Public Health Nursing and Population Health

1. Which statement best describes community-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: A Rationale: By definition, community-based nursing is a setting-specific practice in which care is provided for "sick" individuals and families where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and continuous care. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems. 2. Which statement best describes the goal of community-oriented nursing? a. Providing care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. To preserve, protect, promote, or maintain health and prevent disease ANS: D Rationale: By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, 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 groups b. Illness-oriented care c. Individuals within the family unit d. Health care of communities and populations ANS: D Rationale: In 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 population within it. 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 research b. Advances in surgical techniques and procedures c. Sanitation and other population-based prevention programs d. Use of antibiotics to fight infections ANS: C Rationale: Public health policies and programs were primarily responsible for increasing the average life span from 47 in 1900 to 78.6 years in 2017 through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. 5. A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Provide free health care to all citizens b. To increase the number of individuals with access to effective health care benefits c. Lower the cost of health care to the American population d. To lessen the governmental burden of providing health care to Americans ANS: B Rationale: The central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number of people with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on the American government are serious concerns, they are not the primary focus of ACA. 6. What is the basic assumption stated by Healthy People 2010 as 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: C Rationale: The major premise of Healthy People 2010 was that the health of the individual cannot be entirely separate from the health of the larger community. Public health practice focuses on the community as a whole, and the effect of the community's health status on the health of individuals, families, and groups. 7. Which of the following actions would most likely be performed by a public health nurse? a. Asking community leaders what interventions should be chosen b. Assessing the community and deciding on appropriate interventions c. Using data from the main health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment ANS: D Rationale: The public health nurse works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. Other options do not demonstrate the engagement of the community when making decisions. 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 issues b. The nurse who spent the day attending meetings of various health agencies c. The nurse who talked to several people about their particular health concerns d. The nurse who watched the city council meeting on local cable television ANS: B Rationale: The nurse who spent the day attending meetings of various health agencies is most representative because in public health, concerns are addressed from a broader perspective. Individual concerns are not as important as aggregate priorities, and watching television is less effective than interacting with others. 9. Which of the following best defines aggregate? a. A large group of persons b. A collection of individuals and families c. A collection of people who share one or more characteristics d. Another name for demographic group ANS: C Rationale: An aggregate is defined as a collection of people who share one or more personal or environmental characteristics. The term population may be used interchangeably with 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: A Rationale: Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals 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 development b. Assessment c. Assurance d. Scientific knowledge-based care ANS: C Rationale: Assurance includes making sure that essential community-oriented health services are available in the community. Assessment is systematic data collection on the population. Policy development refers to efforts to develop policies that support the health of the population. 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 able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives 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: D Rationale: Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, mobilizing them to take action rather than merely showing empathy. 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-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups ANS: D Rationale: Public health nursing is a "with the people"—not a "to the people" or "for the people"—approach to planning. There is an imperative to work with members of the community to carry out core public health functions and allow them to act for themselves to solve the problems they are facing. 14. The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals ANS: D Rationale: The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent components 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 clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic ANS: A Rationale: A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. Public health focuses on care of populations, not individuals and families. 16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed ANS: A Rationale: In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance that may or may not be helpful or welcomed. 17. 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 care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism ANS: B, C, D Rationale: As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a stronger commitment to population-focused services. 18. 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 families ANS: A, B, C Rationale: Evidence that public health nurses are practicing effectively includes organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Neither increasing the number of staff nor acting as staff in the delivery of acute and/or chronic care has a relationship to the effectiveness of public health nursing practice. 19. 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, D Rationale: An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting. 1. Which statement best describes community-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: A Rationale: By definition, community-based nursing is a setting-specific practice in which care is provided for "sick" individuals and families where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and continuous care. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems. 2. Which statement best describes the goal of community-oriented nursing? a. Providing care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. To preserve, protect, promote, or maintain health and prevent disease ANS: D Rationale: By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, 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 groups b. Illness-oriented care c. Individuals within the family unit d. Health care of communities and populations ANS: D Rationale: In 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 population within it. 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 research b. Advances in surgical techniques and procedures c. Sanitation and other population-based prevention programs d. Use of antibiotics to fight infections ANS: C Rationale: Public health policies and programs were primarily responsible for increasing the average life span from 47 in 1900 to 78.6 years in 2017 through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. 5. A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Provide free health care to all citizens b. To increase the number of individuals with access to effective health care benefits c. Lower the cost of health care to the American population d. To lessen the governmental burden of providing health care to Americans ANS: B Rationale: The central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number of people with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on the American government are serious concerns, they are not the primary focus of ACA. 6. What is the basic assumption stated by Healthy People 2010 as 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: C Rationale: The major premise of Healthy People 2010 was that the health of the individual cannot be entirely separate from the health of the larger community. Public health practice focuses on the community as a whole, and the effect of the community's health status on the health of individuals, families, and groups. 7. Which of the following actions would most likely be performed by a public health nurse? a. Asking community leaders what interventions should be chosen b. Assessing the community and deciding on appropriate interventions c. Using data from the main health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment ANS: D Rationale: The public health nurse works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. Other options do not demonstrate the engagement of the community when making decisions. 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 issues b. The nurse who spent the day attending meetings of various health agencies c. The nurse who talked to several people about their particular health concerns d. The nurse who watched the city council meeting on local cable television ANS: B Rationale: The nurse who spent the day attending meetings of various health agencies is most representative because in public health, concerns are addressed from a broader perspective. Individual concerns are not as important as aggregate priorities, and watching television is less effective than interacting with others. 9. Which of the following best defines aggregate? a. A large group of persons b. A collection of individuals and families c. A collection of people who share one or more characteristics d. Another name for demographic group ANS: C Rationale: An aggregate is defined as a collection of people who share one or more personal or environmental characteristics. The term population may be used interchangeably with 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: A Rationale: Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals 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 development b. Assessment c. Assurance d. Scientific knowledge-based care ANS: C Rationale: Assurance includes making sure that essential community-oriented health services are available in the community. Assessment is systematic data collection on the population. Policy development refers to efforts to develop policies that support the health of the population. 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 able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives 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: D Rationale: Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, mobilizing them to take action rather than merely showing empathy. 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-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups ANS: D Rationale: Public health nursing is a "with the people"—not a "to the people" or "for the people"—approach to planning. There is an imperative to work with members of the community to carry out core public health functions and allow them to act for themselves to solve the problems they are facing. 14. The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals ANS: D Rationale: The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent components 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 clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic ANS: A Rationale: A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. Public health focuses on care of populations, not individuals and families. 16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed ANS: A Rationale: In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance that may or may not be helpful or welcomed. 17. 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 care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism ANS: B, C, D Rationale: As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a stronger commitment to population-focused services. 18. 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 families ANS: A, B, C Rationale: Evidence that public health nurses are practicing effectively includes organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Neither increasing the number of staff nor acting as staff in the delivery of acute and/or chronic care has a relationship to the effectiveness of public health nursing practice. 19. 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, D Rationale: An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.