NR503 NGN FINAL EXAM STUDY GUIDE 2025-2026
GRADED A
Week .5 .(Ch. .2)
1. Discriminate .populations .at .risk .for .development .of .chronic .health
.conditions .while .associating .the .role .of .the .Advanced .Practice .Nurse
.in .levels .of .promotion.
Common .risk .factors: .unhealthy .diet, .physical .inactivity, .and .tobacco .use
Childhood .risk: .There .is .now .extensive .evidence .from .many .countries .that
.conditions .before .birth .and .in .early .childhood .influence .health .in .adult .life. .For
.example, .low .birth .weight .is .now .known .to .be .associated .with .increased .rates .of
.high .blood .pressure, .heart .disease, .stroke .and .diabetes.
Risk .accumulation: .Ageing .is .an .important .marker .of .the .accumulation .of
.modifiable .risks .for .chronic .disease: .the .impact .of .risk .factors .increases .over .the
.life .course.
Underlying .determinants: .The .underlying .determinants .of .chronic .diseases .are .a
.reflection .of .the .major .forces .driving .social, .economic .and .cultural .change .–
.globalization, .urbanization, .population .ageing, .and .the .general .policy .environment.
Poverty: .Chronic .diseases .and .poverty .are .interconnected .in .a .vicious .circle. .At .the
.same .time, .poverty .and .worsening .of .already .existing .poverty .are .caused .by
.chronic .diseases. .The .poor .are .more .vulnerable .for .several .reasons, .including
,greater .exposure .to .risks .and .decreased .access .to .health .services. .Psychosocial
.stress .also .plays .a .role.
Preventative .health .actions .are .often .categorized .in .three .levels:
• Primary .prevention .- .aims .to .prevent .disease .or .injury
.before .it .ever .occurs.
▪ This .is .done .by .preventing .exposures .to .hazards .that .cause .disease
.or .injury, .altering .unhealthy .or .unsafe .behaviors .that .can .lead .to
.disease .or .injury, .and .increasing .resistance .to
disease .or .injury .should .exposure .occur.
▪ Nurses .play .the .part .of .educators .that .offer .information .and
.counseling .to .communities .and .populations .that .encourage
.positive .health .behaviors .▪ .Examples .include:
• legislation .and .enforcement .to .ban .or .control .the .use .of
hazardous .products .(e.g. .asbestos) .or .to .mandate .safe .and
.healthy .practices .(e.g. .use .of .seatbelts .and .bike .helmets)
• education .about .healthy .and .safe .habits .(e.g. .eating .well,
.exercising .regularly, .not .smoking)
• immunization .against .infectious .diseases.
• Secondary .prevention .- .aims .to .reduce .the .impact .of
.a .disease .or .injury .that .has .already .occurred
▪ This .is .done .by .detecting .and .treating .disease .or .injury .as .soon
.as .possible .to .halt .or .slow .its .progress, .encouraging .personal
.strategies .to .prevent .reinjury .or .recurrence, .and .implementing
.programs .to .return .people .to .their .original .health .and .function
.to .prevent .long-term .problems.
▪ Nurses .work .with .these .patients .to .reduce .and .manage
.controllable .risks, .modifying .the .individuals‘ .lifestyle .choices
.and .using .early .detection .methods .to .catch .diseases .in .their
.beginning .stages .when .treatment .may .be .more .effective.
▪ Examples .include:
• regular .exams .and .screening .tests .to .detect .disease .in .its
.earliest .stages .(e.g. .mammograms .to .detect .breast
.cancer)
• daily, .low-dose .aspirins .and/or .diet .and .exercise .programs
.to .prevent .further .heart .attacks .or .strokes
, • suitably .modified .work .so .injured .or .ill .workers .can .return
.safely .to .their .jobs.
• Tertiary .prevention .- .aims .to .soften .the .impact .of
.an .ongoing .illness .or .injury .that .has .lasting .effects
▪ This .is .done .by .helping .people .manage .long-term, .often-
complex .health .problems .and .injuries .(e.g. .chronic .diseases,
.permanent .impairments) .in .order .to .improve .as .much .as .possible
.their .ability .to .function, .their .quality .of .life .and .their .life
.expectancy.
▪ Nurses .are .tasked .with .helping .individuals .execute .a .care .plan
.and .make .any .additional .behavior .modifications .necessary .to
.improve .conditions .▪ .Examples .include:
• cardiac .or .stroke .rehabilitation .programs, .chronic .disease
.management .programs .(e.g. .for .diabetes, .arthritis,
depression, .etc.)
• support .groups .that .allow .members .to .share .strategies .for
.living .well
• vocational .rehabilitation .programs .to .retrain .workers .for
.new .jobs .when .they .have .recovered .as .much .as
.possible.
Members .of .minorities .are .overrepresented .on .the .low .tiers .of .the .socioeconomic
.ladder. .Poor .economic .achievement .is .also .a .common .characteristic .among
.populations .at .risk, .such .as .the .homeless, .migrant .workers, .and .refugees.
.However, .the .APN .should .be .able .to .distinguish .between .cultural .and
.socioeconomic .class .issues .and .not .interpret .behavior .as .having .a .cultural .origin
.when .the .fact .is .based .on .socioeconomic .class. .A .good .resource .for .APNs .is .the
.Cross-Cultural .Health .Care .Program .(CCHCP), .which .has .a .plethora .of .materials
.to .improve .cultural .competency .among .healthcare .providers, .including .a .training
.program .for .healthcare .providers. .In .order .to .provide .appropriate .healthcare
.interventions, .culture .and .all .its .variants .must .be .addressed.
(p28)APRNs .may .be .able .to .access .health .information .needed .by .working .together
.with .other .sectors .outside .of .health, .such .as .housing, .labor, .education, .and
.community-based .or .faith-based .organizations .that .offer .services .to .immigrant
.communities. .This .involves .the .collection, .documentation, .and .use .of .data .that
.can .be .used .to .monitor .health .inequalities .in .exposures, .opportunities, .and
.outcomes.
, Examples .of .social .determinants .that .are .related .to .health .inequalities .include
.poverty, .educational .level, .racism, .income, .and .poor .housing. .These .inequalities
.can .lead .to .poor .quality .of .life, .poor .self-rated .health, .multiple .morbidities, .limited
.access .to .resources, .premature .death, .and .unnecessary .risks .and .vulnerabilities.
(p25) .APRNs .can .best .determine .the .effectiveness .of .an .intervention .and .longterm
.impact .by .focusing .on .an .accurate .assessment .and .interpretation .of .data .that .are
.generated .or .collected .using .individual, .population, .and .community .health
.indicators.
(p27)APRNs .can .work .in .partnership .with .community .members .to .identify .what
.community .members .see .as .relevant .and .important, .build .social .capital, .use
.outcome .data .to .advocate .for .changes .in .policy, .and .then .continue .to .work .in
.partnership .to .identify .strategies .to .intervene, .monitor,and .improve .those .outcomes
(p40-41)APRNs .have .numerous .resources .they .can .access .to .improve .quality .and
.timely .access .to .quality .healthcare .and .decrease .health .disparities. .The .National
.Partnership .for .Action .(NPA) .to .End .Health .Disparities
( .minorityhealth.hhs.gov/npa) .was .started .by .the .Office .of .Minority .Health .to
.mobilize .individuals .and .groups .to .work .to .improve .quality .and .eliminate .health
.disparities. .The .National .Priorities .includes .key .private .and .public .stakeholders
.who .have .agreed .to .work .on .major .health .priorities .of .patients .and .families,
.palliative .and .end-of-life .care, .care .coordination, .patient .safety, .and .population
.health. .The .Quality .Alliance .Steering .Committee .is .another .partnership .of
.healthcare .leaders .who .work .to .improve .healthcare .quality .and .costs. .Various
.strategies .to .bridge .the .gaps .in .healthcare .quality .are .available .at .the .national .level
.and .may .be .applied .or .considered .at .the .state, .regional, .or .local .level .in
.collaboration .with .stakeholders .as .a .means .of .decreasing .health .disparities.
(p43) .APRNs .are .better .prepared .to .develop .effective .interventions .to .eliminate
.or .reduce .health .disparities. .Such .strategies .may .include .advocating .better .health
.insurance .coverage
for .poor .and .immigrant .populations; .ensuring .that .sufficient
GRADED A
Week .5 .(Ch. .2)
1. Discriminate .populations .at .risk .for .development .of .chronic .health
.conditions .while .associating .the .role .of .the .Advanced .Practice .Nurse
.in .levels .of .promotion.
Common .risk .factors: .unhealthy .diet, .physical .inactivity, .and .tobacco .use
Childhood .risk: .There .is .now .extensive .evidence .from .many .countries .that
.conditions .before .birth .and .in .early .childhood .influence .health .in .adult .life. .For
.example, .low .birth .weight .is .now .known .to .be .associated .with .increased .rates .of
.high .blood .pressure, .heart .disease, .stroke .and .diabetes.
Risk .accumulation: .Ageing .is .an .important .marker .of .the .accumulation .of
.modifiable .risks .for .chronic .disease: .the .impact .of .risk .factors .increases .over .the
.life .course.
Underlying .determinants: .The .underlying .determinants .of .chronic .diseases .are .a
.reflection .of .the .major .forces .driving .social, .economic .and .cultural .change .–
.globalization, .urbanization, .population .ageing, .and .the .general .policy .environment.
Poverty: .Chronic .diseases .and .poverty .are .interconnected .in .a .vicious .circle. .At .the
.same .time, .poverty .and .worsening .of .already .existing .poverty .are .caused .by
.chronic .diseases. .The .poor .are .more .vulnerable .for .several .reasons, .including
,greater .exposure .to .risks .and .decreased .access .to .health .services. .Psychosocial
.stress .also .plays .a .role.
Preventative .health .actions .are .often .categorized .in .three .levels:
• Primary .prevention .- .aims .to .prevent .disease .or .injury
.before .it .ever .occurs.
▪ This .is .done .by .preventing .exposures .to .hazards .that .cause .disease
.or .injury, .altering .unhealthy .or .unsafe .behaviors .that .can .lead .to
.disease .or .injury, .and .increasing .resistance .to
disease .or .injury .should .exposure .occur.
▪ Nurses .play .the .part .of .educators .that .offer .information .and
.counseling .to .communities .and .populations .that .encourage
.positive .health .behaviors .▪ .Examples .include:
• legislation .and .enforcement .to .ban .or .control .the .use .of
hazardous .products .(e.g. .asbestos) .or .to .mandate .safe .and
.healthy .practices .(e.g. .use .of .seatbelts .and .bike .helmets)
• education .about .healthy .and .safe .habits .(e.g. .eating .well,
.exercising .regularly, .not .smoking)
• immunization .against .infectious .diseases.
• Secondary .prevention .- .aims .to .reduce .the .impact .of
.a .disease .or .injury .that .has .already .occurred
▪ This .is .done .by .detecting .and .treating .disease .or .injury .as .soon
.as .possible .to .halt .or .slow .its .progress, .encouraging .personal
.strategies .to .prevent .reinjury .or .recurrence, .and .implementing
.programs .to .return .people .to .their .original .health .and .function
.to .prevent .long-term .problems.
▪ Nurses .work .with .these .patients .to .reduce .and .manage
.controllable .risks, .modifying .the .individuals‘ .lifestyle .choices
.and .using .early .detection .methods .to .catch .diseases .in .their
.beginning .stages .when .treatment .may .be .more .effective.
▪ Examples .include:
• regular .exams .and .screening .tests .to .detect .disease .in .its
.earliest .stages .(e.g. .mammograms .to .detect .breast
.cancer)
• daily, .low-dose .aspirins .and/or .diet .and .exercise .programs
.to .prevent .further .heart .attacks .or .strokes
, • suitably .modified .work .so .injured .or .ill .workers .can .return
.safely .to .their .jobs.
• Tertiary .prevention .- .aims .to .soften .the .impact .of
.an .ongoing .illness .or .injury .that .has .lasting .effects
▪ This .is .done .by .helping .people .manage .long-term, .often-
complex .health .problems .and .injuries .(e.g. .chronic .diseases,
.permanent .impairments) .in .order .to .improve .as .much .as .possible
.their .ability .to .function, .their .quality .of .life .and .their .life
.expectancy.
▪ Nurses .are .tasked .with .helping .individuals .execute .a .care .plan
.and .make .any .additional .behavior .modifications .necessary .to
.improve .conditions .▪ .Examples .include:
• cardiac .or .stroke .rehabilitation .programs, .chronic .disease
.management .programs .(e.g. .for .diabetes, .arthritis,
depression, .etc.)
• support .groups .that .allow .members .to .share .strategies .for
.living .well
• vocational .rehabilitation .programs .to .retrain .workers .for
.new .jobs .when .they .have .recovered .as .much .as
.possible.
Members .of .minorities .are .overrepresented .on .the .low .tiers .of .the .socioeconomic
.ladder. .Poor .economic .achievement .is .also .a .common .characteristic .among
.populations .at .risk, .such .as .the .homeless, .migrant .workers, .and .refugees.
.However, .the .APN .should .be .able .to .distinguish .between .cultural .and
.socioeconomic .class .issues .and .not .interpret .behavior .as .having .a .cultural .origin
.when .the .fact .is .based .on .socioeconomic .class. .A .good .resource .for .APNs .is .the
.Cross-Cultural .Health .Care .Program .(CCHCP), .which .has .a .plethora .of .materials
.to .improve .cultural .competency .among .healthcare .providers, .including .a .training
.program .for .healthcare .providers. .In .order .to .provide .appropriate .healthcare
.interventions, .culture .and .all .its .variants .must .be .addressed.
(p28)APRNs .may .be .able .to .access .health .information .needed .by .working .together
.with .other .sectors .outside .of .health, .such .as .housing, .labor, .education, .and
.community-based .or .faith-based .organizations .that .offer .services .to .immigrant
.communities. .This .involves .the .collection, .documentation, .and .use .of .data .that
.can .be .used .to .monitor .health .inequalities .in .exposures, .opportunities, .and
.outcomes.
, Examples .of .social .determinants .that .are .related .to .health .inequalities .include
.poverty, .educational .level, .racism, .income, .and .poor .housing. .These .inequalities
.can .lead .to .poor .quality .of .life, .poor .self-rated .health, .multiple .morbidities, .limited
.access .to .resources, .premature .death, .and .unnecessary .risks .and .vulnerabilities.
(p25) .APRNs .can .best .determine .the .effectiveness .of .an .intervention .and .longterm
.impact .by .focusing .on .an .accurate .assessment .and .interpretation .of .data .that .are
.generated .or .collected .using .individual, .population, .and .community .health
.indicators.
(p27)APRNs .can .work .in .partnership .with .community .members .to .identify .what
.community .members .see .as .relevant .and .important, .build .social .capital, .use
.outcome .data .to .advocate .for .changes .in .policy, .and .then .continue .to .work .in
.partnership .to .identify .strategies .to .intervene, .monitor,and .improve .those .outcomes
(p40-41)APRNs .have .numerous .resources .they .can .access .to .improve .quality .and
.timely .access .to .quality .healthcare .and .decrease .health .disparities. .The .National
.Partnership .for .Action .(NPA) .to .End .Health .Disparities
( .minorityhealth.hhs.gov/npa) .was .started .by .the .Office .of .Minority .Health .to
.mobilize .individuals .and .groups .to .work .to .improve .quality .and .eliminate .health
.disparities. .The .National .Priorities .includes .key .private .and .public .stakeholders
.who .have .agreed .to .work .on .major .health .priorities .of .patients .and .families,
.palliative .and .end-of-life .care, .care .coordination, .patient .safety, .and .population
.health. .The .Quality .Alliance .Steering .Committee .is .another .partnership .of
.healthcare .leaders .who .work .to .improve .healthcare .quality .and .costs. .Various
.strategies .to .bridge .the .gaps .in .healthcare .quality .are .available .at .the .national .level
.and .may .be .applied .or .considered .at .the .state, .regional, .or .local .level .in
.collaboration .with .stakeholders .as .a .means .of .decreasing .health .disparities.
(p43) .APRNs .are .better .prepared .to .develop .effective .interventions .to .eliminate
.or .reduce .health .disparities. .Such .strategies .may .include .advocating .better .health
.insurance .coverage
for .poor .and .immigrant .populations; .ensuring .that .sufficient
