NURS 6050 – Policy & Advocacy for Improving
Population Health
Final Exam — 2026/2027 Edition
Question 1. A DNP-prepared nurse leader is invited to testify before a state legislative
committee considering a bill to expand APRN scope of practice. Which action best
demonstrates political competence?
A. Declining to speak because nursing should remain outside politics
B. Presenting personal opinions about the bill without supporting data
C. Asking a physician colleague to testify instead
D. Bringing peer-reviewed evidence, patient access data, and a clear position
statement
Correct Answer: D
Rationale: Political competence requires the ability to translate clinical expertise into
evidence-based testimony that informs policymakers. Bringing data and a clear position
demonstrates preparation and credibility, whereas relying on opinion, avoidance, or deferring to
another profession undermines nursing's voice in policy.
Question 2. Which stage of the policy process involves identifying a healthcare problem and
placing it on the legislative agenda?
A. Policy formulation
B. Policy evaluation
C. Policy modification
D. Agenda setting
Correct Answer: D
Rationale: Agenda setting is the initial stage in which a problem gains enough attention from
the public, media, or policymakers to be considered for legislative action. Formulation,
modification, and evaluation occur later in the policy cycle.
Question 3. A community health assessment reveals high rates of uncontrolled hypertension
among low-income residents living more than five miles from the nearest pharmacy. This finding
best illustrates which concept?
A. Provider bias
B. Social determinant of health related to access to care
C. Health literacy deficit
D. Genetic predisposition
Correct Answer: B
Rationale: Geographic distance from pharmacy services reflects the built environment and
access to care, both recognized social determinants of health. While health literacy or bias
,could contribute to disparities elsewhere, the scenario specifically points to structural access
barriers.
Question 4. Under the Affordable Care Act, which provision most directly expanded insurance
coverage for low-income adults in participating states?
A. Health insurance marketplace subsidies for employer plans
B. Medicaid expansion
C. Essential health benefits requirement
D. Individual mandate penalty
Correct Answer: B
Rationale: Medicaid expansion extended eligibility to adults earning up to 138% of the federal
poverty level in states that opted in, directly increasing coverage for low-income populations.
The other provisions affected benefit design, individual compliance, or marketplace subsidies
rather than Medicaid eligibility itself.
Question 5. A nurse advocate wants to influence a bill during the committee stage of the
legislative process. What is the most effective strategy at this stage?
A. Submitting written testimony and meeting with committee staff
B. Organizing a public protest outside the capitol
C. Contacting only the bill's sponsor after passage
D. Waiting until the bill reaches the floor vote
Correct Answer: A
Rationale: Committee stage is when bills are shaped through amendments, so written
testimony and direct engagement with committee staff have the greatest influence on content.
Waiting until floor vote or contacting the sponsor after passage misses the window when the bill
is still malleable.
Question 6. Which ethical principle is most directly applied when a public health department
allocates limited influenza vaccine doses using a tiered priority system?
A. Nonmaleficence
B. Autonomy
C. Veracity
D. Distributive justice
Correct Answer: D
Rationale: Distributive justice concerns the fair allocation of scarce resources across a
population, which is exactly what a tiered vaccine priority system addresses. Autonomy and
veracity relate to individual decision-making and honesty, while nonmaleficence concerns
avoiding harm rather than resource distribution.
,Question 7. A nurse practitioner in a rural clinic is unable to prescribe certain medications
without physician co-signature due to state regulation. This is an example of which type of
practice restriction?
A. Full practice authority
B. Collaborative practice exemption
C. Reduced practice authority
D. Restricted practice authority
Correct Answer: D
Rationale: Restricted practice authority requires supervision, delegation, or team management
by an outside health discipline for the NP to provide patient care, which matches the
co-signature requirement described. Reduced practice allows some independent elements,
while full practice authority removes such requirements entirely.
Question 8. Which federal agency is primarily responsible for administering the Medicare and
Medicaid programs?
A. Health Resources and Services Administration
B. Agency for Healthcare Research and Quality
C. Centers for Medicare & Medicaid Services
D. Substance Abuse and Mental Health Services Administration
Correct Answer: C
Rationale: The Centers for Medicare & Medicaid Services (CMS) administers both programs
and sets reimbursement and quality standards. The other agencies focus on workforce
development, research, and behavioral health services rather than program administration.
Question 9. A population health nurse notices that infant mortality rates are three times higher
in one zip code compared to a neighboring zip code with similar income levels. Which
framework would best guide further investigation?
A. Social-ecological model examining multiple levels of influence
B. Diffusion of innovation theory
C. Health belief model
D. Transtheoretical model of change
Correct Answer: A
Rationale: The social-ecological model examines individual, interpersonal, community, and
policy-level factors, making it well suited to investigating a geographic disparity that persists
despite similar income. The other models focus on individual behavior change rather than
multilevel community factors.
Question 10. Which of the following best describes the primary purpose of a fiscal note
attached to proposed healthcare legislation?
A. Estimating the projected cost or savings of implementing the bill
, B. Listing the bill's sponsors and co-sponsors
C. Summarizing public opinion polls
D. Describing enforcement penalties for noncompliance
Correct Answer: A
Rationale: A fiscal note provides lawmakers with a nonpartisan estimate of the budgetary
impact of proposed legislation, informing debate and decision-making. It does not address
public opinion, sponsorship, or enforcement details.
Question 11. A hospital quality improvement team is using the Plan-Do-Study-Act (PDSA) cycle
to reduce catheter-associated urinary tract infections. During the 'Study' phase, the team should
primarily:
A. Analyze data collected during the small-scale test to determine effectiveness
B. Implement the intervention hospital-wide
C. Draft the original improvement plan
D. Train staff on the new protocol
Correct Answer: A
Rationale: The Study phase involves analyzing outcomes from the small test of change to
determine whether the intervention worked as intended before scaling up. Implementation and
training occur in the Do phase, while planning occurs earlier.
Question 12. Which statement best reflects the concept of health equity as distinguished from
health equality?
A. Providing every individual with identical resources regardless of need
B. Providing resources proportionate to need so all individuals can achieve optimal
health
C. Ensuring insurance coverage for all citizens
D. Standardizing clinical protocols across all populations
Correct Answer: B
Rationale: Health equity recognizes that populations have different needs and barriers, so
resources must be allocated proportionately to achieve fair outcomes, unlike equality, which
distributes resources identically regardless of need.
Question 13. A nurse leader drafting a policy brief for legislators should prioritize which writing
style?
A. Lengthy academic prose with extensive citations
B. Technical clinical terminology to demonstrate expertise
C. Concise, jargon-free language with clear recommendations
D. An emotional narrative without supporting data
Correct Answer: C
Population Health
Final Exam — 2026/2027 Edition
Question 1. A DNP-prepared nurse leader is invited to testify before a state legislative
committee considering a bill to expand APRN scope of practice. Which action best
demonstrates political competence?
A. Declining to speak because nursing should remain outside politics
B. Presenting personal opinions about the bill without supporting data
C. Asking a physician colleague to testify instead
D. Bringing peer-reviewed evidence, patient access data, and a clear position
statement
Correct Answer: D
Rationale: Political competence requires the ability to translate clinical expertise into
evidence-based testimony that informs policymakers. Bringing data and a clear position
demonstrates preparation and credibility, whereas relying on opinion, avoidance, or deferring to
another profession undermines nursing's voice in policy.
Question 2. Which stage of the policy process involves identifying a healthcare problem and
placing it on the legislative agenda?
A. Policy formulation
B. Policy evaluation
C. Policy modification
D. Agenda setting
Correct Answer: D
Rationale: Agenda setting is the initial stage in which a problem gains enough attention from
the public, media, or policymakers to be considered for legislative action. Formulation,
modification, and evaluation occur later in the policy cycle.
Question 3. A community health assessment reveals high rates of uncontrolled hypertension
among low-income residents living more than five miles from the nearest pharmacy. This finding
best illustrates which concept?
A. Provider bias
B. Social determinant of health related to access to care
C. Health literacy deficit
D. Genetic predisposition
Correct Answer: B
Rationale: Geographic distance from pharmacy services reflects the built environment and
access to care, both recognized social determinants of health. While health literacy or bias
,could contribute to disparities elsewhere, the scenario specifically points to structural access
barriers.
Question 4. Under the Affordable Care Act, which provision most directly expanded insurance
coverage for low-income adults in participating states?
A. Health insurance marketplace subsidies for employer plans
B. Medicaid expansion
C. Essential health benefits requirement
D. Individual mandate penalty
Correct Answer: B
Rationale: Medicaid expansion extended eligibility to adults earning up to 138% of the federal
poverty level in states that opted in, directly increasing coverage for low-income populations.
The other provisions affected benefit design, individual compliance, or marketplace subsidies
rather than Medicaid eligibility itself.
Question 5. A nurse advocate wants to influence a bill during the committee stage of the
legislative process. What is the most effective strategy at this stage?
A. Submitting written testimony and meeting with committee staff
B. Organizing a public protest outside the capitol
C. Contacting only the bill's sponsor after passage
D. Waiting until the bill reaches the floor vote
Correct Answer: A
Rationale: Committee stage is when bills are shaped through amendments, so written
testimony and direct engagement with committee staff have the greatest influence on content.
Waiting until floor vote or contacting the sponsor after passage misses the window when the bill
is still malleable.
Question 6. Which ethical principle is most directly applied when a public health department
allocates limited influenza vaccine doses using a tiered priority system?
A. Nonmaleficence
B. Autonomy
C. Veracity
D. Distributive justice
Correct Answer: D
Rationale: Distributive justice concerns the fair allocation of scarce resources across a
population, which is exactly what a tiered vaccine priority system addresses. Autonomy and
veracity relate to individual decision-making and honesty, while nonmaleficence concerns
avoiding harm rather than resource distribution.
,Question 7. A nurse practitioner in a rural clinic is unable to prescribe certain medications
without physician co-signature due to state regulation. This is an example of which type of
practice restriction?
A. Full practice authority
B. Collaborative practice exemption
C. Reduced practice authority
D. Restricted practice authority
Correct Answer: D
Rationale: Restricted practice authority requires supervision, delegation, or team management
by an outside health discipline for the NP to provide patient care, which matches the
co-signature requirement described. Reduced practice allows some independent elements,
while full practice authority removes such requirements entirely.
Question 8. Which federal agency is primarily responsible for administering the Medicare and
Medicaid programs?
A. Health Resources and Services Administration
B. Agency for Healthcare Research and Quality
C. Centers for Medicare & Medicaid Services
D. Substance Abuse and Mental Health Services Administration
Correct Answer: C
Rationale: The Centers for Medicare & Medicaid Services (CMS) administers both programs
and sets reimbursement and quality standards. The other agencies focus on workforce
development, research, and behavioral health services rather than program administration.
Question 9. A population health nurse notices that infant mortality rates are three times higher
in one zip code compared to a neighboring zip code with similar income levels. Which
framework would best guide further investigation?
A. Social-ecological model examining multiple levels of influence
B. Diffusion of innovation theory
C. Health belief model
D. Transtheoretical model of change
Correct Answer: A
Rationale: The social-ecological model examines individual, interpersonal, community, and
policy-level factors, making it well suited to investigating a geographic disparity that persists
despite similar income. The other models focus on individual behavior change rather than
multilevel community factors.
Question 10. Which of the following best describes the primary purpose of a fiscal note
attached to proposed healthcare legislation?
A. Estimating the projected cost or savings of implementing the bill
, B. Listing the bill's sponsors and co-sponsors
C. Summarizing public opinion polls
D. Describing enforcement penalties for noncompliance
Correct Answer: A
Rationale: A fiscal note provides lawmakers with a nonpartisan estimate of the budgetary
impact of proposed legislation, informing debate and decision-making. It does not address
public opinion, sponsorship, or enforcement details.
Question 11. A hospital quality improvement team is using the Plan-Do-Study-Act (PDSA) cycle
to reduce catheter-associated urinary tract infections. During the 'Study' phase, the team should
primarily:
A. Analyze data collected during the small-scale test to determine effectiveness
B. Implement the intervention hospital-wide
C. Draft the original improvement plan
D. Train staff on the new protocol
Correct Answer: A
Rationale: The Study phase involves analyzing outcomes from the small test of change to
determine whether the intervention worked as intended before scaling up. Implementation and
training occur in the Do phase, while planning occurs earlier.
Question 12. Which statement best reflects the concept of health equity as distinguished from
health equality?
A. Providing every individual with identical resources regardless of need
B. Providing resources proportionate to need so all individuals can achieve optimal
health
C. Ensuring insurance coverage for all citizens
D. Standardizing clinical protocols across all populations
Correct Answer: B
Rationale: Health equity recognizes that populations have different needs and barriers, so
resources must be allocated proportionately to achieve fair outcomes, unlike equality, which
distributes resources identically regardless of need.
Question 13. A nurse leader drafting a policy brief for legislators should prioritize which writing
style?
A. Lengthy academic prose with extensive citations
B. Technical clinical terminology to demonstrate expertise
C. Concise, jargon-free language with clear recommendations
D. An emotional narrative without supporting data
Correct Answer: C
