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Test Bank For Public Health Nursing - Revised Reprint: Population-Centered Health Care In The Community, 8th Edition

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    Chapter 01: Population-Focused Practice: The Foundation of Specialization in Public Health Nursing Stanhope: Public Health Nursing, 8th Edition Chapter 01: Population-Focused Practice: The Foundation of Specialization in Public Health Nursing Test Bank MULTIPLE CHOICE 1. One of the primary focuses of improving the health of the American people in the twenty-first century is to address: a. Bioterrorism and global health threats b. Delivery of individual care and hygiene c. The need for increased hospital and acute care d. Chronic disease and disability management ANS: A There are new concerns, and one of the most serious is bioterrorism. The others are not related to public health or are concerns that have been present for many years. DIF: COG: Understanding REF: 4 OBJ: 1 2. The threat of bioterrorism has the potential to: a. Dissolve community-based programs. b. Cause the health care system to collapse. c. Divert funds from other public safety health care programs. d. Increase the need for shelters. ANS: C Bioterrorism may have an impact on the availability of resources for public safety health care programs. DIF: COG: Analyzing REF: 4 OBJ: 1 3. Population-based preventive programs launched in the 1970s are responsible for increased: a. Use of tobacco b. Use of automobile safety restraints c. Incidence of hypertension d. Incidence of obesity

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    ANS: B One outcome of preventive programs launched in the 1970s is the increased use of automobile safety restraints. These programs also are responsible for the decreased use of tobacco and improved blood pressure control. None of these programs addressed the incidence of obesity. DIF: COG: Remembering REF: 5 OBJ: 1 4. The public health nurse must participate in the essential services of public health. These include: a. Monitoring health status by completing a community assessment b. Diagnosing and investigating health problems in the world c. Informing, educating, and empowering people about health issues d. Working in law enforcement to regulate health and ensure safety ANS: C The public health nurse monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The public health nurse would not diagnose or solve “world” problems, or work in law enforcement. Rat her, the public health care nurse would participate with local regulators to protect communities and empower people to address health issues. DIF: COG: Understanding REF: 5 OBJ: 1 5. Which of the following is an example of the mission of public health according to the Institute of Medicine? a. Tracking avian flu outbreaks and doing surveillance in the United States b. Providing a flu shot for an elderly person at the health department c. Keeping track of alternative therapies in use in the United States d. Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta ANS: A The Institute of Medicine’s stated mission on public health is “to generate organized community and technical knowledge to prevent disease and promote health.” DIF: COG: Analyzing REF: 7 OBJ: 1 6. Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care ANS: C Public health is based on scientific knowledge, but is not a core function. The definition does not fit the terms assessment or policy development. DIF: COG: Applying REF: 7 OBJ: 1

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    7. The number and proportion of persons aged 25 or older with less than a high school education is an example of: a. Sociodemographic characteristics b. Health status c. Health risk factors d. Health care resource consumption ANS: A The number and proportion of people is a demographical characteristic. DIF: COG: Analyzing REF: 8 OBJ: 1 8. The purpose of public health core functions is to: a. Clarify the role of the government in fulfilling the mission of public health. b. Ensure the safety of populations in receiving quality health care. c. Provide community-based individualized care to every person in the United States. d. Unite public and private providers of care in a comprehensive approach to providing health care. ANS: A As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government’s role. DIF: COG: Understanding REF: 7 OBJ: 1 9. Which of the following statements about public health is accurate? a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b. Expenditures and resources for public health have increased in recent years. c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior. d. Reform of the medical insurance system is the single change needed to improve the health of Americans. ANS: C Changes, such as immunizations, tobacco use, blood pressure control, and automobile safety, have helped increase the health of communities. DIF: COG: Understanding REF: 7 OBJ: 1 10. Collecting data and monitoring the health status of the population defines which of the core public health functions? a. Assessment b. Prevention c. Assurance d. Policy development

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    ANS: A Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies. Assessment consists of systematic data collection and monitoring health status. DIF: COG: Applying REF: 7 OBJ: 1 11. The nurse who compares the rate of teenage pregnancy in various areas of the city is practicing the public health core function of: a. Assurance b. Assessment c. Prevention d. Policy development ANS: B Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. DIF: COG: Evaluating REF: 7 OBJ: 1 12. Public health nurses who develop and implement local public health policies through partnerships with agencies, organizations, and consumers within the community are using which core public health function? a. Assessment b. Prevention c. Assurance d. Policy development ANS: D Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection. Policy development deals with developing and implementing health policies. DIF: COG: Applying REF: 7 OBJ: 1 13. Providing for the availability of essential personal health services for people who would otherwise not receive health care defines which public health core function? a. Assessment b. Prevention c. Assurance d. Policy development ANS: C

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    Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies. DIF: COG: Applying REF: 7 OBJ: 1 14. The nurse manager who makes sure that the staff members who work in a local clinic are competent is demonstrating the public health core function of: a. Assurance b. Assessment c. Prevention d. Policy development ANS: A Assurance refers to making sure a competent health care workforce is available. DIF: COG: Evaluating REF: 7 OBJ: 1 15. The public health nurse analyzes data related to the number and type of United States Environmental Protection agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional status ANS: C Breathing air of poor quality is a risk to health. DIF: COG: Evaluating REF: 8 OBJ: 1 16. Which is an example of the primary goal of public health? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old woman ANS: C The correct answer is concerned with the health of many people, while the other answers address individual interventions. DIF: COG: Evaluating REF: 7 OBJ: 1 17. The public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management

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    b. Workforce needs assessment c. Acute care services d. Curriculum development ANS: A Workforce needs assessment, acute care services, and curriculum development are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: analytic/assessment, policy development/program planning, communication, cultural competence, community dimensions of practice, basic public health sciences, financial planning and management, and leadership and systems thinking. DIF: COG: Understanding REF: 9 OBJ: 2 18. Public health nursing is a specialty because: a. It has a distinct focus and scope of practice. b. It must be done by a registered nu rse with a master’s degree. c. It is focused on disadvantaged citizens. d. It performs interventions at the acute care level. ANS: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty. DIF: COG: Understanding REF: 10 OBJ: 2 19. The necessary basic preparation for public health nursing is a(n) _____ in nursing. a. Associate’s degree b. Baccalaureate degree c. Master’s degree d. PhD ANS: B A BSN is the necessary basic preparation to function as a beginning staff public health nurse. DIF: COG: Remembering REF: 11 OBJ: 2 20. Public health practitioners prepared at the graduate level should be able to: a. Teach public and community health nursing b. Assess and intervene successfully at the aggregate level c. Diagnose and treat disease and have prescriptive authority d. Run for political office as experts in public health policy ANS: B

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    According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine. DIF: COG: Applying REF: 11 OBJ: 2 21. A public health nurse provides a clinic for HIV-positive citizens in the community. This is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Policy making ANS: C This clinic is for clients who already have a disease process; therefore, it is tertiary prevention. DIF: COG: Applying REF: 11 OBJ: 2 22. An example of a community health nursing practice is: a. Administrating a flu shot to a client in a physician’s office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation center ANS: A Community health nursing practice focuses on providing individual interventions in the community. Administrating a flu shot to an individual is the only example that meets this criterion. DIF: COG: Applying REF: 16 OBJ: 3 23. Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the community as a whole. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice. ANS: A By definition, the first option is correct. Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff public health nurse; however, this is not a requirement for public health nursing or community health nursing practices. DIF: COG: Understanding REF: 16 OBJ: 3

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    24. The term community-based nursing care is applied when implementing which nursing intervention? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a community ANS: B Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition. DIF: COG: Applying REF: 16 OBJ: 3 25. The nurse who conducts vision screenings on children in the school setting is practicing _____ nursing practice. a. Community-oriented b. Public health c. Community health d. Community-based ANS: D This type of nursing is a setting-specific practice. DIF: COG: Applying REF: 16 OBJ: 3 26. Which is an example of an aggregate or population? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who play cards together once a week at private homes ANS: A A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. They can be defined in terms of geography or a special interest. The clients in the first option share a geographical characteristic. DIF: COG: Applying REF: 12 OBJ: 4 27. The nurse investigating environmental health problems caused by contaminated ground water is best described as practicing: a. Community-oriented nursing b. Community-based nursing c. Policy development

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    d. Tertiary care ANS: A Community-oriented nursing emphasizes the prevention of disease and disability. DIF: COG: Analyzing REF: 16 OBJ: 4 28. A population is best defined as a: a. High-risk group b. School or institutional setting c. Collection of individuals who share at least one common characteristic d. Geographical location within a community ANS: C The wrong answers are types of populations; they do not define a population. DIF: COG: Remembering REF: 12 OBJ: 4 29. Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a. Individuals b. Aggregates c. Communities d. Geographical regions ANS: B Aggregates are a defined population made up of individuals in communities of a specific geographical region. DIF: COG: Understanding REF: 12 OBJ: 4 30. Which of the following statements is true with regard to a population focus in public health nursing? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered. ANS: C Public health nurses are concerned with the health of the entire population. DIF: COG: Analyzing REF: 12 OBJ: 4 31. A public health staff nurse who has a clear understanding of population-focused practice: a. Is frustrated providing care to individuals

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    b. Would rather perform population-focused interventions c. Is able to improve the effectiveness of care provided d. Is considered a public health nurse specialist ANS: C Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. Public health nurse specialists are prepared at the master’s level and function in an administrative role. DIF: COG: Analyzing REF: 17 OBJ: 6 32. A key opportunity for public health nurses to improve population-focused care is by: a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practice ANS: B Public health nurses must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care. DIF: COG: Analyzing REF: 17 OBJ: 6 33. Proposed changes to the health care delivery system in the United States will: a. Provide new opportunities for public health specialists. b. Result in isolated care being provided to individuals. c. Emphasize specialty care. d. Increase the utilization of acute care services. ANS: A Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention. DIF: COG: Analyzing REF: 18 OBJ: 6 34. Implementing quality performance standards in public health is important because: a. They are used to guide improvement in the public health system.

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    b. They rigidly control public health. c. Administrators will not monitor public health at the local level, but instead at the national level. d. They can be used as hiring guidelines for nurses. ANS: A These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services. DIF: COG: Applying REF: 9 OBJ: 7 35. To better address emerging public health issues, a public health nurse enrolls in a course addressing which content area? a. Leadership b. Ethics c. Communication d. Finance ANS: B Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: informatics, genomics, cultural competence, community-based participatory research, policy, law, global health, and ethics. DIF: COG: Evaluating REF: 9 OBJ: 7 MULTIPLE RESPONSE 1. Which of the following are considered barriers to public health nursing? Select all that apply. a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d. The number of job opportunities in the area has been steadily declining. ANS: A, B, C All are considered barriers to nurses specializing in public health nursing, except the number of job opportunities, which is not declining. DIF: COG: Understanding REF: 18 OBJ: 5 Chapter 02: History of Public Health and Public and Community Health Nursing Stanhope: Public Health Nursing, 8th Edition Chapter 02: History of Public Health and Public and Community Health Nursing

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    Test Bank MULTIPLE CHOICE 1. In the past, population-centered nurses have been called: a. District nurses b. Almshouse nurses c. Soldier nurses d. Sisters ANS: A In the past, population-centered nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses. DIF: COG: Remembering REF: 23 OBJ: 1 2. Public health practice is an appealing specialty to nurses because of its: a. Interactions with wealthy contributors to secure funding b. Autonomy and independence of practice c. Ability to locate the source of diseases and cure patients d. Opportunities to meet a variety of people ANS: B Community health nurses have a long history of autonomous practice, problem solving, and decision making. Community health care nurses engage in the other activities as well, but overall, they have been best known for autonomy of practice. DIF: COG: Applying REF: 23 OBJ: 1 3. The Elizabethan Poor Law of 1601 is similar to which current law? a. Welfare b. Food Stamps c. Medicaid d. Medicare ANS: C The Poor Law guaranteed medical care for poor, blind, and “lame” individuals, similar to Medicaid. DIF: COG: Evaluating REF: 24-25|36 OBJ: 1

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    4. Current threats to health in the United States that community health nurses are faced with include: a. Diphtheria, cholera, and hepatitis b. HIV, H1N1 influenza, and bioterrorism c. Avian flu, tuberculosis, and radiation d. Polluted water and air ANS: B The newest threats to health that public health nurses are involved in are HIV, H1N1 influenza, and bioterrorism. Hepatitis is also a current threat, but diphtheria and cholera are not concerns in the United States. Avian flu may be a threat, but radiation and tuberculosis are ongoing. Environmental pollution has been reduced; however, there are pollution issues that do raise concerns. DIF: COG: Understanding REF: 23 OBJ: 2 5. A colonist working in the public health sector in early colonial North America would likely have focused on: a. Establishing schools of nursing b. Developing vaccines to administer to large numbers of people c. Collecting vital statistics and improving sanitation d. Developing public housing and almshouses ANS: C The other choices are events that happened after the colonial period. DIF: COG: Applying REF: 24 OBJ: 2 6. The original work of the National Organization for Public Health Nursing has influenced nursing practice today by: a. Requiring that public health nurses have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing nursing cooperatives d. Opening the Henry Street Settlement ANS: B The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet. DIF: COG: Applying REF: 29 OBJ: 2

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    7. A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice ANS: B The Healthy People documents propose national strategies to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. DIF: COG: Analyzing REF: 38 OBJ: 2 8. A major provision of the Social Security Act of 1935 was the establishment of: a. The Frontier Nursing Service to provide nursing service to rural communities b. State and local community health services and training of personnel c. District nursing to provide home health care to sick people d. Community-based settlement houses ANS: B Title VI of the Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses. Nurses completed educational programs in public health and funds were provided to assist states, counties, and medical districts in the establishment and maintenance of adequate health services. DIF: COG: Remembering REF: 32 OBJ: 3 9. Public health nurses are involved in health care reform because reform should: a. Promote the nursing profession. b. Increase funding for public health nursing. c. Address the concerns of nurses. d. Improve health care access and reduce health care costs. ANS: D Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life.

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    DIF: COG: Applying REF: 38-39 OBJ: 3 10. A neighborhood health center is researching its origins. Which of the legislative acts most likely provided funds for its development? a. Emergency Maternity and Infant Care Act of 1943 b. Medicaid legislation c. Social Security Act of 1935 d. Economic Opportunity Act ANS: D Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act. DIF: COG: Analyzing REF: 36 OBJ: 3 11. What task would have been a responsibility of a nurse who was employed by the Marine Hospital Service? a. Setting policy on quarantine legislation for immigrants b. Establishing hospital-based programs to care for the sick at home c. Identifying and improving environmental conditions d. Providing health care for merchant seamen ANS: D Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities. DIF: COG: Analyzing REF: 24 OBJ: 3 12. A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which program would be appropriate for her health insurance needs? a. Medicare b. Medicaid c. Social Security d. Economic Opportunity Act ANS: A The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare.

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    DIF: COG: Analyzing REF: 36 OBJ: 3 13. Florence Nightingale’s contributions to public health included: a. Caring for the sick, poor, and neglected in institutions and at home b. Using a population-based approach that led to improved environmental conditions c. Writing the Elizabethan Poor Law to guarantee medical care for all d. Founding of the district nursing association to provide health care to needy people ANS: B During the Crimean War, Nightingale progressiv ely improved the soldiers’ health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality. DIF: COG: Remembering REF: 25 OBJ: 4 14. Lillian Wald’s major contribution to public health nursing was: a. Founding the American Nurses Association b. Developing the New York Training Hospital for Nurses c. Creating the Public Health Service d. Establishing the Henry Street Settlement ANS: D Lillian Wald established the Henry Street Settlement. DIF: COG: Remembering REF: 27 OBJ: 4 15. Neighborhood centers that provided health care, education, and social welfare programs were called: a. Settlement houses b. Nursing care centers c. Nurse-managed clinics d. Public health services ANS: A Settlement houses were neighborhood centers that provided health care, education, and social welfare programs. Nursing centers, nurse-managed clinics, and public health services are not necessarily in neighborhoods. DIF: COG: Remembering REF: 27 OBJ: 4

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    16. Which topic is most likely to have been discussed when Lillian Wald provided public health education? a. Taking and recording blood pressures accurately b. Safe and sanitary baby and child care c. Environmental pollutants and their effects on lung disease d. Time management: balancing factory work and the home ANS: B Lillian Wald provided health care that included educating the community on health care matters. DIF: COG: Evaluating REF: 26 OBJ: 4 17. Nurses who provided care to people in their homes and provided that care to several people at a time were called _____ nurses. a. Private duty b. Visiting c. Public health d. Community staff ANS: B The visiting nurse cared for several families in a day and helped to make care of the sick poor at home economical, whereas a private duty nurse may live with a family of clients receiving care and was to be available 24 hours a day. DIF: COG: Remembering REF: 26 OBJ: 5 18. Which of the trends in health issues in the United States between 1900 and 1955 is accurate? a. There was a rise in chronic disease such as heart disease and cancer. b. There was a rise in communicable disease. c. The crude mortality rate increased dramatically. d. The life span after diagnosis remained the same. ANS: A Leading causes of death in 1955 were heart disease, cancer, and cerebrovascular disease, whereas in 1900 they were pneumonia, tuberculosis, and diarrhea/enteritis. The mortality rate decreased by 47%. There was a decrease in communicable disease, and the life span after diagnosis increased. DIF: COG: Understanding REF: 34-35 OBJ: 5

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    19. Local health departments were formed in urban areas in the late 1800s to: a. Target environmental hazards associated with crowded living conditions. b. Facilitate interdisciplinary efforts and promote “practical nursing.” c. Provide immunizations and health care services to all citizens. d. Offer public health education to nurses who had finished basic training. ANS: A Local health departments were formed to handle environmental issues in cities, including problems associated with crowded living conditions and dirty streets, and to regulate public baths, slaughterhouses, and pigsties. DIF: COG: Understanding REF: 29 OBJ: 5 20. The practice of a school nurse in the early twentieth century would have focused on: a. Investigating causes of absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an autonomous practice d. Providing medical treatment to enable children to return to school ANS: A Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians. DIF: COG: Applying REF: 28 OBJ: 5 21. When comparing the practices of industrial and occupational health nurses, it is noted that: a. Industrial nurses invented new machines to streamline production of medical goods, whereas occupational health nurses provide care to employees. b. Industrial nurses investigated industrial injuries to improve work conditions, whereas occupational health nurses demonstrate proper body mechanics. c. Industrial nurses treated work related-injuries, whereas occupational health nurses care for families in their homes. d. Industrial nurses provided care for workers in their homes, whereas occupational health nurses care for work-related injuries. ANS: D Early occupational health nursing did not provide care for work-related injuries, but instead focused

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    on the care of employees and their families in the home. Contemporary occupational health nurses provide care for work-related injuries. DIF: COG: Analyzing REF: 28 OBJ: 5 22. The document, Visiting Nurses in the United States, highlighted the fact that: a. Nurses were trained by Boards of Education. b. Trained nurses adequately covered less densely populated areas. c. Visiting nurse services were concentrated in the northeastern United States. d. Nurses were curing diseases such as tuberculosis and typhoid fever. ANS: C This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health. DIF: COG: Remembering REF: 28 OBJ: 6 23. Which statement is true about African American nurses in public health? a. Certificate and graduate education were more difficult to obtain. b. Cities were the major areas where they practiced. c. They often belonged to the Frontier Nursing Service. d. They were recruited heavily as military nurses. ANS: A Due to segregation, certification and graduate education were more difficult to obtain. DIF: COG: Understanding REF: 30 OBJ: 6 24. An example of the resourcefulness of a nurse during the time when the Rural Nursing Service was operating through the American Red Cross was: a. Using hot bricks, salt, or sandbags to substitute for hot water bottles b. Testing well water for pollutants c. Teaching school and developing curricula for rural nursing programs d. Providing post-surgical care ANS: A In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas. DIF: COG: Applying REF: 28 OBJ: 6

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    25. A nurse working with Mary Breckinridge would have likely assisted with: a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Teaching birth control measures to large numbers of women in the South ANS: B Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement. DIF: COG: Applying REF: 30 OBJ: 6 26. Which client would have been most likely to receive care from the Frontier Nursing Service? a. An injured soldier b. A homebound, elderly male c. A woman in labor d. A child with measles ANS: C The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality. DIF: COG: Applying REF: 30 OBJ: 6 27. A nurse is considering joining the American Public Health Association. What information about this organization should be 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 forum for nurses to discuss their public health concerns. d. APHA focuses on providing health promotion education to the public. ANS: C APHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The Public Health Section within APHA provides nurses with a forum to discuss their concerns and strategies. It also serves as a focus of leadership and policy development for community/public health nursing. DIF: COG: Applying REF: 29 OBJ: 6

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    28. A nursing student during World War II would likely join which group? a. The Public Health Service of New York City b. The Marine Nurse Corps c. The Frontier Nursing Service d. The Cadet Nurse Corps ANS: D The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels. DIF: COG: Analyzing REF: 33 OBJ: 6 MULTIPLE RESPONSE 1. The impact of World War I on public health nursing included (select all that apply): a. Many communicable diseases were eradicated. b. The depletion of the ranks of public health nurses to the war. c. The feeling that the greatest patriotic duty was to stay at home. d. Expanding nursing services in the community was limited by lack of funding. ANS: B, C, D Both World Wars I and II depleted the public health nurse population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front. DIF: COG: Understanding REF: 30 OBJ: 6 Chapter 03: Public Health and Primary Health Care Systems and Health Care Transformation Stanhope: Public Health Nursing, 8th Edition Chapter 03: Public Health and Primary Health Care Systems and Health Care Transformation Test Bank MULTIPLE CHOICE 1. According to the 1999 Institute of Medicine report, as many as 98,000 deaths each year are caused by: a. Cardiovascular disease

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    b. Obesity c. Medical error d. Drug overdose ANS: C In 2000, it was thought that our health care system was expensive and that access and quality were not optimal, but we had not considered this important fact: many people die of preventable medical errors in the United States. DIF: COG: Remembering REF: 49 OBJ: 1 2. In the United States, the majority of health care dollars are spent on: a. Prescription drugs b. Hospital care c. Physician services d. Public health services ANS: B The largest share of health care expenditures goes to pay for hospital care, with physician services the next largest item. The money spent for public health services is significantly lower than the other categories and prescription drugs accounted for only 10% of expenditures in 2008. DIF: COG: Remembering REF: 46 OBJ: 1 3. The number of uninsured Americans has dramatically increased because: a. Medicare took over payment of health care costs. b. With a declining population, the costs for health care rose. c. Nursing salaries greatly increased, causing health care costs to rise. d. Health insurance coverage was dropped from employment-based health plans. ANS: D Although the majority of Americans continue to obtain health insurance from their employer as a benefit, employment does not guarantee insurance. Employer-sponsored health insurance is sensitive to both the general economy and changes in health insurance premiums. As costs for insurance premiums rose, employers either shifted more of these costs to their employees or declined to offer employment-based health coverage at all. DIF: COG: Understanding REF: 46 OBJ: 1

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    4. The primary purpose of the World Health Organization is to: a. Coordinate surveillance at the global level. b. Prevent outbreaks of disease. c. Prevent the transmittal of communicable disease among nations of the world. d. Provide humanitarian support in times of disaster. ANS: A The World Health Organization, comprised of 192 member countries, is uniquely positioned to coordinate surveillance and response at the global level. DIF: COG: Understanding REF: 52 OBJ: 1 5. One of the benefits that a public health agency will experience by choosing to implement the electronic health record is: a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost-savings to the agency d. Compliance with JACHO standards ANS: A The 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 reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors. DIF: COG: Applying REF: 52 OBJ: 1 6. African American females have a higher mortality rate from breast cancer than Caucasian females. This is an example of: a. Projection b. Disparity c. Racism d. A sentinel event ANS: B Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.

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    DIF: COG: Applying REF: 46 OBJ: 1 7. A nursing program has initiated a recruitment campaign focusing on increasing the minority students in its program. The rationale for this campaign is that: a. The number of minority versus non-minority nurses should be equal. b. Minority health care professionals who share the same culture with the clients may provide more effective care. c. The profession should be more diverse. d. Minority nurses can mentor other nurses when providing care for diverse populations. ANS: B The Pew Commission suggests that increasing minority representation in the health workforce not only is a commitment to diversity but also will improve the health care delivery system. Minority health professionals can be expected to practice in underserved areas at a greater rate and health professionals who share the same culture and language with the clients they serve can provide more effective care. DIF: COG: Applying REF: 51 OBJ: 1 8. A community health nurse utilizes telehealth because it: a. Enables clients to get nursing care in their homes b. Substitutes for health department delivered care c. Improves access to care in rural areas d. Replaces face-to-face care for those who cannot afford it ANS: C Telehealth provides increased access to health care by the use of a computer monitor and telephone line. It is useful for monitoring clients with chronic disease, but is not a substitute for health care. DIF: COG: Applying REF: 51 OBJ: 1 9. An 80-year-old woman comes to the community health center with a large bag of medications. She tells the nurse she can no longer 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 pay for these medication s. I will refer you to our social worker.”

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    d. “These medications are important. Do your best to pay for them.” ANS: C This elderly patient probably is eligible for benefits through Part C, the Medicare Advantage program, but often a patient needs help negotiating the system. The Medicare Advantage program incorporates private insurance plans into the Medicare program including HMO and PPO managed care models and private fee-for-service plans. These plans receive payments from Medicare to provide Medicare benefits, including hospital, physician, and often, prescription drug benefits. DIF: COG: Evaluating REF: 55 OBJ: 1 10. Residents of rural communities report that they must travel for long distances to obtain health care services. As a result, they seek health care only for emergencies and severe illnesses. Which aspect of the health care system in the United States is illustrated in this situation? a. Access to care b. Cost c. Quality d. Advances in technology ANS: A Funding to clinics in rural areas has been reduced, leading many rural uninsured individuals to use emergency rooms for many illnesses. DIF: COG: Evaluating REF: 47 OBJ: 1 11. A nurse exploring a job opportunity at a community health center would expect that the center: a. Would be located in a large metropolitan area b. Provides care only to the economically disadvantaged c. Offers comprehensive primary care services and supportive services d. Is used for preventive services such as flu shots ANS: C Community health centers serve the entire community for primary health care services, regardless of income. They are located in a high need or medically underserved community, which can be urban or rural. DIF: COG: Applying REF: 47-48 OBJ: 2

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    12. If a 25-year-old woman visits a community health center to obtain a gynecological examination and birth control pills, these activities are termed _____ care. a. Tertiary health b. Public health c. Primary health d. Specialized care ANS: C By definition, primary health care includes basic health care services with the emphasis on prevention. DIF: COG: Applying REF: 53 OBJ: 2 13. A client who receives primary health care services would expect that: a. The care would be provided by a physician. b. Private insurance would be necessary to receive care. c. The emphasis of care provided would be on prevention. d. A referral would be made to a specialist after receiving services. ANS: C The focus of primary health care is a broad range of services that are designed to be affordable for the recipients of the care and the governments who provide them. The emphasis of care is on prevention and the means of providing the care is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods. DIF: COG: Applying REF: 53-54 OBJ: 2 14. When compared to public health care, primary care is: a. Focused on individuals b. Provided by specialists c. Self-reliant d. Community focused ANS: A Primary care also is provided by generalists, is dominated by health care professionals, and is not community focused. DIF: COG: Analyzing REF: 53 OBJ: 2

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    15. What initiative began as a result of a resolution adopted by the World Health Organization (WHO) in 1977? a. Declaration of Alma Ata b. Medicare c. Healthy People d. Primary health care movement ANS: D The WHO adopted a resolution accepting the goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives. The name of the resolution that was adopted was the Declaration of Alma Ata. DIF: COG: Understanding REF: 53 OBJ: 3 16. Primary health care in the United States: a. Has dramatically improved since the passage of the Declaration of Alma Ata b. Focuses on the use of government-funded insurance programs c. Lacks community participation and a multidisciplinary health care delivery team d. Utilizes Preferred Provider Organizations to meet needs of the citizens ANS: C Although primary health care (PHC) has been endorsed by the United States, it faces many challenges. PHC emphasizes broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team; however, this is not the primary method of health care delivery in the United States. DIF: COG: Understanding REF: 54 OBJ: 3 17. A community health nurse reviews Healthy People 2020 when considering the health needs that will be addressed in the community. Which goal would the nurse find in this document? a. Promote healthy behaviors for children. b. Cure cancer. c. Eliminate health disparities. d. Provide primary care to all citizens. ANS: C Elimination of preventable disease, disability, injury, premature death; achievement of health equity; elimination of health disparities; and creation of social and physical environments that will promote

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    good health and healthy development and behavior at every stage of life are the four major goals cited in Healthy People 2020. DIF: COG: Applying REF: 54 OBJ: 4 18. When researching advanced practice nursing options, a nursing student discovers that: a. Nurse practitioners may work as independent practitioners. b. Certified nurse midwives have limited prescriptive authority. c. Clinical nurse specialists typically provide primary care services. d. The Doctorate in Nursing Practice emphasizes the importance of research. ANS: A Nurse practitioners may work as independent practitioners and can be reimbursed by Medicare or Medicaid for services rendered. Certified nurse midwives have prescriptive authority in some form in all states. Clinical nurse specialists may provide primary care services, but often work in consultation, research, education, and administration. The Doctorate in Nursing Practice role is a clinical role. DIF: COG: Applying REF: 55 OBJ: 4 19. A nursing student interviews a member of the local congressional district to learn more about the health care system in the United States. Which statement made by the congressman would be accurate? a. “Managed care was short - lived because too many consumer groups endorsed the plans.” b. “Under managed care, clients had unlimited access to providers of their choice.” c. “Managed care failed because Americans were used to free access to providers of their choice.” d. “Managed care in the United States has been replaced by the Affordable Health Care for America Act.” ANS: C Consumer groups were not only accustomed to freedom of choice and unlimited service, but they did not like the ideas of short-stay maternity care and denial of bone marrow transplantation for breast cancer patients, thus managed care failed in the United States. DIF: COG: Evaluating REF: 55 OBJ: 4 20. The federal agency of the public health system that is most involved with the health and welfare of United States citizens is the:

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    a. Centers for Medicaid and Medicare Services b. Department of Health and Human Services c. Public Health Service d. Secretary for Health ANS: B The Department of Health and Human Services is charged with regulating health care and overseeing the health status of Americans. DIF: COG: Understanding REF: 55-56 OBJ: 5 21. Which program would typically be found in a state health department? a. Senior health b. Dental services c. HIV/AIDS service d. Mental health ANS: C Typical programs in a state health department include: communicable disease service, HIV/AIDS service, and budget and finance. Senior health, dental health, and mental health are typically found in a local health department. DIF: COG: Applying REF: 58 OBJ: 5 22. An expected action by the Department of Homeland Security would be: a. Prevention and protection against terrorist attacks b. Regulation of licensure of medical personnel c. Inspection of the safety of food and cosmetics d. Regulation of managed care organizations ANS: A This agency was created after the terrorist attacks of September 11, 2001, to prevent and deter terrorist attacks and to protect against and respond to threats and hazards to the nation. DIF: COG: Applying REF: 58 OBJ: 5 23. An example of a public health law instituted to protect the health of the community is: a. Requiring all persons to have health insurance coverage b. Administering flu shots in the late fall and early winter

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    c. Mandating immunizations for all children entering kindergarten d. Monitoring and licensing nuclear power plants ANS: C Public health laws protect the community. Required immunizations are an example. DIF: COG: Analyzing REF: 56 OBJ: 5 MULTIPLE RESPONSE 1. What are some of the untoward events categorized in the Institute of Medicine (IOM) report about medical errors? Select all that apply. a. Wrong-site surgery b. Adverse drug events c. Improper transfusions d. Restraint related deaths ANS: A, B, C, D All of the above — wrong-site surgery, adverse drug events, improper transfusions, and restraint- related deaths — are listed in the IOM report. DIF: COG: Understanding REF: 49 OBJ: 1 2. Which statement(s) about the health care workforce are true? Select all that apply. a. There is a shortage of nurses in the United States. b. Schools of nursing turn away qualified applicants due to lack of faculty and limitations of clinical sites. c. More than one million nurses will be needed by 2012 to replace those who are retiring. d. More students are choosing laboratory science, pharmacy technology, and radiology technology over nursing. ANS: A, B, C All are true except the last option. The fields listed in it have also seen declining enrollment. DIF: COG: Applying REF: 50 OBJ: 1 Chapter 04: Perspectives in Global Health Care Stanhope: Public Health Nursing, 8th Edition

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