Community Public Health Nursing 7th Edition Nies Test Bank

Community Public Health Nursing 7th Edition Nies Test Bank [Type here] Chapter 01: Health: A Community View Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which best describes the primary reason that Americans are concerned about health care? a. Politicians are discussing how to improve health care. b. The media has provided mixed messages about the health care system. c. Our national health care costs keep increasing. d. The new health care system offers free services to Americans. ANS: C The primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. The costs of caring for the sick accounted for the majority of escalating health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 17.8% in 2015. Politicians and the media both influence Americans’ perceptions about health care; however, they are not the primary reason why Americans are concerned. The new health care system will change the health care access and availability, but will not necessarily be offering any free services to Americans. DIF: Cognitive Level: Understand (Comprehension) 2. A nurse has begun to lobby with politicians for changes to the health care system. Why is this involvement important? a. Nurses, as central characters in several popular TV series, are currently very visible in American mediN a. R I G B.C M b. Nurses are primarily responUsibSle foNr mTanagingOthe various units in our health care system. c. Nurses are the largest segment of health care providers. d. Nurses are the only group that is employed both inside and outside of hospitals. ANS: C As the largest segment of health care providers, nurses are informed about the current health care system and all the problems that result from people not seeking care until they are desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to our current health care delivery system, can also be instrumental in working politically to create a health care delivery system that will meet health needs. While nurses are in several current TV series and are employed both inside and outside of hospitals, physicians and other health care providers are as well. Nurses are often managers, but managers often have other backgrounds, such as business administration. DIF: Cognitive Level: Understand (Comprehension) 3. What conclusion can be drawn from examining where nurses are employed? a. There is a trend toward consolidation of health care into large central medical centers. b. There is an increased emphasis on community-based health care. c. There is an obvious need to decrease health care costs by cutting positions. d. Managed care organizations (MCOs) are employing nurses to improve customer U S N T O relations. ANS: B MCOs are employing nurses in many capacities. Although hospitals are closing and acute care is increasingly found in central medical centers, the same trend may be seen in an increase in neighborhood-based practice centers. While positions are cut in most industries, health care is recognized as an area where growth in employment is expected. However, nurses are increasingly employed in community settings as opposed to hospitals. This change reflects the move toward community-based care rather than hospital-based tertiary care. To help decrease the continued rise in health care costs, the increased emphasis is on disease prevention rather than high-cost treatment. DIF: Cognitive Level: Understand (Comprehension) 4. Which ethical belief would be most helpful in the current health care crisis? a. Emphasis should be on individual and corporation freedom in the marketplace. b. Emphasis should be on individual autonomy and freedom of choice. c. Emphasis should be on social justice and collective responsibility. d. Emphasis should be on the effectiveness of technology in resolving problems. ANS: C Public health recognizes the necessity of collective action in keeping the environment safe and in egalitarian tradition and vision. An overinvestment in technology and seeking of cures within the market justice system has stifled the evolution of a health system to protect and preserve the health of the population. Although individual autonomy and freedom of choice are important, so is the recognition of collective responsibility in ensuring social justice, which entitles all people to basic necessities. N R I G B.C M DIF: Cognitive Level: Apply (Application) 5. What is the primary problem seen in Healthy People 2020’s emphasis on choosing healthy lifestyle behaviors, such as daily exercise or healthy food choices? a. Emphasis on other lifestyle choices, such as not smoking and minimal use of alcohol or drugs, is also needed. b. All of us must work together to make unhealthy behaviors socially unacceptable. c. It costs more to make healthy choices, such as buying and eating fresh fruits and vegetables as opposed to quick and cheap fast-food choices. d. Public policy emphasizes personal responsibility but ignores social and environmental changes needed for well-being. ANS: D Although all responses are accurate, the primary problem is the emphasis on personal choices in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for community responsibility and action that addresses environmental or cultural restraints to health. DIF: Cognitive Level: Apply (Application) 6. What responsibility does the American Nurses Association (ANA) Code of Ethics require of the nurse beyond giving excellent care to patients? a. Accept longer work schedules to ensure that professional care is always available U S N T O to clients. b. Recognize the need for experienced nurses to mentor new graduates to help increase and expand the number of professionals available. c. Support health legislation to improve accessibility and cost of health care. d. Volunteer to work overtime as needed to ensure maximum quality of care. ANS: C The ANA Code of Ethics promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. The code does not directly address workplace issues, such as work schedules or need for overtime. DIF: Cognitive Level: Analyze (Analysis) 7. What is the community health nursing definition of health? a. Health is a person’s goal-directed purposeful process toward well-being or wholeness. b. Health is an individual’s physical, mental, and social well-being, not merely the absence of disease or infirmity. c. Health is the mutual adaptation between a person and his or her environment in meeting daily existence. d. Health is families and aggregates choosing actions to ensure safety and well-being. ANS: D The text stresses that health is not just the result of an individual’s choices, but choices and actions of individuals, families, groups, and communities that lead to better health. DIF: Cognitive Level: Apply (Application) N R I G B.C M 8. How does community health nursing define community? a. A group of persons living within specific geographic boundaries b. A group of persons who share a common identity and environment c. A group of persons who work together to meet common goals d. A group of persons who resolve a community concern ANS: B Community health nurses work with both geopolitical groups (within specific geographic boundaries) and phenomenological groups (who have a common identity based on culture, history, or goals). A particular phenomenological group may or may not have been a planned group—that is, a group that came together to resolve a recognized common problem or to meet a common goal. However, of all the choices, a group of persons who share a common identity (phenomenological group) and environment (which implies a specific geographic setting) is the broadest and most complete definition. DIF: Cognitive Level: Apply (Application) 9. Which variable has a major influence on a community’s health? a. Behavior choices made by persons in the community b. Number of health care providers and hospitals in the community c. Quality of the public safety officers (police officers, firefighters, etc.) d. The number and credentials of public health officials in the community ANS: A Individual behavior choices are responsible for about 50% of health outcomes. Individual choices are affected through interaction with other individuals, and their mutual social and physical environments. The number of health care providers has not played a major role in the health outcomes in the community in comparison to individual health behaviors. The quality of public safety officers and number of public health officials have not been identified as major contributors to the determinants of health. DIF: Cognitive Level: Apply (Application) 10. What change could most effectively lead to a longer life span in Americans? a. Parenting and sexual behavior classes in all public school systems b. Legislation restricting alcohol and drug use c. Notably reducing speed limits on all state and federal highways, and changing the age limit for driving to 21 years of age d. The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm ANS: D Smoking is responsible for almost 20% of all deaths in the United States. Although smoking is an individual’s choice, all people are affected by social norms. Parenting and sexual behavior classes and legislative changes may influence health, but may not necessarily lead to a longer lifespan. Community health nurses should recognize that health is influenced by a web of factors, some that can be changed and some that cannot. Influencing social norms may better promote change among Americans. DIF: Cognitive Level: Apply (Application) 11. What is the health issue caus NinUg RthSe ImNos Gt Tco Bnc .e CrnOin Mthe United States today? a. Diabetes epidemic b. Increase in cardiac disease c. Increase in obesity d. Rise in cancer rates ANS: C The widespread increase in incidence of overweight and obesity has led to calls for population-based measures to address this issue. The overarching problem of obesity has led to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there should be in a decrease in the other health issues. DIF: Cognitive Level: Understand (Comprehension) 12. What factors are most responsible for the increasing length of life of Americans over the past 100 years? a. Better nutrition and family planning options b. Education concerning the need to reduce salt and fat in the diet c. Improved medical care, including exciting new technologies d. More efficient cancer screenings and early intervention ANS: A N R I G B.C M Average increased life span over the past 100 years can be largely attributed to higher standards of living, better nutrition, a healthier environment, and having fewer children. Public health efforts such as immunization and medical care have also contributed. DIF: Cognitive Level: Understand (Comprehension) 13. Why would a public health nurse want to know about morbidity and mortality statistics on the local, state, and national level? a. To be able to share current trends in health problems with the community b. To be able to observe the community’s statistics over time and compare the community with other communities c. To justify local budgets and the need for increased income from citizens d. To publicize current health issues and suggest appropriate actions to citizens ANS: B Although being informed and being able to educate the public is always preferred and nurses often do have to justify budgets, data are needed to compare the local community with itself over time and with other communities so that problems may be recognized and action taken to confront health issues. The first step is always to recognize problems as they develop. DIF: Cognitive Level: Apply (Application) 14. How do public health efforts differ from medical efforts in improving the health of our citizens? a. Medical care providers autonomously choose appropriate interventions, whereas public health care providers must engage in whatever actions legislation requires. b. Medical care providers are self-employed or agency employed, whereas public health care providers are emUploSyedNbyTand paiOd through the government. c. Medical care providers focus only on individuals, whereas public health care providers focus only on aggregates. d. Medical care providers focus on disease diagnosis and management, whereas public health care providers focus on health promotion and disease prevention. ANS: D Medical care providers are restricted by insurance and government regulations. Providers may also be employed in government facilities, such as Veterans Administration facilities. However, medical care providers primarily focus on diagnosis and treatment of disease, whereas public health care providers try to promote health and prevent disease. Although medical care providers primarily focus on individuals and public health care providers primarily focus on aggregates, their practice is not limited to only individuals or only aggregates. DIF: Cognitive Level: Apply (Application) 15. Which primary prevention would the school nurse choose to address the school’s number of unwed pregnancies? a. Create a class on parenting for both the moms-to-be and the dads-to-be. b. Convince the school board to allow sex education classes to include birth control measures. c. Employ the moms-to-be as 1-hour-a-day employees in the school daycare center for children born to school students. d. Establish a class where all the unwed moms-to-be can learn infant care. ANS: B Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Specific protection efforts reduce or eliminate risk factors. Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies. DIF: Cognitive Level: Apply (Application) 16. What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations? a. Health education b. Secondary prevention c. Specific protection d. Tertiary prevention ANS: C Immunizations are a specific protection effort as part of primary prevention. Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Specific protection efforts reduce or eliminate risk factors. Secondary prevention refers to early detection and prompt interveNntUioRnSduIriNngGtThBe p.eCriOodMof early disease pathogenesis. Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Health education would relate to educating the students about the immunization not making the arrangements for the immunization to be given. DIF: Cognitive Level: Understand (Comprehension) 17. Which action would probably result in the largest change in health care outcomes for Americans? a. Establish large numbers of scholarships for education of nurses, physicians, and other health care providers. b. Fund a one-time extremely large stimulus to allow all health care providers and agencies to create and integrate computer network systems for client health care records. c. Increase funding for hospitals and medical centers to expand their neighborhood clinics. d. Redirect a large portion of federal funding from acute care to health promotion activities. ANS: D Of the choices given, health promotion activities would make the largest difference. Increased expenditures on acute care will not notably change the health of the population, whereas funding that addresses health promotion such as education and safe environments would improve the health of the aggregate. DIF: Cognitive Level: Apply (Application) 18. Which task will be most helpful in meeting the public health agency’s goals? a. Complete staff evaluations in preparation for individual meetings to plan their agency and individual goals for the next year. b. Actively participate in community agencies’ collaborative action plan to meet the community’s health goals for the year. c. Meet with the college of nursing faculty to finalize student objectives and schedules for the next semester. d. Teach a free course in healthful living for community residents. ANS: B Although all tasks may be necessary and important, intra-agency cooperation to meet the health goals of the community as a whole is more central to the agency’s mission than other choices that meet the needs of individuals or groups rather than the community as a whole. DIF: Cognitive Level: Analyze (Analysis) 19. A community health nurse is overwhelmed with all that needs to be done in one day. Which task could most easily be postponed? a. Reviewing the most recent hospital patient data collected by the local college of nursing N R I G B.C M b. Deciding which of severalUpossSibleNneTw clinicOoptions would be most effective in better meeting the needs of the local community c. Evaluating the results of the most recent community-wide screening program before planning for the next community health program d. Giving testimony to the state legislature on a new health and safety bill ANS: A All of the tasks are related to assessing needs, implementing new care options, or evaluating health outcomes measures in the community except reviewing hospital patient data. Hospital patient data may be helpful but not directly related to the agency’s ability to promote primary health and prevent disease. DIF: Cognitive Level: Analyze (Analysis) 20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit to make a home visit to a patient who had been discharged the previous day and to give follow-up care (for overload pay). What kind of nursing would this nurse be doing? a. Acute care hospital nursing b. Community-based nursing c. Community health nursing d. Public health nursing ANS: B The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere in the community. Community-based nursing practice refers to “application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system” (McEwen and Pullis, 2009, p. 6). Community-based nursing is setting specific, and the emphasis is on acute and chronic care and includes such practice areas as home health nursing and nursing in outpatient or ambulatory settings. As the nurse is not focusing on the health of the community but on an individual, it is not community or public health nursing. It is not acute care hospital nursing because the nurse is seeing the patient in his or her home. DIF: Cognitive Level: Apply (Application) 21. Which task is most crucial for the community health nurse to do well? a. Review the most recent morbidity and mortality data. b. Create a new clinic to better meet local health needs. c. Evaluate the results of the recent screening program. d. Give testimony regarding proposed state health legislation. ANS: D Public health’s core functions are assurance, assessment, and policy development. Giving testimony regarding legislation directly reflects policy development, which would have a wider impact than the other options, which are more local and narrow in focus. DIF: Cognitive Level: Analyze (Analysis) 22. A new public health nurse carefully assessed all the local mortality and morbidity data in preparation for making appropriate planning suggestions at a meeting next week. What other action is crucial before the nu NrsUe RcSan IfNee Gl pTr Bep .ar CedO? a. Ask other nursing staff their perceptions of the community’s needs. b. Assess the nurse’s own assets, strengths, and ability to contribute. c. Meet members of the community to determine their culture and values. d. Review discussions and decisions from previous meetings. ANS: C Community health nurses must work with the community. It is essential to assess an aggregate’s needs and resources and identify its values. The best way to do this is by meeting with the members of the community to determine their culture and values. Assessing one’s own assets, asking other nursing staff, and reviewing previous discussions will not allow the nurse to assess the needs of the community. DIF: Cognitive Level: Apply (Application) 23. Why are high-risk and vulnerable subpopulations identified by public health nurses before deciding on appropriate interventions? a. It is easiest to make improvements among these groups. b. Populations are not homogeneous, and resources are limited. c. Such groups are most vocal about their needs and wants. d. These groups are often recipients of special funding. ANS: B U S N T O Populations are not all the same. The needs of subpopulations must be assessed. The high-risk and vulnerable subpopulations must be identified early. Those individuals who do not receive service early become very expensive high-cost users later. DIF: Cognitive Level: Understand (Comprehension) 24. A nurse works hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called? a. Building coalitions b. Collaboration c. Communication d. Community cooperation ANS: A By definition, the nurse’s actions are coalition building. Although collaboration has a very similar meaning, Table 1.4 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, but not yet working with them toward a goal. DIF: Cognitive Level: Understand (Comprehension) 25. After completing a master’s degree, a nurse took a course in marketing. Should the agency reimburse the nurse’s tuition costs? a. No, courses taken for personal enjoyment are not eligible. b. No, courses taken outside the professional’s responsibilities are not eligible. c. Yes, the nurse is demonstrating professional commitment by continuing education. d. Yes, the nurse could use N such R inf I orm G atio B n . in C so M cial marketing for the agency. ANS: D Social marketing tools using marketing principles and technologies are designed to influence the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information would be extremely helpful for agency personnel in improving community health and lifestyle choices. DIF: Cognitive Level: Apply (Application) 26. Which factor is most responsible for differences in an individual’s health? a. Culture of the majority of the community’s citizens b. Individual’s education and income c. Number of physicians and other health care providers in the community d. Quality of the community health agency and hospital in the community ANS: B Factors that contribute to wide variations in health disparities are education, income, and occupation. This is best addressed by looking at an individual’s education and income. The culture, number of physicians, and quality of agencies in the community do not play as important of a role in individual health. DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE 1. What are the leading health indicators found in Healthy People 2020? (Select all that apply.) a. Financial issues b. Health system issues c. Individual behaviors d. Issues related to legal and illegal immigration e. Legislative issues f. Physical and social environmental factors ANS: B, C, F Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues. Financial issues, issues related to legal and illegal immigration, and legislative issues are not found in Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) 2. What historically have been public health nurses’ two most important priorities? (Select all that apply.) a. Establishing school nursing to improve care of children b. Engaging in political activity to improve living conditions c. Giving superb clinical bedside care in the home d. Increasing funding to public health efforts e. Teaching family members how to care for their family f. Working with the community to confront health issues and poverty ANS: B, F Neither administering bedsidNeUclRinSicIalNnGurTsiBng.nCoOr tMeaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty. DIF: Cognitive Level: Understand (Comprehension) 3. Based on Healthy People 2010, what are the two primary goals of Healthy People 2020? (Select all that apply.) a. Eliminate health disparities. b. Expand health promotion activities in every community. c. Improve funding, including diverting funds from other priorities to health care. d. Improve health outcomes measures to be more consistent with other developed nations’ outcomes. e. Increase quality and years of healthy life. f. Reduce mortality and morbidity figures nationwide. ANS: A, E As published, the two goals are to increase quality and years of healthy life and eliminate health disparities. Expanding health promotion activities in every community, improving funding and improving health outcomes, and reducing mortality and morbidity are not the primary goals of Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) Chapter 02: Historical Factors: Community Health Nursing in Context Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which best describes the time period when communities began to agree on collective action to stay healthy? a. When industrialization occurred b. When large urban centers began to develop and the population expanded c. When people gathered together to settle in villages d. When people were nomads engaged in hunting and gathering ANS: D Primitive prehistorical societies had health practices to ensure their survival. Isolation and fumigation were used for thousands of years. This time period is best described by when people were nomads engaged in hunting and gathering. Industrialization, development of large urban centers, and settlement into villages do not describe this time period. DIF: Cognitive Level: Understand (Comprehension) 2. Which best describes the first measures used by large communities to ensure community health? a. Building safe sewage disposal systems b. Healthy food choices and exercise c. Praying to the gods for preservation d. Use of medicine and otheN r heR rbaI l remG edB ie. s C M U S N T O ANS: A In classical times, large cities grew, and elaborate drainage systems were constructed. In Leviticus, the Hebrews formulated the first hygiene code. This hygiene code protected water and food by creating laws that governed personal and community hygiene, such as contagion, disinfection, and sanitation. This is best described through the building of safe sewage disposal systems. Healthy food choices and exercise, praying to the gods for preservation, and the use of medicine and other herbal measures were not among the first measures used by large communities to ensure health. DIF: Cognitive Level: Understand (Comprehension) 3. A nurse has determined that there is always a consistent level of people in the population who experience pneumonia. Which best describes the prevalence of this disease? a. Prevalent b. Endemic c. Epidemic d. Pandemic ANS: B By definition, when diseases are always present in a population they are called endemic. Diseases which were occasionally present and often fairly widespread are called epidemic. Pandemic is used to describe the existence of a disease in a large proportion of the population. Prevalent means widespread, and would not be the best term to describe this disease. U S N T O DIF: Cognitive Level: Apply (Application) 4. Which best describes an innovation introduced by the Romans? a. Citizenship duties b. Immunizations c. Hospitals and nursing homes d. Daily exercise ANS: C The Romans introduced many health innovations such as fresh water, public physicians, hospitals, surgeries, infirmaries, and nursing homes. Unfortunately, these services were only for the wealthy. Citizenship duties, immunizations, and daily exercise were not innovations introduced by the Romans. DIF: Cognitive Level: Understand (Comprehension) 5. Which best describes a modern public health practice that was originally developed as a means of self-protection from the Black Death (bubonic plague)? a. Care in a hospital b. Chemical intervention c. Isolation and quarantine d. Herbal remedies ANS: C Modern public health practices, such as isolation, disinfection, and ship quarantines, emerged in response to the bubonic plague. Care in a hospital was originally developed by the Romans. Chemical intervention and heNrbaRl remIedGies Bwe.rCe noMt used to self-protect from the Black Death. DIF: Cognitive Level: Understand (Comprehension) 6. Which disease provided immunity to smallpox? a. Cowpox b. Measles c. Mumps d. Scarlet fever ANS: A Those that had an infection of cowpox were thereafter immune from smallpox, which was endemic and killed about 10% of the population. Measles, mumps, and scarlet fever did not provide immunity to smallpox. DIF: Cognitive Level: Understand (Comprehension) 7. A scholar during the Sanitary Revolution created medical topographies. What was the advantage of these surveys? a. Citizens knew which wells were safe to use for drinking water. b. People knew what housing areas to avoid. c. Results demonstrated geographical factors related to regional disease. d. The king could isolate areas of disease from safe areas. ANS: C Survey methods were being used to study health problems. The medical topographies illustrated geographical factors related to regional health and disease. They did not address the safety of wells, housing areas, or the isolation of disease. DIF: Cognitive Level: Understand (Comprehension) 8. How did Edwin Chadwick’s ideas help decrease disease in the nineteenth century? a. The minimum wage was increased leading to improved quality of life. b. Parish workhouses where poverty-level children labored for their room and board were closed. c. Social reform legislation resulted in changes such as sidewalks. d. The new emphasis on individual responsibility encouraged people to act to protect their own health. ANS: C Edwin Chadwick’s Report on the Sanitary Conditions of the Labouring Population of Great Britain led to legislation for social reform, including child welfare, factory management, clean water, sewers, fireplugs, and sidewalks. This report did not address increasing the minimum wage, closing parish workhouses, or increasing individual responsibility. DIF: Cognitive Level: Understand (Comprehension) 9. Which best describes how John Snow was able to decrease deaths from cholera? a. Removed a source of contaminated water b. Created the world’s first antibiotic c. Encouraged the new process of vaccination d. Helped pass laws that reqNuUireRdShIomNeGqTuBCtiOneM ANS: A John Snow demonstrated that cholera was transmissible through contaminated water. He removed the pump handle from the contaminated water so an alternate source of water had to be used. Alexander Fleming created the first antibiotic. Legislators were responsible for encouraging the new process of vaccination and passing laws related to home quarantine. DIF: Cognitive Level: Understand (Comprehension) 10. Which best describes the achievement that Lemuel Shattuck is well known for in the United States? a. Publishing the census of Boston, which demonstrated the effect of sanitary reforms b. Demonstrating the usefulness of vital statistics by analyzing environmental data c. Developing ideas about public health care reform, which were eventually adopted d. Establishing a state board of health to deal with the problems he had noted ANS: C Lemuel Shattuck organized the American Statistical Society and issued a census, which demonstrated high mortality rates. His report of the Massachusetts Sanitary Commission recommended modern public health reforms. However, nothing was actually done about the recommendations for almost two decades. Eventually, the merit of his ideas was recognized. DIF: Cognitive Level: Understand (Comprehension) 11. Which nursing intervention would have most likely been used by Florence Nightingale when treating wounded soldiers? a. Establishing private visits with spouses b. Improving food, clothing, and cleanliness c. Administering intravenous medications d. Completing a community assessment of the army hospital ANS: B Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens and a laundry and provided food, clothing, dressings, and laboratory equipment. Her focus on environmental improvements did not address private spousal visits, administration of IV (intravenous) medications, or completion of a community assessment. DIF: Cognitive Level: Understand (Comprehension) 12. Which best describes how Nightingale responded to challenges about her suggestions for reform of health care? a. She influenced male friends as political leaders to publicize her ideas. b. She conveyed her statistical data in more detail and depth, and shared it with political leaders. c. She encouraged those who challenged her to come up with more acceptable approaches to lowering the death rate. d. She understood their concerns and tried to word her suggestions in a more politically acceptable way. ANS: B Nightingale felt very strongly about the unnecessary loss of life and shared her findings widely. When prominent maNleUleRadSeIrsNchGaTlleBCdOhMer conclusions, she rewrote her report in more depth and redistributed it to members of Parliament and military leaders. DIF: Cognitive Level: Understand (Comprehension) 13. When comparing a surgeon today with a surgeon of Nightingale’s time, which best describes the primary difference in how they would operate on a patient? a. Current physicians have better surgical equipment (tools). b. Current physicians have nursing support staff in the operating room. c. Current physicians would carefully scrub between cases. d. Current physicians would prescribe antibiotics in the operating room. ANS: C Physicians in Nightingale’s time believed in spontaneous generation, which stated that disease organisms grew from nothing, and were unaware of how diseases spread. Consequently, they did not use sanitary operating procedures, including scrubbing between cases. The different surgical equipment, nursing support, and use of antibiotics do not describe the primary difference. DIF: Cognitive Level: Apply (Application) 14. Which scientific belief or idea eventually changed medical practice and decreased morbidity and mortality? a. Bad fluids cause disease, which can be cured by their removal. U S N T O b. Specific contagious organisms cause disease. c. Spontaneous generation theory—disease grows naturally. d. The miasmic theory—environmental conditions cause disease. ANS: B The emergence of the germ theory of disease focused diagnosis and treatment on the individual organism and the individual disease. The theories related to bad fluids causing disease, spontaneous generation, and miasmic theory were all proven to be incorrect. DIF: Cognitive Level: Understand (Comprehension) 15. Why did local and state governments start to become more involved in controlling disease? a. Hospitals were becoming overcrowded. b. Businesses were unable to make a profit when employees were ill. c. Physicians demanded government support in their individual efforts. d. Citizens were becoming upset with local conditions. ANS: D Community outcry for social reform forced state and local governments to take notice of deplorable conditions and take more responsibility for controlling the spread of bacteria and other microorganisms. Hospital overcrowding, unprofitability of businesses, and physician demand for government support did not influence the increased involvement of local and state governments. DIF: Cognitive Level: Understand (Comprehension) 16. Which intervention was the first step in controlling the incidence of tuberculosis (TB)? a. Institutions were requiredNtoRrepoIrt TGB cBC. M b. Federal funding was devoted to seeking TB causes and cures. c. Physicians began surveillance of TB cases. d. States built large public hospitals to treat patients with TB. ANS: A Physicians fought being required to maintain surveillance of TB and TB health education. States had to build large state hospitals for treatment but that did not notably control the incidence. The New York City Health Department required institutions to report cases of TB in 1894 and required physicians to do the same by 1897. DIF: Cognitive Level: Understand (Comprehension) 17. Which best describes the overall result of Abraham Flexner’s report? a. All medical schools reorganized into the German model. b. Citizens were encouraged to become more involved in medical education. c. Folk healers again became more widely used than physicians. d. Funding was withdrawn from weak medical schools. ANS: D Funding was withdrawn such that scientifically inadequate medical schools closed, not reorganized into the German model. The Flexner report outlined shortcomings of weak schools that were not built on the German model of a scientific base. Physicians now emerged who had been taught the germ theory of disease. The report did not address citizen involvement in medical education or the increased use of folk healers. U S N T DIF: Cognitive Level: Understand (Comprehension) 18. Which group was primarily responsible for the establishment of the first school of public health? a. The American Medical Association b. The Association of State Departments of Public Health c. The federal government d. The Rockefeller Foundation ANS: D Philanthropic foundations influenced many health care efforts. The Rockefeller Sanitary Commission strived for the eradication of hookworm. This model of prevention was so successful that the Rockefeller Foundation established the first school of public health in 1916. DIF: Cognitive Level: Understand (Comprehension) 19. A family living in England in 1860 was part of the community where district nursing was implemented. Who would most likely have seen this family? a. A social worker and a nurse b. A health teacher and a nurse c. A nurse d. A physician and a nurse ANS: A A nurse and a social worker were assigned to each district to meet the needs of their communities in nursing, sociNal wRorkI, anGd heBCeduMcation. This plan was widely accepted and very successful. DIF: Cognitive Level: Apply (Application) 20. Which intervention was most helpful in assisting people become educated on healthful living in nineteenth-century England? a. Brochures were distributed without charge in public places. b. Health visitors joined nurses in providing care in the homes. c. Nurses spent the majority of their time teaching families. d. Schools set up health programs for neighborhood adults. ANS: B Health pamphlets alone had little effect, so health-visiting services enlisted home visitors to distribute health information to the poor. Eventually, although Nightingale thought district nurses should be the health teachers, district nurses provided care for the sick while the health visitor provided health information in the home. DIF: Cognitive Level: Understand (Comprehension) 21. Which best describes the district nursing service created in the United States by Lillian Wald and Mary Brewster? a. House on Henry Street b. Visiting Nurses Association c. New York City District Nursing Service U S N T O d. Wald and Brewster Nursing Service ANS: A They established a district nursing service on the Lower East Side of New York City called the House on Henry Street for all the unemployed and homeless immigrants who needed health care. It later evolved into the Visiting Nurse Association of New York City and helped establish public health nursing in the United States. DIF: Cognitive Level: Understand (Comprehension) 22. Which statement best summarizes Wald and Brewster’s approach to home nursing? a. “All services all the time” b. “Helping people to help themselves” c. “One person, one family, at a time” d. “Your home or ours” ANS: B The nursing service adopted the philosophy of meeting health needs of aggregates including social, economic, and environmental determinants of health. This aggregate approach empowered people of the community. A later director summarized their role as “one of helping people to help themselves.” Because they were empowering others, the other statements do not fit this philosophy. DIF: Cognitive Level: Understand (Comprehension) 23. Which did Lillian Wald help establish? a. Child employment centers with shortened work days b. Daycare centers for prescNhooRl-agIed cGhildBC M c. Nurseries for infants of working mothers d. School health nursing for school-aged children ANS: D Wald convinced the New York City Health Commissioner to put a public health nurse into a school. The experiment was so successful that schools adopted nursing on a widespread basis, thereby creating the field of school health nursing. Child employment centers, daycare centers, and nurseries for working mothers were not created by Wald. DIF: Cognitive Level: Understand (Comprehension) 24. Which statement best summarizes the view of nurses as seen in novels over the past 100 years? a. Nurses are and have always been seen as very strong intelligent women. b. For the past 50 years, nurses were primarily viewed as promiscuous women. c. Nurses are controlling, almost sadistic women who enjoy their power over patients. d. Nurses are obedient handmaidens to physicians, following whatever orders are given. ANS: B In the early 1900s novels began to depict strong, independent, female nurses. This continued until the 1960s and 1970s when they were presented very negatively as promiscuous “bed hopping honeys.” Popular literature showed the most negative image of nurses, and classics and children’s literature showed a more positive image. DIF: Cognitive Level: Understand (Comprehension) 25. Which best describes the primary focus of health care efforts in the United States? a. Acute illnesses and trauma b. Chronic diseases c. Diarrhea and starvation d. Infectious diseases ANS: B Whereas diarrhea, starvation, and infectious diseases are major causes of death in developing countries, in developed countries such as the United States, chronic diseases are the primary cause of mortality. DIF: Cognitive Level: Understand (Comprehension) 26. Which statement best describes why there is an increased need for advanced practice nurses in primary care? a. Clinics are being built in many middle-class neighborhoods. b. Hospitals are increasing their number of beds. c. More nurses are choosing to obtain master’s degrees. d. Most physicians are specialists. ANS: D NURSINGTB.COM In 2010, about two thirds of the active physicians in the United States were specialists. Because so many physicians are specialists and there is increasing demand for primary care providers, there are increased opportunities for advanced practice nurses in primary care. Hospitals are decreasing the number of beds, not increasing them. The need does not relate to clinics being built in middle-class neighborhoods or to nurses choosing to advance their education. DIF: Cognitive Level: Understand (Comprehension) 27. Which statement best explains the continued incidence of infectious disease in the United States today? a. Illness theory explains that there are many causes of illness resulting from environmental conditions. b. No single theory adequately explains why a particular person gets a particular illness at a particular time. c. The germ theory explains that a specific infection is caused solely by the invasion of particular bacteria. d. The theory of susceptibility states that an individual only gets ill when there is extensive stress in his or her life. ANS: B Each theory explains some disease under some conditions, but no single theory accounts for all disease. Infectious agents cause disease when a person is susceptible as a result of stress and/or environmental conditions. The definition of germ theory is correct; however, this does not best explain the continued incidence of infectious disease in the United States. Illness theory is not a major theory that is used to discuss incidence of infectious disease. DIF: Cognitive Level: Apply (Application) 28. Which best describes the primary concern both historically and today for many people when they become ill? a. Can they get an appointment to see their physician in a timely fashion? b. Can they get admitted to their local hospital without delay? c. How can they afford to take time off from work and lose pay to be ill? d. Will the expenses be covered by their health insurance? ANS: C The greatest health concerns at the beginning of the twentieth century were lost wages associated with sickness. This continues today as many employment positions do not have sick leave; if employees are not at work, they do not get paid. All illnesses do not require a visit to a physician or admission to a hospital. Historically, the public has not paid much attention to health care charges as health care insurance from third party reimbursement has been the payer for many health care services. DIF: Cognitive Level: Analyze (Analysis) 29. Which statement best describes the increase in life expectancy among Americans during the twentieth century? N R I G B.C M a. Life expectancy increased bUy 3S0 yeNarsT; the maOjority can be attributed to advances in medical technology. b. Life expectancy increased by 30 years; the majority can be attributed to public health efforts. c. Life expectancy increased by 30 years; the majority can be attributed to improved physician education. d. Life expectancy increased by 30 years; the majority can be attributed to increased access to care. ANS: B During the twentieth century, the health and life expectancy of persons living in the United States improved dramatically. It is important for nurses to realize that of the 30 years of life expectancy gained during the century, 25 years were attributable to public health efforts. The advances in medical technology, improved physician education, and increased access to care have not had the impact on increasing life expectancy that the public health efforts have had. DIF: Cognitive Level: Understand (Comprehension) 30. Which is a major challenge for health care provider education today? a. Ensuring that research findings related to families and groups are included in the curriculum b. Expanding the curriculum to allow additional experiences in community health settings outside the hospital c. Increasing course emphasis on environmental influences on health d. Refocusing the curriculum from care of the individual to needs of aggregates ANS: D There is an obvious need for a primary care curriculum that prepares students to meet the needs of aggregates through population-based strategies that include understanding of statistical data and epidemiology. Primary health care and health promotion rather than acute care treatment would be emphasized. Such a curriculum would move the focus from the individual to a broader population approach. DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE 1. Which tool(s) were used by Florence Nightingale to create change? (Select all that apply.) a. Her incredible beauty and personality b. Influence of all the nurses Nightingale trained c. Political advocacy d. Publication of treated soldiers’ death rate changed from 42% to 2% e. Use of statistics to demonstrate the effectiveness of her interventions f. Wealth of her family and relatives ANS: C, D, E Nightingale focused on the aggregate of British soldiers and used graphically depicted statistics and other data to demonstrate effectiveness of her interventions, which allowed her to become a political advocate on behalf of the soldiers. Nightingales’ beauty and personality, influence among nurses, and wealth were not tools used to create change. DIF: Cognitive Level: Unders NtaUnd R(SCo I mNp G reThe B ns .io C n)O M 2. Which of Nightingale’s ideas were forgotten until recently? (Select all that apply.) a. The need for education for women b. The influence of environment on health c. The importance of clinical practice for expertise to develop d. The need to recognize gender role limitations e. The problem-solving (nursing) process f. The use of statistics and a sound research base ANS: B, F As the text remarks, it is interesting to note that the paradigm for nursing education and practice did not incorporate her emphasis on statistics and a sound research base. It is also curious why her writing on health’s social and environmental determinants was not consulted until much later. Nightingale did not make issue with the need for education for women, importance of developing expertise through clinical practice, gender roles, or the problem-solving (nursing) process. DIF: Cognitive Level: Apply (Application) 3. Which best describes why folk healers are used by many people? (Select all that apply.) a. Folk healers are often effective. b. Folk healers do not charge for their efforts. c. Folk healers integrate religion and medicine. d. Folk healers use media very effectively. e. Folk healers may involve the whole family. f. Many physicians recommend folk healers. ANS: A, C, E Folk healers offer repeated success, as many of their medicines are effective; their healing practices are socially cohesive, often including family and neighbors; and folk healers often integrate religion and morality with medicine. Folk healers usually have a charge for their services. Folk healers may or may not be using media to promote their services. Most physicians do not recommend folk healers. DIF: Cognitive Level: Understand (Comprehension) 4. What current emphases are focusing attention on public health? (Select all that apply.) a. Cost containment and managed care models b. Focus on disease prevention and health promotion c. Increased funding for care of chronic diseases d. Liberal politicians encouraging public health as part of a national health reform e. Movies showing national disasters and government lack of preparedness f. Shortage of the H1N1 flu vaccine ANS: A, B With a current focus on cost containment and organization of health care services under managed care, the emphasis is increasingly on the community and public health. The community need for a focus on prevention, health promotion, and home care may become more widespread with the changing patterns of reimbursement. Holistic care requires multiple dimensions and must have more attention in the future. Unfortunately, funding has not increased, politicians and legNisUlaRtioSnIaNreGnTotBfo.cCusOedMon public health, and there has not been an emphasis on movies showing national disasters and lack of government preparedness. DIF: Cognitive Level: Understand (Comprehension) 5. Which were the chief factors that led to the creation and growth of health insurance plans? (Select all that apply.) a. Hospitals banded together, and their leaders encouraged such plans. b. Hospitals thought such a plan would allow them to expand further and faster. c. It was an employer alternative to increasing employee pay compensation. d. Nurses fought for the right of all citizens to purchase insurance as desired. e. Physicians were concerned with nonpayment of their office fees. f. Politicians encouraged this alternative to government-supported health care. ANS: A, C Physicians later sought insurance plans, but originally only hospitals created insurance plans based on American Medical Association (AMA) leadership encouragement. During World War II increasing salaries was not an option, so offering health insurance helped ensure employee retention. Although government-supported health plans were suggested as early as the 1930s, politicians were not seriously discussing government-supported care. DIF: Cognitive Level: Understand (Comprehension) Chapter 03: Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which statement best summarizes Lillian Wald’s achievements? a. She suggested new nursing specialties. b. She demonstrated how to improve health in communities. c. She gave expert clinical nursing care to her clients. d. She was appointed a national nursing leader. ANS: B Lillian Wald improved health in a community by using diplomacy and neighborhood power. She was elected president of a national nursing organization and created new nursing specialties such as school nursing. However, she is primarily known for her creation of Henry Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably improved health in many communities. DIF: Cognitive Level: Understand (Comprehension) 2. Which statement best describes “thinking upstream”? a. Modifying economic, political, and environmental factors b. Preparing for nursing career long-term goals by planning now c. Seeking causes of water and air pollution “upstream” from cities d. Trying to understand howNorRwhyIsoGmeoBn.e gCot Mill U S N T O ANS: A Upstream thinking actions focus on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world. DIF: Cognitive Level: Understand (Comprehension) 3. Which statement best describes a weakness of early nursing theories? a. Many nurses did not know or understand the theoretical basis of nursing practice. b. Most nursing theories focused on microscopic individual concerns. c. The theories did not reflect the actual world of nursing practice. d. The theories had global applicability to nursing practice. ANS: B Most nursing theories have an extremely narrow focus on individual nurse–patient care situations. This microscopic focus ignores the broader global social macroscopic perspective. DIF: Cognitive Level: Understand (Comprehension) 4. Which best describes the primary purpose of nursing theory? a. To improve nursing practice b. To demonstrate that nursing is a profession c. To organize nursing knowledge d. To serve as a basis for ongoing nursing research ANS: A Although nursing theory does serve as a basis for ongoing research, does help demonstrate that nursing is a profession, and may help nurses organize their knowledge; its primary purpose is to improve nursing practice. DIF: Cognitive Level: Understand (Comprehension) 5. A client did not attend the clinic for required follow-up care after his extensive surgery. Using the Health Belief Model, which would be the most appropriate conclusion for the nurse to make? a. The client is noncompliant. b. The client is suffering from self-neglect. c. The health care system is not meeting the client’s perceived needs. d. The health care system is not accessible for the client. e. The nurse has not motivated the client appropriately. ANS: C Although it is easy to blame the patient for being noncompliant or neglecting himself or herself, or to blame the nurse for not “educating” the patient appropriately, it is equally plausible that the health care system is not meeting the client’s perceived needs. Clients can have many reasons for not keeping an appointment, such as family emergencies, lack of funds, or lack of transportation. Sociocultural and ethnic barriers can also be factors. This is part of the Health Belief Model where the premise is that the world of the perceiver determines the action. DIF: Cognitive Level: Apply (Application) 6. Which assumption makes OrNemU’RsSthIeoNryGdTifBCltOtoMuse? a. That nurses will always be caring for families and groups b. That clients are able to control their environment c. That clients recognize the need for nursing intervention d. That teaching clients self-care is the primary goal of nursing practice ANS: B Orem’s theory emphasizes self-care not the need for nursing intervention. It assumes that the client can control his or her environment, whereas most persons cannot control work, school, or neighborhood environments. Orem’s theory is focused on individual self-care. The primary focus of nursing practice is on self-care needs and activities. DIF: Cognitive Level: Understand (Comprehension) 7. Which statement best describes the major assumption of the Health Belief Model (HBM)? a. People will act if action is both easy and convenient. b. People will act if exposed to fear messages stressing their vulnerability. c. The major determinant of preventive health behavior is avoiding disease. d. The major determinant of preventive behavior is providing proper health education. ANS: C The HBM is based on the assumption that the primary reason people act is disease avoidance. Such avoidance means they perceive themselves as susceptible to a serious disease, there is some cue to action, and there are more benefits than barriers to acting. DIF: Cognitive Level: Understand (Comprehension) 8. Which assumption of the Health Belief Model (HBM) is problematic? a. People have both free will and access to health resources. b. People listen to the advice given by health care professionals. c. People are influenced by health messages given over media channels. d. People make what they perceive as rational decisions in a given situation. ANS: A The HBM assumes that people have access to health resources, but such resources are not always available to certain groups. Economic, political, and environmental constraints interfere with free choice. The HBM may effectively promote behavior change by altering the patient’s perspectives, but it does not acknowledge the health professional’s responsibility to reduce health care barriers. The HBM places the burden of action exclusively on the client. DIF: Cognitive Level: Understand (Comprehension) 9. A nurse is using Milio’s framework for prevention to improve the health of clients. Which would the nurse most likely implement? a. Create appropriate national health policies. b. Develop health programs that make healthy choices the easiest choices. c. Promote nationwide educational programs with information on making healthy choices. N R I G B.C M d. Stress that clients are respoUnsibSle fNor tTheir owOn health. ANS: A The range of available choices is critical in shaping a society’s overall health status. Policy decisions in governmental and private organizations shape these choices. Hence, national-level policy making is the best way to impact the health of most Americans rather than continue to concentrate on imparting information in an effort to change individual behaviors. Milo challenged the notion that the main determinant for unhealthful behavior choice is lack of knowledge. DIF: Cognitive Level: Apply (Application) 10. A nurse is using Milio’s approach when caring for a client. Which advantage will the nurse experience? a. It will allow for care interventions outside the hospital system. b. It will demonstrate the effectiveness of using a variety of community resources. c. It will encourage the assessment of the personal and societal resources of the client. d. It facilitates open communication between the client and the nurse. ANS: C U S N T O As the model focuses on sociopolitical and environmental constraints to a client’s free choice, it also encourages assessment of such constraints, as well as suggesting alternative avenues to helping the patient obtain needed care. Milio encourages the practice of nursing from a broad understanding of health and illness. DIF: Cognitive Level: Apply (Application) 11. Which health-related variable is examined by the critical theoretical perspective? a. Cultural beliefs b. Effect of history and tradition c. Ethnic and racial differences d. Social inequalities ANS: D Critical theoretical perspective examines social inequalities within the broader political, economic, and social systems of society that keep people from reaching their full potential. Cultural beliefs, the effect of history and tradition, and ethnic and racial differences are not examined by the critical theoretical perspective. DIF: Cognitive Level: Understand (Comprehension) 12. A nurse is using the critical theoretical perspective in daily nursing practice. Which activity would the nurse most likely complete? a. Criticize health insurance programs as a barrier to health care. b. Expose social values underlying the health care system. c. Promote individual freedom and decision-making. d. Exert control over the cli N ent’ R s en I viro G nm B en . t. C M ANS: B Improvements can only be made if societal and personal values are made explicit. Once these values are recognized, they are more easily confronted. Change may be sought toward a more just society. Society must change for health and medical care to improve. Inequities of health care are connected to historically located social arrangements and cultural values of society. DIF: Cognitive Level: Apply (Application) 13. A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the community. Which strategy would the nurse most likely implement? a. Address the root causes of health problems. b. Choose one of the 28 focal areas for emphasis in funding and media attention. c. Concentrate on the goals of improving the quality of life. d. Continue funding expansion of the health care system. e. Expand efforts to put all medical records on electronic media. ANS: A The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social, economic, political, and value-laden processes of daily life that affect health (social determinants of health). Based on Healthy People 2020, advances are needed in these areas in order to improve health. DIF: Cognitive Level: Apply (Application) 14. Which is most closely associated with morbidity and mortality outcomes? a. Number of physicians per capita b. Insurance status c. Crime rate d. Personality traits ANS: B Tremendous disparities for access exist between insured and uninsured people in the United States. Access to care is associated with economic, social, and political factors, and depending on individual and population needs, it can be a primary determinant of health status and survival. Structural variables such as race-ethnicity, educational status, gender, and income are highly predictive of health status. DIF: Cognitive Level: Understand (Comprehension) 15. A nurse has accepted a new position in a public health department. Which characteristic is crucial to the nurse’s success? a. Advanced educational preparation b. Being knowledgeable about the community’s needs c. Listening and showing respect d. Caring and empathetic personality ANS: C Rather than nursing to the community, the nurse must work with the community to be successful. Listening, being patient, providing accurate information, and respecting the experiences of community members are essential for success. DIF: Cognitive Level: ApplyN(AUpRplSicaItiNonG)TB.COM 16. A nurse is using a macroscopic approach when providing care. Which would the nurse most l