Chapter 01: Community- and Prevention-Oriented Practice to Improve Population Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOIC

Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition TESTBANK Chapter 01: Community- and Prevention-Oriented Practice to Improve Population Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. Which of the following 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 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. These nurses may be generalists or specialists in maternal–infant, pediatric, adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems. 2. Which of the following best describes community-oriented nursing? a. Focusing on the provision of care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill inNdivRiduaIls wGithBCeirMfamily setting d. Having the goal of health promotion and disease prevention ANS: D 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 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. Community-based nurses deal primarily with illness-oriented care of individuals and families acorss the life span. The aim is to amanage acute and chronic health conditions in the community, and the focus of practice is on individual or family-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 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 Improvements in control of infectious diseases through immunizations, sanitation, and other population-based prevention programs led to the increase in life expectancy from less than 50 years in 1900 to more than 78 years in 2013. Although people are excited when a new drug is discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant gains 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 interventions would most likely be implemented by the nurse? a. Increase the community’s knowledge about hospice care. b. Promote healthy lifestyle behavior choices among the community members. c. Encourage employers to have wellness centers at each industrial site. d. Ensure timely and effective medical intervention and treatment for community members. ANS: B Public health approaches could help prevent premature deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment. Increasing knowledge of hospice care, encouraging on-site wellness centers, and ensuring timely treatment of medical conditions do not address theNfUocRusSoIfNimGpTroBCg OovMerall health through health promotion strategies. This is the major method that is suggested to decrease the incidence of premature death. 6. Which of the following is a basic assumption of 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 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 protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices 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 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 Although the public health nurse might engage in any of the tasks listed, he or she 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. The interventions of asking community leaders which interventions should be chosen, asessing the community and deciding on appropriate interventions, and using data from health care institutions do not demonstrate the engagement of the community when making decisions about what the community actually wants and needs. 8. Which of the following public health nurses 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 Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others. NURSINGTB.COM 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 An aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of a community 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 term population may be used interchangeably with the term aggregate. A large group of persons, a collection of individuals and families, and another name for demograhpic group are not accurate definitions of the term aggregate. 10. A registered nurse was just employed as a public health nurse. Which question would be the most relevant for the nurse to ask? 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 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 Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment, policy development. Scientific knowledgebased 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 information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. 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 nursNe uRnderIstooGd tBhe.wComMen’s concerns and needs. c. Express empathy, support, and concern. d. Help the women engage in political action. ANS: D 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, it goes beyond merely understanidng the women’s concern, and instead mobilizes them to take action. This action does not demonstrate the nurse showing 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-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 Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a “with the people”—not a “to the people” or “for the people”—approach to planning. The purpose of meeting with community groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them to act for themselves to solve the problems they are facing. The first task of working with the group should occur before addressing maintaining communication links. 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 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 A public health or populationN-fUocRuSseIdNapGpTroBac.hCwOoMuld 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. Caring for clients and their families 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 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 In most nursing practices, the client seeks out and requests assistance. 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 to this population that may or may not be helpful or welcomed. MULTIPLE RESPONSE 1. 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 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, rather it has occurred as overall health needs have become the focus of care. 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. ANS: A, B, C Evidence that public health nurses are practicing effectively in the community would include organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Increasing number of staff does not have a relationship to the effectiveness of public health nursing practice. 3. Why are nurses increasingly providing care in clients’ homes rather than in hospitals? (Select all that apply.) NURSINGTB.COM 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 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. Chapter 02: The History of Public Health and Public and Community Health Nursing Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing? a. Its autonomy and independence b. Its focus on acute care and immediately visible outcomes c. Its collaboration with other health care professionals d. Its flexibility and higher wages ANS: A Public health nursing is known for its autonomy and independence. In many instances, there are limited other health care professionals 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 more flexibility, but typically public health nurses do not receive higher wages. 2. The Elizabethan Poor Law of 1601 is similar to which current law? a. Welfare b. Food stamps c. Medicaid d. Medicare ANS: C NURSINGTB.COM The Elizabethan Poor Law guaranteed medical care for poor, blind, and “lame” individuals, similar to Medicaid. Welfare and food stamps do not provide for medical 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: C Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care. The Industrial Revolution was a time of great advances in technology, transportation, and communication, not a time of economic and political unrest or a time where incredible plagues occurred in Europe. Caregivers during this time period were typically poorly educated and 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 likely been completed? 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 Collecting vital statistics and improving sanitation are examples of activities from the early colonial America. Establishing schools of nursing, developing vaccines to administer to large numbers of people, and developing public housing and almshouses all happened 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: A Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health. The threat of disease was the impotus for creation of the boards of establishing boards of health. The primary interest of the boards of health was to provide public health services for the entire population and not only those who were poverty-stricken. The primary purpose of the boards of health was not to collect accurate vital statistics or receive tax dollars rather its purpose was to ensure the health of the population. 6. A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurseNmUoRsSt lIikNelGy ThaBv.e CcoOmMpleted? 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. Quarantine legislation was enacted by legislation during this time period, but the nurse would not have been responsible for setting these policies. Nursing care for clients in the home began in the 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 role of 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: C It took 19 years for the first of Shattuck’s recommendations to be implemented, but his report was the first effort to create a modern public health organization. This report called for broad changes to improve the public’s health to take place; however, these changes 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 heatlh 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 of the following nurses is famous for creating public health nursing in the United States? a. Florence Nightingale b. Frances Root c. Lillian Wald d. Mrs. Solomon Loeb ANS: C Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades. Mrs. Solomon Loeb was a wealthy layperson who assisted Mary Brewster in the establishment of the Henry Street Nurses Settlement. Francis Root was the first trained nurse in the United States who was salaried as a visiting nurse. Florence Nightingale 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 absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an NautoRnomIouGs prBCe M d. Providing medical treatment to enable children to return to school ANS: A Early school nursing focused on investigating causes of absenteeism. Providing medical treatment was the responsibility of physicians. 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 of the following accomplishments of today was started within this organization? a. Requiring that public health nurses have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing public health nursing competencies d. Opening the Henry Street Settlement ANS: B The National Organization for Public Health Nursing sought to improve the educational and services standards of public health nursing. The Henry Street Settlement was already in existence and was opened by Lillian Wald and Mary Brewster. The baccalaureate 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 focused on care of hospitalized clients. ANS: D Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for home visiting. The specialty of public health nursing practice was developed in the early 1800s. There was not a lack of teachers for this activity, rather the focus of nursing care was in the acute care setting and not in the community. Nightingale did not have a published textbook. 12. A nurse is considering joining the American Public Health Association (APHA). 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 national 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 Nursing Section within APHA provides nurses with a national forum to discuss their concerns and strategies within the larger context of the major public health organization. It also serves as a focus of leadership and policy development for community/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 practical application of public hygiene, which is broader than only heNaUlthRpSroImNoGtiTonBe.dCucOatMion. 13. Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders? a. Creating such a service was the morally correct thing to do. b. Employing nurses directly was less expensive than paying taxes to the city for the same purpose. c. Having the company’s nurses make home visits increased worker morale. d. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company. ANS: D Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of children under the age of 3 years. The insurance company attributed this improvement and the associated reduced costs to the work of visiting nurses. There was limited funding in the early twentieth centurty to extending nursing services in the community; thus, home visiting was a very expensive service to provide. Although Metropolitan Life Insurance Company may have increased worker morale 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 soldier b. A homebound, elderly male c. A woman in labor d. A child with a broken femur 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. Care for soldiers, elderly, and children was not the focus of the care provided by the Frontier Nursing Service. 15. A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? a. Comprehensive assessment and planning done in the community b. Documented needs of the local community c. Federal funding for priority diseases or groups d. Nursing staff’s expertise and skills ANS: C Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort is focused locally. A need in the community may be identified through community assessment, planning, and looking at needs in the community; however, without funding there will not be a way to create necessary programming. The expertise of the staff should 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 Service b. The Marine Nurse Corps c. The Frontier Nursing SerNviUceRSINGTB.COM 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. The U.S. Public Health Serive began to use nurses during World War I to establish a public health nursing program for military outposts. The Marine Hospital Service was established well before World War II in 1798. The Frontier Nursing Service was established by Mary Breckinridge in 1925 and provided health care to the rural and often inaccessible populations 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 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 2020 documents propose a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. The disarray resulting from reduced political support, financing, and effectiveness is described in the The Future of Public Health. The Scope and Standards of Public Health Nursing Practice describes the processes of assessment, analysis, and planning that are carried out by the public health nurse. The Patient Protection and Affordable Care Act improved access to health insurance for Americans. 18. A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts? a. To promote the nursing profession b. To increase funding for public health nursing c. To address the concerns of nurses d. To help improve health care access 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. Health care reform has a larger scope than only the profession of nursing and public health nursing. It addresses the concerns of nurses as well as many other health care professions. MULTIPLE RESPONSE 1. How did Florence Nightingale help bring about community health nursing? (Select all that apply.) a. She convinced socially pNroUmRinSenIt NwGeaTltBhy.wCoOmMen 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 acting to meet those needs. d. She kept careful records on what was done and what were the results. ANS: B, D Nightingale progressively improved the soldiers’ health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes. While Nightingale was part of a wealthy family, the role of nurses during this time period was typically fulfilled by poor women. The focus of Nightingale’s care was to identify health care needs and interventions that influenced the health of the entire population, not individuals. 2. A nurse working with Mary Breckinridge would have likely assisted with: (Select all that apply.) 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. ensuring positive outcomes for pregnancies among women in the Appalachian region. ANS: B, D Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of the Southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement. 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, not the Rockies. 3. How did nursing education change in the 1950s? (Select all that apply.) a. Baccalaureate nursing programs typically included public health nursing concepts. 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. ANS: A, C In the 1950s public health nursing became a required part of most baccalaureate nursing education programs. In 1952 nursing education programs began in junior and community colleges. Associate degree programs began to expand their enrollments, not diploma schools. The need for evidence-based practice continues to grow, but was not a change in the 1950s. 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 sufUfereSd reNducTed politOical support, financing, and effectiveness. ANS: B, C, D During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness. Chapter 03: The Changing U.S. Health and Public Health Care Systems Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO 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-todate assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. There is not evidence that an electronic health record improves client compliance with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies. 2. Which of the following best describes the cost of health care in the United States? a. Health care costs are kept low, and the indicators of health are among the best worldwide. NURSINGTB.COM 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 not the best worldwide. d. Health care costs and indicators of health are the highest in the world. ANS: C Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic product, 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 in comparison 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 physicians 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 to control 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 health care.” d. “It is the best in the world with outstanding research and high-technology care available to all.” ANS: C Health care in the United States consists of a private or personal care system and a public health system, with overlap between the two. The United States health care system is one of the most expensive systems in the world that does not do a good job at controlling costs. Care is provided through an enormous range of facilies and providers, including hosptials, physicians’ and dentists’ offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clincis. Although there is great research and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health care disparities exist among multiple populations making this system not available to all. 4. Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles ANS: B Primary 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 can afford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, not primary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitative services. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted all citizens of the world to live socially and economically productive lives. N R I G B.C M 5. How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider’s permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primarycare providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers who agree to comply with the care approaches established through a case management approcah, not through a point of service list of individual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve different populations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather a case 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 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 help you pay for these medications.” d. “These medications are important. Do your best to pay for them.” ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figure it out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before looking into receiving the medications for free as there may be other barriers which limit the abilities to get these medications at a discounted cost. 7. A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations from Healthy People 2020 d. Services mandated by the state government ANS: D At the local level, health departments provide care that is mandated by state and federal regulations. Data available from the most recent community assessment, suggestions from community members about nNeeUdR, aSnId NreGcoTmBm.eCndOatMions from Healthy People 2020 could all be used. However, funding for these types of programs may not be available. The services that are mandated by the state government 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 the nurse make about this population? a. They have difficulty accessing health care due to a shortage of primary-care providers. b. They most likely receive health insurance through Medicare. c. They are unable to access health care due to the implementation of the Affordable Care Act. d. They have access to affordable health care insurance. ANS: D Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only 2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly different in Massachusetts than in other areas of the country. Low income populations are eligible for Medicaid services, not Medicare. 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 the client to in order to receive care? a. Managed care b. Community health center c. Emergency department d. Physician office ANS: B There is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide a broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and dentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people of all ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specific network of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergency departments and physician offices are not the best place for an individual without health insurance to receive care. Both are expensive and do not provide the necessary resources for the individual to possibly receive health insurance. 10. Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers’ complaints and general unhappiness d. Increased pressure to decrease overlap in services ANS: B Since 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 aNreUa RwSillIbNe GexTpBCd OtoMcollect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, 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-local planning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both important factors to consider, however, this is not the reason why increased collaboration has occurred. There has not been an increase in taxpayer complaints or unhappiness that has caused these changes to occur. 11. African American females have a higher mortality rate from breast cancer than white 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. Projection is an estimate or forecast of a future situation based on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that ones own race is superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the patient. MULTIPLE RESPONSE 1. A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency would want to achieve accreditation? (Select all that apply.) a. To improve health programming and services b. To improve community relationships c. To improve performance and quality d. To improve management ANS: B, C, D The purpose of accreditation for public health departments is to assist and identify quality health department performance and quality, and it develops leadership, improve management, and improve community relationships. The improvement of health care programming and services is not a reason why a public health agency would want to achieve accreditation. 2. What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) 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. ANS: A, B, D The nation’s foreign-born population is growing, and it is projected that from now until 2050 the largest population growth will be due to immigrants and their children. Although African Americans used to be the largest minority group, Hispanics now have that distinction. The population of the United StatesUconStinuNes Tto increOase, and mortality for both genders from all age groups has declined. The leading causes of death have changed from infectious diseases to chronic and degenerative diseases. 3. Which of the following statements are accurate descriptions of current social and economic trends in the United States? (Select all that 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 complementary therapies. d. The gap between the richest and poorest is widening. ANS: A, C, D Several social trends that influence health care include changing lifestyles, a growing appreciation of the quality of life, the changing 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. It is obvious that the gap between the richest and poorest is widening because of the percent wage increase in the higher income levels. Americans spend considerable money on health care, nutrition, and fitness, because health is seen as an irreplaceable commodity. To be healthy, people must take care of themselves. 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. ANS: A, C Employers are typically the purchasers of health care; they want to be able to obtain basic health care plans at reasonable costs for their employees. Many employers have seen their profits diminish as they put more money into providing adequate health care coverage for employees. Nurses working long hours pose a serious threat to patient safety because fatigue slows reaction time, saps energy, and diminishes attention to detail. The Institute of Medicine’s (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. The report makes it clear that the majority of medical errors today were not produced 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 program b. Assessing the health needs of the state’s citizens c. Employing and supervising school health nurses d. Establishing and maintaining child immunization clinics ANS: A, B N R I G B.C M State health departments try toUpreSventNandTresponOd to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in areas such as ongoing assessment of health needs. Employing and supervising school health nurses occurs at the local level, and many times within a specific school. Provision of child immunization clinics occurs at the local level. Chapter 04: Ethics in Public and Community Health Nursing Practice Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. Which of the following is generally considered to be nursing’s first code of ethics? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses d. Principles of the Ethical Practice of Public Health ANS: A The Nightingale Pledge is generally considered to be nursing’s first code of ethics. After the Nightingale Pledge, the Code for Professional 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 of the 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 outcome didn’t seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best 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, administratorNs) wRho ImigGht kBno.wCof Moptions the nurse hadn’t considered c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices ANS: C Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. The supervisor is not responsible for the nurse’s choices, the nurse must maintain responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have similar 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: C The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all relevant 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 the wife’s diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse’s most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family’s current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family’s well-being ANS: D The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health 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 the family 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 primNaryRconIcernG. SBCg uMp a surgical appointment immediately would not be an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has cancer. Assessing the family’s current living situation would not be the first concern of the nurse; the first concern should focus on the family’s well-being. After assessing the family’s well-being, the next action of the nurse may be to educate the family about the treatment and prognosis of breast cancer. 5. The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care would drastically reduce the family’s resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further 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 will have 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 be created. d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious. ANS: A According to Callahan, although the nurse may attempt moral persuasion to change the family’s values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family’s values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family’s decision. Thus, the other answers are not an appropriate 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 other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It is a wife’s responsibility to care for an ill husband.” Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism ANS: C The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. 7. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “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. Communitarianism b. Deontology c. Principlism d. Utilitarianism ANS: D NURSINGTB.COM By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of 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 respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. 8. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “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 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn’t that be fair?” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism ANS: C The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory 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, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “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 is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism ANS: C The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values 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 respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the conseqNuUenRcSesIoNf tGheTaBCnOs.MUtilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make. 10. Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principles ANS: D In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandates or 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 following approaches 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 to administration. ANS: C One of the rules in deontological decision making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly. In the same way, principlism suggests the nurse examine the context and make the decision that can be morally justified within that context. In order to apply the deontological ethics decision process the nurse must first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine their own personal motives, and then