NLE Reading Material

A community is concerned about the threat of bioterrorism.
Which of the following best describes the basis for this

concern?
a.) Bioterrorism has the potential to dissolve community-based programs.
b.) This threat could cause the health care system to collapse.
c.) The threat of bioterrorism may divert funds from other public safety health care programs.
d.) Fear of bioterrorism will increase the need for shelters.
c.) The threat of bioterrorism may divert funds from other public safety health care programs.
Bioterrorism may have an impact on the availability of resources for public safety health care programs. Because funds are
diverted it is possible that community-based programs would be eliminated, the health care system could experience
changes, and that there would be an increase in the need for shelter. However, all of these things would happen because of
the diversion of funds.
2
A PHN develops and implements local public health policies through partnerships with agencies, organizations, and
consumers within the community. Which of the following core public health functions is being used?
a.) Assessment
b.) Prevention
c.) Assurance
d.) Policy development
Policy development deals with developing and implementing health policies.
Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to
systematic data collection.
3
The nurse manager makes sure that the staff members who work in a local clinic are competent in their job
responsibilities. Which of the public health core functions is being demonstrated?
a.) Assurance
b.) Assessment
c.) Prevention
a.) Assurance
Assurance refers to making sure a competent health care workforce is available. Prevention is not a core function,
assessment refers to systematic data collection, and policy development refers to the need to provide leadership in
developing health policies.
4
The PHN analyzes data related to the number and type of United States Environmental Protection Agency air quality
standards that a community failed to meet. This data is an example of using which community health profile indicator?
a.) Sociodemographic characteristics
b.) Health status
c.) Health risk factor
d.) Functional status
c.) Health risk factor
Health risk factors discuss proportions of populations who have particular health conditions or health risks; breathing air
of poor quality is a risk to health. The number and proportion of people is a sociodemographic characteristic. Health status
includes birth and death rates. Functional status refers to reports of good health status by members of the population.
5
A population is best defined as a:
a.) high-risk group.
b.) those interacting within a school or institutional setting.
c.) collection of individuals who share at least one common characteristic.
d.) geographical location within a community.
c.) collection of individuals who share at least one common characteristic.
A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in
common. High risk groups, school or institutional setting, and geographical location within the community all describe
types of populations, not the definition of population.
6
A PHN has been prepared at the graduate level. Which of the following activities should the practitioner be able to
complete?
a.) Teach public and community health nursing
b.) Assess and intervene successfully at the aggregate level
c.) Diagnose and treat disease and have prescriptive authority
d.) Run for political office as experts in public health policy
b.) Assess and intervene successfully at the aggregate level

According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the
aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to
only nursing and medicine.
7
The PHN compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health
is being implemented?
a.) Assurance
b.) Assessment
c.) Prevention
b.) Assessment
Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a core
function, assurance is making sure essential services are available, and policy development is needed to provide leadership
in developing policies.
8
The nurse is investigating environmental health problems caused by contaminated ground water. Which of the following
types of nursing practice is being used?
a.) Community-oriented
b.) Community-based
c.) Policy development
d.) Tertiary care
Community-oriented nursing emphasizes the prevention of disease and disability. Community-based nursing practice is a
setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Policy
development seeks to build constituencies that can help bring about change in public policy. Tertiary care focuses on
highly specialized medical care.
9
A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse
performing?
b.) Public health
c.) Community health
d.) Community-based
d.) Community-based
Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where
they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability.
Public health nursing focuses on the care within the community as a whole. Community health nursing focuses on the
health status of individuals and the effect of their health status on the community as a whole.
10
A nurse is working in a community health nursing practice setting. Which of the following is the nurse most likely to
implement?
a.) Administrating a flu shot to a client in a physician’s office
b.) Conducting a flu shot clinic at a community center
c.) Performing a client assessment in a hospital
d.) Providing supervision of staff in a rehabilitation center
a.) Administrating a flu shot to a client in a physician’s office
Community health nursing practice focuses on the health of individuals, families, and groups and the effect of their health
status on the health of the community as a whole. Administrating a flu shot to an individual is the only example that meets
this criterion. Performing a client assessment focuses only on individual care and not the community. Providing
supervision of staff does not focus on the community. Conducting a flu shot clinic at a community center focuses on
protecting the community as a whole and would be considered public health nursing practice.
11
A public health department is using the mission of public health as described by the Institute of Medicine when planning
its health programming. Which of the following activities will most likely be implemented?
a.) Tracking avian flu outbreaks and doing surveillance in the United States
b.) Providing a flu shot for an elderly person at the health department
c.) Keeping track of alternative therapies in use in the United States
d.) Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta
a.) Tracking avian flu outbreaks and doing surveillance in the United States
The Institute of Medicine’s stated mission on public health is “to generate organized community and technical knowledge
to prevent disease and promote health.” Tracking avian flu outbreaks and doing surveillance applies this concept at a
population level. Providing a flu shot for an elderly person only addresses individual care. Keeping track of the use of
alternative therapies does nothing to prevent disease or promote health of the population. Keeping snake antivenom is
aimed at disease care for an individual, not health promotion or disease prevention.
12
The purpose of public health core functions is to:
a.) clarify the role of the government in fulfilling the mission of public health.
b.) ensure the safety of populations in receiving quality health care.

c.) provide community-based individualized care to every person in the United States.
d.) unite public and private providers of care in a comprehensive approach to providing health care.
a.) clarify the role of the government in fulfilling the mission of public health.
As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development,
and assurance are core functions at all levels of government for the purpose of clarifying the government’s role.
13
To better address emerging public health issues, a PHN plans to complete continuing education in this area. Which of the
following content areas should be included in the course that is chosen?
a.) Leadership
b.) Ethics
c.) Communication
d.) Finance
b.) Ethics
Public health workers should be educated in eight content areas to be able to address emerging public health issues and
advances in science and policy: (1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory
research, (5) policy, (6) law, (7) global health, and (8) ethics.
14
A public health department makes sure that the essential community-oriented health services are available in the
community. Which of the following core public health functions is being implemented?
a.) Policy development
b.) Assessment
c.) Assurance
d.) Scientifi knowledge-based care
c.) Assurance
Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately
carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring
about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating
information on both the health status and the health-related aspects of a community or a specific population. Public health
is based on scientific knowledge, but is not a core function.
15
A nurse is working in the community with an aggregate/population. Who is the nurse most likely to interact with?
a.) Students in a county school system
b.) Christians around the world

c.) A patient in the intensive care unit at the local hospital
d.) People who drink coffee
a.) Students in a county school system
A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in
common. Members of a community who can be defined in terms of geography or a special interest can be seen as
constituting a population. The clients in the first option share a geographical and special circumstance (school)
characteristic. Christians around the world are too large of a geographical space. A patient cannot be an
aggregate/population as there is no one to interact with. People who drink coffee share a common interest, but may not
share a common geographical location to interact.
16
The public health workforce should demonstrate competency in which of the following competency categories?
a.) Financial planning and management
b.) Workforce needs assessment
c.) Acute care services
d.) Curriculum development
a.) Financial planning and management
Workforce needs assessment, acute care services, and curriculum developments are not considered categories of core
competencies of public health. Rather there are eight categories of competency, which include: (1) analytic/assessment, (2)
policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of
practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems
thinking.
FLASHCARDS IN 2 - HISTORY OF PUBLIC HEALTH AND PUBLIC AND COMMUNITY HEALTH NURSING DECK
(29)
1
Current threats to health in the United States that community health nurses are faced include:
a.) diphtheria, cholera, and hepatitis.
b.) HIV, H1N1 influenza, and bioterrorism.
c.) avian flu, tuberculosis (TB), and radiation.
d.) polluted water and air.
b.) HIV, H1N1 influenza, and bioterrorism.
The newest threats to health that PHNs are involved in are HIV, H1N1 influenza, and bioterrorism.
Hepatitis is also a current threat, but diphtheria and cholera are not concerns in the United States. Avian
flu may be a threat, but radiation and TB are ongoing. Environmental pollution has been reduced;
however, there are pollution issues that do raise concerns.
2
During the time when the Rural Nursing Service was operating through the American Red Cross, a nurse
needed to demonstrate resourcefulness. Which of the following tasks would the nurse most likely have
done?
a.) Using hot bricks, salt, or sandbags to substitute for hot water bottles
b.) Testing well water for pollutants
c.) Teaching school and developing curricula for rural nursing programs
d.) Providing post-surgical care
a.) Using hot bricks, salt, or sandbags to substitute for hot water bottles
In providing medical care, rural nurses were resourceful in finding alternatives when they did not have
medical products that were available in urban areas. They were not involved in testing well water,
providing post-surgical care, or teaching in rural nursing programs.
3
A nurse worked in a school setting during the early twentieth century. Which of the following would have
been the focus of this nurse’s practice?
a.) Investigating causes of absenteeism
b.) Teaching school as well as being a nurse

c.) Promoting nursing as an autonomous practice
d.) Providing medical treatment to enable children to return to school
a.) Investigating causes of absenteeism
Early school nursing focused on investigating causes of absenteeism, not providing medical treatment.
That was the responsibility of physicians. Early school nurses did not teach in the schools. Early school
nurses did not promote nursing as an autonomous practice.
4
A nurse is working in a public health nursing setting. Which of the following best describes why this
specialty is appealing to nurses?
a.) Interactions with wealthy contributors to secure funding
b.) Autonomy and independence of practice
c.) Ability to locate the source of diseases and cure patients
d.) Opportunities to meet a variety of people
b.) Autonomy and independence of practice
Community health nurses have a long history of autonomous practice, problem solving, and decision
making. Community health care nurses engage in the other activities as well, but overall, they have been
best known for autonomy of practice.
5
A major provision of the Social Security Act of 1935 was the establishment of:
a.) the FNS to provide nursing service to rural communities.
b.) state and local community health services and training of personnel.
c.) district nursing to provide home health care to sick people.
d.) community-based settlement houses.
b.) state and local community health services and training of personnel.
Title VI of the Social Security Act provided funding for expanded opportunities for health protection and
promotion through education and employment of PHNs. Nurses completed educational programs in
public health and funds were provided to assist states, counties, and medical districts in the
establishment and maintenance of adequate health services.
6
A nurse is considering joining the American Public Health Association (APHA). Which of the following
information about this organization should be considered when making this decision?
a.) APHA focuses on the public health concerns of the medical profession.
b.) APHA represents concerns of nursing specialty practices.
c.) APHA provides a forum for nurses to discuss their public health concerns.
d.) APHA focuses on providing health promotion education to the public.
c.) APHA provides a forum for nurses to discuss their public health concerns.
APHA was formed to facilitate interprofessional efforts and promote the “practical application of public
hygiene.” The Public Health Section within APHA provides nurses with a forum to discuss their concerns
and strategies. It also serves as a focus of leadership and policy development for community/public
health nursing.
7
A nurse is providing care to clients through the FNS. Which of the following clients would the nurse most
likely have seen?
a.) An injured soldier
b.) A homebound, elderly male
c.) A woman in labor
d.) A child with measles
c.) A woman in labor
The FNS nurses were trained in nursing public health and midwifery and provided care to rural and
inaccessible areas, which led to reduced mortality. They would not have seen injured soldiers, males, or a
child with measles.
8
A student is enrolled in a nursing education program during World War II. Which of the following groups
would the student most likely have joined?
a.) The Public Health Service of New York City
b.) The Marine Nurse Corps
c.) The FNS
d.) The Cadet Nurse Corps

d.) The Cadet Nurse Corps
The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased
enrollment in schools of nursing at undergraduate and graduate levels. In 1925, Mary Breckinridge
established the FNS based on systems of care used in the Highlands and islands of Scotland (before
World War II). The first Marine Hospital opened in Norfolk, Virginia, in 1800. The Public Health Service of
New York City was not a group during this time frame.
9
A nurse is providing public health education based on the teachings of Lillian Wald. Which of the following
topics will the nurse most likely discuss?
a.) Taking and recording blood pressures accurately
b.) Safe and sanitary baby and child care
c.) Environmental pollutants and their effects on lung disease
d.) Time management: balancing factory work and the home
b.) Safe and sanitary baby and child care
Lillian Wald provided health care that included educating the community on health care matters. The
focus of the majority of her work was on health services and health promotion for families and children.
Because of her focus on health promotion for families and children, her primary role would not have
been taking and recording blood pressures, discussing environmental pollutants (as her focus was not
occupational health), or time management (as at this point in time very few women were working outside
of the home).
10
A nurse is comparing the historical practices of industrial and occupational health nurses. Which of the
following would the nurse most likely note when comparing these two occupations?
a.) Industrial nurses invented new machines to streamline production of medical goods, whereas
occupational health nurses provide care to employees.
b.) Industrial nurses investigated industrial injuries to improve work conditions, whereas occupational
health nurses demonstrated proper body mechanics.
c.) Industrial nurses treated work related-injuries, whereas occupational health nurses care for families in
their homes.
d.) Industrial nurses provided care for workers in their homes, whereas occupational health nurses care
for work-related injuries.
d.) Industrial nurses provided care for workers in their homes, whereas occupational health
nurses care for work-related injuries.
Early occupational health nursing did not provide care for work-related injuries, but instead focused on
the care of employees and their families in the home. Contemporary occupational health nurses provide
care for work-related injuries. The focus of both of these professions has been on employee care and the
work environment.
11
A nurse was involved in the original work of the National Organization for Public Health Nursing. Which of
the following best describes the influence this has had on nursing practice today?
a.) Requiring that PHNs have a baccalaureate degree in nursing
b.) Standardizing public health nursing education
c.) Developing nursing cooperatives
d.) Opening the Henry Street Settlement
b.) Standardizing public health nursing education
The National Organization for Public Health Nursing sought to standardize public health nursing. The
Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not
developed yet. Cooperative agreements were made between life insurance companies and visiting nurses
associations that expanded availability of public health nursing services.
12
Lillian Wald’s major contribution to public health nursing was:
a.) founding the American Nurses Association.
b.) developing the New York Training Hospital for Nurses.
c.) creating the Public Health Service.
d.) establishing the Henry Street Settlement.
d.) establishing the Henry Street Settlement.
Lillian Wald established the Henry Street Settlement. Isabel Hampton Robb founded the American Nurses
Association. Lillian Wald was a graduate of the New York Training Hospital for Nurses. The Public Health
Service was established by the federal government.
13
In the past, population-centered nurses have been called:
a.) district nurses.

b.) almshouse nurses.
c.) soldier nurses.
d.) sisters.
a.) district nurses.
In the past, population-centered nurses have been called public health nurses (PHNs), district nurses,
visiting nurses, school nurses, occupational health nurses, and home health nurses. Many women who
performed nursing functions in almshouses and early hospitals in Great Britain were poorly educated,
untrained, and often undependable. The original soldier nurses worked with Florence Nightingale at
Scutari. Various groups of “sisters” have been used throughout history to care for the poor.
14
Nurses who provided care to people in their homes and provided that care to several people at a time
were called _____ nurses.
a.) private duty
b.) visiting
c.) public health
d.) community health
b.) visiting
The visiting nurse cared for several families in a day and helped make care of the sick poor at home
economical, whereas a private duty nurse may live with a family of clients receiving care and was to be
available 24 hours a day. PHNs focused on care of populations. Community health nurses would be
considered to be anyone who worked outside of a hospital setting.
15
A PHN is compiling information about how to promote early detection of breast cancer in women. Which
document would most likely provide useful information about this topic?
a.) The Future of Public Health
b.) Healthy People 2020
c.) Patient Protection and Affordable Care Act
d.) Scope and Standards of Public Health Nursing Practice
b.) Healthy People 2020

The Healthy People documents propose national strategies to improve significantly the health of
Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious
diseases. The other documents do not address health promotion topics.
16
A nurse had the opportunity to work with Mary Breckinridge. Which of the following would the nurse
most likely have assisted with?
a.) Establishing the Henry Street Settlement
b.) Developing health programs geared toward improving the health care of the rural populations
c.) Blazing a nursing trail through the Rockies, providing nursing care to miners and their families
d.) Teaching birth control measures to large numbers of women in the South
b.) Developing health programs geared toward improving the health care of the rural populations
Mary Breckinridge developed health programs geared toward improving the health care of the rural and
often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established
the Henry Street Settlement.
ECONOMICS OF HEALTH CARE DELIVERY DECK (33)
1
A nurse plans to implement a primary prevention strategy in the community. Which of the following would the nurse most
likely complete?
a.) Development of a smoking prevention program
b.) Development of a support group for widows
c.) Development of a hypertension screening program
d.) Development of a hospice care program
a.) Development of a smoking prevention program
Primary prevention’s aim is preventing disease. Development of a smoking prevention program is primary prevention.
Development of a support group for widows and development of a hospice care program are examples of tertiary
prevention. Development of a hypertension screening program is an example of secondary prevention.
2
A nurse is working with members of the community to assist them with acquiring health insurance. Which of the
following individuals is most likely to be uninsured?
a.) An 82-year-old woman with chronic medical problems
b.) A 2-year-old whose mother is on welfare
c.) A 50-year-old businessman who works for a large corporation
d.) A 32-year-old man who works part-time at a small business
d.) A 32-year-old man who works part-time at a small business
The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The
elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at
the large corporation probably has health insurance, since most large businesses provide it.
3
When a health care organization’s fees for delivery of services are not decided until after they are provided, it is called:
a.) retrospective reimbursement.
b.) prospective reimbursement.
c.) fee-for-service.
d.) capitation.
Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set
after services are delivered.
Prospective reimbursement is whereby the third-party payer establishes the amount of money that will be paid for the
delivery of a particular service before offering services to the client.
Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of
providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays
the bill.
Capitation is similar to prospective reimbursement for health care organizations; third-party payers determine the amount
that practitioners will be paid for a unit of care.
4
The allocation of scarce resources within the health care sector and the focus on resource allocation issues related to
producing and distributing health care is called:
a.) economics.
b.) health economics.
c.) public health economics.
d.) microeconomic theory.
b.) health economics.
Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation
issues related to producing and distributing health care. Economics is the science concerned with the use of resources,
including the production, distribution, and consumption of goods and services. Public health economics focuses on the
production, distribution, and consumption of goods and services as related to public health and where limited public
resources might best be spent to save lives or increase the quality of life. Microeconomic theory deals with the behaviors
of individuals and organizations and the effects of those behaviors on prices, costs, and the allocation and distribution of
resources.
5
A nurse discusses services with a federal congressman. Which of the following services would the nurse most likely be
discussing?
a.) Family planning
b.) Counseling
c.) Policy making
d.) Prevention of communicable diseases
c.) Policy making
Policy making is offered at the federal level. Family planning, counseling, and preventing communicable and infectious
disease are offered at the state and local levels.
6
An employee is able to receive health insurance from a former employer after changing jobs. Which of the following best
describes the legislation that makes this possible?
a.) Health Insurance Portability and Accountability Act (HIPAA)

b.) Omnibus Budget Reconciliation Act
c.) Balanced Budget Act of 1997
d.) Social Security Act of 1935
a.) Health Insurance Portability and Accountability Act (HIPAA)
HIPAA is a federal intervention to protect health insurance coverage for workers and families following a job change or
loss. The Omnibus Budget Reconciliation Act was a major effort to regulate and control the costs of physician fees. The
Balanced Budget Act of 1997 determined that payments to Medicare skilled nursing facilities (SNFs) would be made on
the basis of prospective payment system (PPS). The Social Security Act of 1935 signaled the federal government’s
increasing interest in addressing social welfare problems.
7
When a third-party payer establishes the amount of money that will be paid for the delivery of a particular service before
offering the service to the client, it is called:
c.) fee-for-service.
d.) capitation.
Prospective reimbursement is the method of paying an organization whereby the third-party payer establishes the amount
of money that will be paid for the delivery of a particular service before offering the services to the client. Retrospective
reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services
are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines
the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who
then pays the bill. Capitation is similar to prospective reimbursement for health care organizations; third-party payers
determine the amount that practitioners will be paid for a unit of care.
8
A nurse implements a teen pregnancy prevention program in a high school that has been shown to decrease the rate of teen
pregnancy. Which of the following best describes the nurse’s action?'
a.) Effectiveness
b.) Efficiency
c.) Microeconomics
d.) Production
a.) Effectiveness
Effectiveness refers to the extent to which a health care service meets a stated goal or objective, or how well a program or
service achieves what is intended. Efficiency refers to producing maximum output using a given set of resources.
Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and
budget constraints of health care. Production refers to how goods are produced or created.
9
A nurse is examining the characteristics that affect one’s health. Which of the following would be of greatest concern to
the nurse?
a.) Obesity
b.) Marital status
c.) Health insurance
d.) Age
a.) Obesity
Personal behavior/lifestyle (obesity) has the greatest effect on health. Environmental factors (marital status) and human
biology (age) are next followed by the health care system (health insurance).
10
A characterization of the fourth developmental phase of the health services delivery framework is:
a.) nurses in the United States being predominantly women.
b.) the expansion of the number and type of health care facilities.
c.) dependence on technology for patient care.
d.) the discovery and development of pharmacological advances.
c.) dependence on technology for patient care.
Nurses have become dependent on technologies to monitor client progress, make decisions about care, and deliver care in
innovative ways as part of the fourth phase. The discovery and development of pharmacological advances is only one way
that technology has increased during the fourth phase. Phase one was concerned with epidemics and infectious disease
control. Physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the
expansion of hospital clinics and long-term care facilities.
11
A nurse is discussing the services that are covered under Medicare Part A with a client who has recently become eligible
for Medicare. Which of the following services is the nurse most likely to mention?
a.) Blood draw to assess prothrombin time (PT)/International Normalized Ratio (INR)
b.) Physical therapy visit
c.) Stay in skilled nursing facility
d.) Transportation by an ambulance
c.) Stay in skilled nursing facility
Medicare Part A covers hospital care, home care, and skilled nursing care.
Laboratory and physical therapy services and transportation by ambulance would be covered by Medicare Part B.
12
A nurse is working with a client who receives health insurance through a managed care organization. Which of the
following best describes this insurance?
a.) Medicare
b.) Medicaid
c.) MSAs
d.) Health maintenance organizations
d.) Health maintenance organizations
Health maintenance organizations and preferred provider organizations are types of managed care. Medicare and Medicaid
are government insurance programs. MSAs are not a type of health insurance.
13
Which was considered the first national health insurance plan in the United States?
a.) Health Maintenance Organization (HMO) Act
c.) Marine Hospital Service
c.) Medicare
d.) Medicaid
c.) Marine Hospital Service
The Marine Hospital Service was created in 1798 by the federal government to provide medical service for sick and
disabled sailors and to protect the nation’s borders against the importing of disease through seaports. The HMO Act
provided assistance and expansion for HMOs in the 1970s. Medicare and Medicaid were established in 1965 to provide
health care services to certain populations.
14
A community health nurse is assisting clients to access health care. Which of the following individuals would most likely
experience a barrier when accessing health care?
a.) A 40-year-old female who speaks English
b.) A 25-year-old female with health insurance
c.) A 50-year-old male with hypertension
d.) A 30-year-old male who is unemployed
d.) A 30-year-old male who is unemployed
Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers,
communication problems, child care needs, lack of time or information, or refusal of services by providers. The
unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health
insurance and limit his income.
15
A nurse enrolls in a microeconomics course at a local college. Which of the following best describes the rationale for
taking this course?
a.) Nurses are often the ones to allocate resources to solve a problem.
b.) Nurses are often involved in federal policy making.
c.) Health care policy can be influenced using these principles.
d.) Health care supplies can be very costly and nurses must use them wisely.
a.) Nurses are often the ones to allocate resources to solve a problem.
Nurses often allocate resources, design, plan, coordinate, and evaluate community-based health services. Policy making
addresses a macroeconomics issue. It is true that nurses need to know about microeconomics in order to use resources
appropriately, but the scope of quality of care and use of health care supplies is larger than the scope of only
microeconomics.
16
A nurse is faced with a macroeconomics issue. Which of the following best describes what is happening?
a.) The evaluation of client access to services
b.) A health policy that makes the development of a new program possible
c.) Informing clients and others of the cost of service
d.) The referral of clients to available services
b.) A health policy that makes the development of a new program possible
Macroeconomics focuses on the “big picture,” such as a program, whereas microeconomics focuses on the individual or
organization.
CULTURAL DIVERSITY IN THE COMMUNITY DECK (33)
1
Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine,
and they experience significantly weaker effects from the drug. Which of the following types of cultural
variations is being demonstrated?
a.) Biological variations
b.) Personal space
c.) Social organization
d.) Perception of time
a.) Biological variations
Biological variations are the physical, biological, and physiological differences that exist between racial
groups and distinguish one group from another. Personal space is the physical distance between two
individuals during an interaction. Social organization refers to the way in which a cultural group structures
itself around the family to carry out role functions. Perception of time is the duration or period between
successive events, where some cultures assign greater or lesser emphasis to events that occur in the past,
present, or future.
2
A nurse will be using an interpreter during a client encounter. Which of the following considerations
should be made by the nurse? (Select all that apply.)
a.) It is appropriate to use family members as interpreters.
b.) Written materials should be available in the client’s primary language.
c.) Observe the interpreter’s gestures to assure client understanding.
d.) The gender, age, and educational level of the interpreter should be evaluated.
e.) The nurse should face the interpreter when speaking.
b.) Written materials should be available in the client’s primary language.
d.) The gender, age, and educational level of the interpreter should be evaluated.
Family members should be used with caution. The client’s gestures and nonverbal messages should be
observed to assure understanding. Written materials should be available in the client’s primary language.
The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered
when selecting the proper interpreter. The nurse should face the client during the dialogue, not the
interpreter.
3
A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he
should take pain medication instead. Which of the following best describes the action taken by the nurse?
a.) Cultural conflict
b.) Cultural blindness
c.) Cultural relativism
d.) Cultural imposition
d.) Cultural imposition
This is an example of cultural imposition—the act of imposing one’s cultural beliefs, values, and practices
on individuals from another culture.
Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when
nurses are unable to respond appropriately to another individual’s cultural practice because of
unfamiliarity with the practice.
Cultural blindness occurs when people state that everyone is treated the same, regardless of their
cultural orientation.
Cultural relativism recognizes that clients have different approaches to health, and that each culture
should be judged on its own merit and not on the nurse’s personal beliefs.
4
Hispanics tend to believe that the needs of the family take priority over those of the individual. Which of
the following types of cultural variations is being demonstrated?
a.) Communication
b.) Personal space
d.) Environmental control
Social organization refers to the way in which a cultural group structures itself around the family to carry
out role functions. Communication is the means by which culture is shared (verbal and nonverbal).
Personal space is the physical distance between two individuals during an interaction. Environmental
control refers to the person’s relationship with nature and to plan and direct factors in the environment
that affect them.
5
In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to
them to provide direction for current situations. Which of the following types of cultural variations is
being demonstrated?
a.) Communication
b.) Personal space
Perception of time is the duration or period between successive events, where some cultures assign
greater or lesser emphasis to events that occur in the past, present, or future. Communication is the
means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between
two individuals during an interaction. Social organization refers to the way in which a cultural group
structures itself around the family to carry out role functions.
6
A nurse supports the use of traditional home remedies in conjunction with Western medicine to promote
healthy behaviors. Which of the following is being demonstrated by the nurse?
a.) Cultural accommodation
b.) Cultural awareness
c.) Cultural preservation
d.) Cultural repatterning
Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions
that help the clients of a particular culture to retain and preserve traditional values, so they can maintain,
promote, and restore health. Cultural accommodation refers to assistive, supportive, facilitative, or
enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or
negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-
examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence
behavior toward other cultural groups. Cultural repatterning refers to assistive, supportive, facilitative, or
enabling nurse actions and decisions that help clients of a particular culture to change or modify a
cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.
7
A nurse believes that the best treatment for illness is the use of Western medicine and alternative
therapies should not be used for healing. Which of the following best describes what has happened?
a.) Ethnocentrism
b.) Cultural imposition
c.) Racism
d.) Stereotyping
a.) Ethnocentrism
Ethnocentrism is the belief that one’s own cultural group determines the standards by which another
group’s behavior is judged. Cultural imposition is the act of imposing one’s cultural beliefs, values, and
practices on individuals from another culture. Racism is a form of prejudice that occurs through the
exercise of power by individuals and institutions against people who are judged to be inferior on the basis
of intelligence, morals, beauty, inheritance, and self-worth. Stereotyping is ascribing certain beliefs and
behaviors about a given racial and ethnic group to an individual without assessing for individual
differences.
8
A Mexican American mother insists on using special candles to help her daughter’s ear infection. The
nurse asks the mother if she would also give her daughter antibiotics. Which of the following best
describes the action of the nurse?
b.) Cultural repatterning
c.) Culture brokering
d.) Cultural awareness
This means that the nurse supports and facilitates the use of cultural practices with interventions from
the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative, or
enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or
negotiate with nurses to achieve satisfying health care outcomes.
Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions
that help clients of a particular culture to change or modify a cultural practice for new or different health
care patterns that are meaningful, satisfying, and beneficial.
Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and
the biomedical health care culture on behalf of clients.
Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases,
stereotypes, and prejudices as they influence behavior toward other cultural groups.
9
A nurse advocates and intervenes between the health care system and the client’s cultural beliefs on
behalf of the client. Which of the following best describes the nurse’s action?
b.) Culture brokering
d.) Cultural repatterning
b.) Culture brokering
Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and
the biomedical health care culture on behalf of clients. Cultural accommodation refers to assistive,
supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture
accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural
preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help
the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote,
and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse
actions and decisions that help clients of a particular culture to change or modify a cultural practice for
new or different health care patterns that are meaningful, satisfying, and beneficial.
10
The tendency to ignore all differences between cultures and to act as though the differences do not exist
is defined as:
a.) cultural conflict.
b.) culture shock.
c.) cultural blindness.
d.) cultural imposition.
c.) cultural blindness.
Cultural blindness occurs when people state that everyone is treated the same, regardless of their
cultural orientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of
expectations when nurses are unable to respond appropriately to another individual’s cultural practice
because of unfamiliarity with the practice. Culture shock is the feeling of helplessness, discomfort, and
disorientation experienced by an individual attempting to understand or effectively adapt to a cultural
group whose beliefs and values are radically different from the individual’s culture. Cultural imposition is
the act of imposing one’s cultural beliefs, values, and practices on individuals from another country.
11
A nurse is working with a population that exhibits a large amount of diversity. The nurse recognizes that
skin color of individuals within this population is an example of:
a.) multiculturalism.
b.) ethnicity.
c.) race.
d.) culture.
c.) race.
Race is primarily a social classification that relies on physical markers. Multiculturalism is the blending of
diverse cultures. Ethnicity is the shared feeling of peoplehood among a group of individuals and relates to
cultural factors, such as nationality, geographic region, culture, ancestry, language, beliefs, and traditions.
Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of
people and transmitted intergenerationally.
12
A client shares with the nurse that her grandparents immigrated to the United States from Germany.
Which of the following best describes what she has disclosed?
a.) Multiculturalism
b.) Ethnicity
c.) Race
d.) Culture
b.) Ethnicity
Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin.
Multiculturalism is the blending of diverse cultures. Race is primarily a social classification that relies on
physical markers. Culture is a set of beliefs, values, and assumptions about life that are widely held
among a group of people and transmitted intergenerationally.
13
A nurse is observing behaviors that may be defined by culture. Which of the following is the nurse most
likely to observe?
a.) Speaking a dialect of a language in a local region
b.) Standing when an older adult gets on the bus to give him a seat
c.) Immigrating to the United States and seeking work
d.) An organizational structure of a cultural group
b.) Standing when an older adult gets on the bus to give him a seat
Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of
people and is transmitted intergenerationally. Behaviors may be culturally determined, as illustrated in
the correct response. This behavior is based on the value of respect of elderly people. Speaking a
particular dialect in a local area would not fit the definition of culture. An organizational structure of a
group is not an observable behavior. Immigrating to the United States does not demonstrate culture.
14
A nurse is unable to provide culturally competent care to a population within the community. Which of
the following is an effect of this type of care?
a.) Enhanced communication
b.) Increased cost of health care
c.) Achievement of health indicators
d.) Improvement in client compliance
b.) Increased cost of health care
Care that is not culturally competent may increase health care costs and decrease positive client
outcomes. Communication is inhibited through care that is not culturally competent. It is not possible to
achieve health indicators if culturally competent care is not given. Client compliance decreases if
culturally competent care is not provided.
15
A nurse wants to obtain information on the alternative methods of health care her 45-year- old female
client uses. Who would be the best person to ask about this?
a.) The husband of the client
b.) A community leader of the ethnic group
c.) The client herself
d.) The religious leader of the ethnic group
c.) The client herself
Clients provide a rich source of information about their own cultures. The client would be the preferred
person to collect this information instead of the husband, community leader, or religious leader.
16
Which of the following statements about race is true?
a.) In the United States, children of biracial parents are usually assigned the race of the father.
b.) Ethnicity and race are synonymous terms.

c.) Individuals may be of the same race but of different cultures.
d.) No social significance is usually placed on race.
c.) Individuals may be of the same race but of different cultures.
It is often a misconception that persons of the same race have the same culture. For example, African
Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very
different cultures. In the United States, children of biracial parents are usually assigned the race of the
mother. Ethnicity is a contrasting term to race. Race is a characteristic that allows for some groups to be
separated, treated as superior, and given access to power and other valued resources, while others are
treated as inferior and have limited access to power and resources.
CHANGING HEALTH BEHAVIOR USING HEALTH EDUCATION WITH INDIVIDUALS, FAMILIES, AND
GROUPS DECK (32)
1
What is the purpose of providing education across the three levels of prevention? Education:
a.) enables clients to attain optimal health.
b.) identifies and treats health problems early to eliminate disability.
c.) enables populations to break into individuals.
d.) teaches people about Healthy People 2020.
a.) enables clients to attain optimal health.
Health education enables clients to attain optimal health, prevent health problems, and identify and treat
health problems early to minimize disability. Elimination of disability may not be possible. Health
education does not teach about the Healthy People 2020 document or break populations into
individuals.
2
Which statement about education is true?
a.) It emphasizes the provider of knowledge and skills.
b.) It emphasizes the recipient of knowledge and skills.
c.) It is a process of gaining knowledge and expertise.
d.) It results in behavioral change.
a.) It emphasizes the provider of knowledge and skills.
Education is the establishment and arrangement of events to facilitate learning. Education emphasizes
the provider’s role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and
skills. Education does not necessarily result in change, as change is typically not easy for most people.
Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise.
3
A nurse uses Healthy People 2020 as a guide when planning health education in the community. Which of
the following actions would be taken by the nurse?
a.) Focus on avoiding cigarette smoking and using alcohol in moderation
b.) Educate clients using primary and secondary levels of prevention
c.) Use Bloom’s taxonomy when planning educational objectives

d.) Design health fairs aimed at individuals
b.) Educate clients using primary and secondary levels of prevention
Healthy People 2020 focuses on implementing health promotion in priority areas using primary and
secondary prevention. Understanding the three learning domains is crucial in providing effective health
care. Health fairs targeted at specific populations can provide a venue for providing primary and
secondary prevention.
4
The cognitive domain includes:
a.) changes in attitudes and the development of values.
b.) the performance of skills.
c.) memory, recognition, understanding, reasoning, and problem solving.
d.) memorization of one set of skills before moving on to the next.
c.) memory, recognition, understanding, reasoning, and problem solving.
The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The
affective domain includes changes in attitudes and the development of values. The psychomotor domain
includes the performance of skills that require some degree of neuromuscular coordination and
emphasizes motor skills. Memorization of skills is only one part of the cognitive domain.
5
A nurse is teaching a client about how to complete a wound dressing change. Which of the following
conditions must be met before learning will occur?
a.) Must be able to memorize the instructions, relay this information to a partner, and demonstrate the
dressing change
b.) Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and
teach another person
c.) Must be able to speak the language of the nurse, have time to practice the dressing change, and
master the dressing change in a short time
d.) Must have the necessary ability, a sensory image of how to carry out the dressing change, and an
opportunity to practice the dressing change
d.) Must have the necessary ability, a sensory image of how to carry out the dressing change, and
an opportunity to practice the dressing change
Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how
to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the
necessary requirements of the learner.
6
A health educator is trying to change a client’s attitudes about smoking. Which of the following domains
would be used?
a.) Cognitive
b.) Affective
c.) Psychomotor
d.) Developmental
b.) Affective
The affective domain is used to attempt to influence what individuals, families, communities, and
populations feel, think, and value.
The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving.
The psychomotor domain includes the performance of skills that require some degree of neuromuscular
coordination and emphasizes motor skills.
Developmental domain is not one of the domains of learning.

7
The nurse is teaching a new diabetic client how to give himself an insulin injection. Which of the following
domains would be used?
a.) Developmental
b.) Cognitive
c.) Affective
d.) Psychomotor
d.) Psychomotor
The psychomotor domain includes the performance of tasks that require some degree of neuromuscular
coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning.
The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The
affective domain is used to attempt to influence what individuals, families, communities, and populations
feel, think, and value.
8
A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother
is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines
the expectations of breastfeeding for the mother and the baby. Considering the events of instruction,
which of the following should the nurse do next?
a.) Ask the mother about her previous experience with breastfeeding
b.) Demonstrate how to position the baby for breastfeeding
c.) Show the mother a video about breastfeeding
d.) Have the mother demonstrate breastfeeding
a.) Ask the mother about her previous experience with breastfeeding
Asking the mother about her previous experience with breastfeeding identifies her educational needs.
Using the TEACH mnemonic, the first thing the nurse should do is “Tune in”: listen before starting to
teach; the client’s needs should direct the content. Thus, this should be done before the nurse does any
demonstration, showing of audiovisual resources, or return demonstration.
9
A nurse has evaluated the learning needs of a community support group. Which of following steps should
the nurse take when developing an educational program for them?
a.) Consider any potential barriers to learning
b.) Establish goals and objectives for the program
c.) Select appropriate materials for the program
d.) Assess the dynamics of the group
b.) Establish goals and objectives for the program
Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the
educational process are: (1) identifying educational needs, (2) establishing educational goals and
objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5)
evaluating the educational process.
10
A nurse is developing a goal for a client who is learning how to care for an ostomy. Which of the following
would be most appropriate to develop?
a.) The client will look at his stoma without disgust each time his ostomy bag comes off.
b.) The client will be able to independently take care of his ostomy bag within three months.
c.) The client will gather all ostomy supplies correctly each time his ostomy bag needs to be changed.
d.) The client will successfully describe to the nurse how to care for his ostomy when he is asked.
b.) The client will be able to independently take care of his ostomy bag within three months.
Goals are broad, long-term expected outcomes. The correct answer describes something that will happen
over a long period of time. The other choices describe objectives.
11
A community health nurse is writing an objective. Which of the following would be most appropriate for
the nurse to write?
a.) Each member of the family will give an insulin injection to the client with accurate dosage 100% of the
time for 10 consecutive trials.
b.) The client will perform a blood sugar test on herself with an accurate blood sugar reading.
c.) The community will take their children to receive immunizations within 1 month of the immunization
due date.
d.) Fifty percent of the eligible women seen in the clinic will return for their scheduled
mammogram appointment.
a.) Each member of the family will give an insulin injection to the client with accurate dosage 100%
of the time for 10 consecutive trials.
Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term
goal. They are written as statements of an intended outcome or expected change in behaviors and should
be defined in measurable terms. The objective “each member of the family will give an insulin injection to
the client with accurate dosage 100% of the time for 10 consecutive trials” contains the components of a
written objective. “The client will perform a blood sugar test on herself with an accurate blood sugar
reading” does not provide any measureable terms. “The community will take their children to receive
immunizations within 1 month of the immunization due date” does not provide a measurable percentage
of the members of the community. “Fifty percent of the eligible women seen in the clinic will return for
their scheduled mammogram appointment” focuses on a long-term goal, rather than a short-term
objective and does not provide a time frame for when this would be measured.
12
A nurse is using the educational process of selecting appropriate educational methods when planning a
community health program. Which of the following steps of the nursing process does this action most
resemble?
a.) Assessment
b.) Evaluation
c.) Implementation
d.) Planning
d.) Planning
Assessment would be identifying educational needs, evaluation would be evaluating educational process,
and implementation would be implementing the educational plan. Planning is similar to selecting
appropriate educational methods.
13
A nurse is teaching a group of clients newly diagnosed with diabetes how to give themselves injections.
Which of the following formats would be most appropriate for the nurse to use?
a.) Demonstration
b.) Health fair
c.) Lecture
d.) Non-native language session
a.) Demonstration
Demonstration also includes return demonstration. Giving injections can best be learned by seeing the
behavior being done. Health fairs target specific populations and are held in a variety of locations. Non-
native language sessions are a way to adapt the health fair to a population that does not speak English.
Lecture is a non-interactive method of teaching.
14
A nurse is implementing an educational program about the importance of being physically active. Which
of the following steps would the nurse complete first?
a.) Provide learning guidance
b.) Present the stimulus
c.) Gain the learner’s attention
d.) Ask learners to recall prior learning
c.) Gain the learner’s attention
Gaining the learner’s attention must happen first before learning can take place. The following steps of
implementation include telling the learners the objectives of the instruction, asking learners to recall
previous knowledge, presenting the essential materials, helping the learners apply the information,
encouraging learning to demonstrate what they have learned, and providing feedback to help learners
improve their knowledge and skills.
15
A nurse is implementing a community health education program at a local church. Which of the following
educational principles should the nurse implement when providing this education?
a.) Refer to trustworthy sources
b.) Use an active voice
c.) Create the best learning environment
d.) Accentuate the positive health behaviors of the participants
c.) Create the best learning environment
The environment must be conducive to learning for educational programs to be effective. The
environment should be free of distractions and consistent with the message. The other strategies may
assist with the educational program, but are not one of the major educational principles discussed in the
textbook.
16
A nurse is working with a group of clients diagnosed with diabetes and is teaching a class about avoiding
the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of
diabetes, which was taught the week before. Which of the following principles of effective education is the
nurse using?
a.) Stimulating recall of prior learning
b.) Gaining attention
c.) Presenting the material
d.) Providing learning guidance
a.) Stimulating recall of prior learning
The educator should have the learners recall previous knowledge related to the topic of interest. The
principle of gaining attention should have been applied as the program started the week before. Recall
should be done before new material is presented and before learning guidance is provided.
COMMUNITY AS CLIENT: ASSESSMENT AND ANALYSIS DECK (31)
1
A nurse focuses intervention strategies on the structural dimension of community health. Which of the
following best describes the focus of these strategies?
a.) Health services
b.) Primary prevention
c.) Health promotion
d.) Secondary prevention
a.) Health services
The structure of the community is defined in terms of services and resources. The subsystems of
community structure consist of physical environment, health and social services, economy, transportation
and safety, politics and government, communication, education, and recreation.
Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.
Primary prevention attempts to promote health and provide specific protection from disease.
Health promotion activities are interventions focused on improving one’s health.

2
A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the
community. Which of the following types of data is being collected?
a.) Quantitative
b.) Qualitative
c.) Focus groups
d.) Participant observation
b.) Qualitative
Qualitative data is collected through interviews and observation. This data is the descriptions provided
by these individuals through interviews.
Quantitative data is the numbers that can be found about the community, such as crime statistics.
A focus group is similar to an interview in that it collects data mainly through asking open-ended
questions to participants, but to a small group rather than an individual.
Participant observation refers to the deliberate sharing in the life of a community, such as participating
in a local fair or festival, or attending a political or social event.
3
A nurse is defining the community as part of the community assessment process. Which of the following
best describes how the community may be defined? (Select all that apply.)
a.) Social group determined by geographic boundaries
b.) Group of people who share common values and interests
c.) Group of people defined by their interactions
d.) Individual with a specific health concern
e.) Individuals with certain interests
a.) Social group determined by geographic boundaries
b.) Group of people who share common values and interests
c.) Group of people defined by their interactions
Community can be defined as many things, including a social group determined by geographical
boundaries, a group of people who share common values and interests, and a group of people defined by
their interactions. Individuals comprise a community, but would not be an accurate definition of a
community.
4
A community health nurse is conducting informant interviews in a small community. Which of the
following would the nurse most likely contact?
a.) The state department of health for death records
b.) A local priest for congregation information
c.) Surrounding communities for crime comparison
d.) The Centers for Disease Control and Prevention (CDC) for illnesses in the area
b.) A local priest for congregation information
Informant interviews are methods of directly collecting data. County health department nurses and
church officials are often good key informants. Key informants need not hold any formal title, but are
generally viewed as community leaders by other community members and often have a long history in
the community.
The state department of health, surrounding communities, and CDC do not meet the definition of an
informant.
5
A nurse is engaging in the evaluation phase of community health program planning. Which of the
following would be part of effective completion of this phase?
a.) Demonstrate the ability to improve the health of the participants
b.) Develop measureable objectives and goals before implementation
c.) Encourage full participation by community members
d.) Improve the health of the population through the program
b.) Develop measureable objectives and goals before implementation
Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-
attaining activities are identified. After implementing the intervention, only the meeting of objectives and
effects of the intervening activities have to be assessed.
Participation by community members and improvement of the health of the population may be
measured through the evaluation phase, but would not demonstrate completion of this phase. The
evaluation phase may determine if the participants’ health improved, but improvement of health is not
part of the completion of this phase.
6
What are the critical attributes in the definition of community?
a.) Families, groups, and health organizations
b.) Health needs, geographical boundaries, and target population
c.) People, place, and functions
d.) Populations and health resources
c.) People, place, and functions
People, place, and function are the critical attributes in the definition of community. These attributes are
found in most definitions of community.
The people are community members or residents; place refers to geographic and time dimensions; and
function refers to the aims and activities of the community.
7
A nurse has identified the boundaries of the community. Which of the following steps should the nurse
take next when completing a community assessment?
a.) Gather relevant existing data and generating missing data
b.) Plan interventions that benefit the entire community
c.) Formulate nursing diagnoses
d.) Evaluate the interventions that were used
a.) Gather relevant existing data and generating missing data
The first step of the community assessment is to define the community. In order to do this, geographic
boundaries, the population within the boundaries, the purpose of the assessment, and a data collection
plan will be identified. Those inhabiting the community are a primary focus of the assessment. A variety
of strategies are used to identify this central core of the community.
The next step involves gathering and generating data to learn more about the community. After the
community has been completely assessed then nursing diagnoses can be formulated, interventions
planned, and finally interventions evaluated.
8
A nurse plans on implementing a community-wide influenza immunization program. Which of the

following factors should the nurse consider when implementing this program?
a.) The number of community members who have already received the immunization
b.) The existence of formal groups in the community
c.) Public policy that mandates influenza immunization for certain populations
d.) The community’s readiness to participate in the program
d.) The community’s readiness to participate in the program
The factors that influence implementation in the community are the nurse’s chosen roles, the type of
health problem selected as the focus for intervention, the community’s readiness to take part in problem
solving, and characteristics of the social change process.
The community’s readiness to participate is more important than public policy, the existence of formal
groups in the community, and the number of community members who have already received the
vaccine.
9
A nurse is trying to develop community partnerships. Which of the following interventions would be the
most appropriate for the nurse to use?
a.) Involve the community residents
b.) Use nurses as the source of information and leadership

c.) Rely on the power of local officials
d.) Include a variety of disciplines
d.) Include a variety of disciplines
Community partnerships occur when community residents and health workers come from a variety of
disciplines. Partnerships should involve a variety of individuals from various backgrounds. There should
be a balance of power and information sharing among all of the participants.
10
A nurse centers his practice around the principle of doing the greatest good for the greatest number.
Which of the following ethical principles is being applied?
a.) Distributive justice
b.) Utilitarianism
c.) Social justice
d.) Health disparities
b.) Utilitarianism
Utilitarianism means doing the greatest good for the greatest number.
Distributive justice means treating people fairly, and distributing resources and burdens equitably
among the members of a society.
Social justice means ensuring that vulnerable groups are included in the equitable distribution of
resources.
Health disparities are the inequalities that exist among different populations.
11
A nurse is writing a nursing diagnosis at the community level using the North American Nursing Diagnosis
Association (NANDA) system as a guide. Which of the following diagnoses would most likely be
developed?
a.) Risk of hypertension related to poor diet and sedentary lifestyle
b.) Risk of obesity among school-age children related to lack of opportunities to engage in physical activity
c.) Risk of ineffective health maintenance among individuals who do not have access to a primary care
provider
d.) Ineffective coping related to multiple stressors, as evidenced by client crying and stating she has no
support system
b.) Risk of obesity among school-age children related to lack of opportunities to engage in physical
activity
There are three parts of the NANDA system: (1) identification of the problem or potential problem; (2) its
relation to factors, stressors, or health issues; and (3) supporting data that documents the problem.
The “risk of” identifies a specific problem or health risk faced by the community.
“Among” identifies the specific community client with whom the nurse will be working in relation to the
identified problem or risk.
“Related to” describes characteristics of the community.

12
What is the purpose of writing a community nursing diagnosis?
a.) To assist with developing the evaluation measures for program planning
b.) To clearly describe the strengths and weaknesses of the community
c.) To lead to the outcomes and strategies to address and improve the identified health problem
d.) To increase the likelihood that the problem will be solved
c.) To lead to the outcomes and strategies to address and improve the identified health problem
The community nursing diagnosis, no matter which classification system is used, leads to expected
outcomes and evidence-based health promotion strategies to address and improve the problem
identified in the diagnosis. This becomes the nursing care plan. The expected outcomes and evaluations
derived from the nursing diagnosis systems suggest subsequent evaluation measures for identified needs
or problems.
A community assessment describes the strengths and weaknesses of a community. The likelihood of
solving a problem is not influenced by writing a community nursing diagnosis.
13
Which data source provides information about the function of the community?
a.) Local restaurant
b.) Elected officials
c.) County health department
d.) Civic groups
c.) County health department

Function refers to the aims and activities of the community.
Civic groups and elected officials refer to people.
Local restaurant refers to a place.

14
A leader of a support group introduces a nurse to its members and discusses the professional
relationship he has with the nurse for the past several years. Which of the functions is the leader
performing?
a.) Gatekeeper
b.) Insider
c.) Community health workers
d.) Advocate
a.) Gatekeeper
Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet
diverse members of the community.
Insiders are those who grew up in the community, have personal ties to the people there or comes from
a similar cultural or ethnic background.
Community health workers are not professional or licensed health care providers but are community
members from diverse backgrounds who receive training to do health outreach work.
An advocate is someone who speaks up for and supports the needs of the community.
15
A nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road
conditions, and modes of transportation. Which method of data collection is being used?
a.) Participant observation
b.) Windshield survey
c.) Focus group
d.) Informant interviews
b.) Windshield survey
Windshield surveys are a method of simple observation, providing a quick overview of a community. By
making observations of the community, the nurse is completing a windshield survey.
An informant interview is a method of community data collection that involves directed conversation
with selected community members.
16
A nurse is using health status indicators to complete a community assessment. Which of the following
best explains what the nurse is doing?
a.) Interviewing key informants in the community
b.) Examining morbidity and mortality rates in the community
c.) Surveying local businesses in the community
d.) Observing community members
b.) Examining morbidity and mortality rates in the community
Health indicators are numerical measures of health outcomes, such as morbidity and mortality, as well as
determinants of health and population characteristics. Generally, these data are from secondary sources
such as websites or printed materials.
Interviewing key informants, surveying local businesses, and making observations are all methods of
primary data collection.
17
A nurse is completing a community assessment. Which of the following actions would be most likely for
the nurse to complete?
a.) Identify community needs and clarify problems
b.) Determine the weaknesses of a community
c.) Perform the core functions of public health nursing
d.) Assess individual needs within a community
a.) Identify community needs and clarify problems
In a community assessment, one of the core functions is a logical, systematic approach to identifying
community needs, clarifying problems, and identifying community strengths and resources.
The focus of the community assessment is on the needs of the community, not on individuals.
The core functions of public health nursing are not all used during the community assessment process.
The community assessment should identify both the strengths and weaknesses of the community.
18
The main characteristics of partnership are:
a.) awareness, flexibility, and distribution of power.
b.) rights, responsibilities, and consensus.
c.) commitment, participation, and articulation.
d.) collaboration, advocacy, and utility.
a.) awareness, flexibility, and distribution of power.
The main characteristics of partnership are awareness, flexibility, and negotiated distribution of
power.
Rights, responsibilities, and consensus are not the main characteristics of partnership. Commitment,
participation, and articulation are not the main characteristics of partnership. Collaboration, advocacy,
and utility are not the main characteristics of partnership.
19
A nurse reads the local community newspaper to gather data about the community. Which method of
data collection is being used?
a.) Informant interview
b.) Focus group
c.) Participant observation
d.) Windshield survey
c.) Participant observation
in a local fair or festival, or attending a political or social event. The nurse is deliberately sharing in the life
of the community by reading the newspaper.
Windshield surveys are a method of simple observation, providing a quick overview of a community.
20
A community has residents who provide information to the city council so that decisions can be made
about the health of the community. Which of the following characteristics is being displayed?
a.) Active partnerships
b.) Passive partnerships
c.) Gatekeeping
d.) Focus groups
b.) Passive partnerships
Coalitions are active partnerships in which all participants share leadership and decision making to some
degree. Unfortunately, some community health efforts view community residents only as sources of
information and receivers of interventions; this limits residents to passive participation.
Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet
diverse members of the community.
questions to participants but to a small group rather than an individual.
21
A nurse is trying to increase participation in a free colorectal screening program for middle- aged adults
who lack health insurance. Which of the following implementation mechanism would be most effective?
a.) Small interacting groups
b.) Health policy
c.) Lay advisors
d.) Mass media
d.) Mass media
The mass media (newspapers, television, and radio) represent an impersonal and formal type of
communication and are useful in providing information quickly to a large number of people.
The other methods will take much longer for the information to spread to the community members.
22
A nurse is assessing the safety in the community using primary data. Which of the following data would
be useful for the nurse to collect? (Select all that apply.)
a.) Number of billboards in the area
b.) Interviews with health care providers who are familiar with the community
c.) Observation of community members
d.) Nurse’s own observations
e.) Morbidity and mortality rates
b.) Interviews with health care providers who are familiar with the community
c.) Observation of community members
d.) Nurse’s own observations
Other nurses, social workers, health care providers, community members, and the nurse’s own
observations are reliable sources of information about the safety of an area. The number of billboards
would not be important data to collect when assessing for safety in the community. Morbidity and
mortality rates would be considered secondary data.
23
A collection of individuals who have one or more personal or environmental characteristics in common is
the definition of a(n):
a.) community.
b.) group.
c.) family.
d.) aggregate.
d.) aggregate.
An aggregate is a collection of individuals who have one or more personal or environmental

characteristics in common.
A community is a group of people that share something in common, such as geographic location,
interests, or values.
A group is people who are located close together.
A family is considered parents and children living together in a household.

24
A nurse is caring for the community as the client. Which of the following is most likely the focus of the
nurse’s care?
a.) Providing care for aggregates living in the community
b.) The collective good of the population
c.) The provision of care for families in the home setting
d.) Providing health education in the community
b.) The collective good of the population
The community is considered the client when the nursing focus is on the collective good of the
population.
Providing education is one way the nurse can care for the community as the client; however, the focus of
nursing care is larger in scope than only education.
Provision of care for aggregates and families does not address the larger scope of community as client.
25
A nurse has collected data about the services available in the community and is using the seven “A”s to
evaluate these services. Which of the following questions will the nurse most likely ask?
a.) Can the community members allocate resources to support the service?
b.) Can the community members afford the service?
c.) Will the community members allow strategies to be implemented to improve the service?
d.) Will the community members approve of the services provided?
b.) Can the community members afford the service?
The seven “A”s include:
1. Is the community aware of its needs and of the service?

2. Is it accessible to community members?
3. Is the service available when the community needs it?
4. Can the community members afford the service?
5. Does the community find the service acceptable?
6. Is the service adequate to meet the needs of the community?
7. And, are the services appropriate to meet the needs of the community?
The following questions do not address the seven “A”s: Can the community members allocate resources
to support the service? Will the community members allow strategies to be implemented to improve the
service? And, will the community members approve of the services provided?
26
A nurse is investigating the structure of the community. Which of the following indicators would the nurse
most likely collect data about?
a.) Infant mortality rate
b.) Effective communication
c.) Crime rate
d.) Emergency room utilization
d.) Emergency room utilization
The structure of the community is defined in terms of services and resources.
The subsystems of community structure consist of physical environment, health and social services,
economy, transportation and safety, politics and government, communication, education, and recreation.
27
A nurse analyzes data from minutes at a community meeting when completing a community assessment.
Which of the following methods of data collection is being used?
a.) Secondary data
b.) Informant interviews
c.) Primary data
a.) Secondary data
Secondary sources include published data about the community. The data is secondary because it is
collected by someone else.
Primary data includes using informant interviews, focus groups, and participant observation in order to
collect information about a community.
28
A nurse lives in a community that demonstrates commitment. Which of the following would most likely be
supported within this community?
a.) Creation of a community club by the city council to facilitate community involvement
b.) Collaboration among area restaurant owners to develop healthier menus
c.) Collaboration with the health department to build a new recreation center
d.) Development of a cooperative agreement with a neighboring city to share needed services
c.) Collaboration with the health department to build a new recreation center
Commitment to the health of the community requires a process of change at each appropriate level on
the continuum. The most successful change processes often arise from collaborative practice models that
involve the community and nurses in joint decision making. Participants must see themselves as part of a
group effort and share in the process, beginning with planning and including decision making.
Collaboration by restaurant owners to develop healthier menus only addresses one population of the
community and does not show involvement by nurses and the larger community. Creation of a
community club by the city council does not engage the larger community in this decision. Developing a
cooperative agreement with a neighboring city does not show commitment between the members of
both communities.
29
A nurse schedules an appointment with a physician who has a practice in the community to learn more
about the community’s beliefs regarding childhood immunizations. Which of the following is being
demonstrated?
b.) Participant observation
c.) Active participation
Active partnerships are those in which all participants share leadership and decision making to some
degree.
30
Change for the community as a client must often occur at several levels because:
a.) health problems caused by lifestyle are multidimensional.

b.) most individuals can change their habits alone.
c.) aggregates are responsible for social change.
d.) geographic areas often have health risks that the nurse must identify.
a.) health problems caused by lifestyle are multidimensional.
Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose
healthy habits, change for the community client must often take place at several levels. Society must also
be involved in the change by supporting individual choices. There may be certain geographic areas that
have higher health risks than others, but this does not explain why care must occur at several levels.
31
A nurse interviews the school nurses in a community to determine their roles in schools because this data
is not available. Which of the following processes is the nurse using?
a.) Photovoice
b.) Spatial data
c.) Primary data
d.) Secondary data
c.) Primary data
Primary data includes using informant interviews, focus groups, and participant observation in order to
collect information about a community.
Spatial data involves looking at the locations of places within the community.
Photovoice, also called photo elicitation, is a community assessment technique in which community
members take photos to represent a topic or theme about community health.
Secondary sources include published data about the community, such as census data.
VULNERABILITY AND VULNERABLE POPULATIONS: AN OVERVIEW DECK (26)
1
The wide variations in health services and health status between certain population groups are called:
a.) vulnerable population groups.
b.) health disparities.
c.) disadvantaged populations.
d.) risk markers.
b.) health disparities.
The wide variations in health services and health status between certain population groups are called
health disparities. Vulnerable populations are typically considered to be those who are at greater risk for
poor health status and who have poor access to health care. Disadvantaged populations have fewer
resources for promoting health and treating illness than does the average person in the United States.
Risk describes that some people have a higher probability of illness than others.
2
Which of the following is most likely to live in poverty?
a.) Those who work in high-risk jobs
b.) Those who have adequate nutrition
c.) Those who effectively manage stress
d.) Those who live in single family homes
a.) Those who work in high-risk jobs
People who are poor are more likely to live in hazardous environments that are overcrowded and have
inadequate sanitation, work in high-risk jobs, have less nutritious diets, and have multiple stressors.
3
Which federal program created support for older and poor Americans?
a.) Social Security Act
b.) Medicare Amendment
c.) Medicaid Amendment
d.) Hill-Burton Act

a.) Social Security Act
The Social Security Act sought direct payments to eligible individuals to ensure a minimum level of
support for people at risk of problems from inadequate financial resources. The Social Security Act
encompasses the Medicare and Medicaid Amendment. The Hill-Burton Act provided funding to assist with
building hospitals.
4
A nurse is working with a 17-year-old pregnant cocaine addict who is homeless. Which of the following
best describes this client?
a.) At risk
b.) A special population
c.) A Healthy People 2020 target group
d,) A vulnerable individual
d,) A vulnerable individual
Vulnerable individuals often have multiple risk factors. Vulnerable populations of concern to nurses are
persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants,
individuals with mental health problems, people who abuse addictive substances, persons who have
been incarcerated, people with communicable diseases and those who are at risk, and persons who are
HIV positive or have hepatitis B virus or STDs. Risk is an epidemiological term meaning that some people
have a higher probability of illness than others.
5
A nurse operates a school-based clinic in a local school where multiple providers and disciplines offer
care to children, making it easier for children to access health care. Which of the following best describes
this approach?
a.) Advocacy
b.) Wrap-around services
c.) Social justice
d,) Comprehensive services
d,) Comprehensive services
Comprehensive services are health care services that focus on more than one health problem or concern.
Stationary or mobile clinics that provide a wide array of health promotion, illness prevention, and illness
management services in migrant camps, schools, and local communities are examples of this. Wrap-
around services describe a system in which comprehensive health services are available and social and
economic services are “wrapped around” these services. Advocacy refers to actions taken on behalf of
another. Social justice describes justice with respect to the concepts of egalitarianism and equality.
6
Which trends are occurring when providing care for vulnerable populations? (Select all that apply.)
a.) Community-based care and interorganizational partnerships
b.) Outreach and case finding
c.) Elimination of disparities
d.) Culturally and linguistically appropriate care
e.) Increased incidence of acute illnesses
a.) Community-based care and interorganizational partnerships
b.) Outreach and case finding
d.) Culturally and linguistically appropriate care
Community-based care and interorganizational partnerships, outreach and case finding, and provision of
culturally and linguistically appropriate care are all trends to improve care among vulnerable populations.
Elimination of disparities is not a trend related to caring for vulnerable populations. Increased incidence
of acute illness is not a trend of care provision for vulnerable populations.
7
A nurse is developing a one-stop service to meet the needs of a vulnerable group. Which of the following
would the nurse most likely create?
a.) Wrap-around services where mental services are linked
b.) Giving all immunizations on a single clinic visit
c.) Providing multiple services during a single clinic visit
d.) Providing free services to the medically indigent
c.) Providing multiple services during a single clinic visit
Providing multiple services during a single clinic visit makes services more responsive to the combined
effects of social and economic stressors. Wrap-around services provide comprehensive health as well as
social and economic services, so it would include more than the linkage of mental health services.
Administering all immunizations or providing free services would not provide a one-stop shop for all
needed services.
8
A nurse is caring for a homeless population. Which of the following characteristics should the nurse
anticipate as a need of this population?
a.) Need more nursing care than other vulnerable groups
b.) Have no desire to seek medical care
c.) Have even fewer resources than poor people who have adequate housing
d.) Are living in despair with no hope or resilience
c.) Have even fewer resources than poor people who have adequate housing
Those who are homeless have even fewer resources than poor people who have adequate housing.
Homeless and marginally housed people must struggle with heavy demands as they try to manage daily
life because their resources are limited. These individuals must cope with finding a place to sleep at night
and a place to stay during the day or moving frequently from one residence to another, as well as finding
food, before even thinking about health care.
9
A nurse is planning and implementing care for vulnerable populations. Which of the following would be
the most appropriate action for the nurse to take?
a.) Setting up multiple clinics in a wide geographic area
b.) Advising legal consultants on a variety of issues
c.) Making laws to protect the homeless
d.) Teaching vulnerable individuals strategies to prevent illness and promote health
d.) Teaching vulnerable individuals strategies to prevent illness and promote health
Teaching vulnerable individuals, families, and groups strategies to prevent illness and promote health is
one of the ways nurses provide care for these populations. Setting up clinics, advising legal consultants,
and making laws do not address the direct care provision role of the nurse.
10
A nurse is promoting social justice. Which of the following actions would the nurse most likely take?
a.) Contacting lawmakers about environmental health issues
b.) Assisting at homeless shelters
c.) Advocating for policies to improve social conditions
d.) Serving on a local coalition to prevent obesity

c.) Advocating for policies to improve social conditions
Social justice refers to providing equitable care and social supports for the most disadvantaged members
of society. Nurses can function as advocates for policy changes to improve social, economic, and
environmental factors that predispose vulnerable populations to poor health.
11
A nurse is working with multiple vulnerable groups. Which of the following would be most sensitive to
adverse effects?
a.) Pregnant teenager living with her parents for financial support
b.) Poor, older woman with no means of transportation
c.) 2-year-old boy of underinsured parents
d.) Recently unemployed father of five
b.) Poor, older woman with no means of transportation
A poor, older woman with no means of transportation has a combination of risk factors. A pregnant
teenager, 2-year-old boy, and recently unemployed father are only displaying one risk factor, not multiple
risk factors as the older woman displays.
12
A set of actions one undertakes on behalf of another is:
a.) social justice.
b.) advocacy.
c.) resilience.
d.) risk.
b.) advocacy.
A set of actions one undertakes on behalf of another is advocacy. Social justice describes justice with
respect to the concepts of egalitarianism and equality. Resilience refers to how vulnerable populations
are able to resist or overcome the effects of the vulnerability. Risk describes that some people have a
higher probability of illness than others.
13
A client is self-employed as a mechanic and has no health insurance coverage. Which of the following best
describes the legislation that will assist this client in obtaining health insurance?
a.) Balanced Budget Act

b.) Health Insurance Portability and Accountability Act (HIPAA)
c.) Patient Protection and Affordable Care Act (ACA)
d.) Social Security Act
c.) Patient Protection and Affordable Care Act (ACA)
The ACA of 2010 provides the opportunity for all to purchase health insurance. The Balanced Budget Act
shifted payment in home health care. The HIPAA was intended to help people keep their health insurance
when moving from one place to another. The Social Security Act created the largest federal support
program for elderly and poor Americans.
14
A nurse “sets the stage” when assessing members of vulnerable population groups. Which of the
following interventions would be completed? (Select all that apply.)
a.) Creating a comfortable, non-threatening environment
b.) Providing culturally and linguistically competent assessment
c.) Collaborating with others as appropriate
d.) Providing financial and legal advice
e.) Developing a free clinic in a low-income neighborhood
a.) Creating a comfortable, non-threatening environment
b.) Providing culturally and linguistically competent assessment
c.) Collaborating with others as appropriate
Nurses set the stage by creating a comfortable, non-threatening environment, providing culturally and
linguistically competent assessment, and collaborating with others as appropriate. A nurse should not
provide financial or legal advice. Developing a free clinic does not “set the stage.”
15
A nurse is examining social determinants of health. Which of the following is the nurse looking at?
a.) Ethnicity
b.) Income
c.) Gender
d.) Marital status

b.) Income
Social determinants of health are such factors as economic status, education, environmental factors,
nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk.
Ethnicity, gender, and marital status are not considered social determinants of health.
16
Resilience refers to the:
a.) resistance of certain groups to risk factors.
b.) increased susceptibility to cumulative risk factors among vulnerable groups.
c.) variability in the effects of stressors according to socioeconomic status.
d.) increased sensitivity of the very young and the very old to risk factors.
a.) resistance of certain groups to risk factors.
Resilience refers to how vulnerable populations are able to resist or overcome the effects of the
vulnerability. These populations do not succumb to the health risks that impinge on them.
APPLICATION OF ETHICS IN THE COMMUNITY DECK (25)
1
According to Leininger and Watson, the moral ideal of nursing is:
a.) caring.
b.) advocacy.
c.) responsibility.
d.) accountability.
a.) caring.
This conceptualization occurred as a response to the technological advances in health care science and
the desire of nurses to differentiate nursing practice from medical practice. Advocacy, responsibility, and
accountability are not part of the moral idea of nursing proposed by Leininger and Watson.
2
Which ethical principle requires “doing no harm?”
a.) Respect for autonomy
b.) Non-maleficence
c.) Beneficence
d.) Distributive justice
b.) Non-maleficence
Non-maleficence refers to doing no harm. Respect for autonomy requires that individuals be permitted to
choose those actions and goals that fulfill their life plans unless those choices result in harm to another.
Beneficence requires that we do good. Distributive justice requires that there be a fair distribution of the
benefits and burdens in society based on the needs and contributions of its members.
3
Which statement regarding Florence Nightingale’s ideas about ethics is correct?
a.) Nursing is a call to service, and the moral character of persons entering nursing is important.
b.) Ethical principles are based on the values of the individual nurse.
c.) Society will dictate the ethical principles to which nurses must adhere.
d.) Ethics are very important in times of war, such as in the Crimean War, when she set up public health
centers.
a.) Nursing is a call to service, and the moral character of persons entering nursing is important.
Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering
nursing as important. Florence Nightingale did not set up public health centers. Florence Nightingale did
not believe that nurses must adhere to society’s view of ethical principles. Ethical beliefs are based on the
values of the individual nurse, not ethical principles.
4
Which of the following are ethical tenets that underlie the core function of assessment? (Select all that
apply.)
a.) Competency: the persons assigned to develop community knowledge are prepared to collect data on
groups and populations
b.) Moral character: the persons selected to develop, assess, and disseminate community knowledge
possess integrity
c.) Service to others over self: a necessary condition of what is “good” or “right” policy
d.) “Do no harm”: disseminating appropriate information about groups and populations is morally
necessary and sufficient
e.) Providers of public health services should be competent and available
a.) Competency: the persons assigned to develop community knowledge are prepared to collect
data on groups and populations
b.) Moral character: the persons selected to develop, assess, and disseminate community
knowledge possess integrity
d.) “Do no harm”: disseminating appropriate information about groups and populations is morally
necessary and sufficient
Service to others over self is an ethical tenet of policy development. Providers of public health services
should be competent and available is an ethical tenet of assurance. Competency, moral character, and
“do no harm” are the ethical tenets of assessment.
5
Which statement about feminist ethics is correct?
a.) Feminists include only women in their worldview.
b.) Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the
legislative process.
c.) Feminists believe that men should not be nurses.
d.) Women’s thinking and moral experiences are important and should be taken into account.
d.) Women’s thinking and moral experiences are important and should be taken into account.
Feminist theory ascribes to the idea that women’s thinking and moral experiences are important and
should be considered. A feminist perspective leads us to think critically about connections among gender,
disadvantage, and health as well as the distribution of power in public health processes. Feminists are
women and men who hold a worldview advocating economic, social, and political equality for women that
is equivalent to that of men.
6
Public health administrators in a community provide a health department to serve an indigent population
of immigrants providing translators on certain days of the week. Which of the following best describes
what is being done?
a.) Policy development
b.) Quality
c.) Assurance
d.) Libertarian philosophy
c.) Assurance
Assurance refers to the role of public health in making sure that essential community- oriented health
services are available, which may include providing essential personal health services for those who
would otherwise not receive them. Policy development refers to the need to provide leadership in
developing policies that support the health of the population, including the use of the scientific
knowledge base in making decisions about policy. Quality refers to providing the best care possible.
Libertarian philosophy refers to the view that the right to private property is the most important right.
7
The community leaders in a lesser-developed country decide not to tell the citizens of a small village
about a chemical spill at a major industrial facility that could produce harmful effects. Which of the
following principles is being violated?
a.) Morality
b.) Advocacy
c.) Caring
d.) Virtue
b.) Advocacy
Advocacy requires that the community be properly informed, and this was violated in the above scenario.
Morality is shared and generational societal norms about what constitutes right or wrong conduct. Caring
represents the essence of nursing. Virtue demonstrates behavior showing high moral standards.
8
The growing multiculturalism of American society can contribute to ethnicity conflicts when:
a.) providing care to different cultural groups.
b.) individual values align with the cultural norms.
c.) ethnic groups overburden the health care system.
d.) the greater community’s values are jeopardized by specific ethnic values.
d.) the greater community’s values are jeopardized by specific ethnic values.
Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree
of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with
what is normative in American culture. Providing care to different cultural groups should not produce an
ethnicity conflict. Individual alignment with cultural norms would make it less likely that an ethnicity
conflict would occur. Ethnic groups using the health care system will not cause it to be overburdened or
result in an ethnicity conflict.
9
A nurse is providing care using the idea of “servicing citizens, not customers.” Which of the following ideas
is being applied by the nurse?
a.) Ethical tenets of policy development
b.) Basic concepts of the feminist theory
c.) Underlying premise of virtue ethics
d.) Components of distributive justice
a.) Ethical tenets of policy development
There are three tenets of both policy and ethics. The approach is based on the voice of the community as
the foundation on which policy is developed. The basic concept of feminist theory allows us to think
critically about connections among gender, disadvantage, and health as well as the distribution of power
in public health processes. The goal of virtue ethics is to enable persons to flourish as human beings.
Distributive justice requires that there be a fair distribution of the benefits and burdens in society based
on the needs and contributions of its members.
10
A nurse is demonstrating advocacy in his nursing practice. Which of the following actions best
demonstrates this principle?
a.) Offering a smoking cessation program

b.) Screening for hypertension
c.) Lobbying for health care reform
d.) Conducting home visits
c.) Lobbying for health care reform
Nurses should participate in implementing new directions for health care and help envision these new
directions. Nurses can be an important voice in advocating for access to consistent, effective, and efficient
health care for all. This is best accomplished by performing interventions at the population level.
11
There are two medically indigent clients in the clinic who have come to get their monthly supply of free
insulin. There is only enough for one client. Which of the following actions would the nurse take first?
a.) Identify all options
b.) Make a decision
c.) Gather additional information
d.) Act and assess decisions made
c.) Gather additional information
The steps of the ethical decision-making framework are to first identify the ethical issues and dilemmas,
then place them within a meaningful context, obtain all relevant facts, reformulate ethical issues and
dilemmas if needed, consider appropriate approaches to actions or options, make decisions and take
action, and evaluate decisions and action.
12
A public health nurse is examining several issues within daily practice. Which of the following issues
would be considered an ethical dilemma?
a.) Whether or not to establish a community health center in a rural area
b.) Allocating resources in a natural disaster
c.) Deciding to withdraw care on a hospice patient
d.) Applying the principles of Florence Nightingale in Bangladesh
b.) Allocating resources in a natural disaster
When resources are scarce, a dilemma may exist as to how to allocate them. Considering establishing a
community health center may be a dilemma, but it probably does not involve ethics. Withdrawing care
from a hospice patient would most likely not be an issue encountered by a public health nurse, as this
represents community health nursing practice, not public health nursing practice. Applying the principles
of Florence Nightingale would not be ethical issue.
13
A nurse refers to the Code of Ethics for Nurses or the Public Health Code of Ethics. Which of the following
describes why the nurse has referred to this document?
a.) To provide answers for ethical dilemmas
b.) To guide professional practice related to ethics
c.) To increase moral leadership in ethics
d,) To find a framework for ethical decision making
b.) To guide professional practice related to ethics
These codes provide general ethical principles and guide personnel in thinking about the underlying
ethics of the profession. They do not provide answers for ethical dilemmas, only serve as a guide. They do
not increase moral leadership, nor do they provide a framework for ethical decision making.
14
An orderly process that considers ethical principles, client values, and professional obligations is:
a.) moral distress.
b.) ethical decision making.
c.) a value.
d.) a code of ethics.
b.) ethical decision making.
Ethical decision making is defined as an orderly process that considers ethical principles, client values,
and professional obligations. Moral distress is an uncomfortable state of self when one is unable to act
ethically. Values are beliefs about the worth or importance of what is right or esteemed. A code of ethics
is a moral standard that delineates a profession’s values, goals, and obligations.
15
A nurse is using the principles of virtue ethics in decision making. Which of the following describes the
action that the nurse would take?
a.) Provide efficient and effective nursing care
b.) Identify the meaningful facts in the situation
c.) Seek ethical community support to enhance character development

d.) Plan ways to restructure the social practices that oppress women
c.) Seek ethical community support to enhance character development
According to Aristotle, virtues are acquired and include interest in the concept of the good, including
benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical
community support to enhance character development. Nurses can demonstrate advocacy when
providing efficient and effective nursing care. Identifying the meaningful facts in the situation is part of
the ethical decision-making process. Planning ways to restructure the social practices that oppress
women is part of the feminist ethics decision-making process.
16
Which statement fits the Liberal Democratic Theory of John Rawls?
a.) One should reject any idea that societies, states, or collectives of any form can be the bearers of rights
or can owe duties.
b.) Inequalities result from birth, natural endowment, and historic circumstances.
c.) Everyone has a right to private property.
d.) Government should be limited.
b.) Inequalities result from birth, natural endowment, and historic circumstances.
Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a
system in which everyone benefits, especially the least advantaged. This is an attempt to address the
inequalities that result from birth, natural endowments, and historic circumstances. The other choices
relate to libertarianism.
POPULATION-BASED PUBLIC HEALTH NURSING PRACTICE: THE INTERVENTION WHEELDECK (23)
1
A PHN is conducting a community assessment. Which of the following is the best example of this action?
a.) Visiting an elderly person at home to assess and evaluate safety and fall risk
b.) Developing diagnoses to identify nursing interventions at a health clinic
c.) Evaluating services at an immunization clinic where a translator provides services
d.) Compiling recent data from the county health department on child abuse cases
d.) Compiling recent data from the county health department on child abuse cases
Compiling recent data from the county health department on child abuse cases is an example of
community assessment, assessing needs and data within a community. Community assessment does not
happen with an individual. Community assessment must be completed before diagnoses can be
developed. Evaluation of services is not part of community assessment.
2
A PHN is using collaboration, coalition building, and community organizing to develop a new program in
the community. Which of the following strategies is the nurse most likely using?
a.) Providing case management, referral, and follow-up services with individuals
b.) Carrying out collective action at the systems or community levels of practice
c.) Conducting a community assessment
d.) Implementing primary and secondary prevention strategies
b.) Carrying out collective action at the systems or community levels of practice
Collaboration, coalition building, and community organizing are the interventions often carried out at the
systems and community levels of practice. These interventions can be used at all levels of prevention.
Providing case management, referral, and follow-up services with individuals represents another group of
interventions described by the green wedge. These interventions are not part of conducting a community
assessment.
3
A PHN is developing a measurable outcome health status indicator that can be used at the individual level
of practice. Which of the following would the nurse most likely use?
a.) A 50-year-old woman receives annual mammograms
b.) School absences in a community decline

c.) Teachers have increased awareness of health problems
d.) Those in poverty utilize the free mammogram program
a.) A 50-year-old woman receives annual mammograms
Outcome health status indicators are used to measure the impact of the interventions on population
health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the
population health when considering those who are receiving the screening.
The other examples do not look at population health as an outcome or are not occurring at the individual
level.
4
A PHN utilizes the nursing process at all levels of practice. Which of the following demonstrates how this
is accomplished?
a.) Including specific goals for community health nurses
b.) Developing an accurate nursing diagnosis
c.) Analyzing the needs of the community, systems, individuals, and families
d.) Utilizing primary, secondary, and tertiary prevention
c.) Analyzing the needs of the community, systems, individuals, and families
PHNs must customize the nursing process to consider the community, systems, and individual/family
levels of practice.
The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are
not demonstrated utilizing the levels of prevention.
5
What is the purpose of the color-coded wedges on the Intervention Wheel?
a.) The interventions are grouped together in related wedges.
b.) The wedges consist of referral information for each wedge.
c.) The element of health teaching is the predominant feature of each wedge.
d.) Coalition building must be implemented with each wedge.
a.) The interventions are grouped together in related wedges.
Each wedge consists of related interventions. The other answers describe some of the individual wedges.
6
A PHN uses Assumption 2, “Public health nursing practice focuses on populations,” to guide practice.
Which of the following would be considered a population of interest?
a.) Healthy school children
b.) Homeless individuals
c.) A person recently diagnosed with diabetes
d.) Teenage parents
a.) Healthy school children
A population is a collection of individuals who have one or more personal or environmental

characteristics in common.
Populations of interest are populations that are essentially healthy but could improve factors that
promote or protect health; one such population is healthy school children.
Homeless individuals and teenage parents would both be considered a population at risk. A person
recently diagnosed with diabetes is not a population.
7
The cornerstones of public health nursing practice include which of the following? (Select all that apply.)
a.) Focus on the health of the entire population
b.) Reflect community priorities and needs
c.) Promote health through strategies driven by epidemiological evidence
d.) Are grounded in an ethic of collaboration.
e.) Provide a framework for ethical decision making
a.) Focus on the health of the entire population
b.) Reflect community priorities and needs
c.) Promote health through strategies driven by epidemiological evidence
Cornerstones of public health nursing practice focus on the health of the entire population, reflect
community priorities and needs, promote health strategies driven by epidemiological evidence, and are
grounded in social justice. Nursing is grounded in an ethic of caring.
8
A PHN is implementing interventions at the systems level of practice. Which of the following interventions
would be used by the nurse?
a.) Involve the entire community in solving the health problem
b.) Identify health problems in the community
c.) Change laws, policies, and practices that influence population-based issues
d.) Provide outreach services to populations at risk
c.) Change laws, policies, and practices that influence population-based issues
Systems level practice consists of changing laws, policies, and practices that influence population-based
issues.
The individual level of practice focuses on interventions that involve working with individuals, either
singly, or in groups, and with families is demonstrated through providing outreach.
Community level interventions are carried out with the community as a whole and is demonstrated by
involving the entire community in identifying and solving health problems.
9
A nursing student develops a teaching plan about hand washing to present to a group of elementary
school children at the local school. Which of the following public health interventions is being
implemented?
a.) Collaboration
b.) Surveillance
c.) Health teaching
d.) Screening
c.) Health teaching
Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs,
and practices of individuals, families, systems, and/or communities.
Collaboration commits two or more persons or organizations to achieve a common goal through
enhancing the capacity of one or more of the members to promote and protect health.
Surveillance describes and monitors health events through ongoing and systematic collection, analysis,
and interpretation of health data.
Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.
10
A PHN is conducting an assessment of the community’s health. Which of the following is being
accomplished through this activity?
a.) Define one problem that will be the focus for a year
b.) Assess a social network of interacting individuals usually in a defined territory
c.) Minimize the effects of health risks and hazards
d.) Intervene at the population level by changing laws and regulations
b.) Assess a social network of interacting individuals usually in a defined territory
A community is defined as a social network of interacting individuals, usually concentrated in a defined

territory. The community assessment generally results in a lengthy list of community problems and
issues. Intervention and minimization do not take place during the assessment phase.
11
PHNs utilize registries to identify children with delayed or missing immunizations. They subsequently
follow up with families by phone calls or home visits. Which of the following levels of practice is being
implemented?
a.) Systems
b.) Community
c.) Policy
d.) Individual
d.) Individual
The individual level of practice focuses on interventions that involve working with individuals, either
singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs,
practices, and behaviors of individuals.
Community level interventions are carried out with the community as a whole. This level of intervention
changes community norms, attitudes, awareness, practices, and behaviors.
Systems level interventions change organizations, policies, laws, and power structures within
communities.
Policy is not a level of intervention described by “The Wheel.”

12
A nurse promotes alliances among organizations for a common purpose. Which of the following public
health interventions is being implemented?
a.) Health teaching
b.) Coalition building

c.) Surveillance
d.) Referral and follow-up
b.) Coalition building
One example of coalition building is promoting alliances among organizations for a common purpose.
Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify
and access necessary resources in order to prevent or resolve problems or concerns.
Surveillance describes and monitors health events through ongoing and systematic collection, analysis,
and interpretation of health data.
Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs,
behaviors, and practices of individuals, families, systems, and/or communities.
13
A social marketing campaign urging community members to avoid driving motorized vehicles after
consuming alcohol is implemented in a local community. Which of the following levels of practice is being
demonstrated?'
a.) Individual
b.) Systems
c.) Community
d.) Government
c.) Community
Community level interventions are carried out with the community as a whole. This level changes
community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations
within the community or occasionally toward populations at risk or populations of interest. Individual
level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals.
Systems level interventions change organizations, policies, laws, and power structures within
communities.
Government is not a level of intervention described by “The Wheel.”

14
The levels of practice encompassed by the Intervention Wheel are:
a.) communities, individuals and families, and systems.
b.) assessment, diagnosis, and evaluation.

c.) primary, secondary, and tertiary.
d.) communities, populations, and aggregates.
a.) communities, individuals and families, and systems.
Communities, individuals and families, and systems are the three levels of public health nursing practice.
The other responses do not describe the levels of practice.
15
Public health interventions are implemented with:
a.) legislators, policy makers, and community leaders.
b.) individuals and families, communities, and systems.
c.) children, adolescents, and adults.
d.) health departments, public health agencies, and visiting nurses associations.
b.) individuals and families, communities, and systems.
It is important to know that PHNs work with individuals and families, communities, and systems.
The other answers may have true parts, but the second option lists the overall groups where PHNs are
intervening.
16
A PHN is implementing the public health intervention of health teaching at the systems level of practice.
Which of the following interventions is most likely being implemented by the nurse?
a.) Participating in the “Great American Smokeout”
b.) Working with a local employer to provide smoking cessation education
c.) Providing one-on-one counseling to smokers
d.) Advocating for increased taxes on tobacco products
b.) Working with a local employer to provide smoking cessation education
Working with a local employer to provide smoking cessation education is the only example of health
teaching at the systems level of practice.
Participating in the “Great American Smokeout” occurs at the community level and is not health teaching.
Providing one-on-one counseling to smokers is health teaching at the individual level of practice.
Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not
health teaching.
CASE MANAGEMENT DECK (31)
1
A patient with a long history of asthma with many hospital admissions is referred to a case manager for
disease management. Which of the following best describes the purpose of this referral?
a.) Chronic and costly disease conditions that require long-term care interventions
b.) Patients who cannot handle their disease
c.) Those who seek to control use by providing clients with correct information
d.) Patients who will need an advanced practice nurse instead of physician for monitoring
a.) Chronic and costly disease conditions that require long-term care interventions
Disease management activities target chronic and costly disease conditions that require long-term care
interventions. Demand management seeks to control use by providing clients with correct information.
Patients who cannot handle their disease or who need an advanced practice nurse instead of a physician
do not explain the referral to disease management.
2
A case manager provides a formal communication link among all parties concerning the plan of care
management. Which of the following roles of the nurse is being implemented?
a.) Facilitator
b.) Liaison
c.) Coordinator
d.) Negotiator
b.) Liaison
The case manager providing a formal communication link among all parties concerning the plan of care
management is performing the role of liaison. As a facilitator, the nurse supports all parties in work
toward mutual goals. When working as a coordinator, the case manager arranges, regulates, and
coordinates needed health care services for clients at all necessary points of services. The case manager
who uses effective collaboration and team strategies to make arrangements for services is performing
the role of negotiator.
3
A nurse is using life care planning when working with a client. Which of the following would be the most
appropriate time for this to be used?
a.) When organizing a timeline of life events

b.) When documenting client information and requests
c.) When assessing present and future client needs
d.) When estimating future costs for medical care
c.) When assessing present and future client needs
Life care planning is a customized, medically based document that provides assessment of present and
future needs. Typically, a life care plan incorporates medical, financial, psychological, vocational, built
environment, and social costs during the remaining life of the client. Life care planning is a tool used in
case management. A life care plan assesses the current and future needs of a client for catastrophic or
chronic disease over a life span.
4
Which model addresses the structure and processes of using the population-based tools of disease
management and critical pathways to offer care for client populations?
a.) Client-focused
b.) System-focused
c.) Social service
d.) Long-term care
b.) System-focused
The system-focused model addresses the structure and processes of using the population- based tools of
disease management and critical pathways to offer care for client populations. The concern in client-
focused models is with the relationship between case manager and client to support continuity of care
and to access providers of care. The social service models provide services to clients to assist them in
living independently in the community and in maintaining their health by eliminating or reducing the
need for hospital admissions or long-term care. Long-term care is not a model of case management.
5
A nurse is working as a case manager and is in the process of performing interdisciplinary, family and
client conferences. Which of the following phases of the nursing process is being implemented?
a.) Assessment
b.) Diagnosis
c.) Planning for outcomes
d.) Implementation
b.) Diagnosis
Diagnosis includes the identification of a problem/opportunity. Examples of activities used during the
diagnosis phase include holding conferences, determining conclusions on the basis of assessment, and
using interprofessional teams. Examples of assessment include developing networks with target
populations and dissemination of written materials. Examples of planning for outcomes include validating
and prioritizing problems and selecting evidence-based interventions. Examples of implementation
include contacting providers and coordinating care activities.
6
A case manager has contacted providers and has negotiated services and prices. Which of the following
phases of the nursing process is being demonstrated?
a.) Assessment
b.) Diagnosis
c.) Planning/outcome
d.) Implementation
d.) Implementation
The implementation phase of the nursing process occurs when a case manager advocates for clients’
interests and arranges for the delivery of service. Examples of assessment include developing networks
with target populations and dissemination of written materials. Diagnosis includes the identification of a
problem/opportunity. Examples of activities used during the diagnosis phase include holding
conferences, determining conclusions on the basis of assessment, and using interprofessional teams.
Examples of planning for outcomes include validating and prioritizing problems and selecting evidence-
based interventions.
7
The process of moving conflicting parties toward an outcome is called:
a.) negotiation.
b.) conflict management.
c.) problem-purpose expansion method.
d.) brainstorming.
a.) negotiation.
The process of moving conflicting parties toward an outcome is called negotiation. Conflict management
has the goal of mutual benefit with limited loss, which is directed toward getting all parties to work
together. The problem-purpose-expansion method is a way to broaden limited thinking by restating the
problem and expanding the problem statement so that different solutions can be generated. In
brainstorming, as many alternatives as possible are generated without placing a value on them.
8
The nurse is involved in a conflict resolution situation with the parents of a 2-year-old boy. The parents
are deciding if “spanking” the child is a disciplinary method that they will employ. The mother says, “I do
not believe in spanking. I see it as abusive and demeaning.” Which of the following best describes the
statement by the mother?
a.) Cooperation
b.) Assertiveness
c.) Bargaining
d.) Collaboration
b.) Assertiveness
The mother’s statement is an example of assertiveness, the ability to present one’s own needs.
Cooperation is the ability to understand and meet the needs of others. Bargaining is part of the
negotiation process when debates include gathering facts based on reasoning that will generate
understanding and promote relearning. Collaboration is a dynamic highly interactive and interdependent
process in which people work together to share resources and a vision for a goal.
9
A nurse is assisting clients to improve their health status. Which of the following types of management is
being used by the nurse?
a.) Care management
b.) Case management
c.) Disease management
d.) Demand management
d.) Demand management
Demand management seeks to control use by providing clients with correct information and education
strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health
status, and to make fewer demands on the health care system. Care management is an enduring process
in which a manager establishes systems and monitors the health status, resources, and outcomes for a
targeted aggregate of the population. Case management is defined as a collaborative process of
assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to
facilitate an individual’s and family’s comprehensive health needs through communication and available
resources to promote quality cost-effective outcomes. Disease management constitutes systematic
activities to coordinate health care interventions and communications for populations with disease
conditions in which client self-care efforts are significant.
10
A nurse is working as a case manager. Which of the following best describes the diagnoses that the case
manager is most likely to encounter?
a.) Bankruptcy, financial distress, and depression
b.) Flu, colds, and frequent headaches
c.) Malaria, bird flu, and Dengue fever
d.) AIDS, spinal cord injury, and ventilator dependency
d.) AIDS, spinal cord injury, and ventilator dependency
Case-managed conditions include many chronic conditions. AIDS, spinal cord injury, and ventilator
dependency are the only chronic conditions listed. The other options are acute or nonmedical conditions.
11
What are the six “rights” of case management?
a.) Care, time, provider, setting, price, and outcomes
b.) Patient, medication, route, time, documentation, and evaluation
c.) Place, setting, patient, plan, outcomes, and documentation
d.) Disease process, time, place, beneficence, advocate, and care provider
a.) Care, time, provider, setting, price, and outcomes
Care, time, provider, setting, price, and outcomes are used to judge the effectiveness of case
management.
12
A nurse is using population management as part of the nursing care that is provided. Which of the
following activities is the nurse most likely completing?
a.) Census taking to determine the total number of people in the population
b.) Assessing the needs of the client population through compilation of health histories
c.) Providing case management services for every citizen in the community
d.) Selecting programs for wellness that are repeated annually
b.) Assessing the needs of the client population through compilation of health histories
Population management involves assessing the needs of the client population through health histories,
claims, use-of-service patterns, and risk factors. Population management does not include census taking,
providing case management services for all, or repeating wellness programs on an annual basis.
13
An enduring process in which a manager establishes systems and monitors the health status, resources,
and outcomes for a targeted aggregate of the population is called:
a.) case management.
b.) care management.
c.) disease management.
d.) demand management.
b.) care management.
Care management is an enduring process in which a manager establishes systems and monitors the
health status, resources, and outcomes for a targeted aggregate of the population. Case management is
defined as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and
advocacy for options and services to facilitate an individual’s and family’s comprehensive health needs
through communication and available resources to promote quality cost-effective outcomes. Disease
management constitutes systematic activities to coordinate health care interventions and
communications for populations with disease conditions in which client self-care efforts are significant.
Demand management seeks to control use by providing clients with correct information and education
strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health
status, and to make fewer demands on the health care system.
14
A case manager uses effective collaboration and team strategies to make arrangements for services.
Which of the following roles is being applied?
a.) Broker
b.) Negotiator
c.) Liaison
d.) Facilitator
b.) Negotiator
The case manager who uses effective collaboration and team strategies to make arrangements for
services is performing the role of negotiator.
The role of broker is used when acting as an agent for provider services that are needed by clients to stay
within coverage according to budget and cost limits of the health care plan.
When acting as a liaison, the nurse provides a formal communication link among all parties concerning
the plan of care management.
As a facilitator, the nurse supports all parties in work toward mutual goals.
15
Mutual benefit with limited loss for everyone is a goal of:
a.) negotiating.
b.) assertiveness.
c.) conflict management.
d.) cooperation.
c.) conflict management.
Mutual benefit with limited loss for everyone is a goal of conflict management. This involves using skills
directed toward learning all parties’ needs and desires, detecting their areas of agreement and
disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and
activities for reaching a goal. The process of moving conflicting parties toward an outcome is called
negotiation. Assertiveness is the ability to present one’s own needs. Cooperation is the ability to
understand and meet the needs of others.
16
A nurse who is using population management needs to be able to work with integrated care delivery
systems. Which of the following describes the rationale for this competency?
a.) Management has shifted from inpatient care to primary care providers as points of entry.
b.) Emphasis is on episodic illness care for individuals rather than on population management.
c.) Care management services and programs do not provide access and accountability, as provided by
case management services.
d.) Assessment of the needs of the population is no longer necessary.
a.) Management has shifted from inpatient care to primary care providers as points of entry.
Management has shifted from inpatient care as a point of entry to primary care providers as points of
entry. The other statements are false.
ENVIRONMENTAL HEALTH DECK (24)

1
Environmental health is important to nurses because chemical, biological, and radiological materials are:
a.) a major cause of global warming.
b.) often found in the air, water, and products we use.
c.) frequently linked to the development of chronic illnesses.
d.) products that nurses work with on a daily basis.
b.) often found in the air, water, and products we use.
Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink,
and the products we use. These are not a major cause of global warming. They are not frequently linked
to the development of chronic illnesses. These are not products that nurses work with on a daily basis.
2
A nurse has identified a point source of air pollution. Which of the following has the nurse identified?
a.) A smoke stack
b.) The number of cars and trucks
c.) The amount of fossil fuel consumed in a community
d.) Ground ozone levels
a.) A smoke stack
Point sources of pollution are identifiable sources of air pollution, such as a smoke stack. Nonpoint
sources come from more diffuse exposures, such as from cars and trucks. The amount of fossil fuel that
is consumed and ground ozone levels do not identify sources of air pollution.
3
A nurse is completing the first phase of a risk assessment. Which of the following questions would the
nurse most likely try to answer?
a.) Has the chemical been released into the environment?
b.) How much and by which route of entry can the chemical enter the body?
c.) Is the chemical known to be associated with a negative health effect?
d.) What is the prediction for potential harm?
c.) Is the chemical known to be associated with a negative health effect?
The first phase is determining if a chemical is known to be associated with negative health effects (in
animals or humans): Is the chemical known to be associated with a negative health effect? The second
step is determining if the chemical has been released into the environment: Has the chemical been
released into the environment? The third step is estimating how much and by which route of entry the
chemical might enter the human body: How much and by which route of entry can the chemical enter the
body? The final step takes into account the previous steps: What is the prediction for potential harm?
4
Which is considered a nonpoint source of pollution?
a.) Hazardous waste site
b.) Animal waste from wildlife
c.) Chlorine poured down a well
d.) Stagnant water
b.) Animal waste from wildlife
Nonpoint sources come from more diffuse exposures to pollution. Animal waste is the only diffuse
exposure given. The others are considered point sources; point sources are individual, identifiable
sources such as smoke stacks.
5
A PHN working with a family living in poverty is concerned about their exposure to environmental
hazards. Which of the following factors should the nurse consider that may put the family at risk? (Select
all that apply.)
a.) Limited funds to pay for health care
b.) Poor nutrition
c.) Homes located closer to hazardous waste sites
d.) Less education
e.) Unsafe working conditions
a.) Limited funds to pay for health care
b.) Poor nutrition
c.) Homes located closer to hazardous waste sites
Families living in poverty are more likely to experience environmental justice issues such as
disproportionate environmental exposures. Substandard housing, living closer to hazardous waste sites,
working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to
this issue. Although limited education is related to poverty, it is not discussed as causing an increase in
environmental exposure.
6
A nurse is assessing for environmental health risks in the community. Which of the following approaches
would be most appropriate for the nurse to use? (Select all that apply.)
a.) Ask legislators to provide a list of environmental pollutants in the area
b.) Develop a list of exposures associated with urban, rural, or suburban settings
c.) Assess the risk by medium such as air, water, soil, or food
d.) Divide the environment into functional locations: home, school, workplace, and community
e.) Recruit community members to sign a petition to decrease pollution
b.) Develop a list of exposures associated with urban, rural, or suburban settings
c.) Assess the risk by medium such as air, water, soil, or food
d.) Divide the environment into functional locations: home, school, workplace, and community
Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by
medium such as air, water, soil, or food, and dividing the environment into functional locations: home,
school, workplace, and community are ways a nurse can assess the environment. Asking legislators for a
list of pollutants or recruiting community members to sign a petition are not effective means to assess for
environmental health risks.
7
A nurse works at the individual level to reduce pollution in the environment. Which of the following
actions would most likely be taken by the nurse?
a.) Provide a tax incentive to factories that do not pollute
b.) Make laws related to allowed levels of pollution in the area
c.) Recycle paper, glass, cans, and plastic
d.) Move to an area with less pollution
c.) Recycle paper, glass, cans, and plastic
Nurses can reduce pollution by doing their part, which can include choosing to recycle paper, glass, cans,
and plastic. Providing a tax incentive and creating laws would not be completed at the individual level to
reduce pollution in the environment. Moving to an area with less pollution would not help to improve the
problem.
8
Employees working with hazardous chemicals have the “Right to Know” about the chemicals they are
working with through the creation of the:
a.) Material Safety Data Sheet (MSDS).
b.) Consumer Confidence Report.
c.) Hazard Communication Standard.
d.) EPA.
c.) Hazard Communication Standard.
The Hazard Communication Standard requires employers to maintain a list of all hazardous chemicals
that are used on site. Each of the chemicals should have an associated chemical information sheet known
as an MSDS, which is written by the chemical manufacturer. Consumer Confidence Reports summarize
the results of the annual testing of the public water supply. The EPA sets forth policies, regulations, and
public laws for the safety of the environment and the population.
9
Epidemiology:
a.) is a science that studies the poisonous effects of chemicals.
b.) explains the association between learning disabilities and exposure to lead-based paint at the cellular
level.
c.) helps nurses understand the strength of the association between exposure and health effects.
d.) is a method for tracking the prevalence of health outcomes.
c.) helps nurses understand the strength of the association between exposure and health effects.
Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of
the association between exposure and health effects. Toxicology is the science that studies the poisonous
effects of chemicals. Environmental surveillance provides data with which to track and analyze the
incidence and prevalence of health outcomes. Epidemiology does not examine causes at the cellular
level.
10
A nurse fulfills the environmental health competency of “assessment and referral.” Which of the following
actions has the nurse most likely completed?
a.) Advocating for public policy changes
b.) Understanding policy framework and major pieces of legislation
c.) Completing an environmental health history
d.) Describing the scientific principles about environmental health

c.) Completing an environmental health history
Assessment and referral states that all nurses should be able to successfully complete an environmental
health history, recognize the potential environmental hazards and sentinel illnesses, and make
appropriate referrals for conditions with probably environmental causes. Advocating for public policy
changes is part of advocacy. Understanding policy framework and legislation is part of legislation and
regulation. Describing the scientific principles of environmental health is part of basic knowledge and
concepts.
11
A nurse wants to find more information about indoor air quality. Which of the following websites would
be most helpful?
a.) The National Institutes of Health (NIH)
b.) The American Lung Association
c.) “Right to Know”
d.) The Occupational Safety and Health Administration (OSHA)
b.) The American Lung Association
Indoor air quality is a growing public health concern in office buildings, schools, and homes and is
reflected in the alarming rise in asthma incidence in the United States, particularly among children.
Sources of information about indoor air quality include the EPA and the American Lung Association. The
NIH is part of the U.S. Department of Health and Human Services (USDHHS) and is responsible for health
and biomedical research. “Right to Know” is part of a workplace safety legislation. OSHA regulates safety
in factories and businesses.
12
A nurse is addressing the problem of air pollution in the community. Which of the following would be the
first step the nurse would take?
a.) Setting standards
b.) Monitoring
c.) Permitting
d.) Compliance
c.) Permitting
Permitting is a process by which the government places limits on the amount of pollution emitted into the
air or water. Environmental standards may describe a permitted level of emissions, a maximum
containment level, an action level for environmental cleanup, or a risk-based calculation. Monitoring is an
ongoing process after an action has happened. Compliance refers to the processes for ensuring that
permit/standard/regulatory requirements are met.
13
A public health nurse (PHN) is working with a migrant farm worker who has experienced an exposure to a
pesticide. When researching pesticides, the nurse looks at the “family” of the chemical. What similarities
are found among chemicals that have been placed in the same family?
a.) Route of entry into the body
b.) Actions and associated risks
c.) Effects that they have on the body
d.) Potency and toxicity
b.) Actions and associated risks
Chemicals are grouped so it’s possible to understand the actions and risks associated with each group.
Although some common health risks exist within these families of chemicals, the possible health risks for
each chemical should be evaluated individually when a potential human exposure exists.
14
A PHN is organizing a multidisciplinary team to address the issue of water pollution in the community.
The most likely members that would be invited to address this issue would be:
a.) physicians, water sanitation workers, and occupational therapists.
b.) pharmacologists, radiologists, and epidemiologists.
c.) nurse practitioners, pharmacologists, and environmentalists.
d.) geologists, meteorologists, and chemists.
d.) geologists, meteorologists, and chemists.
Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and
chemists. The other professionals are not experts in the area of water pollution in the community.
15
Which environmental law sets basic structure for regulating pollutants to United States waters?
a.) Safe Drinking Water Act
b.) Toxic Substance Control Act
c.) Clean Water Act

d.) Pollution Prevention Act
c.) Clean Water Act
The Clean Water Act sets basic structure for regulating pollutants to United States waters. The Safe
Drinking Water Act authorized the EPA to establish safe standards of purity and required all owners or
operators of public water systems to comply with primary standards. The Toxic Substance Control Act
gives the EPA the ability to track the 75,000 industrial chemicals currently produced or imported into the
United States. The Pollution Prevention Act focused industry, government, and public attention on
reduction of the amount of pollution through cost-effective changes in production, operation, and use of
raw materials.
16
The greatest single source of air pollution in the United States is from:
a.) waste incineration.
b.) power plants.
c.) motor vehicles.
d.) molds.
c.) motor vehicles.
Mobile sources such as cars and trucks are the greatest single source of air pollution in the United States.
Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to
poor indoor air quality.
PUBLIC HEALTH NURSING AT LOCAL, STATE, AND NATIONAL LEVELS DECK (19)
1
A nurse is providing information about safe-sex practices. Which of the following levels of prevention is
being implemented?
a.) Primary prevention
b.) Secondary prevention
c.) Tertiary prevention
d.) Assessment
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or
disability—providing information about safe sex practices.
Secondary prevention focuses on early detection and screening.
Tertiary prevention focuses on treatment and rehabilitation. Assessment is not a level of prevention.
2
A nurse is providing services for uninsured women. Which of the following best describes the role that the
nurse is using?
a.) Role model
b.) Primary caregiver
c.) Outreach worker
d.) Case manager
b.) Primary caregiver
A nurse providing services for uninsured women is acting in the role of primary caregiver. The public
health function of a nurse who assists a client in identifying the services needed the most at the least cost
is a case manager. A nurse serves as a role model for the client by being a person for the client to look up
to. As an outreach worker, the nurse is able to gain acceptance with the population served.
3
Which is a principle of good practice for community partnerships?
a.) Partnerships are easily formed among those working in public health.
b.) Partnerships use their own roles to accomplish tasks.

c.) Partnerships are built on identified strengths and assets.
d.) Partnerships are loose associations among people.
c.) Partnerships are built on identified strengths and assets.
Partnerships are built upon identified strengths and assets, including areas that need improvement. This
is one of the principles of good practice. An effective partnership is formed by balanced power and
understanding among the partners. Partnerships use mutual trust and respect genuineness and
commitment as part of their relationship.
4
Which agency delegates the authority of the local health department?
a.) The federal government
b.) The state
c.) Local authorities
d.) Regional governing boards
b.) The state
The authority of the local health department is delegated by the state. The federal government, local
authorities, and regional governing boards are not involved with delegating authority of the local health
department.
5
A nurse is implementing tertiary prevention strategies in the community. Which of the following best
describes what the nurse is doing?
a.) Providing immunizations
b.) Conducting lead screening activities for children
c.) Providing case management services for clients with chronic illness
d.) Identifying and treating clients in a tuberculosis (TB) clinic
c.) Providing case management services for clients with chronic illness
Providing case management services for clients with chronic illness demonstrates tertiary prevention, as
it is focused on treatment and rehabilitation. Providing immunizations is a primary prevention, and
conducting lead screening activities and identifying and treating clients in a TB clinic are at the secondary
level of prevention.
6
A nurse considering working as a PHN refers to the American Public Health Association (APHA) Public
Health Nursing Section to determine what level of educational preparation has been recommended.
Which of the following best describes the educational preparation?
a.) Associate degree
b.) Baccalaureate degree
c.) Master’s degree
d.) Certification
b.) Baccalaureate degree
All PHNs should have a background in the social and behavioral sciences, epidemiology, environmental
health, current treatment modalities, and health care delivery options in order to fully understand health
policy, research, and treatment choices and to translate this knowledge into the promotion of healthy
populations.
7
Which is an example of a federal agency? (Select all that apply.)
a.) The U.S. Department of Health and Human Services (USDHHS)
b.) The Centers for Disease Control and Prevention (CDC)
c.) The Health Resources and Services Administration (HRSA)
d.) The Pentagon
e.) The Congress
a.) The U.S. Department of Health and Human Services (USDHHS)
b.) The Centers for Disease Control and Prevention (CDC)
c.) The Health Resources and Services Administration (HRSA)
The USDHHS, the CDC, and the HRSA are all federal agencies. The Pentagon and the Congress are not
federal agencies.
8
Which event has the potential to weaken existing public health programs?
a.) The shift in funding to support bioterrorism response efforts
b.) The outbreaks of H1N1 influenza

c.) The number of citizens with human immunodeficiency virus (HIV)
d.) The lack of PHNs
a.) The shift in funding to support bioterrorism response efforts
The events of the twenty-first century have shifted funding to bioterrorism programs. This shift of funding
has the potential to weaken existing important public health programs.
9
What is the goal of local public health departments?
a.) To monitor communicable diseases
b.) To improve the health status of communities
c.) To offer services for the uninsured
d.) To enforce environmental codes and laws
b.) To improve the health status of communities
The goal of local public health departments is to safeguard the public’s health and improve the health
status of communities. The federal and state levels monitor communicable diseases, offer services for the
uninsured, and enforce environmental codes and laws.
10
A PHN collaborates with agencies to address the problem of obesity in the community. Who would be the
most appropriate people to include in this collaborative partnership? (Select all that apply.)
a.) Local health department staff members
b.) Restaurant owners
c.) Parks and recreation department staff members
d.) Church representatives
e.) Appliance store managers
a.) Local health department staff members
b.) Restaurant owners
c.) Parks and recreation department staff members
d.) Church representatives

PHNs practice in partnership with each other at the local, state, and federal levels and with other public
health staff, other governmental agencies, and the community to safeguard the public’s health and to
improve the community’s health status. All of these people would provide valuable insight into the
problem of obesity in the community.
11
A nurse is implementing secondary prevention strategies in the community. Which of the following best
describes what the nurse is doing?
a.) Screening children for lead poisoning
b.) Working with communities on emergency preparedness plans
c.) Developing social networking interventions to modify community norms
d.) Educating patients with strokes at rehab centers to help optimize their functioning
a.) Screening children for lead poisoning
Screenings are secondary prevention activities. Secondary prevention focuses on early detection and
screening. Tertiary prevention focuses on treatment and rehabilitation— educating patients with strokes.
disability—working with communities on emergency preparedness plans and developing social
networking interventions.
12
The PHN aims to change behaviors such as poor hand washing skills and unsafe sex practices. Which of
the following best describes the role that the nurse is using?
a.) Case manager
b.) Advocate
c.) Educator
d.) Role model
c.) Educator
The PHN works as an educator, teaching to the level of the client so that information received is
information that can be used. The PHN who aims to change behaviors, such as poor hand washing skills
and unsafe sex practices, is acting in the role of educator. The public health function of a nurse who
assists a client in identifying the services needed the most at the least cost is a case manager. As an
advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and
prioritize needed services, whether the client is an individual, a family, a community, or a population. A
PHN discusses with a client which services are appropriate to meet her needs. A nurse serves as a role
model for the client by being a person for the client to look up to.
13
Which principles are included in the Scope and Standards of Public Health Nursing Practice? (Select all
that apply.)
a.) The client or “unit of care” is the population.
b.) Primary prevention is given priority.
c.) All processes must include partnering with representatives of the people.
d.) Government agencies mandate requirements for public health.
e.) The focus of many interventions should be on secondary prevention.
b.) Primary prevention is given priority.
c.) All processes must include partnering with representatives of the people.
The eight tenets of public health nursing distinguish public health nursing from other nursing specialties.
Primary prevention is given priority and all processes must include partnering with representatives of the
people as part of these established principles.
14
A PHN is working with uninsured individuals. Which of the following is the most appropriate action for the
nurse to take?
a.) Providing direct care for this population in times of acute illness
b.) Advocating for federal policy changes for this population
c.) Assisting this population to access necessary health care services
d.) Encouraging lifestyle changes for this population
c.) Assisting this population to access necessary health care services
PHNs serve vulnerable populations by acting as a bridge between these populations and the resource
needs for this at-risk group by approaching health care providers on behalf of individuals seeking
medical/health services and keeping the needs of this population on the political agenda.
15
A PHN is involved in disaster planning. Which of the following best describes why this is important?
a.) To be most effective as a disaster responder
b.) To anticipate the potential disasters that may occur
c.) To educate the public about their responsibilities if a disaster occurs

d.) To demonstrate the importance of community partnerships
a.) To be most effective as a disaster responder
16
A nurse is working in a public health department. Which of the following would most likely be the focus of
the care that is provided?
a.) Home visiting and hospice care
b.) Care of communicable diseases
c.) Health maintenance and health promotion
d.) Illness prevention
c.) Health maintenance and health promotion
Public health nurses (PHNs) employed in local, state, and federal agencies work together to identify,
develop, and implement interventions that will improve and maintain the nation’s health.
THE NURSE IN OCCUPATIONAL HEALTH DECK (30)
1
Which was the first legislation that specifically required certain prevention programs for workers?
a.) Occupational Safety and Health Act
b.) NIOSH
c.) Mine Safety and Health Act
d.) SIC Code
c.) Mine Safety and Health Act
The Mine Safety and Health Act was enacted in 1968. It was the first legislation that specifically required
certain prevention programs for workers. The Occupational Safety and Health Act established OSHA and
NIOSH to carry out the Act’s purpose of ensuring “safe and healthful working conditions for working men
and women.” NIOSH examines potential hazards of new work technologies and practices. The SIC Code
did not require certain protection programs for workers.
2
An employer offers a limited duty program after an employee has experienced a cumulative trauma
injury. Which of the following levels of prevention is being implemented?
d.) Assessment
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from
disease, injury, or disability—limited duty program after injury. Primary prevention refers to those
interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention
occurs after a disease process has already begun.
3
An occupational health nurse has conducted a walk-through assessment and has identified potential
hazards in the workplace. The nurse recognizes that it will be easiest to modify exposure to which hazard?
a.) Bacteria
b.) Aerosols
c.) Noise
d.) Burnout
c.) Noise
Controlling physical agents, such as noise, can usually be accomplished through engineering strategies
and personal protective equipment. It is much harder to change biological agents (bacteria), chemical
agents (aerosols), and psychosocial agents (burnout).
4
A nurse in the occupational health arena is implementing a secondary prevention strategy. Which of the
following best describes the action that was taken by the nurse?
a.) Providing education on safety in the workplace to prevent injury
b.) Working with chronically diabetic workers to ensure appropriate medications
c.) Screening for hearing loss resulting from noise levels in the plants
d.) Ensuring that a person with cardiovascular disease attends a rehab program
c.) Screening for hearing loss resulting from noise levels in the plants
Secondary prevention occurs after a disease process has already begun—screening for hearing loss.
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from
disease, injury, or disability—working with chronically diabetic workers and ensuring that a person with
cardiovascular disease attends rehab. Primary prevention is aimed at prevention of a disease before it
occurs—providing education on safety in the workplace to prevent injury.
5
An occupational health nurse is involved in disaster planning. Which of the following actions would be
most appropriate for the nurse to take?
a.) Assess for possible disasters
b.) Prevent injuries and death of workers
c.) Store Medical Data Sheets in a safe place
d.) Collaborate with government authorities to plan disaster management
b.) Prevent injuries and death of workers
The occupational health nurse is a key player in occupational disasters. The goals of a disaster plan are to
prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide
effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of
different personnel within the company and community. There are not Medical Data Sheets rather
MSDSs.
6
Which types of industries are noted for high degrees of hazards associated with the work?
a.) Data entry, animal rescue, and hospice
b.) Engineering, science, and laboratories
c.) Manufacturing, mining, and agriculture
d.) Aeronautics, plastics, and nursing
c.) Manufacturing, mining, and agriculture
Manufacturing, mines, construction, and agriculture are noted for their high degree of hazards associated
with their work. However, no worksite is free of occupational health and safety hazards.
7
A nurse is employed in an occupational health setting. Which of the following activities would be a
primary role of the nurse?
a.) Caring for employees and their families
b.) Providing health promotion and emergency care
c.) Updating the Material Safety Data Sheets (MSDSs)
d.) Reporting communicable diseases
b.) Providing health promotion and emergency care
The customary role of the occupational health nurse extends beyond emergency treatment and
prevention of illness and injury and also includes the promotion and maintenance of health, overall risk
management, care for the environment, and efforts to reduce health- related costs in business. The
occupational health nurse does not typically care for families of employees, update MSDSs, or report
communicable diseases.
8
An occupational health nurse is working in an occupational health and safety program. Which of the
following services is the nurse most likely to provide? (Select all that apply.)
a.) Health/medical surveillance
b.) Health screening
c.) Case management

d.) Job task analysis
e.) Counseling
a.) Health/medical surveillance
b.) Health screening
c.) Case management
d.) Job task analysis
The services provided by onsite occupational health programs range from those focused only on work-
related health and safety problems to a wide scope of services that includes primary health care. An
occupational health and safety program may include health/medical surveillance, health screening, case
management, and job task analysis.
9
Which population would have been the focus of care for an occupational health nurse in the early 1900s?
a.) Injured workers
b.) All workers
c.) Families
d.) The community
c.) Families
In the early days of occupational health nursing, the nurse’s work was holistic and centered on the family.
The care provided by Betty Moulder and Ada Mayo Stewart focused on both ill workers and their families.
10
A nurse is working in an occupational health setting. Which of the following roles will the nurse most likely
have?
a.) Administrator
b.) Clinicians/practitioner
c.) Consultant
d.) Educator
b.) Clinicians/practitioner
An occupational health nurse could be employed in any of these roles. However, the majority of
occupational health nurses work as nurse clinicians/practitioners.
11
A nurse is assessing a worker who has had a health reaction to a “safe” low-level exposure. Which of the
following most likely describes what has happened?
a.) An allergic reaction
b.) A compromised immune system
c.) Hypersusceptibility
d.) Malnutrition
c.) Hypersusceptibility
A number of host factors appear to be associated with this hypersusceptibility: light skin, malnutrition,
compromised immune system, glucose-6-phosphae dehydrogenase deficiency, serum alpha1-antritrypsin
deficiency, chronic obstructive pulmonary disease, sickle cell trait, and hypertension. A worker who has a
health reaction to “safe” low-level exposures is experiencing hypersusceptibility.
12
An occupational health has become a member of the AAOHN. Why would a nurse join this organization?
(Select all that apply.)
a.) To promote the health and safety of workers
b.) To lobby in Congress for safer work places
c.) To advance the profession by supporting research
d.) To promote and provide continuing education in the specialty
e.) To obtain certification as a specialist in occupational health nursing
a.) To promote the health and safety of workers
c.) To advance the profession by supporting research
d.) To promote and provide continuing education in the specialty
The AAOHN is the professional organization for occupational health nurses. It supports the work of the
occupational health nurse and advances the specialty by: promoting the health and safety of workers,
defining the scope of practice and setting the standards of occupational health nursing practice,
developing the code of ethics for occupational health nurses with interpretive statements, promoting and
providing continuing education in the specialty, advancing the profession through supporting research,
and responding to and influencing public policy issues related to occupational health and safety. A nurse
joining the AAOHN would most likely not go to lobby in Congress; rather, AAOHN provides a lobbyist to
address pertinent issues. Joining the AAOHN will not assist the nurse in obtaining specialty certification.
13
The nurse is doing a walk-through to identify workplace hazards. Which of the following levels of
prevention is being implemented?
d.) Assessment
disability. A walk-through is part of an assessment, which is part of primary prevention. Tertiary
prevention includes those interventions aimed at disability limitation and rehabilitation from disease,
injury, or disability. Secondary prevention occurs after a disease process has already begun.
14
An occupational health nurse refers an employee to an employee assistance program. Which of the
following problems would most likely be addressed?
a.) Obesity
b.) Smoking
c.) Alcohol abuse
d.) Lack of exercise
c.) Alcohol abuse
Employee assistance programs are designed to address personal problems such as marital/family issues,
substance abuse, or financial difficulties. These issues are addressed because they affect the employee’s
productivity. These efforts are cost-effective for businesses.
15
An occupational health nurse is assessing the need for MSDSs at the worksite. Which of the following
items would require an MSDS?
a.) Hand soap
b.) Eye goggles

c.) Aprons
d.) Earplugs
a.) Hand soap
The Hazard Communication Standard requires that all worksites with hazardous substances inventory
their toxic agents, label them, and provide information sheets, called MSDSs, for each agent. Hand soap is
a toxic agent. Eye goggles, aprons, and earplugs are not toxic agents and therefore, do not need an
MSDS.
16
An occupational health nurse is educating employees about work-related hazards. Which of the following
hazards would the nurse most likely discuss in the presentation?
a.) Workplace stress leading to hypertension and cardiovascular disease
b.) Asbestos, plastics, lead, and solvents leading to dermatitis
c.) Cement dust and metals leading to bronchitis
d.) Hormones and nitroglycerine leading to reproductive effects
a.) Workplace stress leading to hypertension and cardiovascular disease
Work-related stress or burnout has been defined as an important problem for many individuals.
Responses to negative interpersonal relationships, particularly those with authority figures in the
workplace, are often the cause of vague health symptoms and increased absenteeism. Education about
stress would be pertinent to all workers, regardless of specific job or setting.

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A community is concerned about the threat of bioterrorism.

Which of the following best describes the basis for this

a.) Bioterrorism has the potential to dissolve community-based programs.

d.) Fear of bioterrorism will increase the need for shelters.

d.) Policy development

d.) Policy development

Policy development deals with developing and implementing health policies.

d.) Policy development

a.) Sociodemographic characteristics

b.) Health status

c.) Health risk factor

d.) Functional status

c.) Health risk factor

A population is best defined as a:

a.) high-risk group.

b.) those interacting within a school or institutional setting.

c.) collection of individuals who share at least one common characteristic.

d.) geographical location within a community.

c.) collection of individuals who share at least one common characteristic.

a.) Teach public and community health nursing

b.) Assess and intervene successfully at the aggregate level

c.) Diagnose and treat disease and have prescriptive authority

d.) Run for political office as experts in public health policy

b.) Assess and intervene successfully at the aggregate level

d.) Policy development

c.) Policy development

d.) Tertiary care

b.) Public health

c.) Community health

a.) Administrating a flu shot to a client in a physician’s office

b.) Conducting a flu shot clinic at a community center

c.) Performing a client assessment in a hospital

d.) Providing supervision of staff in a rehabilitation center

a.) Administrating a flu shot to a client in a physician’s office

c.) Keeping track of alternative therapies in use in the United States

The purpose of public health core functions is to:

b.) ensure the safety of populations in receiving quality health care.

a.) Policy development

d.) Scientifi knowledge-based care

a.) Students in a county school system

b.) Christians around the world

d.) People who drink coffee

a.) Students in a county school system

a.) Financial planning and management

b.) Workforce needs assessment

c.) Acute care services

d.) Curriculum development

a.) Financial planning and management

a.) diphtheria, cholera, and hepatitis.

b.) HIV, H1N1 influenza, and bioterrorism.

c.) avian flu, tuberculosis (TB), and radiation.

d.) polluted water and air.

b.) HIV, H1N1 influenza, and bioterrorism.

b.) Testing well water for pollutants

d.) Providing post-surgical care

a.) Investigating causes of absenteeism

b.) Teaching school as well as being a nurse

d.) Providing medical treatment to enable children to return to school

a.) Investigating causes of absenteeism

a.) Interactions with wealthy contributors to secure funding

b.) Autonomy and independence of practice

c.) Ability to locate the source of diseases and cure patients

d.) Opportunities to meet a variety of people

b.) Autonomy and independence of practice