Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32)

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Chapter 01: Public Health Nursing and Population HealthStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.Which statement best describescommunity-based nursing?a.A practice in which care is provided for individuals and families.b.Providing care with a focus on the group’s needs.c.Giving care with a focus on the aggregate’s needs.d.A value system in which all clients receive optimal care.ANS:ABy definition, community-based nursing is a setting-specific practice in which care is provided for “sick” individuals and familieswhere they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive,coordinated, and continuous care. These nurses may be generalists or specialists in maternal–infant, pediatric, adult, or psychiatricmental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather thanfocusing on groups, aggregates, or systems.2.Which statementbestdescribes the goal ofcommunity-oriented nursing?a.Providing care to individuals and familiesb.Providing care to manage acute or chronic conditionsc.Giving direct care to ill individuals within their family settingd.To preserve, protect, promote, or maintain health and prevent diseaseANS:DBy definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease topromote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their familysetting, and help manage acute or chronic conditions. These definitions are not specific to community-oriented nursing.3.Which of the following is the primary focus of public health nursing?a.Families and groupsb.Illness-oriented carec.Individuals within the family unitd.Health care of communities and populationsANS:DIn public health nursing, the primary focus is on the health care of communities and populations rather than on individuals, groups,and families. The goal is to prevent disease and preserve, promote, restore, and protect health for the community and the populationwithin it. Community-based nurses deal primarily with illness-oriented care of individuals and families across the life span. Theaim is to manage acute and chronic health conditions in the community, and the focus of practice is on individual orfamily-centered illness care.4.Which of the following is responsible for the dramatic increase in life expectancy during the 20th century?a.Technology increases in the field of medical laboratory researchb.Advances in surgical techniques and proceduresc.Sanitation and other population-based prevention programsd.Use of antibiotics to fight infectionsANS:CThere has to be indisputable evidence collected over time that public health policies and programs were primarily responsible forincreasing the average life span from 47 in 1900 to 78.6 years in 2017, an increase of approximately 60% in just over a century plusthrough improvements in (1) sanitation, (2) clean water supplies, (3) making workplaces safer, (4) improving food and drug safety,(5) immunizing children, and (6) improving nutrition, hygiene, and housing. Although people are excited when a new drug isdiscovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significantgains in the health of populations that have come largely from public health accomplishments.5.A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventionswould most likely be implemented by the nurse?a.Provide free health care to all citizensb.To increase the number of individuals with access to effective health care benefitsc.Lower the cost of health care to the American populationd.To lessen the governmental burden of providing health care to AmericansANS:BThe central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number ofpeople with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on theAmerican government are serious concerns, they are not the primary focus of ACA.lOMoARcPSD|13778330

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6.What is the basic assumption stated byHealthy People 2010as it relates to public health efforts?a.Health disparities among any groups are morally and legally wrong.b.Health care is the most important priority in government planning and funding.c.The health of individuals cannot be separated from the health of the community.d.The government is responsible for lengthening the life span of Americans.ANS:CThe major premise ofHealthy People 2010was that the health of the individual cannot be entirely separate from the health of thelarger community. Public health practice focuses on the community as a whole, and the effect of the community’s health status(resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protectthe health of the community as a whole. Public health can be described as what society collectively does to ensure that conditionsexist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. Thefocus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthychoices is the directive for lengthening life span not the role of the government.7.Which of the following actions would most likely be performed by a public health nurse?a.Asking community leaders what interventions should be chosenb.Assessing the community and deciding on appropriate interventionsc.Using data from the main health care institutions in the community to determineneeded health servicesd.Working with community groups to create policies to improve the environmentANS:DAlthough the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the communityto carry out core public health functions, including assessment of the population as a whole and engaging in promoting health andimproving the environment. The interventions of asking community leaders which interventions should be chosen, assessing thecommunity and deciding on appropriate interventions, and using data from health care institutions do not demonstrate theengagement of the community when making decisions about what the community actually wants and needs.8.Which public health nurse most clearly fulfills the responsibilities of this role?a.The nurse who met with several groups to discuss community recreation issuesb.The nurse who spent the day attending meetings of various health agenciesc.The nurse who talked to several people about their particular health concernsd.The nurse who watched the city council meeting on local cable televisionANS:BAny of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents orgroups about health concerns. A major challenge for the future is the need for public health nursing specialists to be moreaggressive in working collaboratively with various groups in the community as well as professional colleagues in institutionalsettings to deal with barriers to health. However, the nurse who spent the day attending meetings of various health agencies is themost representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concernsof the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregatepriorities, and watching television (a one-way form of communication) is less effective than interacting with others.9.Which of the following best definesaggregate?a.A large group of personsb.A collection of individuals and familiesc.A collection of people who share one or more characteristicsd.Another name for demographic groupANS:CAn aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of acommunity can be defined in terms of either geography (e.g., a county, a group of counties, or a state) or a special interest (e.g.,children attending a particular school). These members make up a population. The termpopulationmay be used interchangeablywith the termaggregate. A large group of persons, a collection of individuals and families, and another name for demographicgroup are not accurate definitions of the term aggregate.10.Which question asked by a novice nurse would be the most reflective of an understanding of the role of a public health nurse?a.“Which groups are at the greatest risk for problems?”b.“Which patients should I see first as I begin my day?”c.“With which physicians will I be most closely collaborating?”d.“With which nursing assistants will I partner the most?”ANS:AAsking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus onindividuals rather than a community-oriented perspective.11.Making sure that essential community-oriented health services are available defines which of the core public health functions?a.Policy developmentb.Assessmentc.Assuranced.Scientific knowledge-based careANS:CAssurance includes making sure that essential community-oriented health services are available in the community. The definitiondoes not fit the termsassessment,policy development.Scientific knowledge-based care is not a core function of public health.Assessment is systematic data collection on the population, monitoring the population’s health status, and making informationavailable about the health of the community. Policy development refers to efforts to develop policies that support the health of thepopulation, including using a scientific knowledge base to make policy decisions.lOMoARcPSD|13778330

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12.When talking to a women’s group at the senior citizens’ center, the nurse reminded them that the only way the center would be ableto afford to provide transportation services for them would be for them to continue to write letters to their local city councilrepresentatives requesting funding for such a service. What was the nurse trying to accomplish through this action?a.Ensure that the women did not expect the nurse to solve their problem.b.Demonstrate that the nurse understood the women’s concerns and needs.c.Express empathy, support, and concern.d.Help the women engage in political action.ANS:DPublic health nurses engage themselves and others in policy development and encourage and assist persons to communicate theirneeds to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyondmerely understanding the women’s concern, and instead mobilizes them to take action. This action does not demonstrate the nurseshowing empathy rather the nurse is empowering these women.13.The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community.Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first?a.To increase the group’s self-esteemb.To maintain communication links with the groupsc.To make the groups feel good about their contributiond.To work with the groups, not for the groupsANS:DHistorically, health care providers have been accused of providing careforortopeople without actually involving the recipients inthe decisions. Public health nursing is a “with the people”—not a “to the people” or “for the people”—approach to planning. Thereis an imperative to work with members of the community to carry out core public health functions. The purpose of meeting withcommunity groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them toact for themselves to solve the problems they are facing. The first task of working with the group should occur before addressingmaintaining communication links.14.The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should usein such cases?a.The specific moral or ethical principle related to the situationb.The cheapest, most economical approachc.The most rational probable outcomed.The needs of the aggregate rather than a few individualsANS:DThe dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices representcomponents of a decision that the nurse might consider in determining the needs of the aggregate.15.Which of the following actions best represents public health nursing?a.Assessing the effectiveness of the high school health clinicb.Caring for clients in their home following their outpatient surgeriesc.Providing care to children and their families at the school clinicd.Administering follow-up care for pediatric clients at an outpatient clinicANS:AA public health or population-focused approach would look at the entire group of children being served to determine whetheravailable services are effective in achieving the goal of improving the health of the school population. Caring for clients and theirfamilies focuses on individuals and families and not on the entire population. Public health focuses on care of populations.16.Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such anunsafe area?a.To assess the needs of the homeless who live thereb.To demonstrate their courage and commitmentc.To distribute some of their own surplus clothes to those who can use themd.To share with various churches and other charities what is neededANS:AIn most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to thosewho might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses wherethe nurse is trying to give assistance to this population that may or may not be helpful or welcomed.MULTIPLE RESPONSE1.Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.)a.Economic turmoil and demand for high-technology careb.Emergence of new or drug-resistant infectious diseasesc.Emphasis on overall health care needs rather than only on acute care treatmentd.Threat of bioterrorismANS:B, C, DAs overall health needs become the focus of care in the United States, a stronger commitment to population-focused services isemerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention topopulation-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a strongercommitment to population-focused services, rather it has occurred as overall health needs have become the focus of care.lOMoARcPSD|13778330

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2.Which of the following actions demonstrate effective public health nursing practice in the community? (Select all that apply.)a.Epidemiologic investigations examine the environment for health hazards.b.New services are organized where particular vulnerable populations live.c.Partnerships are established with community coalitions.d.Staff members at the public health agency continue to increase in number.e.Staffing walk in clinics for low income familiesANS:A, B, CEvidence that public health nurses are practicing effectively in the community would include organizing services where peoplelive, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Neitherincreasing the number of staff nor acting as staff in the delivery of acute and/or chronic care has a relationship to the effectivenessof public health nursing practice.3.Why are nurses increasingly providing care in clients’ homes rather than in hospitals? (Select all that apply.)a.Home care is less expensive.b.It is much more efficient to give care in the home.c.Nurses prefer to give home care with individual attention.d.People prefer to receive care in their homes rather than in hospitals.ANS:A, DAn increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care infamiliar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differas to their preferred employment setting.lOMoARcPSD|13778330

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Chapter 02: The History of Public Health and Public and Community Health NursingStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this positionwould be appealing?a.Its autonomy and independenceb.Its focus on acute care and immediately visible outcomesc.Its collaboration with other health care professionalsd.Its flexibility and higher wagesANS:APublic health nursing is known for its autonomy and independence. In many instances, there are limited other health careprofessionals and staff with whom to interact. In-patient acute care nurses focus on acute care with outcomes known fairly quickly.Acute care nurses collaborate frequently with other health care professionals. Depending on the position there may be moreflexibility, but typically public health nurses do not receive higher wages.2.The Elizabethan Poor Law of 1601 is similar to which current law?a.Welfareb.Food stampsc.Medicaidd.MedicareANS:CThe Elizabethan Poor Law guaranteed medical care for poor, blind, and “lame” individuals. This minimal care was generallyprovided in almshouses supported by local government similar to Medicaid assistance. Welfare and food stamps do not provide formedical care. Medicare provides medical care to primarily the elderly population.3.How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors,becoming inadequate?a.Economic and political wars resulted in frequent death and injuries.b.Incredible plagues consistently and constantly swept the European continent.c.Migration and urbanization resulted in increased demand for care.d.Caregivers could easily find other employment, so they demanded to be paid.ANS:CCare became inadequate because of the social changes in Europe, with great advances in transportation, communication, and othertechnologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care. The IndustrialRevolution was a time of great advances in technology, transportation, and communication, not a time of economic and politicalunrest or a time where incredible plagues occurred in Europe. Caregivers during this time period were typically poorly educatedand untrained, so there was not an issue related to wages or employment.4.A colonist is working in the public health sector in early colonial America. Which of the following activities would have likelybeen completed?a.Establishing schools of nursingb.Developing vaccines to administer to large numbers of peoplec.Collecting vital statistics and improving sanitationd.Developing public housing and almshousesANS:CCollecting vital statistics and improving sanitation are examples of activities from the early colonial America. Establishing schoolsof nursing, developing vaccines to administer to large numbers of people, and developing public housing and almshouses allhappened after the colonial period.5.Why did American citizens become interested in establishing government-sponsored boards of health?a.They were afraid of infectious diseases such as yellow fever.b.The government could force the poverty-stricken to accept care.c.Such boards could tax and thereby ensure adequate funds to pay for care.d.Such a system would allow for accurate records of births and deaths.ANS:AThreat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health.The threat of disease was the impetus for creation of the boards of establishing boards of health. The primary interest of the boardsof health was to provide public health services for the entire population and not only those who were poverty-stricken. The primarypurpose of the boards of health was not to collect accurate vital statistics or receive tax dollars rather its purpose was to ensure thehealth of the population.lOMoARcPSD|13778330

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6.A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likelyhave implemented?a.Setting policy on quarantine legislation for immigrantsb.Establishing hospital-based programs to care for the sick at homec.Identifying and improving environmental conditionsd.Providing health care for merchant seamenANS:DProviding health care to seamen was an early effort by the federal government to improve public health. The purpose of the MarineHospital Service was to secure its maritime trade and seacoast cities. Quarantine legislation was enacted by legislation during thistime period, but the nurse would not have been responsible for setting these policies. Nursing care for clients in the home began inthe first half of the 1800s through a variety of agencies including the Ladies’ Benevolent Society of Charleston South Carolina.Identifying and improving environmental conditions was a focus of the public boards of health, not necessarily specifically a roleof the nurse.7.What was the outcome of the Shattuck Report?a.Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated.b.Environmental sanitation efforts became an immediate priority.c.Guidelines for modern public health organizations were eventually developed.d.Local and state governments established boards of health after its publication.ANS:CIt took 19 years for the first of Shattuck’s recommendations to be implemented, but his report was the first effort to create a modernpublic health organization. This report called for broad changes to improve the public’s health to take place; however, thesechanges did not happen immediately after publication. They took 19 years to be implemented in the first state of Massachusetts.The report included establishment of a state health department and local health boards in every town, sanitary surveys, and food,drug, and communicable disease control, but none of these changes happened quickly.8.Which nurse is famous for creating public health nursing in the United States?a.Florence Nightingaleb.Frances Rootc.Lillian Waldd.Mrs. Solomon LoebANS:CLillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during itsearly decades. Mrs. Solomon Loeb was a wealthy layperson who assisted Mary Brewster in the establishment of the Henry StreetNurses Settlement. Francis Root was the first trained nurse in the United States who was salaried as a visiting nurse. FlorenceNightingale had many accomplishments, but none of these occurred in the United States.9.Which of the following would have been the focus of a school nurse in the early 20th century?a.Investigating causes of absenteeismb.Teaching school as well as being a nursec.Promoting nursing as an autonomous practiced.Providing medical treatment to enable children to return to schoolANS:AEarly school nursing focused on investigating causes of absenteeism. Providing medical treatment was the responsibility ofphysicians. School nurses did not teach in the schools nor were they part of an autonomous practice during this time period.10.A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which accomplishments of todaywere started within this organization?a.Requiring that public health nurses have a baccalaureate degree in nursingb.Standardizing public health nursing educationc.Developing public health nursing competenciesd.Opening the Henry Street SettlementANS:BThe National Organization for Public Health Nursing sought to improve the educational and services standards of public healthnursing. The Henry Street Settlement was already in existence and was opened by Lillian Wald and Mary Brewster. Thebaccalaureate degree in nursing was not developed yet. Public health nursing competencies were developed by the Quad Council.11.Why were nurses so unprepared for public health nursing in the early 20th century?a.Public health nursing had not yet been created as a field.b.No one would teach the nurses how to engage in public health activities.c.Nightingale’s textbook did not include content on public health nursing.d.Nurses were educated in diploma schools, which emphasized care of hospitalclients.ANS:DNursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared forhome visiting. The specialty of public health nursing practice was developed in the early 1800s. There was not a lack of teachersfor this activity, rather the focus of nursing care was in the acute care setting and not in the community. Nightingale did not have apublished textbook.lOMoARcPSD|13778330

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12.A nurse is considering joining the American Public Health Association (APHA). What information about this organization shouldbe considered when making this decision?a.APHA focuses on the public health concerns of the medical profession.b.APHA represents concerns of nursing specialty practices.c.APHA provides a national forum for nurses to discuss their public healthconcerns.d.APHA focuses on providing health promotion education to the public.ANS:CAPHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The PublicHealth Nursing Section within APHA provides nurses with a national forum to discuss their concerns and strategies within thelarger context of the major public health organization. It also serves as a focus of leadership and policy development forcommunity/public health nursing. The focus of public health concerns of the APHA is broader than only the medical profession.The APHA focuses on concerns of public health nurses, not all nursing specialty practice. The APHA focuses on practicalapplication of public hygiene, which is broader than only health promotion education.13.Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing healthprogram for policyholders?a.Creating such a service was the morally correct thing to dob.Employing nurses directly was less expensive than paying taxes to the city for thesame purposec.Having the company’s nurses make home visits increased worker moraled.Public health nurses visits led to fewer policyholder deaths and lowers companycostsANS:DMetropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths ofchildren under the age of 3 years. The insurance company attributed this improvement and the associated reduced costs to the workof visiting nurses. There was limited funding in the early 20th century to extending nursing services in the community; thus, homevisiting was a very expensive service to provide. Although Metropolitan Life Insurance Company may have increased workermorale that was not the primary reason for continuation of the program.14.Which client would have been most likely to receive care from the Frontier Nursing Service?a.An injured soldierb.A homebound, elderly malec.A woman in labord.A child with a broken femurANS:CThe Frontier Nursing Service nurses were trained in nursing, public health, and midwifery and provided care to rural andinaccessible areas, which led to reduced mortality. Care for soldiers, elderly, and children was not the focus of the care provided bythe Frontier Nursing Service.15.A public health nurse is determining what type of programming should be developed for the community. Which of the following isthe most crucial factor that will influence program development?a.Comprehensive assessment and planning done in the communityb.Documented needs of the local communityc.Federal funding for priority diseases or groupsd.Nursing staff’s expertise and skillsANS:CPrograms are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effortis focused locally. A need in the community may be identified through community assessment, planning, and looking at needs inthe community; however, without funding there will not be a way to create necessary programming. The expertise of the staffshould not be the determining factor when deciding on programming in the community.16.A nursing student during World War II would likely join which group?a.The US Public Health Serviceb.The Marine Nurse Corpsc.The Frontier Nursing Serviced.The Cadet Nurse CorpsANS:DTheBolton Actof 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursingat undergraduate and graduate levels. The U.S. Public Health Service began to use nurses during World War I to establish a publichealth nursing program for military outposts. The Marine Hospital Service was established well before World War II in 1798. TheFrontier Nursing Service was established by Mary Breckinridge in 1925 and provided health care to the rural and often inaccessiblepopulations in the Appalachian region of southeastern Kentucky.17.A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which documentwould most likely provide useful information about this topic?a.The Future of Public Healthb.Healthy People 2020c.Patient Protection and Affordable Care Actd.Scope and Standards of Public Health Nursing PracticeANS:BTheHealthy People 2020documents propose a national strategy to significantly improve the health of Americans by preventing ordelaying the onset of major chronic illnesses, injuries, and infectious diseases. The disarray resulting from reduced politicalsupport, financing, and effectiveness is described inThe Future of Public Health. TheScope and Standards of Public HealthNursing Practicedescribes the processes of assessment, analysis, and planning that are carried out by the public health nurse. ThePatient Protection and Affordable Care Act improved access to health insurance for Americans.lOMoARcPSD|13778330

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18.A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in theseefforts?a.To promote the nursing professionb.To increase funding for public health nursingc.To address the concerns of nursesd.To help improve health care accessANS:DPublic health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion anddisease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life. Health carereform has a larger scope than only the profession of nursing and public health nursing. It addresses the concerns of nurses as wellas many other health care professions.MULTIPLE RESPONSE1.How did Florence Nightingale help bring about community health nursing? (Select all that apply.)a.She convinced socially prominent wealthy women to volunteer to give care.b.She focused on all soldiers and their environment.c.She interacted with each individual person, assessing his or her needs and actingto meet those needs.d.She kept careful records on what was done and what were the results.ANS:B, DNightingale progressively improved the soldiers’ health using a population-based approach that improved both environmentalconditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate theoutcomes. While Nightingale was part of a wealthy family, the role of nurses during this time period was typically fulfilled by poorwomen. The focus of Nightingale’s care was to identify health care needs and interventions that influenced the health of the entirepopulation, not individuals.2.A nurse working with Mary Breckinridge would have likely assisted in what activity? (Select all that apply.)a.Establishing the Henry Street Settlementb.Developing health programs geared toward improving the health care of the ruralpopulationsc.Blazing a nursing trail through the Rockies, providing nursing care to miners andtheir familiesd.Ensuring positive outcomes for pregnancies among women in the AppalachianregionANS:B, DMary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessiblepopulations in the Appalachian regions of the Southern Kentucky. Breckinridge introduced the first nurse-midwives into the UnitedStates when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancycomplications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. LillianWald established the Henry Street Settlement. Mary Breckinridge developed health programs geared toward improving the healthcare of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky, not the Rockies.3.How did nursing education change in the 1950s? (Select all that apply.)a.Baccalaureate nursing programs typically included public health nursingconcepts.b.Diploma schools of nursing continued to expand their student numbers.c.Junior and community colleges began offering nursing programs.d.Nurses were strongly encouraged to have a scientific basis for their practice.e.Post diploma training was initiated nationwide.ANS:A, CIn the 1950s, public health nursing became a required part of most baccalaureate nursing education programs. In 1952, nursingeducation programs began in junior and community colleges. Associate degree programs began to expand their enrollments, notdiploma schools. The need for evidence-based practice continues to grow but was not a change in the 1950s. In 1914 MaryAdelaide Nutting, working with the Henry Street Settlement, began the first course for post-diploma school training in publichealth nursing at Teachers College in New York City.4.How did health care and its delivery change during the 1980s? (Select all that apply.)a.Funding to public health increased as funding for acute hospital care decreased.b.Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco.c.Nurse practitioners were increasingly used to provide care.d.Public health programs suffered reduced political support, financing, andeffectiveness.ANS:B, C, DDuring the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-termcare. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer andprofessional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under theinfluence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.lOMoARcPSD|13778330

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Chapter 03: US and Global Health CareStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.A public health agency is planning to implement the electronic health record. (Which is a benefit of this choice?a.Facilitation of interprofessional careb.Improved client compliance with medical regimensc.Cost savings to the agencyd.Compliance with JCAHO standardsANS:AThe electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals;24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol remindersfor prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increasedclient safety; and decline in medication errors. There is no evidence that an electronic health record improves client compliancewith medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies.2.Which statementbestdescribes the cost of health care in the United States?a.Health care costs are kept low, and the indicators of health are among the bestworldwide.b.Health care costs are low which has resulted in poor health outcomes.c.Health care costs are the highest in the world, but the indicators of health are notthe best worldwide.d.Health care costs and indicators of health are the highest in the world.ANS:CHealth care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domesticproduct, the indicators of what constitutes good health do not document that Americans are really getting their money’s worth.Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor incomparison to other countries who spend less money on health care.3.A nurse is explaining the health care system in the United States to a group of health care providers visiting from South America.How would the nurse best describe the current health care system?a.“It is a logical, rational approach to meeting expressed needs while still trying tocontrol costs.”b.“It is a centralized system that provides care in hospitals.”c.“It is divided primarily into two components: private health care and public healthcare.”d.“It is the best in the world with outstanding research and high-technology careavailable to all.”ANS:CHealth care in the United States consists of a private or personal care system and a public health system, with overlap between thetwo. The United States health care system is one of the most expensive systems in the world that does not do a good job atcontrolling costs. Care is provided through an enormous range of facilities and providers, including hospitals, physicians’ anddentists’ offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clinics. Although there is greatresearch and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health caredisparities exist among multiple populations making this system not available to all.4.Which statement best describes ideal primary health care?a.Based on a multidisciplinary group of health care providers that work as a teamb.Essential care available to all community members, which encouragesself-managementc.Focused on health promotion and disease prevention for everyone enrolled in thehealth centerd.Local efforts to meet the Declaration of Alma Ata principlesANS:BPrimary health care is generally defined as essential care made universally accessible to individuals, families, and the community.Health care is made available to them with their full participation and is provided at a cost that the community and country canafford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, notprimary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitativeservices. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted allcitizens of the world to live socially and economically productive lives.lOMoARcPSD|13778330

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5.How does managed care (MC) attempt to control costs of care?a.By encouraging families to use the point of service list of individual practiceassociatesb.By requiring families to choose a care provider from the MC network and notallowing access to other services without their provider’s permissionc.By moving Medicaid-eligible families onto state Medicare enrollmentd.By refusing permission for families to use urgent care or emergency departmentservicesANS:BManaged care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper whocontrols access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or othercare without permission from their primary-care providers. Thus, those enrolled in Medicaid managed care have restrictions thathelp keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers whoagree to comply with the care approaches established through a case management approach, not through a point of service list ofindividual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve differentpopulations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather acase management approach is used to control costs.6.An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can nolonger afford these medications because her only income is Social Security. Which statement is the best response by the nurse?a.“Let’s go through these medications and see which ones we can delete.”b.“You can get these medicines at this clinic for free.”c.“Let’s see if we can get some help from Medicare to help you pay for thesemedications.”d.“These medications are important. Do your best to pay for them.”ANS:CThis elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to helpcover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figureit out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before lookinginto receiving the medications for free as there may be other barriers which limit the abilities to get these medications at adiscounted cost.7.A nurse is determining which health care services must be offered at a local public health clinic. Which factor is most important forthe nurse to consider?a.Data available from the most recent community assessmentb.Suggestions from community members about what is neededc.Recommendations fromHealthy People 2020d.Services mandated by the state governmentANS:DAt the local level, health departments provide care that is mandated by state and federal regulations. Data available from the mostrecent community assessment, suggestions from community members about need, and recommendations fromHealthy People 2020could all be used. However, funding for these types of programs may not be available. The services that are mandated by the stategovernment will be funded and allow the clinic to be able to provide these services.8.A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can thenurse make about this population?a.They have difficulty accessing health care due to a shortage of primary-careproviders.b.They most likely receive health insurance through Medicare.c.They are unable to access health care due to the implementation of the AffordableCare Act.d.They have access to affordable health care insurance.ANS:DMassachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantlydifferent in Massachusetts than in other areas of the country. Low-income populations are eligible for Medicaid services, notMedicare. The program in Massachusetts became a model for the Affordable Care Act.9.A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct theclient to in order to receive care?a.Managed careb.Community health centerc.Emergency departmentd.Physician officeANS:BThere is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide abroad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, anddentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people ofall ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specificnetwork of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergencydepartments and physician offices are not the best place for an individual without health insurance to receive care. Both areexpensive and do not provide the necessary resources for the individual to possibly receive health insurance.lOMoARcPSD|13778330

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10.Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaboratemore closely in the last few years?a.Increased administrative pressures to demonstrate outcomesb.Increased focus on emergency preparedness and responsec.Increased taxpayers’ complaints and general unhappinessd.Increased pressure to decrease overlap in servicesANS:BSince the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response.In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accuratelyreport the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediatearea, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for,recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-localplanning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both importantfactors to consider; however, this is not the reason why increased collaboration has occurred. There has not been an increase intaxpayer complaints or unhappiness that has caused these changes to occur.11.Minority nurses represented about 30.1 percent of the RN population. What is this an example of?a.Projectionb.Disparityc.Racismd.A sentinel eventANS:BDisparities are racial or ethnic differences in the quality of health care or representation of a faction of the population, not based onaccess or clinical needs, preferences, or appropriateness of an intervention. Projection is an estimate or forecast of a future situationbased on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that one’s own raceis superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the pa tient.MULTIPLE RESPONSE1.A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency wouldwant to achieve accreditation? (Select all that apply.)a.To improve health programming and servicesb.To improve community relationshipsc.To improve performance and qualityd.To improve managemente.To decrease cost of health careANS:B, C, DThe purpose of accreditation for public health departments is to assist and identify quality health department performance andquality, and it develops leadership, improve management, and improve community relationships. Neither the improvement ofhealth care programming and services nor minimizing health care costs is a reason why a public health agency would want toachieve accreditation.2.What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all thatapply.)a.Foreign-born immigrant population is increasing.b.Hispanics are the largest minority group population.c.Leading causes of death are from infectious diseases.d.Mortality for both genders in all age groups declined.e.Unintentional injuries are among the top 10 causes of death.ANS:A, B, D, EThe nation’s foreign-born population is growing, and it is projected that from now until 2050 the largest population growth will bedue to immigrants and their children. Although African Americans used to be the largest minority group, Hispanics now have thatdistinction. The population of the United States continues to increase, and mortality for both genders from all age groups hasdeclined. The leading causes of death have changed from infectious diseases to chronic and degenerative diseases withunintentional injuries being among the top 10.3.Which of the following statements is accurate descriptions of current social and economic trends in the United States? (Select allthat apply.)a.Citizens are appreciating the quality of life enjoyed in the United States.b.Enjoying life is not as important as the need to take care of oneself.c.People often spend a considerable amount of their own money on complementarytherapies.d.The gap between the richest and poorest is widening.e.The composition of families and living patterns are changing.ANS:A, C, D, ESeveral social trends that influence health care include changing lifestyles, a growing appreciation of the quality of life, thechanging composition of families and living patterns, changing household incomes, and a revised definition of quality health care.People often spend a considerable amount of their own money for these types of therapies because few are covered by insurance. Itis obvious that the gap between the richest and poorest is widening because of the percent wage increase in the higher incomelevels. Americans spend considerable money on health care, nutrition, and fitness, because health is seen as an irreplaceablecommodity. To be healthy, people must take care of themselves.lOMoARcPSD|13778330

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4.Which of the following provides evidence that the US health care system is in crisis? (Select all that apply.)a.Health insurance is an expensive benefit for employers to provide.b.Incompetent or negligent nurses are an ongoing source of medical errors.c.Long work hours and provider fatigue are a major factor in medical errors.d.More punitive measures must be taken to decrease provider errors.e.Consumers want lower costs and high-quality health care without limits.ANS:A, C, EConsumers want lower costs and high-quality health care without limits and with an improved ability to choose providers andservices of their choice while employers are typically the purchasers of health care; they want to be able to obtain basic health careplans at reasonable costs for their employees. Many employers have seen their profits diminish as they put more money intoproviding adequate health care coverage for employees. Nurses working long hours pose a serious threat to patient safety becausefatigue slows reaction time, saps energy, and diminishes attention to detail. The Institute of Medicine’s (IOM) reportTo Err IsHumanrecommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting systemfailures by designing safety into the process of care. The report makes it clear that the majority of medical errors today were notproduced by provider negligence, lack of education, or lack of training.5.A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting?(Select all that apply.)a.Administering the Medicaid programb.Assessing the health needs of the state’s citizensc.Employing and supervising school health nursesd.Establishing and maintaining child immunization clinicse.Providing education regarding established health codesANS:A, B, EState health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health carefinancing and administering Medicaid, providing mental health and professional education, establishing health codes, licensingfacilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local healthdepartments in areas such as ongoing assessment of health needs. Employing and supervising school health nurses occur at thelocal level, and many times within a specific school. Provision of child immunization clinics occurs at the local level.lOMoARcPSD|13778330

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Chapter 04: Government, the Law, and Policy ActivismStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.Which of the following best defines the wordpolitics?a.The art of influencing othersb.The outcome of governmental policiesc.A provision of power for making decisionsd.The result of legislative actionANS:APolitics is the art of influencing others to accept a specific course of action.Politicalactionresults in governmental policies andlegislation. The result of legislative action typically is done in the form of laws and policies. The provision of power for makingdecisions is typically assumed by the government.2.Which of the following activities is completed by the executive branch of the federal government?a.Administration of policyb.Interpretation of policyc.Proposal of policyd.Passage of policyANS:AThe executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws).The judicial branch interprets laws.3.A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the followingbranches of the government is the nurse working?a.Constitutional branch of governmentb.Executive branch of governmentc.Legislative branch of governmentd.Judicial branch of governmentANS:CThe legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifiesproblems and proposes and then debates, passes, and modifies laws to address those problems. There is not a constitutional branchof the government. The executive branch administers and regulates policy. The judicial branch interprets laws.4.Which of the following statements best describes why the federal government has become involved in health care?a.The states asked the federal level to become involved.b.Because of rising costs to the states, the federal budget needed to be used to payfor necessary services.c.The Constitution gives the federal government the power to promote the generalwelfare.d.This step was necessary to standardize care on a national level.ANS:COne of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. TheSupreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution,that such federal governmental action was within the powers of Congress to promote the general welfare. According to Article I,Section 8 of the US Constitution Congress has multiple roles in relation to health care: provide for the general welfare, regulatecommerce among the states, raise funds to support the military, and provide spending power. Thus, Congress was within its role tobecome involved in health care and was not asked to do so by the states or used to standardize care on the national level.5.A client states to the nurse, “I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far Ihave seen no benefits from this legislation.” Which of the following statements would be the best reply by the nurse?a.“Maybe you have not directly seen the changes; however, several things havechanged in health care because of this bill.”b.“It will take years to see any effects from the act because of the delays inimplementation of the changes.”c.“This legislation will primarily improve care for the elderly and poor populations,so this is why you may not have seen any benefits.”d.“The way health care operates at the federal and state levels has changed, so mostindividuals will not see any direct impact.”ANS:AIt is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects ofthis law. The goal of the Affordable Care Act was to improve the health of the nation and access care. Several changes to healthcare have already been made because of this legislation, and more changes will continue in the future. Multiple provisions of theact will affect individuals and families.lOMoARcPSD|13778330

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6.What was the significance of the 1979 Surgeon General’s report?a.It planned the goals and priorities for the entire Veterans Administration medicalsystem.b.It vastly increased funding for health promotion activities.c.It identified the use of tobacco as a cause of lung cancer.d.It created national goals for promoting health and preventing disease.ANS:DThe 1979 Surgeon General’s report began a focus on preventing disease and promoting health for all Americans. It was a nationaleffort with all levels of government, as well as other interested parties, involved. The 1979 report did not plan goals and prioritiesfor the Veterans Administration medical system; rather it looked at health of all Americans. There was no funding associated withthe report. It addressed prevention of disease and promotion of health for multiple diseases, not just lung cancer.7.A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of thefollowing factors should the nurse emphasize?a.Providing disease investigation trainingb.Providing research opportunitiesc.Providing leadership experiencesd.Providing salaries commensurate with responsibilitiesANS:DThrough the input of the Division of Nursing’s National Advisory Council for Nursing Education and Practice (NACNEP), theDivision of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place tosupport the public health nurse role are competitive salaries commensurate with responsibilities, experience in health promotionand prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating healthdisparities. The Division of Nursing’s National Advisory Council for Nursing Education and Practice (NACNEP) did notemphasize the importance of providing disease investigation training, research opportunities, or leadership experiences.8.A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type oflaw will the nurse refer?a.Common lawb.Constitutional lawc.Legislation and regulationd.Judicial lawANS:BConstitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry.State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfareof their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe onindividual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. Thecommunity’s rights are deemed more important than the individual’s rights when there is a threat to the health of the public.Judicial law, based on court and jury decisions, and the principles of common law (precedent, justice, fairness, respect for anindividual’s autonomy, and self-determination) are both used by court’s as the basis to make a decision and do not relate to havingthe right to isolate a patient. Legislation is law that comes from the legislative branches of the government and regulations arespecific statements of law related to defining or implanting individual pieces of legislation. Neither are as important in this case asthe constitutional law of the police power of the states in regards to isolation of a patient.9.Who is responsible for determining the scope of practice for registered nurses?a.American Nurses Associationb.Federal legislatorsc.State legislatorsd.US Department of Health and Human ServicesANS:CHealth care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practiceof professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nursepractice act is governed by legislators in each state. The American Nurses Association, US Department of Health and HumanServices, and federal government do not determine the scope of practice for nurses; this responsibility is the role of stategovernments. The US Department of Health and Human Services is the agency most heavily involved with the health and welfareof US citizens.10.Which of the following statements by a client indicates alack of understandingregarding an appropriate reason to sue forprofessional negligence?a.“Because the health care workers didn’t turn my mother every 2 hours, shedeveloped bedsores.”b.“I received permanent nerve damage because they would not remove a cast thatwas too tight.”c.“My daughter wasn’t given a call light, and for a whole shift no one checked onher condition.”d.“They amputated the wrong leg during surgery.”ANS:CProfessional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify aninjury, except for “My daughter wasn’t given a call light, and for a whole shift no one checked on her condition,” in which case thecare was substandard but no injury resulted. The incorrect responses all specify an injury whereas professional negligence, ormalpractice, is defined as an act (or failure to act) that leads to injury.lOMoARcPSD|13778330

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11.Which of the following statements best describes the law in relation to clinical practice by nursing students?a.Students are considered certified until licensure is obtained.b.Students are expected to meet the same standard of care as the professional nurse.c.Students are not legally liable for errors because they practice under the license oftheir instructor.d.Students have a scope of practice determined by the nurse practice act.ANS:BNursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Studentsare expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similarcircumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act,they also cannot perform the tasks and responsibilities of the licensed practitionerwithinthe scope of practice until they havereceived adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the student’slevel of education.12.A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Whichof the following would be the best time for the nurse to request support from the local senator, who is not on the committee that isreviewing this bill?a.When the bill is first assigned to a committee.b.When the bill is discussed and debated within the committee.c.When the bill moves out of committee to be heard by the entire Senate.d.When the bill passes the Senate and moves to the House of Representatives.ANS:COnce the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact thissenator, who will then be in a position to act on it. To contact the senator when the bill is first assigned to the committee or is beingdiscussed and debated within the committee is too early to effectively influence the individual senators. The nurse would not wantto wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.13.The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows andrequires. Which of the following effects will this change have on nurses in this state?a.None, because they are just helpful guidelines for maximum safety.b.None, because they just give specifics that may change over time.c.Major, because prudent nurses would follow such regulations.d.Major, because these rules and regulations have the effect of law and must beobeyed.ANS:DWhen the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations.Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practiceconsistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They arelaws that must be followed, not guidelines.14.A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nursetake to influence the bill’s implications?a.Exercise veto power by calling for petitions from health care agencies.b.Contact the regulatory agency and participate in public hearings.c.Call members of congress to request that they rescind the legislation that waspassed.d.Discuss the change in services with the administrators at the hospital.ANS:BOnce a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not toolate to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes theregulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbyingagainst a bill because it shapes the final implementation of the law. Health care agencies do not have the ability to veto a bill. Aftera bill has been passed, it is too late to contact members of congress. Calling the hospital will not change the implications of the bill.Contact must be made with the regulatory agency in order to influence how the law is regulated.15.Which of the following agencies has the most influence on the health and welfare of US citizens?a.Agency for Healthcare Research and Quality (AHRQ)b.Centers for Disease Control and Prevention (CDC)c.US Department of Health and Human Services (USDHHS)d.World Health Organization (WHO)ANS:CAs the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the healthand welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO’s policy-making body provides policy optionsand guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaidthrough the Centers for Medicare and Medicaid Services (CMS).lOMoARcPSD|13778330

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16.Which of the following laws established programs for provision of health services for women and children and supportedcommunity-oriented nursing practice?a.Early Periodic Screening and Developmental Testing (EPSDT) Initiativeb.Healthy People 2000Initiativec.Sheppard-Towner Actd.State Child Health Improvement Act (SCHIP)ANS:CThe Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, andsocial welfare policy. Of particular importance was the fact that it established standards for programs to serve women and childrenand made nurses available to provide these services in the community setting. Within the Sheppard-Towner Act was a provision tostart the EPSDT initiative. SCHIP provides insurance for children and families who cannot otherwise afford health insurance.Healthy People 2000focuses on promoting health and preventing disease for all Americans.MULTIPLE RESPONSE1.Which of the following describes the significance of the passage of The Public Health Threats and Emergencies Act? (Select allthat apply.)a.It funded ongoing activities of the public health system.b.It led to improved water quality and food safety guidelines.c.It included funding for public health activities.d.It validated that the public health system was prepared for terrorism.e.Expanded the role of Secretary of HHS to include aspects of public healthemergencies.ANS:B, CThe Public Health Threats and Emergencies Act was the first federal law to comprehensively address the public health system’spreparedness for bioterrorism and other infectious disease outbreaks and signaled the beginning of renewed interest in public healthas the protector for entire communities. The focus of this law was to address emerging threats to the public’s health and authorizethe Secretary of HHS to take appropriate response actions during a public health emergency, including investigations, treatment,and prevention. A focus was the improvement of water quality and food safety. It did not support the ongoing activities of publichealth. It did not validate the public health system was prepared for terrorism.2.Which of the following best describes the importance of the World Health Organization (WHO) to the United States? (Select allthat apply.)a.Provides daily information on disease occurrences.b.Establishes international standards for antibiotics and vaccines.c.Creates international legislation regarding international cooperation.d.Supports national programs to fight disease when asked to do so.e.Monitors for adverse drug reactions.ANS:A, B, D, ESome WHO services that benefit all countries (including the United States) are providing day-to-day information service on theoccurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoringadverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can requestassistance with strengthening the delivery of health services, supporting national programs to fight disease, and training healthworkers—which the United States does not. WHO can suggest but cannot legislate to individual countries.3.Which of the following activities is the responsibilities of the Centers for Disease Control and Prevention (CDC)? (Select all thatapply.)a.Conduct research to enhance disease prevention.b.Detect and investigate infectious disease problems.c.Develop public health policies.d.Publish national goals for promoting health and preventing disease.e.Serves as an advocate of public health policesANS:A, B, C, EThe mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. Tomonitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, and developand advocate sound public health policies and other prevention strategies. The safety and health of the workplace is the specificresponsibility of OSHA. The CDC cannot write or pass legislation. The USDHHS published national health goals inHealthyPeople 2020.4.A nurse is visiting a state legislator to encourage the legislator to vote for a particular health bill that the state n urses association hasendorsed. Which of the following actions would be most important for the nurse to complete? (Select all that apply.)a.Encourage the legislator or staff to ask relevant questions.b.Be friendly and engage in small talk so that rapport can be established.c.Be aware that legislators are well informed; don’t insult the legislator by statinginformation that is obvious.d.Have a handout that summarizes all the major points in support of the bill.ANS:A, DLegislators might not be well informed about every issue, so they need and want important information. The nurse should allowtime for questions or clarifications of information shared and have the material on a handout for the legislator’s convenience. It isalso helpful to invite the legislator to attend nursing conferences or meetings where health issues will be discussed. The nurseshould not waste time with small talk but briefly present his or her stand, emphasizing other nurses who support the bill, becausenumbers count. Legislators might not be well informed about every issue, so they need and want important information that thenurse can provide.lOMoARcPSD|13778330

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5.A nurse would like to become involved in political action. Which of the following actions would be most appropriate for the nurseto accomplish this goal? (Select all that apply.)a.Become a member of the state nurses association.b.Be friendly with everyone, whether supportive or not of your ideas.c.Focus on being appointed to the state level committees.d.Focus all your efforts on your specialty practice area and your employment site.e.Volunteer to serve on relevant committees.ANS:A, BA nurse wishing to become politically involved should begin by joining the state nurses association, networking with othersinvolved, and volunteering to serve on committees or in offices. Be friendly and network to increase your knowledge beyond yourown workplace or specialty and seek opportunities to share expertise with others. Becoming involved locally is a good opportunityto start becoming involved in political action and allows for networking at the local level. Seeking opportunities beyond one’sworkplace or specialty area allows the nurse to gain additional knowledge and share expertise in specialty area with others.6.A nurse is testifying at a committee meeting about a health bill. Which of the following actions should be taken by the nurse?(Select all that apply.)a.Briefly describe professional education.b.Discuss how the bill affects more than just nurses.c.Include factual data and, if possible, statistical information in visual form.d.Provide written proof of personal and professional qualificationse.Provide information about relevant expertise and related experience.ANS:A, B, C, ELanguage must be simple and carefully chosen to convey information to listeners and to avoid professional jargon. The nurse mustshare a bit of personal education, experience, and expertise to be seen as a credible source, but written proof of credentials is notnecessary unless specifically requested. The testimony must go beyond just nursing’s interest and include accurate, credible data.The data must be accurate and credible which may not be the case when getting names from the media.lOMoARcPSD|13778330

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Chapter 05: Economics of US Health Care DeliveryStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussedas the criterion that is used to ration health care?a.Clinic operating hoursb.Ability to pay for servicesc.Availability of local provider servicesd.Transportation availabilityANS:BBecause there are not enough health care services available to provide desired services to everyone, the focus has been on reducingcosts by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing(either directly or indirectly). Theprimarydeterminant, however, is the ability to pay for services. Without this ability, services aredenied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out ofpocket are unable to obtain services regardless of operating hours, transportation issues, or availability.2.Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocatehealth care resources?a.Insurance resourcesb.Health care rationingc.Health economicsd.Medical technologyANS:CEconomics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect thehealth care industry. Insurance resources, health care rationing, and medical technology are important components of healtheconomics but by themselves do not provide the broad understanding called for in this question.3.Which of the following individuals would most likely experience a barrier when accessing health care?a.A 40-year-old female who speaks English as a second languageb.A 25-year-old female with co-pay health insurancec.A 50-year-old male with hypertensiond.A 30-year-old male who is unemployedANS:DBarriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communicationproblems, childcare needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely toexperience a barrier because of not having a job, which may reduce his access to health insurance and limit his income. Those whospeak English as a second language and have health insurance even with co-pay requirements should both find it easier to accesshealth insurance than someone who is unemployed since the inability to afford health care is a primary barrier. Medical diagnoses,such as having hypertension, do not present a barrier to accessing health care.4.Which person is most likely to be uninsured?a.An 82-year-old woman with chronic medical problemsb.A 2-year-old whose mother is on welfarec.A 50-year-old business man who works for a large corporationd.A 24-year-old man who works part-time at a small businessANS:DYoung adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes.The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at thelarge corporation probably has health insurance, because most large businesses provide it.5.Which of the following is most closely correlated with poor health?a.Age and gender (i.e., older males)b.Low socioeconomic statusc.Minority race statusd.High-risk lifestyle behaviorsANS:BPoverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors. Therate of uninsured remained higher among people with lower incomes and lower among those with higher incomes. Households ofthree with less than $20,000 annual income are at the highest risk for being uninsured. Socioeconomic status has the closestcorrelation to health status; thus, age, gender, minority race status, and high-risk lifestyle behaviors do not have the closestcorrelation.lOMoARcPSD|13778330

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6.A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Whichof the following statements would be most appropriate for the nurse to make?a.“Don’t drop out of school.”b.“Sign up for childbirth classes.”c.“Sign up for the WIC program.”d.“Take your prenatal vitamins daily.”ANS:AThe question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Becausesocioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be lesslikely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child. Thepriority of the nurse should be to encourage the teenager to stay in school as this choice will provide for the best long-term outcomefor the client. Signing up for childbirth classes, the WIC program, and taking prenatal vitamins all address short-term outcomeswhich are not as important as the future of the teenager raising this child.7.A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have thefinancial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to thefamily?a.A managed care organizationb.An emergency departmentc.Medicaidd.MedicareANS:CMedicaid provides coverage for adults with low income and their children. Managed care is a type of private insurance whileMedicare is available to persons aged 65 and older. The emergency department would charge a co-pay for care given to both thechild and the parents.8.Which of the following best explains how the government unintentionally encourages low-income persons to use emergencydepartments as their primary care provider?a.A huge amount of paperwork is required when Medicaid clients go to aphysician’s office.b.Government regulations require Medicaid clients to use emergency departmentswhen their primary health care provider is unavailable.c.Legally, emergency departments must see clients even if clients can’t pay.d.Physicians’ limited office hours make them unavailable during evenings andweekends.ANS:CPeople on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians canchoose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless ofability to pay. Emergency department co-payments are modest and are frequently waived if the client is unable to pay. Thus, lowout-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary careservices. Limited physician office hours over the weekend does make it difficult for low-income persons to access care through aprimary care provider; however, this is not influenced by a government decision. The government does not require Medicaid clientsto use the emergency department when their primary care provider is unavailable, rather the policies of the emergency departmentto see all clients regardless of ability to pay may inadvertently encourage them to use this service. The paperwork at a physician’soffice that needs to be completed by a Medicaid client is not any different than any other client receiving care at the office.9.Which of the four main factors that affect health, is the most important?a.Environmentb.Human biologyc.Lifestyle choicesd.Health care systemANS:CPersonal biology and behavior (or lifestyle), environmental factors and policies (including physical, social, health, cultural, andeconomic environments), social networks, living and working conditions, and the health care system—medical services are said tohave the least effect. Behavior and lifestyle have been shown to have the greatest effect on longevity, with the environment andbiology accounting for the greatest effect on the development of all illnesses.10.A nurse is trying to maximize the quality of life of clients while reducing health care costs. Which of the following actions wouldmost likely be completed by the nurse?a.Assisting in cast application for a client who was injured in a skateboard incidentb.Irrigating the eyes of a client splashed with chemicalsc.Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of aclient with a heart conditiond.Teaching a high school boy about sexually transmitted infections and propercondom applicationANS:DEducation is primary health care prevention. A proactive investment in disease prevention and health promotion targeted atimproving health behaviors and lifestyle has the potential to improve health status and reduce health care costs. Assisting in a castapplication, irrigating a client’s eyes, and restoring a normal cardiac rhythm are all tertiary prevention methods as a condition hasalready occurred and the nurse is focusing on restoring health. In order to maximize quality while reducing health care costs, thenurse should focus on primary prevention strategies.lOMoARcPSD|13778330

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11.Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in theUnited States?a.Education of health care providers moved into universities.b.People finally had enough money to pay for medical care.c.The improved outcomes of hospital care were recognized.d.Advances were made in sewage disposal, and water and milk quality.ANS:DEnvironmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milkquality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infectionsor traumatic episodes. The education of health care providers did move into universities during this time period; however, this isnot the reason why there was an increased focus on infections and trauma. Health care was paid for primarily by individuals duringthis time period so there was not an increase in the amount of money available to pay for health care. The outcomes of hospital careimproved because of the advances that were being made in technology, not because health care providers were focusing more oninfections and trauma.12.Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century?a.Lack of available space to provide care for clients in hospitalsb.Emergence of new and old communicable and infectious diseasesc.New guidelines for chronic disease managementd.Increased use of technology leading to a decreased need for health care workersANS:BIn the 21st century, the emergence of new and the reemergence of old communicable and infectious diseases are occurring as wellas larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and intothe community. Chronic disease management will be a challenge for health care providers; however, new guidelines should easethe care provided for these diseases and wouldn’t be seen as a challenge. The use of technology will continue to increase, but theneed for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.13.Which of the following demographic factors is expected to have the greatest influence on national health care spending?a.The aging populationb.Use of diagnosis-related groups to determine reimbursementc.Insurance reformd.An increasing number of people without health insuranceANS:AThe aging population is expected to affect health services more than any other demographic factor. The majority of older adultsrely on publicly funded programs. As the Baby Boom generation ages and retires, federal expenses for Social Security and healthcare will increase. The use of diagnosis-related groups to determine reimbursement started in 1983 and is not expected to have agreat influence on national health care spending at this time. Insurance reform is not a demographic factor. Due to the AffordableCare Act, the number of people without health insurance is decreasing.14.Which of the following groups pays the largest amount for health care in the United States today?a.Consumersb.Federal and state governmentc.Insurance companies and other third-party payersd.Hospitals and health care providersANS:BCombined state and federal governments paid the most for health care in 2018. Health care financing has evolved from a time whenthe most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, andfinally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than privateinsurance companies or consumers. From 1960 to 2018, the percentage of third-party public insurance payments increased and thepercent of out-of-pocket payments declined.15.Which of the following services would be covered under Medicare Part A?a.Blood draw to assess PT/INRb.Physical therapy visitc.Stay in skilled nursing facilityd.Transportation by an ambulanceANS:CMedicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers “medically necessary” services,such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services andphysiotherapy.16.A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as durable medicalequipment. Which of the following best describes this part of Medicare?a.Part Ab.Part Bc.Part Cd.Part DANS:BMedicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such aslaboratory services, ambulance transportation, prostheses, durable medical equipment, and some supplies. Medicare Part A covershospital care, home care, and skilled nursing care. Medicare Part C plans are coordinated care plans that include healthmaintenance organizations, private fee-for-service plans, and medical savings accounts. Medicare Part D provides prescription drugcoverage.lOMoARcPSD|13778330

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17.Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided?a.A proportion of actual cost arbitrarily decided by the Medicare panelb.The federal budget constraints for the current fiscal yearc.Hospital and health care provider feedback and political persuasiond.Prospective payment scale based on the medical diagnosisANS:DAs a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted aprospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more careand toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs). There isnot a Medicare panel that determines the actual cost of services. Payments are determined in advance based on DRGs and are notdetermined by the budget of the federal government. Hospital and health care provider feedback do not influence the prospectivereimbursement; rather, the third-party payer establishes the amount of money that will be paid for the delivery of a particularservice before offering the services to the client.18.Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal ofreducing the need for professional health care intervention and therefore also lowering cost?a.Managed care planb.Fee-for-service paymentc.Prospective reimbursementd.Retrospective reimbursementANS:AThe concept of managed care is that costly care could be reduced if consumers had access to education and health promotion.Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based onthe same criteria, but managed care integrates the financing and the delivery of health care.19.Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clientsregardless of the services needed and provided?a.Capitationb.Fee for servicec.Rationingd.Retrospective reimbursementANS:AIn payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period oftime. In the fee-for-service payment system, which is like the retrospective reimbursement, the practitioner determines the costs ofproviding a service, delivers the service to a client, submits a bill for the delivered service to a third-party payer, and is paid by thethird-party payer. Rationing implies reduced access to care and potential decreases in the acceptable quality of services offered.20.A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the followingwould most likely be a consequence of capitation?a.Coercing clients to attend health promotion education classesb.Encouraging clients to seek care elsewherec.Increasing the number of interventions to maximize paymentd.Neglecting to order certain tests or treatment to minimize cost to the providerANS:DIn capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set periodof time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize theamount of money received to provide care to members of this group. In a capitated arrangement, the provider would most likely notincrease the number of interventions used or coerce clients to attend health promotion classes as both of these strategies would costthe provider more money, and the provider will be receiving a set amount of money to provide care for a given client for a setperiod of time. It is unlikely that the provider would encourage clients to seek care elsewhere; rather the provider would beconscientious about the number of tests and treatments that are ordered in order to try to contain costs.21.When did medicine in the United States make a shift away from the treatment of acute infection to care of chronic illnesses?a.Between 1890 and 1920b.Between1920 and 1940c.Between 1940 and 1960d.Between 1945 and 1984ANS:DThe later part of the 20th Century (1945-1984) ushered in a shift away from acute infectious health problems of previous stagestoward chronic health problems such as heart disease, cancer, and stroke.22.A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the followinginterventions is the nurse most likely completing?a.Applying for a grant to establish a daycare center to serve dependent older adultclients living with working familiesb.Persuading legislators to pass a bill offering health care financial aid to families atriskc.Screening cocaine addicts for financial assistance eligibility for drug treatmentd.Referring clients with renal failure to apply for MedicareANS:BPrimary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass abill offering health care financial aid to families at risk addresses initiating interventionsbeforean illness occurs. Applying for agrant and referring clients with renal failure both demonstrate the use of tertiary prevention as the illness or condition has alreadydeveloped. Screening cocaine addicts displays the use of secondary prevention as a screening technique is being used to identifythe problem as soon as possible.lOMoARcPSD|13778330

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MULTIPLE RESPONSE1.In which of the following situations would the federal government provide money through tax relief for private enterprise? (Selectall that apply.)a.A business pays for part of health insurance premiums for its employees.b.A business purchases gifts for its employees to award them for their service.c.An employer provides health screenings.d.An employer requests reimbursement for employee transportation costs.e.An employer offers immunizations to all eligible employees.ANS:A, C, EBusinesses can pay for disease prevention and health promotion services for employees (and sometimes their families) in the formof immunizations, health screenings, and counseling. The business can then deduct these costs as a business expense, whichreduces the amount the business owes the government in taxes on their profits. Similarly, when businesses subsidize healthinsurance for their employees—and families—this is also a business expense, which decreases the amount the business wouldotherwise pay in taxes. Thus, the government indirectly provides the money, but the business, a part of the private sector, decideshow it is used. A business purchasing gifts for its employees and an employer requesting reimbursement for employeetransportation costs do not result in tax relief for the business. Rather, the business providing health insurance and healthpromotion/disease prevention services allows the amount of taxes that the business owes to the government to be reduced.2.Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.)a.Clients may have preexisting conditions not covered by insurance.b.Many physicians won’t accept Medicaid clients.c.Medicaid won’t pay for certain medical interventions.d.Medicaid recipients are noncompliant with their health care providers’recommendations.e.There is a general hesitancy among those eligible to seek health care.ANS:A, B, CThe primary reasons for delay, difficulty, or failure to access care include inability to afford health care and a variety ofinsurance-related reasons, including the insurer not approving, covering, or paying for care; the client having preexistingconditions; and physicians refusing to accept the insurance plan. Practical problems such as lack of childcare, transportation, longwaiting periods, and communication issues also interfere. Noncompliance is not a primary reason why Medicaid clients have pooroutcomes. There is no research to confirm that Medicaid recipients are reluctant to seek medical care. Rather there are usually othercompounding factors that interfere with the client following the regimen or accessing other needed health care services which resultin the poor health outcomes.3.A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of thefollowing interventions should be implemented by the nurse? (Select all that apply.)a.Publicize data on success of health promotion efforts.b.Lobby for decreased reimbursement for secondary and tertiary care services.c.Establish standards for appropriate screenings at specific intervals.d.Encourage members of the military service to engage in appropriate healthylifestyle behaviors.e.Provide transparency to the public regarding service costs and savings.ANS:A, EReasons given for the lack of emphasis on prevention in clinical practice and lack of financial investment in prevention includeprovider uncertainty about which clients should receive services and at what intervals, lack of information about preventiveservices, negative attitudes about the importance of preventive care, lack of time for delivery of preventive services, delayed orabsent feedback regarding success of preventive measures, less reimbursement for these services than for curative services, lack oforganization to deliver preventive services, and lack of use of services by the poor and elderly. Considering how health care dollarsare spent in the United States, it would not be reasonable to lobby for decreased funding for secondary and tertiary services, as thiswould result in less care available for individuals. Requiring people to change their lifestyle would be illegal.4.Which of the following are some major differences in health care today, as compared with the first half of the 20th century? (Selectall that apply.)a.Consumers are influenced by advertising for specific health care agents orprocedures.b.The emphasis is on the continued expansion of health care facilities, especiallyacute care hospitals.c.Education and specialization of personnel have increased.d.The need to create new ways to pay for health care is a central focus.e.Hospital stays are much shorter.ANS:A, C, ESince the 1980s, the United States has been in a period of limited resources, with an emphasis on containing costs, restrictinggrowth in the health care industry, and reorganizing care delivery. Results have included shorter hospital stays and substitution ofone set of personnel (such as nurse practitioners) for another set (physicians). Such trends are made more challenging by increaseddirect marketing to consumers. Also with increased knowledge has come increased education and specialization. Shorter hospitalstays continue to occur so there is a focus on expanding care in the community, not in acute care hospitals. Containment of costs isa major focus; however, creation of new payment methods has not been part of this conversation.lOMoARcPSD|13778330

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Chapter 06: Ethics in Public and Community Health Nursing PracticeStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.Which of the following is generally considered to be nursing’s first code of ethics?a.Nightingale Pledgeb.Code for Professional Nursesc.Code of Ethics for Nursesd.Principles of the Ethical Practice of Public HealthANS:AThe Nightingale Pledge is generally considered to be nursing’s first code of ethics. After the Nightingale Pledge, the Code forProfessional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times,until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements. The Principles ofthe Ethical Practice of Public Health was approved in 2002.2.A nurse didn’t know what to do when faced with a particular ethical dilemma because an option that would have a good outcomedidn’t seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the followingbest describes the nurse’s actions?a.Appropriate, because the supervisor is responsible for the nurse’s choices.b.Intelligent, because the supervisor has access to resource persons (clergy,physicians, administrators) who might know of options the nurse hadn’tconsidered.c.Justified, because this provides an opportunity to discuss the issue but the nursemaintains responsibility for the decision.d.Wise, because the supervisor would be more knowledgeable concerning agencypriorities and traditional practices.ANS:CEthically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience toa supervisor or any external rule or policy. The supervisor is not responsible for the nurse’s choices, the nurse must maintainresponsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should havesimilar knowledge as the supervisor.3.Which of the following is the first and most crucial step in a generic ethical decision-making process?a.Assess the context or environment in which the decision must be made.b.Consider the various ethical principles or theories.c.Identify the ethical issues and dilemmas.d.Make a decision and act on it.ANS:CThe first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifyingthe ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain allrelevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6)make the decision and take action, and (7) evaluate the decision and action.4.A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband thewife’s diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is thenurse’s most important action?a.Emphasizing that the family must set up a surgical appointment for the wifeimmediatelyb.Assessing the family’s current living situation, including insurance and otherassetsc.Educating the family concerning the usual treatment and the prognosis of breastcancerd.Interviewing the family concerning their perspective of the threat to the family’swell-beingANS:DThe United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, thehealth care professionals must understand the family’s cultural, psychological, social, communal, and environmental contexts,because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview thefamily to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures,the family, rather than the individual, is the unit of primary concern. Setting up a surgical appointment immediately would not bean appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she hascancer. Assessing the family’s current living situation would not be the first concern of the nurse; the first concern should focus onthe family’s well-being. After assessing the family’s well-being, the next action of the nurse may be to educate the family about thetreatment and prognosis of breast cancer.lOMoARcPSD|13778330

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5.The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the carewould drastically reduce the family’s resources and ability to meet the needs of other family members. Ethically, which of thefollowing actions should be taken by the nurse?a.Appreciate that the family has made the decision that it feels is best and take nofurther action if it is clear the family has made an informed choice.b.Stress that each individual in society has a right to health care and the family willhave to create some way to raise funds for the needed treatment.c.Talk to the media to see whether a campaign to raise funds for the family can becreated.d.Try to convince the agency to give the care for free, even if it means economicstress for the agency, because the medical need is obvious.ANS:AAccording to Callahan, although the nurse may attempt moral persuasion to change the family’s values, in the absence ofimmediate and grievous harm, no ethical requirement exists to interfere with the family’s values. Because there is no immediate orgrievous harm, it is not in the best interest of the nurse to interfere with the family’s decision. Thus, the other answers are not anappropriate action for the nurse to take.6.Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the otherfamily members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It isa wife’s responsibility to care for an ill husband.” Which of the following ethical approaches is being used by this nurse?a.Consequentialismb.Communitarianismc.Deontological ethicsd.PrinciplismANS:CThe nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Thenurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Based uponthis understanding, none of the other options correctly describes the nurse’s statement.7.Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, andthe other family members have chosen to continue working rather than take time off to care for the ill family member. One nursestates, “The whole family is being affected and will fall apart if they don’t focus on their family’s needs first before anything else.”Which of the following ethical approaches is being used by this nurse?a.Communitarianismb.Deontologyc.Principlismd.UtilitarianismANS:DBy focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this timeof stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision-making.Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and thecommunity. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of theactions.8.Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, andthe other family members have chosen to continue working rather than take time off to care for the ill family member. One nursestates, “But it doesn’t have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3days. That way they could all take a turn at helping and yet not upset their employers. Wouldn’t that be fair?” Which of thefollowing ethical approaches is being used by this nurse?a.Communitarianismb.Deontologyc.Principlismd.UtilitarianismANS:CThe nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do noharm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethicsand looks at the relationship and responsibility between the individual and the community. The ethical approach of deontologydescribes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethicaltheory associated with outcomes or consequences in determining which choice to make.9.Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, andthe other family members have chosen to continue working rather than take time off to care for the ill family member. One nursestates, “It’s not up to us; it’s the family’s decision. They know what is best for them.” Which of the following ethical approaches isbeing used by this nurse?a.Communitarianismb.Deontologyc.Principlismd.UtilitarianismANS:CThe nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill itsvalues and goals. Therefore, the nurse is using Principlism—that is, basic principles are the basis of the nurse’s actions.Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and thecommunity. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of theactions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choiceto make.lOMoARcPSD|13778330

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10.Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acutehealth care?a.Doing what is best for the communityb.Doing what is best for the familyc.Obeying legal mandatesd.Upholding ethical principlesANS:DIn acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy beingthe dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandatesor doing what is best for the community or family.11.The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the followingapproaches should the nurse use in personally deciding what is right?a.Do whatever will not get the nurse in trouble with employer.b.Do whatever is supported by an ethical expert, such as the hospital chaplain.c.Do whatever the nurse would recommend to anyone in a similar situation.d.Do whatever the nurse supervisor would feel comfortable reporting toadministration.ANS:COne of the rules in deontological decision-making is to determine whether the proposed actions can be generalized so that allpersons in similar situations are treated similarly. In the same way, Principlism suggests the nurse examine the context and makethe decision that can be morally justified within that context. In order to apply the deontological ethics decision process, the nursemust first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine theirown personal motives, and then determine whether the proposed actions can be generalized. Doing whatever will not get the nursein trouble, whatever is supported by an ethical expert, or whatever the nurse supervisor feels comfortable with is not an appropriateway to make an ethical decision.12.A man entered the emergency department bleeding profusely and screaming, “I’ve got to see a doctor right now! I’ve got arighttosee a doctor! I’m hurt. You have to take care of me!” Which of the following premises would ethically justify such a demand forimmediate attention?a.All hospitals receive federal money and all capable employed adults pay taxes, soall adults have a right to what their tax money has purchased.b.Saving an individual’s life improves society and upholds tradition.c.Our society believes that all persons should be treated equally and that basicneeds, such as not dying if death can be avoided, should be met.d.The man has a property right to his own body, and the government is responsibleto ensure that property rights are protected.ANS:CThe ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of thegoods of society—and that the government’s role is to ensure this happens, at least on a basic level. Therefore, the man has a rightto emergency care. Hospital funding and use of taxpayer money does not demonstrate the use of an ethical principle. Saving anindividual’s life may or may not improve society. There is not an ethical principle that states that the man has a property right to hisown body.13.From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life shouldalways be fair, and that everyone should make his or her own decisions?a.With this belief, the needs of society as a whole are ignored.b.Insufficient resources exist to give everyone a fair share.c.This belief leads to a propensity for some people to like to be taken care of.d.Some people think they deserve more than others.ANS:AAll principles of justice focus on the individual, which ignores the needs of society as a whole. The rights of an individual mayconflict with the rights of the community as a whole. It is recognized that distribution should be based on what needs and deservesthere is considerable disagreement that exists when considering what these terms mean in the context of fairness.14.A health care provider refuses to order pain medication for a drug addict who has been severely injured in a car accident. Whenreminded by nurses that pain medication has not been ordered, the provider merely replies that the patient’s suffering from the painof his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories isbeing using (or misusing)?a.Consequentialismb.Communitarianismc.Deontological ethicsd.Virtue ethicsANS:DVirtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider ispaternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn fromhis experience and possibly develop into a drug-free person. Communitarianism is similar to virtue ethics and looks at therelationship and responsibility between the individual and the community. When decisions are based on outcomes or consequences,it is known as consequentialism. The ethical approach of deontology describes adhering to moral rules or duty rather than to theconsequences of the actions.lOMoARcPSD|13778330

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Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32) - Page 27 preview image

15.Which of the following is considered the most important goal in nursing today?a.Adapting to technological advances such as electronic medical recordsb.Demonstrating caring as the basis of nursing practicec.Distinguishing nursing care from medical cared.Seeking evidence-based outcomes to demonstrate nursing’s contribution to careANS:BSince the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursingpractice. Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationshipbetween the patient and the care provider. The primary goal of nursing is not to adapt to technological advances, distinguishnursing from medical care, or seek evidence-based outcomes; rather, the goal of nursing is to implement caring which has been themoral ideal of nursing for many years.16.With which of the following ethical approaches are Gilligan and Noddings associated?a.Distributive justice approachb.Feminine ethicc.Principlism approachd.Virtue ethicsANS:BGilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality ofresponsibility in relationships that emphasize connection and caring as a moral imperative. Distributive justice (fair distribution ofthe benefits and burdens of society), Principlism (relying on ethical principles for decision- making), and virtue ethics (seeking toenable persons to flourish as human beings) were not developed by Gilligan and Noddings.17.How are ethics and public policies similar?a.Both are abstract principles that often differ in actual practice.b.Both are best achieved by persons in high political office who can effect change.c.Both strive for the public good.d.Both use general principles in making decisions.ANS:CAn important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. Ethicsinvolves the application of specific principles when making decisions. There is nothing that supports that ethics and public policiesare better achieved by those in high political office.18.A new nurse states to a nursing colleague, “But why do I have to be involved in politics? I just want to be the very best clinicalnurse I can.” Which of the following would be the best response from the nursing colleague?a.“As long as you pay your membership fee to the American Nurses Association,you have participated in the profession’s political endeavors.”b.“Political action is the way you try to fulfill your ethical responsibilities toclients.”c.“You’re absolutely right; if you are good clinically, you have fulfilled yourobligation.”d.“When you’ve completed your clinical orientation, then you’ll have time to beinvolved in politics.”ANS:BTo be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action toensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked accessto quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as themechanism to affect social justice and reform regarding homelessness, violence, and stigmatization. Nurses need to be involved inthe political process in more ways than only being a dues paying member to the American Nurses Association. Clinical practice isnot the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse. Nurses mustmake a conscious effort to be involved in political action.19.Which of the following would confirm that the nurse’s advocacy has been truly successful or effective?a.Audiences agree with the nurse who is serving as advocate.b.Legislators discuss appropriate legislation to better allocate resources.c.People verbalize that the disenfranchised should be better treated.d.Systematic social changes are made to improve quality of life.ANS:DAdvocacy is the application of information and resources to effect systematic changes that shape the way people in a communitylive to reduce death and disability and improve quality of life in the community. Only when systematic social changes are made toimprove quality of life can advocacy be considered truly effective. Systematic change encompasses the complete role of the nurseas an advocate. Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations mayhave different views than the nurse. Advocacy goes beyond only working with legislators to allocate resources. Serving those whoare disenfranchised is only one part of the advocacy role.20.How can nurses know whether they have been effective in assessing the community and planning and implementing appropriateinterventions?a.Ask community leaders for their opinion of the interventions.b.Examine the morbidity and mortality rate of the community.c.Reassess the community to determine whether obvious needs have been met.d.Systematically survey community residents regarding their perception.ANS:BThe end products of appropriate advocacy are decreased morbidity and mortality. In other words if advocacy has been effective,public health problems will be decreased. Effectiveness cannot be assessed accurately by asking community leaders for theiropinions, reassessing the community, or surveying community members regarding their perception; data must be collected todetermine results.lOMoARcPSD|13778330

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Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32) - Page 28 preview image

21.How can ethics be applied to public health nursing practice?a.Ethics and actual nursing practice are not related.b.Knowing ethics allows nurse to recognize the source of most problems.c.Ethics is constantly involved in nurses’ clinical decisions.d.Although ethics is important, political and legal responsibilities are moreimportant in practice.ANS:CEthical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation,conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of publichealth nursing as nurses attempt to meet the needs of the community. Ethical principles are applied in nursing practice on a regularbasis and assist with problem-solving. The use of ethics does not allow the nurse to recognize the source of most problems. Theused of ethics is more important than political and legal responsibilities in practice.MULTIPLE RESPONSE1.Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nursebelieves that deciding on care rather than cure is the woman’s decision and no one else can decide for her. The second nurse saysthat it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility ofcure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn’t fair for thefamily members to expend all their resources on the woman, who is probably going to die anyway. Which of the followingconclusions can be drawn from this dispute? (Select all that apply.)a.Ethical principles can conflict with one another.b.The nurses are each using different ethical approaches.c.The first nurse is correct because autonomy demands that the woman decide forherself.d.There is no single accepted approach for resolving such disagreements.ANS:A, B, DOne of the criticisms of using ethical principles is that they can conflict with one another in any given situation. No rule exists forhelping resolve such conflicts. Each nurse can apply different ethical principles to reach their own ethical decision. Because there isno one rule to assist with solving an ethical conflict, and ultimately no one right answer, there is not a correct decision that can bemade.lOMoARcPSD|13778330

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Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32) - Page 29 preview image

Chapter 07: Culture of Populations in CommunitiesStanhope: Foundations for Population Health in Community/Public Health Nursing, 6th EditionMULTIPLE CHOICE1.Which of the following best describes most Americans’ attitude toward immigrants?a.Ambivalence, because there are no clear solutions about how to address theirneeds.b.Strongly negative, because immigrants take jobs that native-born Americanscould have instead.c.Strongly positive, because immigrants bring useful job skills and often joinprevious family members already in the United States.d.Strong opposition to further immigration, because of the increasing population inthe United States.ANS:AMost Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing thatit is a complex issue that has no clear solutions. Because Americans are ambivalent, there is neither a strong negative nor a positiveattitude toward immigrants. However, many times immigrants do enter the United States because they have useful job skills orfamily ties. They are more likely to be low-income workers who work in low-wage, blue-collar jobs and industries.2.Earlier in the week, a nurse carefully taught a patient from a different culture exactly how much medication to take and emphasizedthe importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdosealthough the patient denies taking more than the label indicated. Which of the following is the most likely explanation?a.The patient was taking more mediation in the hope of getting well faster.b.The patient was also taking folk medicines that had many of the same effects andperhaps some of the same ingredients as the prescribed medication.c.The patient truly did not understand and thought the dose being taken was correct.d.The patient had a unique response to the medication and should have a smallerdose ordered.ANS:BFor fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. Thetwo medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may developfeelings of inadequacy and helplessness because they are often unable to effectively help their clients. It is unlikely that the patientwas taking too much medication, taking the incorrect dose, or having a unique reaction to the medication. Rather the nurse shouldfirst interview the patient about use of folk medicine which may interact with the prescribed medication regimen.3.A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first?a.Complete a survey of all the various ethnicities represented in the nurse’scommunity.b.Consider how the nurse’s own personal beliefs and decisions are reflective of hisor her culture.c.Invite a family from another culture to join the nurse for an event.d.Study the beliefs and traditions of persons living in other cultures.ANS:BCultural awareness requires self-examination and an in-depth exploration of one’s own beliefs and values as they influencebehavior. Cultural awareness is the first element in the model of cultural competence. Following the development of culturalawareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethnicgroups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness andcultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The fourth construct essential tothis model is cultural encounter, which is the process that permits nurses to seek opportunities to engage in cross-culturalinteractions with clients of diverse cultures to modify existing beliefs about a specific cultural group.4.A nurse is caring for a client of another culture. Which of the following actions would be the most appropriate for the nurse to take?a.Alter personal nonverbal behaviors to reflect the cultural norms of the client.b.Keep all behaviors culturally neutral to avoid misinterpretation.c.Rely on friendly gestures to communicate caring for the client.d.Avoid any pretense of prejudice by treating the client in the same way as anyother client.ANS:ACultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touchduring conversation, modify the physical distance between themselves and others, and use strategies to avoid culturalmisunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent are expected to respectother cultures and value diversity. These behaviors tend to provide more responsive care. Nurses should be knowledgeable of othercultures and communicate with the client based on cultural norms. Culturally skillful nurses understand the unique differenceamong individuals within a given culture and work with those individuals to learn more about their culture and provide culturallysensitive care.lOMoARcPSD|13778330

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Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32) - Page 30 preview image

5.A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client’shistory. He stopped doing this around specific clients after being told that they were offended when he exposed the sole of his foot(shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior?a.Cultural accommodationb.Cultural impositionc.Cultural re-patterningd.Cultural skillANS:DCultural skill is the effective integration of cultural knowledge and awareness to meet client needs—in this case, the clients need tonot be offended by having the bottom of the nurse’s foot or shoe in view of the client’s face. The nurse using cultural skill makessure that nonverbal communication techniques take into consideration the client’s use of body language and space. Culturalaccommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system toimplement essential treatment plans. Cultural imposition is the process of imposing one’s values on others. Cultural re-patterning isworking with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.6.The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is “hot”and he believes that penicillin, a “hot” medicine, will not provide balance. Which of the following terms best describes the actiontaken by the NP when the client’s prescription is changed to a different yet equally effective antibiotic?a.Cultural awarenessb.Cultural brokeringc.Cultural knowledged.Cultural skillANS:CCultural knowledge is information about organizational elements of diverse cultures and ethnic groups; emphasis is on learningabout the client’s worldview from an emic (native) perspective. Cultural skill involves the provision of care that is beneficial, safe,and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nursepractitioner’s need to prescribe an effective antibiotic. Cultural awareness is the self-examination and in-depth exploration of one’sown biases, stereotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, andintervening between the client’s culture and the biomedical health care culture on behalf of clients.7.An immigrant who takes metamizole (banned in the United States) for pain may experience life-threatening agranulocytosis. Whichof the following actions would be taken by a nurse who employs cultural re-patterning?a.Complete a cultural assessment to identify any other dangerous medications thatthe client may be taking.b.Put this into perspective by considering that many drugs used in the United Statescause agranulocytosis.c.Explain the harmful effects of metamizole and recommend an alternativemedication for pain.d.Recognize that taking metamizole is common among persons living in Mexicoand accept this as a cultural tradition.ANS:CCultural re-patterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices whenthe practice is harmful to them. Completing a cultural assessment involves learning more about the client’s culture but does notaddress the need to consider changing or modifying cultural practices. In order to complete cultural re-patterning, the nurse has totake an action to resolve this potential problem.8.A health care worker tells a nurse, “It does no good to try to teach those Medicaid clients about nutrition because they will just eatwhat they want to no matter how much we teach them.” Which of the following is being demonstrated by this statement?a.Cultural impositionb.Ethnocentrismc.Racismd.StereotypingANS:DStereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequateattention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes arenot educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clientsthe worker has known may have been related to an inability to afford nutritious food. Cultural imposition is the belief in one’s ownsuperiority, or ethnocentrism, and is the act of imposing one’s values on others. Ethnocentrism is a type of cultural prejudice at thepopulation level which involves the belief that one’s own group determines the standards for behavior by which all other groupsshould be judged. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals,beauty, or self-worth.9.An American nurse says, “I’m not going to change the way I practice nursing based on where the client is from because researchshows that Western health care technology and research is best.” Which of the following is being demonstrated by the nurse’sstatement?a.Ethnocentrismb.Prejudicec.Racismd.StereotypingANS:AEthnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one’s own group determines thestandards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think,“The way we do it is the only right way to provide this care.” Prejudice refers to having a deeply held reaction, often negative,about another group or person. Racism refers to the belief that persons who are born into a particular group are inferior inintelligence, morals, beauty, or self-worth. Stereotyping occurs when attributing certain beliefs and behaviors about a group to anindividual without giving adequate attention to individual differences.lOMoARcPSD|13778330

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Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32) - Page 31 preview image

10.A nurse states, “The best way to treat a client from another country is to care for them the same way we would want to be cared for.After all, we are all humans with the same wants and needs.” What does this statement reflect in relation to culture?a.Awarenessb.Blindnessc.Knowledged.PreservationANS:BCultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from differentcultures may have different expectations, wants, and needs. Cultural awareness is the self-examination and in-depth exploration ofone’s own biases, stereotypes, and prejudices that influence behavior. Cultural knowledge is information about organizationalelements of diverse cultures and ethnic groups; emphasis is on learning about the client’s worldview from an emic (native)perspective. Cultural preservation means that the nurse supports and facilitates the use of scientifically supported cultural practicesfrom a person’s culture along with those from the biomedical health care system.11.A Spanish-speaking family comes to the public health department. No one in the family speaks English, and nobody at the healthdepartment speaks Spanish. Which of the following actions should be taken by the nurse?a.Attempt communication using an English–Spanish phrase book.b.Call the local hospital and arrange a referral.c.Emphatically state, “No hablo Español” (I don’t speak Spanish).d.Obtain an interpreter to translate.ANS:DCommunication with the client or family is required for a careful assessment. When nurses do not speak or understand the client’slanguage, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client.The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriateaction if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for theclient—attempting communication using a book, stating that he or she does not speak English, and arranging for a referral do notaddress the priority action of finding an interpreter.12.A nurse who is explaining to an immigrant client why it is important to take medication states, “The medication takes a couple ofweeks to be effective, but then you should feel better.” When the client is next seen, no medication has been purchased. Which ofthe following is the most likely explanation?a.The nurse emphasized that eventually the client would feel better, but the clientneeded to feel better immediately so didn’t bother with the drug.b.The medication required a trip to the pharmacy, and the client just hadn’t hadtime to obtain the drug yet.c.The medication was too expensive for the client’s family.d.The client really hadn’t understood why the medication was important.ANS:AIf we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses arefuture oriented, whereas many families may place greater value on quality of life and view present time as being more important.When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focuson the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time shouldbe the immediate concern of the nurse. It is possible that the client did not have the necessary resource or did not understand theimportance of the medication, but the nurse should first investigate the potential cultural disconnect.13.A client is crying softly and saying, “What did I do to deserve this punishment, Lord?” Which of the following responses by thenurse would be the most appropriate?a.“God doesn’t punish people. You’re sick just because of bad luck.”b.“I can call the hospital chaplain to help you talk about these feelings.”c.“What can I do to be helpful to you right now?”d.“Would you like to confess your sins and repent so this illness will go away?”ANS:CSome clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do notshare their beliefs. Because the nurse may not be a member of the client’s religious faith group, an open-ended response showingcaring is the most appropriate statement. The most therapeutic response from the nurse is an open-ended question. This allows theclient to share information and not feel like his or her actions are being judged by the nurse. Also, this allows the nurse to not giveadvice or offer false information to the client.14.A patient who identifies as Buddhist enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to givea meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisburysteak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Whichof the following considerations was omitted by the nurse?a.The patient should not be served any food until a primary care provider’s order isobtained.b.The patient’s Buddhist faith probably requires a vegetarian diet.c.The patient may be too frightened about the tests to want to eat very much.d.The patient may have diabetes or be allergic to some foods.ANS:BAlthough it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. MostBuddhists are vegetarians and don’t eat meat. The nurse should be aware of the cultural considerations that should be made forBuddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that theseconsiderations can be made. The nature of the test determines the fasting requirements; no order is needed. Whether the client isdiabetic or allergic to some foods should be determined upon admission.lOMoARcPSD|13778330

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