultural backgrounds of the workers in a specific area such as the health sector Ans: A Feedback: Quality of care is defined by the Institute of Medicine as the degree to which health services for individuals an d populations increase the likelihood of desired outcomes and are consistent with current knowledge. Reform is the improvement of what is wrong or unsatisfactory. Cost – benefit is an economic approach or analysis tool used to evaluate the effectiveness of a treatment or intervention. Workforce diversity is the presence of a variety of ethnic, racial, and cultural backgrounds of the workers in a specific area such as the health sector.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 13 Page 7 13. A nurse has just finished providing teaching and care to a child with type 1 diabetes. On the basis of the five dimensions of healthcare identified by the Institute of Medicine, indicators of quality care include that the child: (Select all that apply.) A) Safely self - injected insulin in the office B) Has maintained an appropriate blood glucose level consistently for 6 months C) Was seen by the nurse 2 hours after arriving for a scheduled appointment D) Received care that was identical to that provided to six other clients of various racial backgrounds E) Received instructions directly from the nurse in the office, not via a parent Ans: A, B, D, E Feedback: The Institute of Medicine lists the following dimensions of healthcare systems that should be considered when quality, cost, and access are examined: 1) safety: avoiding injury and harm from care that is meant to aid clients; 2) effectiveness: assuring tha t ― e viden c e - b a s e d‖ ca r e is a c tual l y d e liv ere d, b y a v oiding ov e r u s e of m e d i ca l l y unp r ov e n care and underuse of medically sound care; 3) client - centeredness: involving clients thoroughly in the decision - making process about their care, thereby respecting their culture, social circumstances, and needs; 4) timeliness: avoiding unwanted delays in t reatment; and 5) equality: closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes. Origin: Chapter 3 - Health Policy, Politics, and Reform, 14 14. Nurses are effective and influential shapers of healthcare policy because of their expertis e in: (Select all that apply.) A) Clinical practice B) Administration C) Education D) Political science E) Research Ans: A, B, C, E Feedback: Nurses' expertise as clinicians, educators, researchers, and administrators lends them much power in public policy. Nurses, as a whole, do not typically have expertise in political science.

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    Origin: Chapter 3 - Health Policy, Politics, and Reform, 15 Page 8 15. Which represent ways nurses can actively engage in policy making? (Select all that apply.) A) Testify at congressional hearings B) Disseminate information on health issues in the media C) Serve as members of governing boards D) Document client symptoms following a physical examination E) Review articles in recent nursing journals Ans: A, B, C Feedback: In terms of policy making, nurses can 1) provide vital evidence that either supports or opposes a policy, 2) be members of a n organization or a group that introduces a specific problem into the national agenda and identifies the goals and tools needed to implement it, and 3) advocate for and disseminate information on health issues through the media. Nurses may also advocate fo r their clients by testifying at congressional hearings, healthcare summits, and regional forums regarding the need to eliminate disparities in healthcare access among various client demographics. The American Nurses Association works with coalitions and advocates for nurses to serve as members of governing boards in each state, to advance the role and recognition of nurses, to prevent potential d eclines in quality, and to communicate with the Congress in the prevention of harmful changes in Medicare. Documenting client symptoms and reviewing articles in nursing journals are tasks commonly performed by nurses but are not directly related to policy making. Origin: Chapter 3 - Health Policy, Politics, and Reform, 16 16. Which is the primary way that U.S. federal government has encouraged improved information management in the healthcare system? A) Publishing of guidelines for increased efficiency in filing client records B) Tax deductions for the installation of new telephone systems C) Reimbursement and bonuses for physicians and hospitals for adopting electronic health records D) Grants for hiring office managers trained in health information technology Ans: C Feedback: As established in the American Recovery and Reinvestment Act, physicians who adopt and use electronic health records (EHRs) meaningfully can be reimbursed for their services up to $44,000 over 5 years. Similarly, hospitals that effectively utilize EHRs earn an incentive of $2 million through a one - time bonus. The other answers are not true.

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